E24 – A Change for Better + guest Ashley Cairns

Julie Interviews Guests

Julie Legg chats with Ashley Cairns, CEO and director of A Change for Better. They discuss the ACFB Fund – the charitable side of the organisation, mental health services, subsidised ADHD online assessments, and how the organisation is expanding to provide a wrap-around service.       

By offering asynchronous assessments, the organization reduces wait times and costs, making diagnostic services available to rural and low-income clients through flexible payment options. Their approach includes comprehensive reports, post-diagnosis support, and customized treatment plans. With a dedicated team of psychologists and a fully online service model, A Change for Better is pioneering more inclusive, effective pathways for ADHD diagnosis and mental health support across New Zealand.

KEY TAKEAWAYS

  • About A Change for Better: Founded in 2019, A Change for Better is a mental health organization in New Zealand, offering streamlined, subsidized ADHD and autism assessments through the ACFB Fund to make these services more accessible​.

  • Efficient, Asynchronous Assessment Model: To reduce costs and wait times, A Change for Better uses asynchronous assessments, allowing clients to complete detailed questionnaires on their own time. This model reduces psychologist admin time, leading to faster, more cost-effective assessments​.

  • Affordable and Flexible Payment Options: Assessments are priced based on household income, with flexible interest-free payment plans available to ensure affordability, including the option to pay as little as $10 per week​.

  • Comprehensive Diagnostic Process: Clients undergo multiple assessments, including ADHD, autism, trauma, and mood screens. Reports are detailed, often 20+ pages, offering a thorough diagnostic process. This detailed approach is accepted by partner psychiatry programs, reducing the need for repeat assessments​.

  • Post-Diagnosis Support and Treatment Plans: The organization aims to provide wrap-around support post-diagnosis, including treatment plans, counselling, neurodiversity coaching, and customized support groups for individuals and parents​.

  • Nationwide Reach: As a fully online service, A Change for Better is accessible to people across New Zealand, particularly beneficial for rural clients who face limited local resources​.

  • Specialized Team Structure: The organization uses a multi-psychologist approach, with clinical, educational, and general psychologists assigned to clients based on their needs, ensuring appropriate support for each case complexity​.

  • Future Services: Plans include expanding into general mental health assessments and offering free counselling for individuals with ACC sensitive claims, reflecting their commitment to comprehensive mental health support​.

LINKS

TRANSCRIPT

JULIE: I’m Julie Legg, author of The Missing Piece and diagnosed with ADHD at 52. Welcome to ADHDifference. In today’s episode I’ll be chatting with Ashley Cairns, CEO and director of  A Change for Better. We discuss their organization and their online ADHD assessment process, their low wait times, the pathway from seeing a psychologist through to a psychiatrist if necessary, and also the possibility for subsidization if the client meets a certain criteria. Good morning Ashley. Thank you so much for joining me today.

ASHLEY: Thanks Julie, good morning.

JULIE: Good morning. So, you’re director and CEO of A Change for Better. Can you tell us all about that?

ASHLEY: Sure, absolutely. So, A Change for Better is a mental health organization dedicated to helping mental health professionals connect with available clients throughout New Zealand. We started that venture in 2019, late 2019-early 2020, really dedicated to the professional side. We saw the opportunity to do charity, to do good. And so in January of 2023, sorry 2022, I can’t believe that we’re almost two years old now, we started the charitable side, the ACFB Fund. ACFB standing for A Change for Better and through that we’ve been able to provide subsidized mental health assessments including for ADHD and autism as well as counselling. We’ve got some really exciting services that we’re planning for 2025 so I guess watch the space.

JULIE: That’s incredible and given the extended wait times for many undiagnosed adults and children alike looking for assessment in New Zealand, it’s wonderful that (a) I believe you’ve got quite some low waiting times and (b) also the potential for subsidy or part subsidy, that is music to many ears, I’m sure. Can you tell me a little about how the fund side of things was set up and how you’re able to offer this subsidy?

