Sensitive Claims Unit changes raise concern

An editorial from the Otago Daily Times by Sandra Buchanan

Today, ACC minister Nick Smith is expected to announce that levies will rise and entitlements will be cut. Sandra Buchanan takes a critical look at the proposed reduction in counselling through the Sensitive Claims Unit.
Since 1972, children, women and men who have been mentally injured, as a result of sexual abuse, have been able to access counselling funded by ACC's Sensitive Claims Unit. ACC has recently announced policies to change and substantially limit this - their new Clinical Framework.
Today, ACC Minister Nick Smith is expected to reveal about 20 areas across ACC's purview where it is looking to cut back entitlements.
As a registered psychotherapist and ACC-registered counsellor, I have grave concerns about the proposed Sensitive Claims Unit changes. These concerns are shared by the majority of the providers of services, both clinicians and NGOs.
Since the changes were first proposed by ACC in early August, we have been providing thorough, research-based evidence to support our claim that these changes are poorly conceived and potentially dangerous to clients. Professional associations are united in their opposition to the plans.
ACC has denied the changes have anything to do with cost-cutting and in fact the greater report-writing and external assessments being proposed will have higher administrative costs. It is already the case that for every $19 million spent annually on administrating the Sensitive Claims Unit, only $2 million actually goes to counselling.
Some minor changes have been made to the new framework since it was first proposed. One such change means there will no longer be a categorical divide between the clinician assessing the client and the clinician providing the treatment - such a separation could have meant that a client saw up to three health professionals (including first disclosing to a GP) before any actual treatment began.
It appears ACC is also backtracking on providing two sessions only for the therapist and client to produce a report which determines cover. Four sessions has been the norm till now but even that was quite limited. It is not simple for someone to disclose very personal and traumatic information that they may not have spoken of previously at all.
Of most concern however, and there seems no sign of ACC rethinking on this, is that most clients will receive 16 sessions only, with any further treatment needing to be approved by an external assessor or internal ACC multi-disciplinary panel. ACC note in their latest document that it is unlikely there will be many clients in this group.
ACC says it is basing these changes on research undertaken for them by Massey University last year, the so-called Massey Guidelines, although many of their conclusions cannot be drawn from this work. ACC states that best clinical outcomes for the majority of clients can be achieved through shorter-term programmes of focused intervention.
Clinicians and other experts in the field take issue with this statement. Sixteen sessions of brief, focused psychotherapy may well assist previously functional adults who have sustained a one-off sexual assault, to recover their lives. It is totally insufficient for the clients that I typically work with, as a psychotherapist.
Individuals unfortunate enough to face childhood sexual abuse (particularly that which has occurred frequently and at the hands of a trusted family member or friend) will typically have experienced such profound assaults on their sense of trust, that their ability to form an attachment with others will be impaired.
In such a situation it may take the full 16 sessions and many more for the client to form the necessary therapeutic relationship for any treatment of the trauma to occur.
It is also of great concern that ACC is demanding that every client now have a psychiatric diagnosis to be eligible for ACC-funded counselling.
Many sexual abuse survivors do, of course, struggle hugely with depression, anxiety or post-traumatic stress disorder, which are psychiatric diagnoses - some, however, require assistance to reclaim their lives and do not have symptoms such that they would meet the criteria for such a diagnosis.
In general, therapists prefer a more holistic approach that sees the person, with their strengths and struggles, rather than a diagnosis.
At present, ACC typically requires progress reports after every 20 sessions or so, and an external assessment after about 50 sessions.
This system, to my mind, has generally worked well for years. It is now proposed that reports be done every four weeks and external assessments much more frequently. It feels as if those of us in the field are not being trusted to make our own decisions, regarding our clients' treatment.
All counsellors belonging to reputable professional bodies already have regular clinical supervision where assessment of our treatment plans for sensitive claims clients could be reviewed.
It is already the case that there are insufficient ACC-registered counsellors, particularly in specialist areas such as working with children or Maori/Pacific Islanders. There is also scarce provision outside of the major urban centres.
Therapists are so concerned about the possible dangers to clients of these changes that discussion has been given to whether it will actually be ethical to continue this work at all.
It is highly likely some counsellors will no longer provide services to ACC under these circumstances, making it even harder for clients to access therapy. (It is important to stress however that no-one is suggesting treatment of existing clients will be affected.)
The new system depends either on NGOs, such as Rape Crisis, or the public mental health services, being able to step in to provide safety for clients during extensive delays while decisions are made by the Sensitive Claims Unit.
Both NGOs and public services are already extremely stretched, as we well know. A client has to be very psychiatrically unwell to meet the criteria for services within the public mental health system, whose brief is to cover the 3% of the population with moderate to severe psychiatric disorders.
We hear a lot in the news about limited provision of services to victims of crime as opposed to offenders. ACC's system of providing counselling to those who have been victims of sexual offending was a fantastic example of actually providing some help before the ambulance at the bottom of the cliff.
It did mean assistance for victims and was about empowering individuals to recover their lives after abuse. It is also clearly minimally expensive compared with the costs of keeping offenders, many of whom have suffered their own childhood abuse, in prison for years.
None of these arguments has made any difference to the policy makers at ACC or the Government, which has been very quiet on the issue. This is a real concern for democracy.

http://www.odt.co.nz/opinion/opinion/77958/sensitive-claims-unit-changes-raise-concern