Questions for written answer

13310 (2009). Lynne Pillay to the Minister for ACC: How many people have approached the ACC Sensitive Claims Unit for assistance, by region, 1 December 2008?
Hon Dr Nick Smith (Minister for ACC) replied: I refer the Member to the attached table which provides details of the number of people that have approached the ACC Sensitive Claims Unit for assistance, from 1 December 2008 to 20 August 2009. This information is broken down by clients who have had their claims accepted, declined, or are awaiting a decision, and by region.
http://www.parliament.nz/en-NZ/PB/Business/QWA/3/d/2/QWA_13310_2009-13310-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

13311 (2009). Lynne Pillay to the Minister for ACC: How many sensitive claims has ACC approved since 1 December 2008, by month and region?
Hon Dr Nick Smith (Minister for ACC) replied: I refer the Member to my answer to Parliamentary Question for Written Answer 13310 (2009).
http://www.parliament.nz/en-NZ/PB/Business/QWA/9/f/9/QWA_13311_2009-13311-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

13312 (2009). Lynne Pillay to the Minister for ACC: What meetings, if any, has the minister had regarding sensitive claims since 1 December 2008 by date and organisation?
Hon Dr Nick Smith (Minister for ACC) replied: I have not had any meetings specifically focused on sensitive claims, since 1 December 2008. Issues in relation to sensitive claims do however come up from time to time in my regular meetings with ACC staff.
http://www.parliament.nz/en-NZ/PB/Business/QWA/c/8/1/QWA_13312_2009-13312-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

13313 (2009). Lynne Pillay to the Minister for ACC: What, if any, oral reports relating to sensitive claims has he received since 1 December 2008, by date and title?
Hon Dr Nick Smith (Minister for ACC) replied: At my usual weekly meeting with officials regarding my ACC portfolio we discuss items that have been brought to my attention in the Chief Executive’s weekly report. Oral reports are not recorded by date and title.
http://www.parliament.nz/en-NZ/PB/Business/QWA/f/2/e/QWA_13313_2009-13313-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

13314 (2009). Lynne Pillay to the Minister for ACC: How many sensitive claims has ACC declined since 1 December 2008, by month and region?
Hon Dr Nick Smith (Minister for ACC) replied: I refer the Member to my answer to Parliamentary Question for Written Reply 11310 (2009).
http://www.parliament.nz/en-NZ/PB/Business/QWA/6/c/b/QWA_13314_2009-13314-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

13315 (2009). Lynne Pillay to the Minister for ACC: What, if any, written reports relating to sensitive claims has he received since 1 December 2008, by date and title?
Hon Dr Nick Smith (Minister for ACC) replied: I have received one Briefing Paper relating to sensitive claims, since 1 December 2008. The report is “Clients Affected by the Giltrap Decision”, dated 24 July 2009. The issue over sensitive claims also sometimes been covered in weekly reports.
http://www.parliament.nz/en-NZ/PB/Business/QWA/c/f/a/QWA_13315_2009-13315-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

13316 (2009). Lynne Pillay to the Minister for ACC: What, if any, papers has the Minister taken to Cabinet, relating to sensitive claims and or ACC’s Sensitive Claims Unit, since 1 December 2008, by date and title?
Hon Dr Nick Smith (Minister for ACC) replied: I have taken no papers to Cabinet, relating to sensitive claims and or ACC’s Sensitive Claims Unit, since 1 December 2008.
http://www.parliament.nz/en-NZ/PB/Business/QWA/d/5/1/QWA_13316_2009-13316-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

13317 (2009). Lynne Pillay to the Minister for ACC: What committees, taskforces, or other work groups has he or his officials established since 1 December 2008, relating to sensitive claims?
Hon Dr Nick Smith (Minister for ACC) replied: Neither ACC nor I have established any committees, taskforces, or other working groups since 1 December 2008, relating to sensitive claims.
http://www.parliament.nz/en-NZ/PB/Business/QWA/a/3/3/QWA_13317_2009-13317-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

13320 (2009). Lynne Pillay to the Minister for ACC: What is the cost of any contractors hired by ACC’ Sensitive Claims Unit, per week, broken down by individual contractor?
Hon Dr Nick Smith (Minister for ACC) replied: I am unable to provide the member with a full answer to her question in the timeframes required for Parliamentary Questions for Written Reply, as ACC has informed me that the detailed week-by-week information is held on individual invoices, some of which have been archived. However, I can advise the Member that there are five contractors hired by the ACC Sensitive Claims Unit. I refer the Member to the attached table which provides the annualized information for the aforementioned contractors.
http://www.parliament.nz/en-NZ/PB/Business/QWA/8/2/c/QWA_13320_2009-13320-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

13321 (2009). Lynne Pillay to the Minister for ACC: How many, if any, casual staff are employed by ACC in the Sensitive claims unit?
Hon Dr Nick Smith (Minister for ACC) replied: There are no staff employed on a casual basis in ACC’s Sensitive Claims Unit.
http://www.parliament.nz/en-NZ/PB/Business/QWA/6/1/3/QWA_13321_2009-13321-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

13322 (2009). Lynne Pillay to the Minister for ACC: What, if any, meetings has the Minister had, relating to sensitive claims, with lobby groups since 1 December 2008, by date and group?
Hon Dr Nick Smith (Minister for ACC) replied: I have not had any meetings, relating to sensitive claims, with lobby groups since 1 December 2008.
http://www.parliament.nz/en-NZ/PB/Business/QWA/7/e/a/QWA_13322_2009-13322-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

National bows to pressure - but what about victims?

