Influx expected with funding for ACC sexual abuse service set to double

An article from NZ Doctor by Ruth Brown

ACC is braced for an influx of new sex abuse claimants following the launch of its more generous service for sensitive claims. The budget for this financial year is $14.6 million, to cover support assessment and treatment. This is set to almost double to $29.5 million for the 2015/16 year. In the 2013/14 year ACC spent $12.5 million on sensitive claims.
A year-on-year 10 per cent increase is conservatively estimated, says Emma Powell, strategy manager, sexual violence at ACC. Since the service began rolling out last November, an extra 1000 claims have been lodged for the service which, at any one time, is dealing with 5500–6000 claims. The main difference is the service is now fully funded so clients won’t be asked to make a copayment which previously was sometimes as high as $90 for counselling sessions, Ms Powell told New Zealand Doctor.
The Integrated Services for Sensitive Claims (ISSC) was officially launched in Wellington last night.

‘Less daunting’ assessment
Ms Powell says the assessment process for claimants has changed significantly after feedback from clients that it was “pretty daunting”. Instead of assessments being conducted by an independent party over one or two sessions, ACC now offers supported assessments which have been allocated up to 26 hours. This is allocated for support sessions interwoven with assessment sessions and a de-brief with the claimant at the end. Also, counsellors who may have conducted the original sessions are likely to be involved with the supported assessments, she says.

Not enough counsellors
Ms Powell acknowledges a lack of trained counsellors in some parts of the country.
In a previous New Zealand Doctor story, Wellington GP and deputy chair of Doctors for Sexual Abuse Care GP Cathy Stephenson said sexual abuse survivors were still facing barriers because of too few counsellors.
Ms Powell says areas such as South Canterbury, the West Coast and remote rural areas were most affected by a lack of counsellors specialising in sexual abuse. But ACC will pay for providers to travel to these areas.
“We will be working through some of those gaps fairly smartly,” she says.
ACC currently has 175 suppliers with 770 providers on its books and it’s currently assessing and processing another 110 potential providers, she says.

© 2015 MIMS (NZ) Ltd

http://www.nzdoctor.co.nz/news/2015/march-2015/03/influx-expected-with-funding-for-acc-sexual-abuse-service-set-to-double.aspx

Therapy out of reach for many survivors of sexual abuse

An article from NZ Doctor by Reynald Castaneda

A Wellington GP is calling on ACC to recruit more sensitive claims counsellors, saying abuse survivors encounter long delays before their first therapy session.

ACC’s sensitive claims process has improved over the years, but survivors still face barriers because of a lack of counsellors, Doctors for Sexual Abuse Care deputy chair and GP Cathy Stephenson says.
Ease of access is important for people with a physical and/or mental injury suffered as a result of sexual abuse or sexual assault. Even the smallest inconvenience can discourage them from seeking help, Dr Stephenson says.
For example, when assisting one of her clients to find a counsellor in a different city, she called nine counsellors from a list of 10, and all were fully booked. Left to make these calls on their own, the client wouldn’t persist after being told “no” several times, she says.
Another problem is counsellors who can take new clients will not accept victims of sexual abuse, Dr Stephenson says. This is “fair enough” as they shouldn’t be overwhelmed by too many such cases.
ACC sexual violence strategy manager Emma Powell says the system is still evolving after multiple makeovers in the past several years.
 “We couldn’t have changes overnight … relationships had to be repaired within the sector to a point where we could all be working collaboratively,” Ms Powell told New Zealand Doctor.
“We want people to come forward and we want people to access services … this is not one of those [services] where we try to reduce people [coming] forward”, she says.
Changes to ACC’s sensitive claims pathway began five years ago after an independent review. ACC has been tinkering with this pathway since then, with recent changes going live at the end of last year.
More than 118 individuals and organisations offer sensitive claims services under the new contract, with approximately 800 providers including counsellors, Ms Powell says.
Survivors no longer have to get approval from ACC to see a counsellor, she says. But if more therapy sessions are needed, an individual assessment needs to be completed. If approved, the client can receive other types of treatment, including psychiatric and psychological help as well as financial compensation if they were earning at the time of the abuse. If a client is declined, in that the client’s mental issues are not caused by the sexual abuse incident, the client is redirected to other pathways which can help them.
“ACC doesn’t just say sorry, that’s it … it’s a very different system these days.”
Survivors who do not reach the assessment stage because they volunteered not to continue with any more counsellor sessions are also marked as “declined” in ACC’s books.
In the financial year 2013/14, 5118 sensitive claims were lodged and 3595 (70 per cent) marked as “declined”.This is a jump from 4828 claims lodged in 2012/13 (65 per cent were “declined”) and 4430 claims lodged in 2011/12 (63 per cent were “declined”).
Asked whether this conflated use of “declined” hides the real number of claims turned down by ACC, Ms Powell says survivors receive a personalised service even with this “accept or decline” system. Real numbers are revealed after audits are completed.

