Group based therapy application form – Sensitive Claims Service

Complete this form if you are planning to develop a group to provide therapy under the Sensitive Claims Service.

Group-based therapy is focused on helping kiritaki (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 service provider for individual treatment.

Kiritaki 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 Tailored Support to Wellbeing Package A or B and is only available for kiritaki with an accepted claim.

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

All proposals must align with expectations as outlined in the Sensitive Claims Service Operational Guidelines

Group details and objectives

Group name

Identify the geographical areas this group will be delivered within and rationale for chosen area. This should include information demonstrating that a service gap exists for the region and will be filled by the delivery of this group.

Please detail the number of participants

Outline the number of sessions and the duration?

Please discuss the rationale for the group. This should include theoretical foundations and references to relevant evidence for the group. 

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

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 kiritaki.

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.

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

How and when will you communicate with the lead service providers of the kiritaki? This should include discussion with lead providers regarding how safety is managed outside the group.

How will you ensure all cultures and ethnicities of kiritaki are acknowledged and potential biases addressed to ensure positive and equitable outcomes are achieved for all participants?

How will you evaluate and measure kiritaki outcomes?

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.

Supplier's name

Supplier's number

Supplier’s email address

Lead service provider's name(s)

Lead service provider's ACC provider number

Relevant training and experience to provide proposed services

Co-facilitator's name

Co-facilitator's phone number

Co-facilitator's ACC provider number (if applicable)

Co-facilitator's relevant training and experience to provide proposed services

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