Press release from the New Zealand Labour Party

Victims of sexual abuse have been left in limbo by a partial back down by the Government on changes to ACC funding for counselling services, Labour’s Victims Rights Spokesperson Lynne Pillay says.
“Labour welcomes the decision by National to back down on a cruel proposal that would have required victims of sexual abuse to repeat their story of abuse over and over again to an ACC assessor in order to receive counselling.
“However, we have serious concerns that the National Party are subjecting sexual abuse victims to continued uncertainty around access to counselling.
“Yesterday the National Party defended changes to counselling for sexual abuse victims saying they were in the best interests of victims, but just a few hours later ACC informed media that they would not be going ahead with the cruel proposals because they wouldn’t work.
“National had earlier rejected advice from psychotherapists and victims rights groups and it was only when media became increasingly involved did they back-down.
“I congratulate the Association of Psychotherapists and victims rights groups who have publicly highlighted the arrogant actions of the Government in attempting to cut access to counselling,” Lynne Pillay said.
“ACC Minister Nick Smith’s claims today the back down had been because of clinical input were completely cynical and simply unbelievable. He was put under public pressure and was forced to back down on a proposal that should never have been put forward in the first place.
“It is extremely disappointing that vulnerable victims of sexual abuse have been subjected to cheap politicking by National. The reality is National already had clinical advice that its proposals wouldn’t work and yet it still went out publicly threatening to strip victims of access to counselling in a shameful attempt at cost cutting.
“Nick Smith today refused to provide any public guarantees that victims of sexual abuse would continue to have access to counselling services without further political interference or cost saving measures.
“Victims of sexual abuse have suffered greatly and they should be given every guarantee that they will be supported to recover from the trauma they have suffered,” Lynne Pillay said.

http://www.scoop.co.nz/stories/PA0908/S00397.htm

Question to Minister: ACC sensitive claims and sexual abuse victims

LYNNE PILLAY (Labour) to the Minister for ACC: Has ACC abandoned all changes relevant to sexual abuse victims since question time yesterday?
Hon Dr NICK SMITH (Minister for ACC) : No. The Accident Compensation Corporation (ACC) is consulting providers on the clinical guidelines for sensitive claims. No final decisions have yet been made. I assure the member that the needs of sexual abuse survivors will be paramount. Decisions on the clinical guidelines will be made by clinicians, not by politicians.
Lynne Pillay: Given the Minister’s assurance in the Chamber yesterday that the proposals were in the best interests of victims, followed by ACC’s back-down a few hours later because the proposals would not work, can the Minister guarantee victims of sexual abuse that they will not be subjected to more cost-cutting strategies at their expense?
Hon Dr NICK SMITH: I can assure the member opposite that in dealing with sensitive claims what is paramount, in respect of ACC’s policy, is ensuring the very best quality of service.
Sue Moroney: Can the Minister provide any evidence of representations or submissions made by the Minister of Women’s Affairs to the Minister for ACC on behalf of victims of sexual abuse?
Hon Dr NICK SMITH: No, and I will tell the member why. We on this side of the House believe that clinical decisions should be made by clinicians, not by politicians. I am disappointed that members opposite think we want ACC’s clinical decisions to be made on a political whim.
Michael Woodhouse: What was the origin of the new clinical guidelines, and when did the process being?
Hon Dr NICK SMITH: I am surprised that Labour members are today criticising the clinical guidelines. In June 2008 the official launch of the guidelines was praised by none other than the Hon Steve Maharey. The origins of the guidelines go back to 2004, when concerns were raised about the effectiveness of sexual abuse counselling. That resulted in an $800,000 comprehensive research programme, which led to new guidelines being produced last year. Those guidelines are now being consulted on for implementation.
I seek leave to table a photo of the Hon Steve Maharey at the launch of the clinical guidelines, where he said what an important step forward—
Mr SPEAKER: Leave is sought to table that document. Is there any objection? There is objection.
http://www.parliament.nz/en-NZ/PB/Debates/Debates/1/4/0/49HansD_20090826_00000001-Questions-for-Oral-Answer-Questions-to-Ministers.htm

Question to Minister: ACC sensitive claims and sexual abuse victims

Hon DAVID PARKER (Labour) to the Minister for ACC: How will the proposed changes to the treatment of sensitive claims meet the legal requirements of the ACC scheme to provide “for a fair and sustainable scheme for managing personal injury that has, as its overriding goals, minimising both the overall incidence of injury in the community, and the impact of injury on the community”?
Hon PANSY WONG (Acting Minister for ACC) : The proposed changes of the Accident Compensation Corporation (ACC) to the treatment guidelines for mental injury resulting from sexual abuse are based on a comprehensive 5-year programme of clinical research commissioned by the corporation. The Massey University school of psychology undertook this research with a team comprising 23 researchers and an advisory committee of 13 people. A multi-method approach was taken, utilising quantitative and qualitative analysis, literature reviews, questionnaires, and focus groups. The research team included specialists in survivor advocacy, psychology, counselling, education, migrant resettlement, indigenous issues, and the mental health of children and older people.
Hon David Parker: Will the Minister release the medical and scientific evidence that the Minister has relied upon to conclude that the current clinical pathway for the treatment of victims of childhood sexual abuse is not satisfactory, and why were the professional bodies of the current treatment providers excluded from meaningful consultation?
Hon PANSY WONG: I am very pleased to table the report by Massey University commissioned by the corporation, Sexual Abuse and Mental Injury: Practice Guidelines for Aotearoa New Zealand. It was somehow totally forgotten and neglected by the previous Labour Government.
Sue Bradford: How does the Minister reconcile the proposal to impose an arbitrary cap on accident compensation funding for counselling for victims of sexual abuse with the statement by the Prime Minister in a recent speech to the Sensible Sentencing Trust that “where New Zealanders do become victims of crime, National will give them the support and respect they deserve.”?
Hon PANSY WONG: Indeed, this is a new guideline. It has been proposed because it is not fair or right for victims to have one-size-fits-all treatment, so this proposed treatment takes into account tailored treatment for survivors whether they are women, men, children, adolescents, Māori, Pasifika, or ethnic.
Lynne Pillay: Can the Minister reassure childhood sexual abuse victims that the proposed accident compensation cuts will not detrimentally impact their quality of life; if so, how?
Hon PANSY WONG: Indeed, all those have been taken into account because this Government is committed to improving the life of survivors and—
Hon Members: Rubbish!
Hon PANSY WONG: This is a very serious issue. The Opposition might feel agitated and not want to know the real reasons, but others might. According to this study, victims’ traumatic ordeals should be seen as a complex life experience and not as a disorder or life sentence. That is why the best-practice treatment is being implemented.
Sue Bradford: Why is the Government requiring victims of sexual abuse to see at least three different health professionals, and does the Minister think it is easy for victims to go over their traumatic experiences, over and over again, with strangers?
Hon PANSY WONG: Indeed, the clinical research conducted by Massey University is not asking victims to relive their traumatic ordeals. This is tailor-made clinical treatment that takes into account each survivor’s personal circumstances.
Lynne Pillay: Given that the Prime Minister promised substantial increases in funds for victims of crime to the Sensible Sentencing Trust at its conference and that there have been cuts to prevention education from $170,000 to $27,000, does the Minister believe that childhood sexual abuse survivors are no longer considered victims of crime?
Hon PANSY WONG: I hope that the member listened to my previous answer, because I am forced to repeat it. Survivors of childhood sexual abuse will receive appropriate treatment based on their personal circumstances. This best-practice guideline will make sure that not all survivors are treated exactly the same.
Lynne Pillay: I seek leave to table a letter to Nick Smith from the New Zealand Association of Psychotherapists explaining the shock wave of disbelief at the proposed changes to accident compensation funding.
Mr SPEAKER: Leave is sought to table that document. Is there any objection? There is no objection.
http://www.parliament.nz/en-NZ/PB/Debates/Debates/c/a/a/49HansD_20090825_00000047-Questions-for-Oral-Answer-Questions-to-Ministers.htm