ASHLEY: Absolutely. So, the fund was set up like I said in 2023, and actually our first … or 2022, again I cannot believe we’re going to be two years old, it seems like a dream. We really launched trying to provide counselling and we found it quite difficult financially to provide a subsidized counselling model with the people that we had available to us that are providing this service. So, in that kind of brainstorming kind of venture Dr Amy Marschall and I came up with this idea to do ADHD/ autism assessments. She is a recognized expert in the field. She’s written many books on how to do autism and ADHD assessments very effectively, and so we came up with this model that made the psychologist really only doing psychology. So a lot of where the cost comes in, and a lot of where the wait times comes in, is that the clinical psychologist, or whatever psychologist is doing it, is doing all the admin. The back and forth with the client, the discovering of the medical records, and getting school records and all of this stuff, and so maybe 60% of their time is being spent on admin instead of clinical stuff, and so the cost keeps going up. So that’s why we have such a bottleneck. So we got together with my husband Joe, who is a cyber security specialist for Visa, quite a techy kind of person, and we said “Where can we get rid of admin? Where can we get rid of overhead? How can we make this process more efficient, more streamlined?” And, between Amy, Joe, and myself we came up with the model that you’ll see on our website. And so now when you come into the program you’re given a fee and that fee is based on your household income. So we expect those who can afford to pay to help to subsidize for those that can’t afford to pay. So we get quite a broad mix of people that do come through the service. A lot of them, I’d probably say about 40%, are on the lower end because again this is a charity and these are the people we’re trying to support anyway. And so once you get that fee and accept that fee, we offer a range of different ways that you can pay this, and this is different than other places in the industry too. So, we allow interest-free payment plans as little as $10 a week. So being ADHD myself, I know if you ask me to spend $1,000 I have to save that $1,000. I might spend $2,000 or $3,000 in the process, you know, trying to put it into the account and all the stress and anxiety that comes with that. So we wanted to provide that different approach by allowing interest-free flexible payment plans. So say this week you’ve got $10, great. Say next week you want to do $30 because you got to save an extra $20, good go for it. Say you want to pay it off, half of it off this week, and then do the rest of it over like small payments, great fine. We’re happy with any arrangement. The situation is that they need to pay 50% though to get those questionnaires. And here’s a difference that we do different to the industry as well is that we do what’s called asynchronous assessment. [Okay.] So asynchronous assessment is giving the client all of the questionnaires and allowing them to do that in their own time, in their own space, as they feel ready for it – versus the psychologist reading out each question, waiting for the response, and putting that in.

JULIE: I’m sorry to interrupt you here but that is brilliant and I think when I was assessed for ADHD, I was so stressed leading up to that point because I was “What if I didn’t say something really important? What if I went off on a tangent and it didn’t quite answer the question?” I wanted to tell it like it is but my mind takes time to process things. So, I can completely understand how being given that information in advance would be a wonderful opportunity to really consider all aspects of your life, not just a knee-jerk reaction in a very stressed environment. Wonderful, carry on.

ASHLEY: And actually that’s what the research shows as well is like specifically for ADHD and autism that when people have the ability to think about what they want and they’re not feeling pressured, they’re more forthcoming. They’re more honest. They’re more able to connect the dots and we have more accurate diagnoses because of it. So yes, 100% what you just said.

JULIE: Also too, with … you specialize in autism and/or ADHD, and often they’re a combined pairing, aren’t they? Your psychologists are able to look at a range of disorders; dyspraxia, dyslexia, the rest? Yeah so it’s … ?

ASHLEY: Well no sorry, not dyslexia, dyspraxia. So we do ADHD, autism. The thing about dyslexia and dyspraxia is that, and dyscalcuia and whatnot, is that there isn’t agreed upon way to assess for that. So each psychologist does that differently and we found that those ones would be best to be done in person. Right. So we’re focusing on anything that can be done online more efficiently. So, we saw ADHD and autism as the best way to go from there. And, next year we’re going to be offering general mental health assessments as well. So like, you know that you don’t have a neurodiversity but you’ve got a lot of questions about what’s going on in your head. We want to be able to provide quite a broad answer for you. And, going back to that asynchronous assessment, the other benefit of that is that we can send more assessments to you for you to do in less time for us. So when you go to another psychologist they might run two or three sorts of tests on you, and then say “Yep, you have it,” or “No, you don’t.” We run a minimum I think of 10 different tests and that all depends too on what you’re coming in for. If you’re coming in for both ADHD and autism, we’re running a full mental health screen, a trauma screen, mood disorder screen. We’re doing all the autism assessments, plus sensory assessments, plus the ADHD assessments, because our psychologists aren’t running it with you simultaneously. You’re doing it in your own time. It doesn’t cause us more time which also then, the on-flow of that is that our reports are more comprehensive than anybody else in the industry. I haven’t seen a report less than 20 pages. [Wow, wow.] And then the flow on effect of that is that one of the new services we’re going to be offering, because this psychologist knows you so well by the end of this process, so you are … Once those questionnaires come and you do get in front of the psychologist. It’s just like we’re doing right now. It would be like over Meet or over Zoom and after that they then go back and make that big giant report, and that’s where they do their case formulation as well which is something that not everybody does. And then from there we’d like to start doing treatment planning, so …

JULIE: Excellent. Ashley if we could just backtrack a little with regards to, so it’s all online. [Fully.] Therefore, it’s fully accessible nationwide throughout New Zealand. [Correct.] Brilliant. What are the current waiting times that people can expect?

