ACC2126 Training for Independence report

Training for Independence Report (ACC2126) **Part A, Report type and service** Report type: [x] Plan [ ] Variation report [ ] Completion report Service type: [x] Training for Independence programme (TI) [ ] Advisory Services Short-term [ ] Advisory Services Long-term TI service stream: [ ] Te Ata Pō [x] Te Ata Tū [ ] Tamariki and Rangatahi **Part B, Background** **1. Assessment details** Supplier name: Kāpiti Community Rehabilitation Services Ltd ACC supplier number: S14826 Purchase order number: PO2026-04839 Key worker's name: Hannah Bradshaw, Occupational Therapist Date of first contact: 18/03/2026 **2. Client details** Client name: Daniel Harrison Date of birth: 11/09/1997 Claim number: 10082341 **3. ACC details** ACC contact person: Mere Whitiao Contact phone number: 04 816 7421 Email address: mere.whitiao@acc.co.nz **Part C, Plan** **4. Plan objectives** Objective 1: Return to work as a graphic designer at part-time hours (3 days per week, 4 hours per day) within a flexible hybrid arrangement, by 24 weeks from programme start (week ending 03/09/2026). Progress measured against agreed hours worked per week, sustained for four consecutive weeks, and confirmed by employer feedback. Objective 2: Achieve independent community mobility using public transport for at least three return journeys per week (including bus and train routes between home in Paraparaumu and central Wellington), by 12 weeks from programme start (week ending 11/06/2026). Progress measured by independent journey log and key worker observation. Objective 3: Implement a structured daily routine incorporating energy management strategies, with a self-reported cognitive fatigue rating of 4 or less on a 10-point scale on at least 5 of 7 days per week, by 16 weeks from programme start (week ending 09/07/2026). Progress measured by daily activity diary and Mayo-Portland Adaptability Inventory-4 (MPAI-4) re-administration. Objective 4: Re-engage in social and recreational activity at a frequency of at least one community-based activity per week (excluding therapy appointments), including resumption of recreational cycling on the Kāpiti coastal path with appropriate safety adaptations, by 20 weeks from programme start (week ending 06/08/2026). Progress measured by activity diary and Community Integration Questionnaire (CIQ) re-administration. Client summary Client background: Daniel is a 28-year-old graphic designer who lives with his parents in Paraparaumu, having returned to their home for support following his discharge from inpatient rehabilitation. Prior to his injury he lived independently in a Wellington flat with two friends, worked full-time at a creative agency in central Wellington, and was an active recreational cyclist and rock climber. He has a partner of three years, Olivia, who lives in Wellington and visits at weekends. Daniel describes his whānau as supportive and is close to his younger sister Rosie, who lives in Christchurch. He identifies as New Zealand European and is not currently affiliated with a religious or cultural group. He has no children and no financial dependents. Injury related information: Daniel sustained a severe traumatic brain injury on 14/03/2025 when he was struck by a motor vehicle while cycling home from work in Wellington. He underwent decompressive craniectomy and was managed in the intensive care unit at Wellington Hospital for four weeks. His acute rehabilitation occurred at the ABI Rehabilitation Wellington unit, where he remained as an inpatient until 22/01/2026. On discharge he had residual mild left-sided motor weakness, executive function difficulties (planning, initiation, working memory), cognitive fatigue, low mood with reactive features, and reduced insight into the impact of fatigue on his function. He is no longer fit to drive and has been advised by his neurologist that driving cessation will be reviewed at 18 months post-injury. He is currently on sertraline 50 mg daily, prescribed by his GP, and has weekly contact with the ABI community team during the transition to TI. Non-injury related information: Daniel has no significant prior medical history. He has been a recreational user of alcohol, with intake currently abstinent on medical advice. His relationship with Olivia has remained intact throughout the inpatient phase, although both have acknowledged the impact of his cognitive changes on their communication. His parents have taken extended leave from work to support him; this support is time-limited and Daniel's father is planning to return to full-time work in three months, which will reduce the in-home practical support available. Current function and participation in usual roles and activities: Daniel is independent in personal self-care including showering, dressing, and toileting. He prepares simple meals (sandwiches, reheated leftovers) but does not yet cook from scratch. He manages medication with a weekly pill organiser set up by his mother. He does not currently drive and uses lifts from family for most community access. He has not returned to work; his employer has held his position open and has offered a graduated return-to-work plan when he is ready. He uses social media to maintain contact with friends but has not attended any in-person social events since discharge. Outcome measures completed at programme start: MPAI-4 total T-score 56 (moderately severe limitations); CIQ total score 14 of 29 (reduced community participation); Goal Attainment Scaling baseline ratings at -2 for all four objectives. Identified strengths include high pre-injury motivation, a supportive whānau and partner, intact long-term memory and language skills, technical computer skills retained, and demonstrated willingness to engage with rehabilitation. Factors impacting current function include cognitive fatigue (the most significant barrier identified by Daniel), low mood, reduced insight into fatigue, and loss of pre-injury identity as a cyclist and creative professional. **5. Plan strategies** Objective 1 (return to work) will be addressed through a graduated return-to-work programme led by the Occupational Therapist (key worker) in collaboration with Daniel, his employer, and the Vocational Counsellor. Workplace assessment to be completed in week 4. Initial return at 2 hours per day, 2 days per week from week 8, with structured fortnightly increases until the objective target is reached. Cognitive strategies will be integrated, including task chunking, scheduled rest breaks, and use of a digital task management system. Clinical Psychology will provide concurrent support for adjustment to altered work identity and for managing performance anxiety related to return to work. Outcome measure: hours worked per week, sustained over four consecutive weeks. Objective 2 (community mobility) will be addressed by the Occupational Therapist and Physiotherapist jointly. The Physiotherapist will progress lower limb strength and balance work to ensure safe ambulation in busy environments, including bus stops and train platforms. The Occupational Therapist will deliver a graded public transport programme starting with familiar short routes (Paraparaumu to Waikanae) and progressing to longer commuter journeys (Paraparaumu to Wellington). Mobile phone-based wayfinding and journey planning will be taught. Outcome measure: independent journey log, with at least three return journeys per week sustained over a fortnight. Objective 3 (energy management) will be addressed by the Occupational Therapist using a structured fatigue management programme adapted for traumatic brain injury, including activity pacing, energy conservation strategies, sleep hygiene, and the introduction of a daily routine matrix. Clinical Psychology will contribute mindfulness-based interventions for managing low mood and rumination. Outcome measures: daily activity and fatigue diary; MPAI-4 re-administration at weeks 8 and 16. Objective 4 (social and recreational re-engagement) will be addressed through a graded community participation plan led by the Occupational Therapist. Cycling re-engagement will be supported by the Physiotherapist with a graded reintroduction to a stationary cycle, then a recumbent trike on flat terrain, then upright cycling on the Kāpiti coastal path with helmet, hi-vis, and a riding buddy. Social Worker input will support reconnection with friend group and exploration of a local TBI peer support group. Outcome measures: activity diary; CIQ re-administration at week 20. Proposed programme length: up to 6 months (24 weeks) Proposed setting: client's home, community settings (public transport routes, workplace, Kāpiti coastal path), and Telehealth where appropriate Frequency of client contact: weekly to fortnightly, varying by discipline and programme phase Proposed hours by service item: | Service item | Delivering discipline | Proposed hours | |---|---|---| | Key worker coordination and case management | Occupational Therapist (Hannah Bradshaw) | 18 | | Occupational therapy intervention | Occupational Therapist | 36 | | Physiotherapy | Physiotherapist | 20 | | Clinical psychology | Clinical Psychologist | 16 | | Vocational counselling and workplace liaison | Vocational Counsellor | 12 | | Social work | Social Worker | 8 | | Whānau and partner support sessions | Occupational Therapist and Social Worker | 6 | **Part F, Provider/Supplier declaration** I declare the information provided on this form is, to the best of my knowledge, accurate and complete. Plan, Provider/Supplier signature: _______________________________ Date: 28/05/2026 In the collection, use, disclosure, and storage of information, ACC will at all times comply with the obligations of the Privacy Act 2020, the Health Information Privacy Code 2020 and the Official Information Act 1982. The Privacy Act 2020 and the Health Information Privacy Code 2020 apply to personal and health information. Further details of how and why we collect, use, store and disclose information are set out in our Personal Information and Privacy Policy, which may be viewed on our website www.acc.co.nz/privacy. We use the information collected on this form to fulfil the requirements of the Accident Compensation Act 2001. **Information gaps, assessor review required** 1. Section 1, Assessment details: purchase order number PO2026-04839 was confirmed verbally; cross-check against the ACC purchase order email before submission. 2. Section 2, Client details: confirm Daniel's preferred contact details (his mobile vs his parents' landline) before the plan is finalised. 3. Section 4, Objective 1: confirm the employer's specific written commitment to the graduated hybrid return-to-work arrangement before locking in the 24-week target; current commitment is verbal only. 4. Section 4, Objective 4: confirm with neurologist that recreational cycling at week 20 is medically appropriate; this objective is contingent on neurologist clearance. 5. Section 5, Proposed hours: total proposed hours come to 116 across all disciplines; confirm this aligns with the available Te Ata Tū hours envelope for this purchase order before submission. 6. Section 5, Frequency: frequency listed as "weekly to fortnightly" pending discipline-specific scheduling; finalise the discipline-by-discipline cadence with each team member before plan sign-off. 7. Client summary: GP name and contact details for medication management were not captured during the assessment session; obtain and add before submission. 8. Outcome measures: baseline MPAI-4 and CIQ scores recorded above; confirm the date of administration (assumed to be week of first contact) and append the completed measures to the plan submission.