Open Letter to Nick Smith, Minister for ACC

A letter from the New Zealand Association of Psychotherapists

ACC Changes in Funding of Sexual Abuse Counselling

24 August 2009

Dear Minister, we speak for the members of the New Zealand Association of Psychotherapists as well as for other counsellors and therapists who have lent their support to presenting this document to you.
Over the last two weeks ACC has presented providers of sexual abuse counselling and psychotherapy services with imminent changes in delivery of sexual abuse counselling effective from 14 September 2009. These changes have been made without consultation with relevant professional bodies. Even groups that have been in dialogue with ACC about improving services (TOAH NNEST: Te Ohaakii a Hine-National Network Ending Sexual Violence Together, and SCAG: Sensitive Claims Advisory Group) have not been consulted.
The planned changes have sent shockwaves of disbelief through the counselling/therapeutic and survivor communities. The Minister for ACC will have been aware of these changes. We would like the opportunity to present a different point of view and have some vital questions answered.

Legacies Of Childhood Sexual Abuse (CSA)
Sexual abuse takes many forms, it can be a single episode involving someone who is ordinarily healthy and well functioning; it can be multiple episodes in the context of physical violence; it can take place in childhood over long periods and in single episodes. Our concern, in addressing the proposed ACC changes, is mainly with those who suffer most deeply from the experience of abuse, most especially those who have suffered abuse as children or from continued abuse as adults. This is not to minimise the effects of frequently highly traumatic events occurring to adults.
The sexual abuse of children causes the arrest or disruption of the development of the self leading to complex clinical presentation of impaired performance of ‘self-functions’ such as cognition, autonomy, selfresponsibility, emotional regulation, distress tolerance, identity, and social functioning (1) (2) (3) (4). For this reason the onset of abuse is significant (earlier onset leads to more severe problems) whereas people who are abused later in life show less severe problems. Survivors receiving counselling or therapy early in childhood show little or no disturbance later on. When CSA goes untreated survivors problems accumulate over the years leading to impairments in self-regulation, social functioning, occupational functioning, cognitive disturbances due to abuse-based beliefs, and shattering of internal psychological functioning. The cost of sexual abuse to the individual and to New Zealand society was estimated in 2001 to be $2,465m annually (5) and is probably higher for 2009.

ACC’s Responsibility For Victims Of Sexual Abuse
Independent of the question as to whether ACC is the best agency to provide services for survivors of sexual abuse, current regulation (IPRC 2001) demands that ACC “is to enhance the public good and reinforce the social contract represented by the first accident compensation scheme by providing for a fair and sustainable scheme for managing personal injury that has, as its overriding goals, minimising both the overall incidence of injury in the community, and the impact of injury on the community (including economic, social, and personal costs)”

Comment: Under the proposed changes ACC will not meet required responsibilities set out in the act! According to ACC 's injury statistics counselling/medical fees are about $2m for 2008 (6). The costs of financial entitlements such as Independence Allowance and Weekly Compensation raise the total claimantrelated costs to $19m. Costs for running the Sensitive Claims Unit alone are about $30m. It is clear that the costs of adMinistering the organisation exceed by far the services it is supposed to fund.

Question For The Minister: How does the Minister justify the expenditure of a system where the administration of services is 1 ½ times the cost of the service it administers; and where is the Minister’s commitment to improve funding for services and prune the top-heavy administration?

Comment: To make huge changes in the recovery pathways of mainly female victims of sexual abuse by relying only on one study which was funded by ACC is highly questionable. A study burdened with such funding bias can hardly be deemed trustworthy (7).

Comment: Studies conducted by world experts (1) (8) (2) (9) (10) (3) (11) as well as New Zealand research (12) have delivered evidence that the therapy relationship is the main factor behind positive outcomes. The provision and/or restoration of social support is a major buffer against the destructive force of stress and trauma. Social support and closeness with others helps survivors with the integration of difficult experiences and are vital for survivors’ recovery (3) (12) (13). “Emotional attachment is probably the primary protection against feelings of helplessness and meaninglessness; it is essential for biological survival in children, and without it, existential meaning is unthinkable in adults”(11).
Within the therapeutic relationship survivors’ recovery involves the (re)establishment of trust, development of self-confidence, development of social connections, meaning, hope, and self-agency. This will and always has taken time (2). These qualities can not be gained through a drug, a book, or in short term work of a few months. Recovery from sexual abuse can not be compared to a broken leg which heals by itself in 6 weeks. Recovery from sexual abuse takes place through caring and supportive interactions with others (2) (14) (12). However, these studies seem not to have been considered or given adequate weight.

Question For The Minister: How is the Minister going to convince the public and survivors of sexual abuse that he has considered a broad range of paradigms before he sanctions budget cuts that will impact detrimentally on CSA victims’ quality of life?

