In May 2009 ACC counsellors received forms requesting information on qualifications, recent training and preferred treatment modalities - no reason for this was given, though it was obviously in preparation for selecting preferred treatment modalities.Copyright © 2010 Aotearoa New Zealand Association of Social Workers
On August 10 2009 Dr Peter Jansen, Senior Medical Advisor to ACC, and Ann Aitcheson began rolling out ACC’s “Clinical Pathways”, the plan to radically change how the Sensitive Claims Unit managed new claims. This came as a complete shock to all counsellors, psychotherapists, social workers and some psychologists working with survivors of sexual abuse. ACC intended these new pathways to be implemented on 14 September - a whole three weeks’ notice!
The Clinical Pathways project had been developed away from counsellors, psychotherapists and social workers. SCAG was ignored and TOAH NNEST (Te Ohaakii A Hine - National Network Ending Sexual Violence Together), which had been working with Government Ministers for two years, had heard nothing about what was being planned either.
Further, the Clinical Pathway has been implemented without consultation with Maori, and lacks connection with appropriate pathways to help Maori claimants. In discussions with Maori members of various professional bodies, many Maori feel the mainstream systems again have not yet recognized the resources and richness of healing methods for dealing with victims of sexual violence which can be used by Maori counsellors. There have been numerous attempts as groups and individuals to keep the Maori voice vocal. Although the new system is in place now it is important to continue to challenge this ACC process, and its lack of safety for Maori clients particularly. Pacific Island groups had not been consulted either, nor any other ethnic groups.
SCAG members believed that the announcement of the new Pathways was deliberately chosen to occur between the SCAG meeting in March (where there was no mention of the new Pathways) and the next scheduled meeting in October.
Widespread anger and discontent from all NZ counselling, social work and psychotherapy associations along with organisations such as Rape Crisis (as well as clients and ex-clients) directed at ACC and the Minister of ACC, Nick Smith, in response to the proposed changes. Bowing to pressure from professional bodies, Peter Jansen then decided to delay implementation date by a month while ACC “consulted” with professional organisations. Submissions were called for. Consultations, however, constituted professionals being informed what the clinical pathways entailed.
SCAG members wrote to Nick Smith requesting a meeting. Despite numerous follow-up calls, no meeting eventuated because of his firm refusal to meet with us.
September 18 at the NZAC Conference in Hamilton, Peter Jansen and David Chapman attended an ACC Forum along with a vocal group of counsellors. Dr Jansen would not back down on his desire to see the Pathways implemented, and continued to reiterate that ACC was following the Massey Guidelines and “best practice”. Some counsellors walked out in protest at his refusal to hear their concerns and put the changes on hold until further full consultation.
In media interviews Dr Jansen told reporters that claimants who are denied counselling can easily access counselling through other community agencies, mental health providers, etc, which most counsellors in every region believe is not the case.
September 30 TOAH NNEST met with ACC and its Tauiwi caucus presented ACC with their Principles for the Development of a Clinical Pathway. ACC insisted on using DSM-IV even though there are other assessment methods which show clear links between the abuse and its effects.
ACC met with SCAG on October 2 and SCAG requested an urgent workshop to precede implementation of the Pathways. This request fell on deaf ears. However, it was announced that the Pathways would be delayed yet again for another two weeks to further “consult”. No actual consultation took place.
During the period from early October to the implementation of the Pathways on October 27 ANZASW along with members of all counselling associations took every opportunity to issue press releases, write to ACC and Nick Smith, talk with government and opposition MPs and spread the word through community agencies and local and national media. On October 28, a day after implementation date, further changes to Pathways announced. ANZASW, together with other professional bodies, makes yet another press statement about our concern about unsafe, unethical practices.
Press releases on the ethical implications of the Pathways given to media by NZAC.
On October 27 an online petition with almost 4000 signatures, calling for the Pathways to be stopped, was presented to Parliament. Many professional announce that they will not accept futher ACC referrals under the new system.
The same day ACC Minister Nick Smith announced an “independent” review of the ACC Pathways which would be finalized after six months (after repeatedly stating that the Government was not getting involved in the issue).
By the time you are reading this column no doubt other significant events will have taken place. One of the positive outcomes of these struggles is that the counsellor, psychotherapy and social work associations are communicating with one another, strategising, sharing experiences and supporting one another through this exhausting process.
MASSEY UNIVERSITY HAS NOW DISTANCED THEMSELVES FROM ACC’s USE OF THEIR RESEARCH SAYING IT IS BEING INAPPROPRIATELY INTERPRETED – which makes their frequently quoted “best practice” a mockery and vindicates what professionals have been saying all along.
