Association Of Supported Employment NZ Conference Mary Leighton Disability Support Services Programme Manager ACC National Serious Injury Service 15 September 2009

Presentation includes: Overview of ACC Scheme Philosophy of National Serious Injury Service Evaluation results: Supported Employment What’s coming up in future

Overview of ACC Scheme

Features of NZ’s accident compensation scheme –No fault –Everyone in NZ including workers, non-workers, & tourists –Any kind of personal injury caused by an accident (including assault, treatment injury, mental injury) –Funded by everyone through direct levies on workers, employers & car owners, and through general taxation

Features of NZ’s accident compensation scheme Client base scattered over a long, narrow country: –Over a third live in the top half of the North Island Ethnically diverse client populations Need to provide service to many small rural communities

ACC’s serious injury clients Injury causes –45% motor vehicle crashes Have permanent disabilities after an accident –Brain injuries –Spinal cord injuries –Other e.g. severe burns, multiple amputations ACC funds life-long care and support

ACC receives 1.5 million + claims per year 250 – 300 are serious injury claims Currently ACC has 4,500 serious injury clients Size of the serious injury client base will continue growing for another years ACC’s serious injury clients

Currently 4,500 clients with a serious injury: –465 are children 0-18 years 83 are aged 80+ years –Average age at injury= 28 years Average age now= 41 years –74% male 26% female –650 potential candidates for employment participation

Situation June Need to manage liabilities better because they were growing too fast Need to get better outcomes for clients –Low participation in work & community –High dependency on funded responses National Serious Injury Service established in July 2007 to: –Stablise rate of growth in liabilities –Increase client independence & participation

Philosophy of National Serious Injury Service

NSIS service philosophy Social disability model Use international research & practice to choose interventions & disability support services: –Evidence-based –Outcomes-focused Specialist, localised case management

Recovery Medical model Less useful when applied to disability –There is limited recovery –Long-term therapy & rehabilitation builds dependency & despondency –Causes client frustration –Wastes resources Treatment Therapy Rehabilitation Injury Infection Disease Disability

Supports & services Disability model Supporting the person to lead an everyday life –Not just about funded services Focus on independence & participation: –Family life –Community life –Work Needs local knowledge of support networks & services to work efficiently & effectively Client goals

Interventions Case Management Objectively determining clients’ need for support Sourcing & easing access to supports Planning centred on clients’ life goals Services Outcome = client achieving functional improvement, learnt new skills, behavioural self-management Outcome = supporting clients to achieve their life goals

Spinal services Short-term programmes Supported Living Situation 30 June 2007 Integrated TBI service Attendant care Assistance dogs School to Work Transition Self Management Supported Employment Build a suite of disability support services

Spinal services Short-term programmes Supported Living Integrated TBI service Attendant care Assistance dogs School to Work Transition Self Management Supported Employment Stay at Work Graduated Return to Work School to Work Transition Work Preparation Programme Obtain Employment Supported Employment Spinal Injury Vocational Service Training for Independence Integrating disability support services with other relevant ACC services

Evaluation results for Supported Employment

Service Evaluation The purpose of evaluation is to determine if the service actually does what was intended: –Get clients into permanent, paid employment To do this, evaluators examine: –What results have been achieved –What are the value of the results –What has happened in the service –How the service can be improved

Service Evaluation Colmar Brunton were commissioned by ACC to undertake the evaluation of Supported Employment services in May/June Feedback gathered from 20 service participants, plus: –Family/whanau –ACC client service staff –Supported Employment service providers –Employers 1. An evaluation of Supported Living services took place concurrently

Acknowledgement… Supported Employment is relatively new ACC has configured this service differently to how other funders purchase similar services ‘Teething problems’ are inevitable with most new services

Keep up the good work Successful client outcomes Clients in paid employment Must try harder Understanding clients with TBI Keeping families in the loop Reporting to ACC

What happens when the service works well? Benefit to the clients include: Increased self confidence Increased motivation Self directedness A sense of having ’achieved’ Acquired new skills and reclaimed old skills Increased social interaction Ability to anticipate the future

What happens when the service works well? Benefits to client’s family members include: Improved relationships with partners and reduced stress at home Not excessively worrying about the person’s safety and security in the home and community

What happens when the service works well? Factors contributing to positive outcomes: Co-ordinated approach by all providers working with the individual Motivated participants wanting to work Skilled, knowledgeable, proactive SE vocational consultants Good matching of client with SE vocational consultant Supportive employment work supervisors and co- workers supporting the client The provider has excellent community and employer networks

What has limited the success of the service? Providers’ capability & performance Varying levels of capability and performance resulted in some clients (in a few instances) being: –referred to unsuitable jobs –asked by employers to undertake tasks they are not capable of performing –provided with little support in the workplace

What has limited the success of the service? Families not kept in the loop Some parents of clients with brain injuries expressed concern that they did not know what was happening in the service with their family member Parents commented, “We are the first to notice when things start to go wrong”: –Felt they were left to cope eventually with a crisis situation

How can the service be improved? ACC Clarify standards for goal setting Appropriate referrals to service More information about the services available in the sector Case coordination - who is responsible? Providers Increase knowledge and skill of working with clients with spinal and brain injuries Regular monitoring of the service linking in with all parties Greater collaboration between ACC & providers to achieve results

What’s coming up in future Current contract expires May 2010 Propose to re-tender Feb 2010: –Limited vendor model –Changed service specifications  building on learning from evaluation –Emphasis on the following: Knowledge and skill working with people that have spinal & TBI injuries Links with ACC vocational & related services Term of new SE contracts:1 June 2010 to 30 May 2012 Roll out of the SCHOOL TO WORK transition service for youth ( years) 12 October 2009

Any questions