Much of the research that leads to a preference for short term intervention focuses on isolated symptoms i.e. depression without looking at underlying causes. This may work in controlled situations where study participants are carefully selected to meet well-defined inclusion and exclusion criteria; it is certainly not working for many survivors of CSA. That this paradigm is not working for survivors of CSA is shown in the public mental health system (32)(12). Between 50-80% of patients in psychiatric care have a history of sexual abuse that is not acknowledged and not considered in their treatment (15) (16) (17)(33). Public mental health treats symptoms e.g. depression with drugs and short term therapeutic input (if at all), a route ACC is now proposing. The ballooning costs for mental health show that this approach is not very effective. Instead patients are sentenced to a life of misery and poor social and occupational functioning. (12)

Comment: Up to this point ACC has failed to explain on what grounds the decision has been made to propose and then hurriedly push through a change in clinical pathway especially as ACC has not collected any outcome data regarding the quality of currently provided counselling services. (18)

Question For The Minister: What is the Minister’s basis for the assumptions that the current clinical pathway is not satisfactory?

Survivors of sexual abuse are marginalised in the following ways according to the statutes of the act:

1. establishing as a primary function of the Corporation the promotion of measures to reduce the incidence and severity of personal injury:

Comment: ACC has cut the funding for prevention education from $170,000 2006/2007 to $27,000 estimated for 2008/2009 (19).

Question For The Minister: How does the Minister explain these cuts given John Key’s speech (15) in April 2008 at the Sensible Sentencing Trust Victims Conference where he promised substantial increase of funds for victims of crimes? Are CSA survivors no longer considered victims of crime? How is the Minister going to justify the continuous victimisation of CSA survivors?

Comment: The new scheme requires vulnerable clients to visit three different therapists in the first five sessions. Research has shown that attending assessments and telling one’s sensitive and painful life story to a stranger is retraumatising (12).

Question For the Minister: How will the Minister guarantee that the process will not increase the severity of personal injury?

2. Providing for a framework for the collection, co-ordination, and analysis of injury-related information:

Comment: The client is required to reveal sensitive personal data to three different professionals in the first five sessions. Not only has research shown this to be re-traumatising (12), it also violates clients’ rights to privacy (Right 1 + 7 ACC Code of Claimants Rights) and the IPRC 2001 Act. Being granted a maximum of 16 hours (of which four will be for discussing progress reports) will effectively end the hope of recovery from CSA for many and will mean great struggle for survivors. This violates the IPRC 2001 Act that requires that the primary focus of ACC should be on rehabilitation to restore health, independence, and participation.
The assessor/provider split has been favoured by many managed care agencies overseas because it alleviates bureaucrats’ fear of assessment bias (therapists could over-diagnose to feather their own nest). Besides being insulting and causing significant interference with the therapeutic process (12) (20) (21) (22), assessor/provider split is not practical because the therapist responsible and liable for the outcome of treatment will need to make their own assessment and plan the treatment to work effectively.

Question For The Minister: How does the Minister envisage the clients being kept safe? Who should, according to the Minister, be liable and responsible for potential self-harm, suicide or psychiatric emergency, or any other form of harm that could befall the client?

3. ensuring that, where injuries occur, the Corporation's primary focus should be on rehabilitation with the goal of achieving an appropriate quality of life through the provision of entitlements that restores to the maximum practicable extent a claimant's health, independence, and participation:

Comment: Childhood sexual abuse (CSA) causes the arrest of self-development and interrupts healthy selffunctions leading to common symptoms such as mood disorders, anxiety disorders, or dissociative disorders (1). Ethical and professional practice has to address the cause of the symptoms to assure lasting improvement. A treatment protocol based on symptom reduction will not be able to rehabilitate clients with self-disturbances (1) (12) (3). Cancer is not treated with paracetamol, although it may help with the headaches.
Trauma specialists have conclusively demonstrated that persons abused in their childhood suffer complicated problems that often require long-term treatment (1) (19) (7) (3). About 90% of counselling for sexual abuse in New Zealand has been provided by counsellors and psychotherapists (18) in the last 20 years. They unanimously agree that it will be impossible for most survivors of CSA to complete their rehabilitation within 20 hours. They have delivered good and cheap services which in 2004/05 did not even come near $1m. (12) That deserves respect and not the patronizing restrictions imposed by ACC.

Question For The Minister: How does the Minister justify the marginalisation of two respectable professions who have done 90% of the CSA work in the last 20 years by refusing them their due recognition? How does the Minister justify that counsellors and psychotherapists are regulated by psychologists and psychiatrists, two professions who don’t even have sexual abuse training in their compulsory training curriculum and whose practical experience is limited to only 10% of the total ACC work? Furthermore, how will the Minister justify survivors of sexual abuse not being given the opportunity for recovery and thereby passing on the detrimental effects of trauma to their children?

4. ensuring positive claimant interactions with the Corporation through the development and operation of a Code of ACC Claimants' Rights:

Comment: According to the IPRC, Section 27, a mental injury means a clinically significant behavioural, cognitive, or psychological dysfunction. This is interpreted by ACC as “Mental injuries (as defined in Section 27 of the IPRC Act) must meet the criteria outlined in “The Diagnostic and Statistical Manual (DSM-IV™) of the American Psychiatric Association" in order to be eligible for ACC cover”.

Question For The Minister: Who authorised ACC to convert a clinically significant dysfunction into a DSM-IV diagnosis?

This effectively excludes survivors from accessing ACC funding for counselling who may have significant impairment in daily functioning yet not qualify for a DSM-IV diagnosis. Those who do fit DSM criteria will be disadvantaged and could be re-traumatised by seeing numerous health workers, being offered limited time with a counsellor, and then being referred on to public mental health services who even now don’t have the capacity to address CSA.
Receiving a diagnosis of mental illness is also problematic because it effectively shifts the responsibility for abuse away from the perpetrator (a crime was perpetrated causing a context specific response) towards the victim (she needs to see a shrink, she is crazy) (2). Failing to place psychiatric disturbances in the context of abuse is discounting the violation and injustice survivors have experienced (2) (20). Both the discounting and the pathologising of their trauma symptoms by attaching the label of mental illness is a withholding of survivors’ rights to have the injustice of the abuse recognised and to receive treatment that leads to recovery (12) (23).

