ACC update Dr Kris Fernando ACC National Advisor

ACC update Dr Kris Fernando. ACC National Advisor: Psychology and Mental Health April 2012 Branch Advisory Psychologists

Topics to be Covered • Revised DATA Contract • Role of Branch Advisory Psychologists • Symptom Validity

Revised DATA Contract • Choice of classification methods • Involvement of the treatment provider at a variety of levels depending on client need • Causation ‘a substantial’ cause • 6 hours funding allocated for the assessment/report and an additional 2 hours available for complex cases – looking at this • Funding for TRR increased to 4 hours • No DATA – replaced by either TRR or IART • Impact on everyday functioning stressed.

Mental Injury Contract • Amalgamation of a number of assessment contracts • Three categories – MICPI, MICSA, WRMI • No significant change in assessor criteria – some flexibility (health, educational and counselling psychologists, psychotherapists) • At least 12 months away

Branch Advisory Psychologists • • • 9 working in physical injury 10 in Sensitive Claims (2 psychotherapists) All part-time 0. 4 -0. 8 ths Most do clinical work outside of their BAP work All highly skilled and experienced Previously contracted – now the majority are employed and moving towards more centralised management • Has enabled more of a team approach and increased consistency nationwide

Role of Branch Advisory Psychologists • Provide advice to Claims Management Staff on clinical matters to facilitate recovery of clients • To educate providers as to ACC requirements • BAPs are now alerted when new providers come on board • Feedback to providers on their assessments and intervention reports • Identification of areas of strength and where improvements are required • ACC similarities and differences to the requirements of other organisations • The BAP is meant to be a colleague who can assist you with ACC requirements – smooth the path in working with ACC • KPI – Positive and constructive relationships with providers. • Provider Feedback questionnaire – please respond

Training/Supervision • • Yearly PD allowance Fortnightly teleconferences Monthly peer review consultation Annual Advisor’s 2 -day conference Regional advisor’s meetings 2 -3 times a year Additional face to face meeting External supervision once a month

Symptom Validity DATA Contract ‘Note whether you have identified any inconsistencies in the information obtained from the client, additional sources, and/or psychometric measures administered. ’ ‘If you identify any inconsistencies, please provide possible reasons for their occurrence. ’

Symptom Validity Cont…. • What is being asked for is consideration of whether symptom validity may be an issue • Not an in-depth assessment • Informed consent and good rapport/relationship essential. Discussion of issues prior to the assessment. • Comprehensive clinical interview, review of relevant previous assessments/reports, collateral information • Use of psychometric measures if familiar with the measures and competent with the interpretation • If issues around symptom validity are identified, provide some hypotheses and rationale as to possible reasons for symptom exaggeration/fabrication

Symptom Validity Cont Possible signs of issues around symptom validity • Unlikely symptoms or clinical course • Inconsistency of symptom presentation • Bizarre or unlikely symptoms • Atypical fluctuation in symptoms in response to external incentives • Unusual response to intervention • Markedly discrepant capacity for work versus recreation

Symptom Validity Cont … • Familiarity with the symptom validity literature • Supervision • Careful documentation as to how you reached your conclusions and the rationale for your opinion • Provide hypotheses re why the client might be exaggerating/fabricating symptoms • State findings clearly using neutral language which is not derogatory • ACC will have an ongoing relationship with the client – need to work with the client re the identified SV issues and look to progress the client’s rehabilitation • Need to retain a respectful working relationship with clients.

ACC’s Responsibility • We need to be clearer as to what is required – evolving over time • Need to ensure that the client is treated fairly and ethically • Need to have a collaborative approach with providers and the professional bodies • Written guidelines • More training for providers and internal staff – written guidelines • National Panel for complex cases

ACC Contracts available for Psychologists • Diagnostic and Treatment Assessment Services • Psychological Services – Assessment and treatment • Pain Management Psychological Services – Assessment and Treatment • Neuropsychological Assessment Service • Concussion Services. • Procurement Contact Person Karen. macguire@acc. co. nz