ASHLEY: So today is the 7th of October. If you were to pay today and get all those questionnaires done today, we are booking for about the end of November, so about 6-8 weeks at the moment out, with the report expected probably after Christmas break. Our staff members are going to be taking some time off. It’s been a very busy year. [I bet.] So we’ve been telling everybody expect your reports in the beginning of new year at this point.

JULIE: Excellent and what type of clients, what, where on the journey are they when they contact you? Are they confused that they may resonate with a few traits and want to know, or have they already done some online self-questionnaires and think they’re further down the track, you know? Where do they sit?

ASHLEY: All ranges. I get a lot of parents. So probably 80% of the work that we do is with adults. A lot of them are parents whose child has been diagnosed and then they realize “Oh while I was filling out the questionnaires for them I was like oh yeah, but I do that too. Oh yeah, but I do that too,” and it was a big eye-opener for them. For some people we get a lot of from the HIPS, the health improvement practitioners across the country, we’re seeing a lot from them. A lot of rural because they just can’t find any other solution. We usually get people who’ve been searching for a while as well and haven’t been able to find something that doesn’t have a 2-year plus wait list and cost $3,000. So we try to be, yeah, just accept accessible as much as possible.

JULIE: That’s absolutely wonderful. Now back to when we were talking about treatment and post diagnosis. So you say you also offer counselling sessions as well?

ASHLEY: We’re going to be in the new year. Oh brilliant. So this is a big couple of months for transition. We’ve recently been awarded the ACC sensitive claims tender contract so we will be able to provide free counselling to anybody who has experienced sexual harm, through our network of counsellors. We’re limited to certain regions at the moment, and certain practitioners, however we’ve proven, we hope to have proven ourselves with ACC by the beginning of the year to allow us to expand that contract further. Wonderful. Yeah, in addition to that we will be doing general counselling and neurodiversity coaching as well.

JULIE: Wonderful and, I think for me, I did so much research around the time of my diagnosis and post- diagnosis, but I’ve always considered it, you know, the journey, the real journey, actually begins on diagnosis. There’s so much to unpack and so many things to work on, tools to use and adapt, and strategies, and the whole lot, so it is quite exciting. Now you have psychologists. [Yep.] Now psychologists won’t be able to prescribe medication for ADHD. [Correct.] Can you talk me through the pathway. What if they feel at that point post-diagnosis, that medication is more likely to be their, you know, part of their pathway. Can you talk me through how that would work?

ASHLEY: Yep. So for different regions it has different requirements, there are different requirements. So here in Canterbury there is a special program for those that are severely impacted by their ADHD, where they can go to their GP with our report. The GP sends it off to the hospital and the hospital then signs off on that Special Authority Number and gives medication recommendations and they never see that psychiatrist. It’s just done through the system. But throughout different regions we find that there is not a program like that yet. I don’t know if there is maybe something in the making. If there isn’t, I’m … here’s the plea because this has been really a game changer here, at least in Canterbury for a significant number of people. So for anybody outside of Canterbury they do need to find a psychiatrist. Our recommended psychiatry place is the Nelson Clinic. So, when we were first developing our program, we worked alongside them and their psychologist and their psychiatrist to develop reports that were thorough, in-depth, that would get across the line from many different government organizations. They really mentored us a lot. We’ve since even expanded on that, on the reports, but they will accept our reports to their psychiatry program. We are the only organization that we know of that they will let bypass their own assessment service. So we’re quite lucky because otherwise it would be like $700 for them for the psychology part, and then another x amount for their psychiatry part.

JULIE: Wow. That’s fabulous. And because your reporting is so comprehensive, that’s … it’s wonderful that you had brainstormed before rolling it out so you know that’s the case. Oh that … that must have some very positive implications when it comes to the psychiatrist side of things, cutting down on time, hours spent in assessment. That would be quite interesting, wow. And I guess at the beginning of the process again, there will be those that don’t understand whether … because you don’t know if medication is going to be right for you, or if there are other tools in the toolbox that can be used, or whether even medication is going to suit you. And I know for many people with some underlying health issues, some medical issues, it may not, that may not be the part of the journey for them. Wonderful that is, that’s amazing. No wonder ….