Question For The Minister: How does the Minister justify that victims of sexual abuse are discriminated by being labelled mentally ill?

5. ensuring that persons who suffered personal injuries before the commencement of this Act continue to receive entitlements where appropriate.”

Comment: After 16 hours of therapy/counselling the client will be referred to public mental health service who don’t provide counselling, or to a psychologist for a maximum of 10 hours focused work. The new changes do not guarantee that clients will receive their due entitlements for recovery. Clients do not primarily seek financial compensation, they seek to be able to live a life worth living. The new scheme does not provide that opportunity.

Question For The Minister: How does the Minister plan to respond to victims of CSA who struggle to make ends meet financially, mentally, and emotionally knowing that he has sanctioned the cut of services of mainly female victims of crime while other sectors receive additional funding?

Conclusion
Counselling and psychotherapy have a long history of practice embedded in ethical values that include commitment to the physical and emotional well being of clients, their right to confidentiality, privacy, selfdetermination, and a secure therapeutic working relationship (NZAP, 1986). As Saakvitne and Abrahamson stated “The goal of psychotherapy is to understand the complex meaning of psychological and interpersonal events, largely through the creation of meaning in the therapeutic relationship” (24). In working with those suffering mental injury from sexual abuse, psychotherapists work towards repairing the internal sense of self and functioning that has been shattered by abusive experiences.
Research has repeatedly confirmed that 40% of positive outcome in therapy is due to client factors, 30% is due to the relationship between client and therapist, 15% is ascribed to the placebo effect, and only 15% of outcome is due to therapeutic modalities, and training (25) (26). It is nonsensical to construct a complete new approach to dealing with CSA around a questionable benefit of 15% given that meta-studies have proven that all therapeutic approaches are equally effective as long as therapist and client can establish a working therapeutic relationship.
Improvement would not come about by restricting hours that are clinically justified but by enabling a collaborative working environment in which the different services recognise each others qualities and support each other in the fight against sexual abuse and child abuse. It needs to be kept in mind that counselling is not the big expense in the ACC Sensitive Claims Unit. Instead, the surveillance mechanisms put in place give very much the impression of paranoia that led to millions being spent to save $500,000. This does not make good business sense and would probably be impossible in the private corporate world.
Rather than setting up a complicated system of separate people doing assessment, treatment, and review of treatment those counsellors who do not already use assessment and diagnostic tools could be encouraged and taught to do so. Many psychotherapists who currently provide services to Sensitive Claims Unit are practiced in assessment and treatment planning.
Our concern is for the well-being of those who have been victims of abuse, as children and as adults. Counsellors and psychotherapists may feel some financial effect with the new regulations, but they will be able to compensate for any income losses they may suffer. The tragedy is that clients do not have that luxury. Unless they can afford to pay privately for their counselling, they will be marginalised being bereft of recovery from sexual abuse and the attainment of quality of life, something the Minister and many others who will read this paper take for granted.
It is not enough for the society to be horrified at the number of children who get abused and killed in this country. Society needs to set aside funds to help victims of sexual abuse to rehabilitate so they can provide for their children and grandchildren and break the hideous cycle of abuse.
We, the undersigned, request on behalf of the organisation we represent that the Minister halts the implementation of the proposed changes and meets with CSA survivors and with the representatives of those who have worked at the coal face of sexual abuse recovery to hear our views, to increase his understanding of the complexity of the problem, and to support policies that reflect the social responsibilities the government has towards victims of childhood sexual abuse.

Eileen Birch (President NZAP)
Susan Hawthorne (NZAP SCAG representative)
Dr Gudrun Frerichs
Miriam van Dingenen
Sean Manning
Ondra Williams
Lesley King
Suzanne Johnson (Chair of Public Issues NZAP Council)

