Association Of Supported Employment NZ Conference

Mary LeightonDisability 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 20-25 years

ACC’s serious injury clients

ACC’s serious injury clients

Severe brain injury20%

Moderate brain injury37%

Other18%

Spinal cord injury25%

ACC’s serious injury clients

• Currently 4,500 clients with aserious injury:

– 465 are children 0-18 years83 are aged 80+ years

– Average age at injury = 28 years Average age now = 41 years

– 74% male26% female

– 650 potential candidates for employment participation

Situation June 30 2007

• 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

TreatmentTherapy

Rehabilitation

InjuryInfectionDisease

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 2007Integrated TBI service

Attendant care

Assistance dogs

School to WorkTransition

Self Management

Supported Employment

Build a suite of disabilitysupport services

Spinal services

Short-term programmes

Supported Living

Integrated TBI service

Attendant care

Assistance dogs

School to WorkTransition

Self Management

Supported Employment

Stay at WorkGraduated 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 20091.

• 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 (16 -21 years) 12 October 2009

Any questions