Transcript Association Of Supported Employment NZ Conference

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’s serious injury clients
• 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
Other
18%
Severe brain
injury
20%
Spinal cord
injury
25%
Moderate brain
injury
37%
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 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
Medical model
Treatment
Therapy
Rehabilitation
Injury
Disability
Infection
Disease
• Less useful when
applied to disability
– There is limited recovery
– Long-term therapy &
rehabilitation builds
dependency & despondency
– Causes client frustration
– Wastes resources
Recovery
Disability model
• Supporting the person
to lead an everyday life
Client goals
– Not just about funded
services
• Focus on independence
& participation:
– Family life
– Community life
– Work
Supports &
services
• Needs local knowledge
of support networks &
services to work
efficiently & effectively
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
Build a suite of disability
support
Situationservices
30 June 2007
Integrated
TBI service
Supported
Employment
Assistance
dogs
Attendant care
School to Work
Transition
Short-term
programmes
Supported
Living
Spinal
services
Self
Management
Integrating disability support
services with other relevant
ACC services
Supported
Integrated
Training
TBI
service
for
Independence
Employment
Spinal
Injury
Vocational
Service
Assistance
dogs
Obtain
Employment
Attendant care
Supported
Employment
Short-term
Work
programmes
Preparation
Programme
Supported
Living
Stay at Work
Self
Management
School to Work
School to
Transition
Work
Transition
Spinal
Graduated
services
Return
to
Work
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:
–
–
–
–
1.
Family/whanau
ACC client service staff
Supported Employment service providers
Employers
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 coworkers 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
Providers
Greater collaboration between ACC &
• Clarify standards for
• Increase knowledge and
providers to achieve results
goal setting
• Appropriate referrals to
service
• More information about
the services available in
the sector
• Case coordination - who
is responsible?
skill of working with
clients with spinal and
brain injuries
• Regular monitoring of
the service linking in
with all parties
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