Specialist Assessment for ACC Sensitive Claims ServicePlease read through the below information carefully. Client Consent Information * Your lead provider (therapist) has asked me to complete an assessment for you regarding ACC funding for your therapy sessions. ACC will use the outcome of the assessment to support their decision regarding the cover of your claim. Who am I? I am a clinical psychologist working in Christchurch. I am registered to provide both assessments and therapy for people for adults of all ages under ACC’s Sensitive Claims Service. I have been working as a psychologist for nine years. What’s the purpose of this assessment? When it comes to Sensitive Claims, ACC’s role is to pay for psychological therapy if the difficulties someone needs therapy for are caused by sexual trauma. Unfortunately, unlike physical injuries, there is no quick x-ray or scan to identify a psychological injury and therefore ACC ask a specialist to provide an assessment and an opinion about whether someone has suffered a “mental injury” that has been caused by sexual trauma. It sounds daunting; however, most people find the process is easier than they expect. What happens in the assessment? We will meet, and I will ask a wide range of questions about your life, including about your early life. This interview helps me understand you as a whole person. We will need to talk about the trauma that happened, although often not in a lot of detail if your therapist has already provided this information to me. We will spend some understanding how the trauma impacts on you now. This appointment will take up to three hours. ACC may also send me information regarding your mental health history or relevant medical history from your GP or other services you have been involved with (i.e., Oranga Tamariki or mental health services). If you have had an ACC assessment before, they will also provide that to me. You will also be asked to complete some questionnaires. Before we meet, your lead provider may give a some of questionnaires to complete to send to me. I may also send you some questionnaire via email (direct from Pariconnect or Novopsych). You complete these online and I will be able to access your results. Once I have all this information, I will write a report for ACC. I will offer you a chance to hear from me how I understand your difficulties and my opinion on your claim before the report is submitted to ACC. You can also ask ACC for a copy of the report at any time. You are welcome to bring a support person to your meeting/s with me. This includes your lead provider/therapist, if you wish. You may feel tired after our meeting. It’s a good idea not to have too much planned for after your appointment. Where is the assessment? Your appointment will be held at the Mental Health Co-Lab Clinic, 95a Main South Road. There are client carparks outside the building or free street parking. What about confidentiality? For the most part, the content of our sessions will remain between us, your therapist and ACC. However, there are some limits to this confidentiality. First, if I believe either you or someone else is at risk of harm (either from yourself or others) I may need communicate this to others, to try and keep everyone safe. Your information will be collated and submitted in reports to ACC. I will also discuss your assessment and any concerns with your ACC Recovery Partner and lead provider. ACC also have a team of Psychology Advisors who I may discuss your assessment with. Additionally, your information may be viewed by the ACC Supplier managing your claim. I engage in professional supervision and as part of this I discuss cases with my supervisors. My supervisors are also bound by confidentiality. Where needed, I will also seek cultural supervision or specialist consultation with other relevant health professionals. Where is my information kept? I keep electronic records of your assessment. These records are stored via a password protected Cloud storage system. This means your information is not stored on an individual computer and therefore is not at risk from theft or fire. Clinical Psychologists are required by law to retain records of clients for ten years and after this time your records will be destroyed. Availability outside of the assessment session? Your primary contact remains your therapist and your GP. You are welcome to contact me regarding session times or questions about the assessment, please do so via e-mail. I will do my best to get back to you within four business days. Urgent mental health support can be accessed from Crisis Resolution (CR). CR are available 24 hours, 7 days a week. You can call them on 0800 920 092 or 03 364 0640. In an emergency, call 111. I look forward to meeting with you soon. I have read and agree to the above terms for my Specialist Assessment under ACC Sensitive Claims Name * First Name Last Name Prefered Pronouns * They/Them She/Her He/Him Email * Phone (###) ### #### Do you intend to bring a support person to your assessment? * I will be attending on my own. I will be bringing a support person. I'm not sure yet. If you are bringing a support person to your appointment, please provide their name and relationship to you. Thank you! I will be in touch via email regarding the next steps.