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12. Frerichs, G. Balancing Recognition and Disrespect: Recovery as a Process of Identity Formation: A New Zealand Study How Services Shape Recovery From Sexual Abuse. Auckland : AUT, 2008.
13. Social Support and Coping Strategies as Mediators of Adult Adjustment Following Childhood Maltreatment. Runtz, M. G., & Schallow, J. R. 2, s.l. : Child Abuse and Neglect, 1997, Vol. 21.
14. The psychotherapeutic needs of women who have been sexually assaulted. Draucker, C. B. 1, s.l. : Perspect Psychiatr Care,, 1999, Vol. 35. 18-28.
15. Child Abuse and Severity of Disturbance Among Adult Psychiatric Inpatients. Read, J. 5, s.l. : Child Abuse and Neglect, 1998, Vol. 22.
16. Staff responses to Abuse Histories of Psychiatric Inpatients. Read, J., & Fraser, A. 2, s.l. : Australian and New Zealand Journal of Psychiatry, 1998, Vol. 32.
17. Trauma History Screening in a Community mental health Center. Cusack, K. J., Frueh, B. C., & Brady, K. T. 2, s.l. : Psychiatric Services, 2004, Vol. 55. 157-162.
18. Sexual abuse counselling: Treatment rates provided by psychiatrists, psychologists and counsellors under ACC funding. Goodyear-Smith, F., Lobb, B., & Mansell, J. 6, s.l. : NZFP, 2005, Vol. 32. 389-93.
19. Access support services . Access support services . [Online] July 2009. http://www.accesssupport.co.nz/issues.html.
20. Provision of psychotherapy under managed health care: A growing crisis and national nightmare. Karon, B. P. 1, s.l. : Professional Psychology: Research and Practice, 1995, Vol. 26. 5-9.
21. Contemporary ethical dilemmas in psychotherapy: Cosmetic psychopharmacology and managed care. Sperry, L. 1, s.l. : American Journal of Psychotherapy, 1999, Vol. 52. 7
22. The Traumatic Bond Between the Psychotherapist and Managed Care. Weisgerber, K. Northvale, NJ : Jason Aronson Inc, 1999.
23. Sidanius, J., & Pratto, F. Social Dominance: An Intergroup Theory of Social Hierarchy and Oppression. Cambridge : University Press, 1999.
24. The impact of managed care on the therapeutic relationship. Saakvitne, K. W., & Abrahamson, D. J. s.l. : Psychoanalysis and Psychotherapy, 1994, Vol. 11.
25. Lambert, M. J. Psychotherapy outcome research: Implications for integrative and eclectic therapists. [book auth.] J. C. Norcross & M. R. Goldfried (Eds.). Handbook of psychotherapy integration. NY : Basic Books, 1992.
26. Toward an outcome-informed therapeutic practice. Miller, S., Duncan, B., Johnson, L., & Hubble, M. A. J. 2, s.l. : Psychotherapy in Australia, 2000, Vol. 6. 30-36.
27. Schore, A. Affect Dysregulation & Disorders of the Self. NY : Norton, 2003.
28. Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma. Kolk, v. d. B. A., Pelcovitz, D., Roth, S., Mandel, F. S., McFarlane, A., & Herman, J. L. 7, s.l. : Am J Psychiatry, 1996, Vol. 153. 83-93.
29. Crampton, D. ACC case manager and assessor collude prior to assessment to save money. http://www.scoop.co.nz/ archive/scoop/stories/df/75/200302180838.a99a52e3.html. Wellington : Scoop, 2003.
30. The History of Child Abuse. DeMause, L. 3, s.l. : Journal of Psychohistory, 1998, Vol. 25.
31. Form of Social Support That Moderate PTSD in Childhood Sexual Abuse Survivors. Hyman, S. M., Gold, S. N., & Cott, M. A. 5, s.l. : Journal of Family Violence, 2003, Vol. 18. 295-300.
32. On being invisible in the mental health system. Jennings, A. 4, s.l. : J Ment Health Adm, 1994, Vol. 21. 374-87.
33. Asking About Abuse During Mental Health Assessments: Clients' Views and Experiences. Lothian, J., & Read, J. 2, s.l. : New Zealand Journal of Psychology, 2002, Vol. 31. 98-103.
34. The long-term impact of the physical, emotional, and sexual abuse of children: a community study. Mullen, P. E., Martin, J. L., & Anderson, J. C. 1, s.l. : Child Abuse and Neglect, 1996, Vol. 20. 7-21.
35. Childhood Trauma, the neurobiology of adaptation and use-dependent development of the brain. How states become traits. Perry, Pollard, Blakely, Baker, & Vigilante. 271-291, s.l. : Infant Mental Health Journal, 1995, Vol. 16.
36. Siegel, D. J. The Developing Mind: How relationships and the brain interact to shape who we are. NY : Guilford, 1999.
37. The Great Psychotherapy Debate: Models, Methods, and Findings. Wampold, B. E. NJ : Erlbaum, 2001.
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http://www.ncwnz.org.nz/assets/Action/Letter-To-The-Minister-Of-ACC.pdf

Nicholas: ACC Sensitive Claims Unit Insensitive To Survivors

An article from Voxy

Louise Nicholas, Survivor Advocate for Rape Prevention Education, is absolutely disgusted with ACC Sensitive Claim Unit's (SCU) proposed changes that will make it harder for survivors of rape and sexual abuse to access therapy.
Currently survivors have 4 sessions with a counsellor to disclose their abuse experiences before their claim is assessed for ongoing therapy. Often survivors will choose to have ongoing therapy with the counsellor that they have already built a relationship with.
The new Clinical Pathway which is proposed to come into effect 14th September 2009, will make the survivor tell their "story" three times to three different professionals and they can be declined help at any stage in this process; they have to 'prove' they have a mental injury which fits the criteria for a psychiatric problem.
A person who has been affected by rape or sexual abuse can take many years to disclose their trauma.
Finding someone who they can trust to disclose to is often a major issue as there are many barriers that need to be dealt with before they even get to the stage of being able to talk about the actual abuse incident.
Many survivors, especially children, are threatened by the perpetrator with loss of their lives or whanau and friends lives if they tell, or "no-one will believe you if you tell, you will be called a liar".
The importance of being able to heal and move on with your life often literally lies in the hands of the counsellor that you have come to trust.
I am shocked to see that ACC state that "shorter term therapy is more beneficial for clients than longer term therapy".
Many survivors, including myself, speak about the difficulty in being able to open up and talk about their experiences which needs to be at their own pace and with someone they trust which is vital in their healing process.
The ACC Draft Clinical Pathways Provider Workshop that I attended in Auckland this month, was not about seeking "better services" for survivors; in my opinion it was obviously about cutting costs.
I viewed it as taking vital resources away from counsellors and specialist service providers and putting them into the costs of assessments by clinical psychologists.
In 2004/2005 I had to give up my full time employment due to the stress of the Police investigation into the rapes I endured by members of the NZ Police. I wanted to return to ACC subsidised counselling and seek an increase to my Independence Allowance (of $7.00 per week) from ACC. To have this happen I was offered a return flight to Auckland and a couple of hours with a psychologist who would determine whether or not I had a mental injury. ACC were prepared to pay $3,000.00 for this assessment. I had to decline the assessment as the ACC reviewing psychologist would be required to use the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) to diagnose a mental injury. Once I was labelled with a DSMIV (psychiatric) diagnosis defence counsel could use this diagnosis against me in court.
Rape and sexual abuse is a crime that is committed upon a person by another person deliberately causing harm. It is not like a self inflicted recreational or sporting injury.
The effect of this new Clinical Pathway is likely to be detrimental to not only survivors of rape and sexual abuse but also to agencies, mental health services and other specialist service providers who will have to take on many more survivors who are likely to be declined for subsidised counselling through ACC.
These agencies are also likely to be weighed down by the extra workloads that will inevitably see even more specialist services crumble under the weight of inadequate funding and resources.
I ask that ACC not proceed with the new Clinical Pathways on the 14th September and that ACC truly consult with the counsellors who work on a day to day basis with survivors of sexual violence - not those ACC paid professionals who are removed from the day to day realities that survivors face when trying to access the services they need to keep themselves alive and functioning in the world.
If any survivors would like to contact me about this issue my email address is louise@rapecrisis.org.nz
I am about to begin a tour of the country in the next few months visiting most of the agencies (depending on how far my travel budget can stretch) that work to support survivors of sexual violence. I would like to hear from survivors and those who work with them about the supports you need in your area. I look forward to hearing from agencies and survivors that would like me to visit them.