ASHLEY: This is also why we’re offering the treatment plan service. So once we do the diagnosis, it’s like what to do from here? So you’re right. Medication one might be one part of that journey, but the other part is like behaviour change, and acknowledgment, and coming to grips with that grief. You know, we deal with, we work with a lot of adults, and the grief of feeling like “Why did no one see this? Why did I have to wait this long to have this answer?” So that has ramifications and so our treatment plan, then we can hand over to our counselling team. So what we’re trying to do is a wrap-around service. The other service I forgot to mention before is that we’re going to start support groups as well. So you’ve just been diagnosed it’s “What do I do from here?” And, they’re customized tailored support groups both to parents and to the individual.

JULIE: That sounds perfect, it really does. And I understand, you know, for me an ADHD diagnosis was quite validating. I’d wrapped my head around the whole concept and I was relieved to be honest. But, for those women that I interviewed for The Missing Piece certainly that wasn’t always the case. And it may have come to that after time but some were still on that journey, very angry … yes, not for being picked up but also grief as to what could have been. You know, how could have my life been. And being diagnosed as an adult, you’ve got a lifetime of undiagnosed chaos in many cases. And you know, middle-aged to discover that your youth, you know, could have been very very different is … it’s hard for some people to cope with. So I love the idea of a wrap-around service and that post diagnosis it’s not that your left to your own devices, and that you know there is help out there for you. Can you talk about your team. It’s … tell me about the team.

ASHLEY: We’re incredibly lucky. So our co-founder, Dr Amy Marschall is a clinical psychologist currently located in South Dakota, which is a very interesting arrangement but she is licensed here in New Zealand. Pre-covid she had a job offer here however the borders had closed by the time she was able to move over and it just didn’t work out. So she wanted to keep those connections and keep her license going so this was a great opportunity for her, and we’re very lucky. Our second Clinical Director is Dr Natalie Peart. She is a graduate of Auckland University I believe and has extensive experience working in this field. She’s been amazing, her ideas. So Amy and I launched with the assessments, just the diagnosis side, and Natalie has really picked up the rest of the stuff, the rest of the services and really made it her own. So really excited to see what comes of that. Then we have two educational psychologists, Kate Nitschke and Kiia Naidoo. Kiia works for MOE [Ministry of Education] full-time and moonlights for us nights and weekends to try to help with the backlog. And Kate has extensive experience and is located in Marton, just near like Wanganui, I believe. [Yes, yes.] Yep and then we have … sorry?

JULIE: I was just going to ask, can you tell me what an educational psychologist does, as opposed to a clinical psychologist or …?

ASHLEY: Yeah absolutely. So our educational psychologists focus more on functionality and assessment like strict assessments for ADHD autism, versus a clinical psychologist that is also looking at more mental health stuff, personality disorders, trauma, depression, anxiety, mood stuff, that kind of stuff. So we use a multi-psychologist approach in this. So when somebody comes in, they’re first assigned to clinical support and a clinical support person is somebody with good clinical knowledge of the questionnaires that you’re doing and the process itself. They’re able to hold you through the process, kind of like a case manager. Over to the psychologist then the psychologist, depending upon how complex the person is. And I hate to use the word complex but I mean, there are straight-forward cases and then there are ones that take a lot more time and we need to have the right person looking at the right people. So their job is to then assign the right psychologist to the right person. So if it’s more straight-forward, if it’s younger people as well, it tends to go to our educational psychologists. If there’s that level of trauma or other things going on we tend to send that to the clinical psychologist. We’ve also recently taken on a couple general psychologists because they do kind of do a little bit of everything. They’re kind of a ‘Jack of all trades and a master of none.’ So we tend to give them clinical support kind of roles as well as basic assessment as well.

JULIE: Well, the whole package sounds wonderful and I look very … I look forward very much to airing this episode because I think so many people are looking for solutions. And as you said, rural folk and those financially struggling, I think an ADHD assessment and potential diagnosis should be accessible to all, and I think location and finance, it’s an absolute crying shame that they don’t get the same care and attention as everyone else in more urban areas. So it’s … what a wonderful organization. Ashley thank you so much for taking the time to chat today and all about A Change for Better. And I look forward to airing this podcast very shortly in the ADHD Awareness Month of October.

ASHLEY: Thank you, awesome. Thank you for having me and for helping us as a new organization to be seen and be heard. We’re here to help people and it’s great to have people like you helping to connect us with the right audience. Thank you.

JULIE: Thank you.

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