Group based therapy application form – ISSC

Complete this form if you are planning to develop a group for delivery of services.

Group-based therapy is focused on helping clients to develop the specific skills which are the focus of that group. Group-based therapy is supplementary to individual treatment – all participants are required to have an ACC lead provider for individual treatment.

Clients would only be included in a group if they require the specific skills to address their mental injury. Group-based therapy is planned and delivered as part of Support to Wellbeing and is only available for clients with an accepted claim.

Support groups and unstructured group therapy are not included in this service and are not included as part of the ISSC.

All proposals must align with expectations as outlined in the ISSC Operational Guidelines

Group details and objectives

Please provide the group name

Please discuss the rationale for the group. This should include theoretical foundations and references if appropriate.

Please outline the objectives, including a high-level outline of the content. Describe what outcomes you hope to achieve for participants?

Please detail the number of participants

Outline the number of sessions and the duration?

Group program outline and typical sessions

Describe a typical session and group program outline

Who is this group for? Describe inclusion criteria for the group, for example age range, mental injury/ies to be addressed, gender etc.

Who would not be appropriate for this group? Please outline exclusion criteria, for example active psychosis, acute risk to self or others, etc.

What will you do to prepare participants for the group? Please describe how will you source referrals, review potential clients for safety and suitability, and seek consent from clients.

How will you manage potential risks? Outline potential risks and management plans.

If the group is delivered online, please outline how you will ensure access and safety for online participants. For example, participants will need to have stable internet, a private confidential space, and provide a phone number for a support person.

How and when will you communicate with the client’s lead providers? This should include discussion with lead providers regarding how safety is managed outside the group.

How will you address relevant cultural engagement?

How will you evaluate and measure client outcomes (i.e., what outcome measures will be included)?

Below is Appendix A which contains specific considerations for online groups. Please download and read, and indicate you have done so below.

Appendix A

Please indicate you have read Appendix A and agree to these conditions

Yes

Please provide the venue details or indicate whether this will be run online.

Please provide the proposed dates for when this group will be run.

Suppliers name

Suppliers number

Lead providers name

Lead ACC provider number

Relevant training and experience to provide proposed services

Co-facilitator name

Co-facilitator phone number

Co-facilitator ACC provider number (if applicable)

Co-facilitator relevant training and experience to provide proposed services

Currently we are unable to accept CVs submitted as part of this form. Please ensure you email the CVs of co-facilitators who are not contracted ACC providers to MentalHealth@acc.co.nz after submitting this form.

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