http://www.voxy.co.nz/national/nicholas-acc-sensitive-claims-unit-insensitive-survivors/5/21767

ACC focuses on recovery for victims of abuse

Press release from ACC

ACC has been talking to sexual abuse counsellors, psychotherapists, psychiatrists and psychologists about how it can achieve better outcomes for people who have a significant mental injury as a result of sexual abuse or a sexual assault.
“We’ve been concerned for some time about whether we have been getting the best outcomes for this very vulnerable group,” said Dr Kevin Morris, ACC’s Director of Clinical Services. “In the past, we haven’t had the benefit of a clear-evidence-based framework that shows the most effective way to treat and rehabilitate people who have suffered from sexual abuse. So four years ago we started working with psychologists, psychotherapists and other experts in this area to create a set of comprehensive guidelines that focus on treating individuals appropriately to work towards rehabilitation.
“We will be following the recommendations made in the Massey Guidelines for the Assessment and Treatment of Mental Injury as a result of Sexual Assault or Sexual Abuse. These guidelines were developed in New Zealand, for New Zealanders and focus on the best ways to get people back to their everyday lives after they have suffered sexual abuse.”
The Massey Guidelines were published in 2008 and suggest that relative, shorter-term therapy is more beneficial for many clients than long term therapy. The guidelines also state that sexual abuse should be viewed as a ‘complex life experience’ not a disorder or a life sentence.
To align itself with these guidelines ACC is proposing changing the way it works with its sensitive claims clients by introducing a standard procedure which focuses on early diagnosis of the presence of a mental injury to enable earlier decisions on claims and therapy to be made. The number of counselling sessions and progress being made will also be more closely monitored, with a focus on a positive return to everyday life for the client as the main goal.
“ACC’s role in supporting people who have suffered a significant mental injury as a result of sexual abuse is to rehabilitate the mental injury. We want to give the best, most appropriate evidence based service for each individual, as individual needs can obviously differ,” said Dr Morris. “We are looking at other options for rehabilitation as well”.
“We’ve just run eight workshops across the country with providers in the field and have already modified our proposal to reflect their feedback. Our main focus is to put the future of people who have suffered sexual abuse first here and we are using some strong research to support the changes we propose.”

http://www.scoop.co.nz/stories/PO0908/S00244.htm

ACC targets sexual abuse counseling amidst concerns about safety of new clinical framework

Press release from the New Zealand Association of Counsellors, the New Zealand Association of Psychotherapists and the Aotearoa New Zealand Association of Social Workers

Specialists in the provision of counselling and psychotherapy for sexual abuse are joining together to challenge ACC’s drive to push down operating costs at the expense of the current options available to their clients.
Treatment providers throughout New Zealand – including approximately 750 counsellors – have been informed by ACC that a push is being made to find areas of “innovation” within the treatment of sensitive claims clients – primarily by creating an assessor/provider ‘split’ more commonly found in the insurance business. ACC has also stated that a new approach is being taken to “streamline the service to ensure we will return to acceptable operating parameters in the near future”.
“The Sensitive Claims Unit of ACC has declared that it is changing the way it works in response to difficult times, but it seems to have overlooked the fact that the clients involved in receiving our services are some of the most traumatised members of society,” says Susan Hawthorne of the NZ Association of Psychotherapists.
Under a new Clinical Framework about to be implemented for ACC’s Sensitive Claims Unit an acceptance that a client’s circumstances will affect the duration, intensity and type of counselling needed is limited to “exceptional circumstances”. Counsellors who have been informed about the Framework are critical of plans to devote more resources to the role of clinical psychologists in the overall process and have other concerns such as the lack of reference to cultural competency, an emphasis on artificially curtailing the number of counselling sessions and assumptions that psychologists alone can provide the specialist knowledge required to work successfully in this field.
“Putting in place a top-down treatment approach to manage a growing volume of need downwards will, we believe, put the wellbeing of clients in jeopardy. It ignores the scale of sexual abuse and the injuries caused to affected people and our ethical response to that,”says Susan Hawthorne.
Sean Manning, President-elect of the NZ Association of Psychotherapists, adds that “ACC is in the business of addressing the effects of trauma, but the proposed process where a victim of sexual abuse will have to tell their story to three people before getting help, will actually be damaging. If you want to put people off asking for help, this is a good way to do it. It is a shocking way to deliver a supposedly rehabilitative service.”
“Other than an implied criticism that there are clients who are receiving ‘too much’ counselling we have yet to hear clearly from ACC what it is they believe isn’t working under the current system. Instead we’re seeing a set of changes hurriedly imposed that we predict will impact negatively on clients who are already distressed by experiencing difficulties with getting cover, unreasonable delays and the impacts this has on safe practice,” says Adrienne Dale of the NZ Association of Counsellors.
“Private practitioners who belong to the Aotearoa New Zealand Association of Social Workers will always put our clients’ needs first. We are concerned that ACC appears to have undertaken an ill thought out re-gearing of the system towards pathways that dumb down our specialist skills without any real consultation, and that claim to be ‘best practice’ when that may not be the case. The risk is that ACC will end up by turning therapy into a factory line that assumes that everyone will recover from sexual abuse in a predetermined way,” says Cathy McPherson, convenor of ANZASW’s Private Practitioners Interest Group.
The counselling community have also expressed concern that any dollar gains envisaged by ACC from its stated goal of streamlining the current system are minimal, whereas the pain of changes to the system for sexual abuse clients could be huge.
According to information published by ACC’s Senstive Claims Unit as many as 5,000 clients access counselling every month, and on average the Unit receives about 550 new claims related to mental injury caused by sexual abuse, including trauma caused by incest, each month.