Why are we objecting to the Clinical Pathways?
• Lack of safety particularly for Maori. There have been continued promises for ‘hui’ with Maori that never eventuate.
• Lack of safety for Pacific Island clients.
• Lack of action about different arrangements for children and adolescents, even though these have been promised by Peter Jansen.
• Lack of consultation with professionals in the field.
• Misuse of Massey Guidelines (2008) e.g. that 16 sessions is a suitable limit for most counselling survivors of sexual abuse. ACC was taking a comment made about a specific set of circumstances - adult victim of one sexual assault - and applying it to all survivors, e.g. childhood sexual abuse survivors who may have suffered numerous events and possibly numerous abusers. As stated above, Massey have finally spoken up about misuse of their research.
• Unethical aspects of the new Pathways - e.g. multiple assessments carried out at the beginning of ACC’s new process where many clients are likely to be unsafe. Clients would not have enough time to develop a therapeutic alliance with one counsellor – critical for positive outcomes for the client.
• The risk that some clients may become emotionally/psychologically unstable early in the disclosure process, where there is no provider clearly accountable to ‘hold’ the client through that early process of trying to establish a claim, is significant.
• There may be mental health casualties when potential claimants’ requests for help are not easily accepted, or their claims declined.
• Longer-term therapy with more complex clients under ACC is likely to disappear. Offering shorter term affectual symptomatic relief, on its own, is likely to lead to poor results.
• Insistence on the use of DSM-IV and assessment of ‘mental injury’ so early in the counselling process may create problems for people’s career paths, insurance prospects and future travel, and is quite inappropriate for children and adolescents. Somehow, requirement of mental injury has been transformed into a requirement for mental illness diagnosis with no legislative change. A legal challenge has been commenced on this issue.
• ACC foisting the Pathways on us under the guise of ‘concerns’ that it has regarding some ACC counsellors working too long with their clients, or that many counsellors are unable to write satisfactory ACC reports, is short-sighted. ACC could easily monitor these “rogue” counsellors and suggest targeted training to bring them up to the mark; it did not need to change the whole system.
• The preference for clinical psychologists and psychiatrists to carry out client assessments so early in the process, instead of permitting counsellors to complete their own assessments, when psychologists, on the whole, have not been the main group in the past who are experienced in delivering treatment interventions to traumatized clients, is limiting and not best practice. ACC does not appear to value the establishing of the therapeutic relationship as a tool for healing.
• The overseeing of the continued treatment (after the assessment) of the client’s therapy by ACC psychologists is another problem, which reduces therapeutic creativity, adherence to CLIENT and provider goals together, and inhibits other modalities effective operations. This was NOT a recommendation by the Massey Guidelines researchers!!
• Lack of clarity of choice for clients as to who carries out their assessments or becomes their later counsellor provider.
• Lack of consultation with Mental Health and NGOs about ACC’s expectation that declined clients will be absorbed by these organisations.
• Victims of crime (sexual abuse survivors) are being exploited by ACC in the name of saving money, despite the National-led government promise to create better outcomes for these people.
• SOCIAL WORKERS ARE NOT DEEMED TO BE ABLE TO USE DSM-IV SO NEED TO REFER TO A PSYCHOLOGIST FOR THEIR CLIENTS TO BE ASSESSED - WE BELIEVE THIS TO BE INSULTING TO OUR PROFESSION.
• Privacy requests by ACC in the new pathways go too far for the purposes of the ACC’s need for information at the point of entering the ACC system. Clients may lose many aspects of their own privacy if they sign the form required at the outset by ACC.
In conclusion, at this point of writing (early November 2009) we are still hopeful that there can be some turnaround or embargo placed on the ACC’s Clinical Pathway. We desire ACC to hold proper consultation with clinically-trained professionals who have already worked in this specialized area of trauma treatment. From this ACC could develop improvements that will make it safer and more ethical for clients and providers, for Maori and Pakeha, for complex needs clients, and for children and adolescents to receive the ACC rehabilitation under the ACC regulations which they are entitled to as victims of crimes.
These issues affect all of our profession. Please make your protest known to ACC. This is a social justice issue as vulnerable clients are now being denied the help they are entitled to.
You can email the architect of these changes with your concerns: peter.jansen@acc.co.nz.
Please email me with any concerns or ideas on how we can challenge this extremely abusive process: cathy.mcpherson@goalscentre.co.nz.
http://anzasw.org.nz/user/file/428/NB%20December%20Final.pdf
No comments:
Post a Comment