Recent Sensitive Claims Advisory Group (SCAG) meeting

Information from the New Zealand Christian Counsellors Association

The Sensitive Claims Advisory Group (SCAG) met on the 18th and 19th October in a working session to focus on:
* Service issues, gaps and improvements for children and adolescents
* Approaches to mental injury assessment and alternatives to DSM-IV
* Feedback on the implementation of the 16 hours of support
* Support for returning clients
* Sexual abuse provider workforce development needs

Outcomes from the session included:
* Agreement on a number of principles for working with children and adolescents and subsequent recommendations for further service improvement and development.
* Formation of a working party to focus on and progress child and adolescent service improvements. The working party will included representatives from the New Zealand Association of Psychotherapists, New Zealand Association of Counsellors, Aotearoa New Zealand Association of Social Workers, New Zealand College of Clinical Psychologists and Te Ohaakii a Hine - National Network Ending Sexual Violence Together (TOAH-NNEST). The first meeting will be held on 2 December in Wellington. ACC is also investigating a range of possible representatives from the wider sector including health, education, DSAC and Maori and Pacific groups to act as a secondary consultation and advisory group.
* Generation of a range of alternative assessment methods for mental injury which are currently being reviewed by ACC.
* Establishment of a Maori working group to focus on developing culturally appropriate and safe services for Maori with the first meeting on 26 November in Wellington.
* Endorsement for ACC to work closely with the professional bodies representing service providers to establish a process for addressing quality and workforce issues.
* Identification of a preferred approach for working with Pacific people in sensitive claims and discussion regarding the formation of a working group.

http://www.nzcca.org.nz/acc/

ACC matters - cautiously optimistic!

An article from ANZASW NoticeBoard by Cathy McPherson

On May 7 I attended a hui in Wellington, requested by the Sensitive Claims Advisory Group at our last meeting in March, when ACC admitted that they need some assistance to fill in the “gaps” in service left by their new Pathways. The meeting was faciltated by Graham Bashford. While Peter Jansen was in attendance, he had no role to play in the meeting, and in fact appeared extremely subdued... SCAG members were not entirely sure what to make of this development. Approximately 60 attended the meeting.
The week before the meeting, there was an announcement by the Minister of Justice that the Minister of Social Development would be undertaking a “stocktake of Government spending on specialised sexual violence services. The terms of reference are expected to be finalised soon, and she expects to report back by the end of the year. The aim of the stocktake is to build on TOAH NNEST’s work, establish what the Government is already purchasing, what the current and long term demands for services will be, identifying opportunities for efficiency and effectiveness and considering future funding options”.
As a consequence of this announcement, we were informed the day before the meeting by ACC that “the agenda for the ACC facilitated workshop would include the time to develop a statement from the group to provide to the Minister.”

Impressions of SCU Workshop:
The workshop was attended by approximately 60 people including SCAG, representatives of Police, child and adolescent and adult mental health, representative of Commissioner for Children, Massey University and ACC including James du Plessis and David Rankin, and Denise Cosgrove, the new General Manager of Claims Management, as well as some claims managers.
ACC was actually asking and listening as to how to fill the gaps left by the new Pathways.
They made a clear statement that they recognized there were clear gaps in the system, and that ACC were committed to doing everything they could to address these “within the constraints of the legislation”. Furthermore, they stated they would record and forward the gaps highlighted by us to the review panel.
Graham Bashford went on to outline the history of the changes and the current situation of which the most salient point was a recognition of clear delays, namely that they have approved claims within three days when all the information has been present, but that the current average is 47 days. (This was challenged by SCAG as we have it well-documented that clients have been waiting for decisions from last year).
It was also acknowledged that the approval rate is very low. It appears that ACC see a clear difference between their legislative responsibility and clinical responsibility, as the phrase “within the constraints of the legislation” kept coming up.
Concern was expressed that a great number of ACC counsellors have either left the profession or have taken on new positions because of the almost zero approval rate by ACC.
ACC for the first time stated that over the years, ACC had become the default provider of counselling services for sexual abuse survivors even when mental health, difficulties prior to the sexual abuse, prior alcohol and drug issues etc were in existence. One of the suggestions at my discussion table (which included Kim McGregor, David Rankin, James Du Plessis, Commisioner for Children rep, Police rep, DSAC rep) and the suggestion was from the ACC people that funding for counselling have contributions from Health and Ministry of Social Development.
Police expressed concern about how much more difficult it is to obtain a prosecution when complainant is not adequately supported through that process and may be legally discredited due to mental health diagnosis.
It was acknowledged by those present that the present system was clinically unsafe and that the present process was not working either for ACC or for clients.

Some of the suggestions from the meeting:
Clear call for long term goal to be implemented of TOAH NNEST framework; namely a multi-ministry and cross agency response that is seamless and well funded and can respond quickly to the acute situation of disclosure.
Also a clear indication that some sort of short-term emergency response needs to be implemented immediately to stop the decline. Various ideas were tabled, including going back to four sessions for all new claims to hold clients until a decision is made by ACC re approval of claim.
Finding culturally safe ways of working within the Pathways.

ACC made the following commitments:
To document and discuss suggestions at next SCAG - I will report back on this after the June 19 meeting.
To inform both the CEO of ACC and the Minister of the outcomes and content of this meeting as a matter of urgency.
To record our concerns and suggestions unedited and as discussed.
To pass on outcomes of the meeting to the review.

At the end of the day, SCAG members came away feeling cautiously optimistic and hoping this was not just window-dressing. We were quite impressed with Denise Cosgrove but only time will tell. We certainly came away believing that our concerns have been listened to, and look forward to the departure of Graham Bashford, and hopefully Peter Jansen as well.
Also the Review Committee has just been announced for the promised six month review of the Pathways. There will be an opportunity for us all to make submissions to this Committee. I am trying to get an address to send submissions to and will publicise this as soon as I have it.

http://anzasw.org.nz/sw-in-nz/publications/

ACC changes - background information

An article from ANZASW NoticeBoard by Cathy McPherson

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.

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.

Copyright © 2010 Aotearoa New Zealand Association of Social Workers
http://anzasw.org.nz/user/file/428/NB%20December%20Final.pdf

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

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