http://www.scoop.co.nz/stories/PO0908/S00246.htm

Questions for written answer

12451 (2009). Hon David Parker to the Minister for ACC: How many sensitive claims did ACC approve for each month in 2008?
Hon Dr Nick Smith (Minister for ACC) replied: Accepted Sensitive Claims Jan-08 198 Feb-08 234 Mar-08 212 Apr-08 298 May-08 232 Jun-08 340 Jul-08 337 Aug-08 255 Sep-08 262 Oct-08 293 Nov-08 307 Dec-08 297
http://www.parliament.nz/en-NZ/PB/Business/QWA/1/9/2/QWA_12451_2009-12451-2009-Hon-David-Parker-to-the-Minister-for-ACC.htm

12452 (2009). Hon David Parker to the Minister for ACC: How many sensitive claims did ACC approve for each month for the year so far in 2009?
Hon Dr Nick Smith (Minister for ACC) replied: Accepted Sensitive Claims Jan-09 274 Feb-09 198 Mar-09 277 Apr-09 236 May-09 187 Jun-09 213 Jul-09 205
http://www.parliament.nz/en-NZ/PB/Business/QWA/9/c/6/QWA_12452_2009-12452-2009-Hon-David-Parker-to-the-Minister-for-ACC.htm

ACC builds a fortress against sex abuse claims

A press release by the New Zealand Association of Counsellors, the New Zealand Association of Psychotherapists and the Aotearoa New Zealand Association of Social Workers

ACC have claimed that their new “clinical pathway” for sexual abuse claims is proving a “success”. In fact they have built a barbed wire fence, and the predators are on the wrong side of the fence.
They are succeeding in their policy of reducing the number of sexual abuse claims, not by a programme of prevention, but by putting barriers in the way of victims of sex crimes getting the treatment they need. “They demand an unrealistic skill set from assessors, which means that there are very few available in New Zealand to undertake this work. According to ACC, assessors need to be not just qualified to make a mental illness diagnosis but they must also be skilled and experienced in work with sexual abuse survivors and willing to do this work for ACC.”
ACC’s own statistics show a serious reduction in approved claims. They claim that this is because of a “more robust” policy of approval. This is just the same “tough it out” language that the latest campaign against mental health stigma is trying to stop.
This must please the rapists and paedophiles. They believe that what they do doesn’t cause any harm – the new ACC pathway is a Rapists’ Charter.
Information from counsellors and therapists in the community is showing that a high number of claims are being declined or delayed by the new system. Treatment providers are pulling away from offering services and victims of crime are being deterred by insistence on a diagnosis of mental illness.
In the 6 weeks since the new pathway was introduced at least 20 therapists have pulled away from offering ACC services. Reasons have included: unwillingness to be part of a scheme that potentially retraumatises crime victims; excessive unpaid reporting requirements; and uncertainty about being able to provide continuity of care.
Claims are being declined for a raft of spurious reasons, including:

1. No culturally appropriate pathway for Maori yet established (2 cases)
2. No culturally appropriate pathway established for Pacific clients (1)
3. No appropriate pathway established for children and adolescents (1)
4. Decline because of pre-exiting or coexisting psychological or family (“dysfunctional”) condition (6)
5. ACC deciding sex was “consensual” even when clearly coerced (victim under age at 12 years) (1)

Delays are occurring because of:

1. Shortage of appropriate clinical psychologists to assess (69) – includes geographical location (36)
2. Confusion over which therapists are “qualified” to provide assessment (5)
3. Referral to a second psychiatrist after referral from mental health services (1)
4. Ineffecient administrative processes, eg.:
   a) Losing track of clients’ information (1)
   b) Delays in responding to phone calls and emails (1)
   c) Inadequate preparation of forms, codes etc before rolling out the new CP (4)
   d) ACC staff blaming therapists or claimants for their own mistakes rather than admit a mistake has been made (1)
5. No lists of suitably qualified counsellors who are still available for clients to contact (2)

Victims of crime are finding the process too daunting to continue (7), examples of inhumane actions by ACC include:

1. Claimants being processed under new pathway even though claim was lodged before the date this applied (2)
2. Claimants having no choice of therapist now SCU decides who they will see (4)
3. Claimants’ experience of Clinical Psychologists’ appropriate treatment methods, inc.
   a. A male suggesting he come to the home of a female claimant to assess her (1)
   b. Sent exhaustive questionnaires to fill in ahead of assessment (2)
4. Claimants denied further hours because they are seen to have “had enough”, an administrative rather than a clinical decision (1)
5. No lists of suitably qualified counsellors who are still available for clients to contact (2)

In a submission to Parliament last week, representatives of the NZ Association of Psychotherapists, supported by NZAC and ANZASW urged Parliament to change the definition of Mental Injury in the ACC legislation. ACC insists that a legal judgement on the definition of Mental Injury is forcing them to require a diagnosis of mental illness. NZAP insists that it has always been Parliament’s intention that it is the impairment that constitutes the mental injury, not a diagnosis of mental illness.

http://www.scoop.co.nz/stories/PO0912/S00099.htm

ACC must go back to drawing board on sexual abuse

Press release from the New Zealand Labour Party

Opposition to ACC plans to change sexual abuse counselling practices is mounting and damaging the credibility of the agency and a two week delay is not good enough - it must revisit the plans, says Labour's Victims Rights spokesperson Lynne Pillay.
“The changes were due to be introduced next week and have now been deferred again – this time by two weeks. But what is needed is a complete rethink.
“Sexual abuse counsellors around the country are outraged and significant numbers of them have signalled they will stop doing ACC-funded work because they believe the new guidelines will restrict access to counselling and re-victimise people in the process.
“They are also angry about ACC’s sham consultation process. The Sensitive Claims Advisory Group was not consulted and ACC has only just agreed to a proper meeting with the group – but only after the release of the new guidelines, which adds to the farce,”Lynne Pilllay says.
“ACC says the door is open, but minds are clearly closed!”
“ACC is already facing questions about how it has allowed significant delays in processing sexual abuse claims to occur and has also been criticised by the Privacy Commissioner and Rape Crisis over the invasive forms it requires claimants to sign.
“The agency’s credibility has taken a hammering and the ACC Minister should intervene and demand a rethink.
“Up to 700 sexual abuse claims are lodged a month and the public won’t tolerate such shoddy treatment from a Government that claims to stand up for victims of crime,” says Lynne Pillay.

http://www.scoop.co.nz/stories/PA0910/S00095.htm

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