In essence
Wellington GP Cathy Stephenson says ACC needs to enlist more sensitive claims counsellors because survivors encounter long delays before their first therapy appointment.
ACC says the system has been improving in the past five years and dramatic changes cannot happen overnight.
Survivors don’t need approval from ACC to have an appointment with a counsellor, but must go through an assessment if more sessions or treatment are required.

© 2015 MIMS (NZ) Ltd

http://www.nzdoctor.co.nz/in-print/2015/february-2015/18-february-2015/therapy-out-of-reach-for-many-survivors-of-sexual-abuse.aspx

Question to Minister

Question 3: Katrina Shanks (National) to the Minister of Justice: What steps is the Government taking to support victims of sexual violence?



Hon JUDITH COLLINS (Minister of Justice): The Government is committed to providing better support for victims of crime, including all victims of sexual violence. As a result of the Law Commission’s recent review of the Evidence Act, I will shortly be introducing proposals to improve the way some evidence is dealt with in these cases. If the defence wants to raise issues about a complainant’s previous sexual history, they will need to give notice before trial. In addition, child witnesses under the age of 18 will be able to give evidence by video recording, which can be challenged in trial. They will be able to have a support person sitting nearby when they give evidence. There is a range of support services for sexual violence victims across the Government. They include specialist victim support, no real limitation period on the making of a complaint, automatic name suppression in criminal proceedings, and the court is closed when victims give evidence. Victims can give evidence behind a screen, and they are allowed a support person with them in court while giving evidence, and there is a range of counselling and financial support through the Ministry of Justice, ACC support, or the Ministry of Social Development, including funding of agencies such as Doctors for Sexual Abuse Care, Auckland Sexual Abuse Helpline, and Wellington Rape Crisis. The Victims of Crime Reform Bill, which is awaiting its second reading, will also introduce a new victims’ code.
Katrina Shanks: What criminal processes exist to deal with sexual violence offences?
Hon JUDITH COLLINS: In New Zealand we have a common law justice system based on democratic principles of fairness. Some European and former communist countries have a different system, the inquisitorial method of criminal justice, which effectively means that any accused person has to prove their innocence. Accused persons are examined directly by judges trained in the inquisitorial method of examination. There is limited ability to challenge evidence presented to the judge. In the common law method, prosecution and defence each present their evidence and arguments to the court, and have the right to challenge each other’s evidence. In 2012 the Law Commission published an issues paper and invited submissions on a range of pre-trial and trial processes, particularly to consider whether inquisitorial processes could be incorporated into our justice system for sexual offences. Some of the issues considered have been advanced, such as child protection orders, greater use of restorative justice to deal with sexual violence offences, protection for child witnesses, and requiring notice to be given if the defence intends to raise evidence of the complainant’s prior sexual history.
Katrina Shanks: What else is the Government doing to help prevent sexual violence victimisation?
Hon JUDITH COLLINS: Prevention is obviously the key for progress in this matter. Sexual violence is obviously abhorrent but it is also linked with alcohol and other drugs. The Government’s alcohol reform legislation comes into force on 18 December. From 18 December this year it will be an offence to supply alcohol to a minor without parental consent. In addition, the Government has passed the Psychoactive Substances Act to stop the sale of harmful party pills. The Ministry of Health funds a rape prevention programme in schools called BodySafe, which is currently run in many schools and teaches young people how to keep themselves safe from sexual violence and how to deal with a sexual attachment if it does happen. Earlier this year, Minister Bennett announced a major funding boost for victims of sexual violence through agencies such as the Auckland Sexual Abuse Help Foundation. In addition, ACC is redesigning its support, assessment, and treatment services for sensitive claims to provide more responsive services to victims of sexual violence. Sadly, many victims of sexual violence are repeat victims, and part of the approach is to help victims keep safe to prevent re-victimisation. There is a good deal currently being done to deal with sexual violence in this community, and it is a real problem that affects old and young. We need to continue to bring offenders to justice and to acknowledge that sexual violence is a crime and needs to be dealt with accordingly.

http://www.parliament.nz/en-nz/pb/business/qoa/50HansQ_20131112_00000003/3-crime-victims-sexual-offences%E2%80%94support

Disarray in Bay’s sex abuse service

An article from New Zealand Doctor magazine by Lucy Ratcliffe

Seven months of negotiations have failed to bring agreement on who will deliver a new model of sexual abuse assessment and treatment in the Bay of Plenty.
Western Bay of Plenty PHO has pulled out of contract negotiations for the ACC-funded Sexual Abuse Assessment and Treatment Services, or SAATS, because concerns couldn't be allayed. Bay of Plenty DHB isn't impressed. "The PHO's decision has resulted in seven months of lost time and is very disappointing," DHB chief executive Phil Cammish writes in a report to his board.
What's more, other PHOs are unlikely to step up because of capacity and capability issues, Mr Cammish says.
Western Bay of Plenty PHO chief executive Roger Taylor says contract negotiations ceased mainly because of the DHB's reluctance to provide an appropriate facility to undertake the assessments in Whakatane, and contract terms relating to management fees and fee-for-service.
The contract's draft terms included an "exceedingly poor" management fee, and in response to that, Mr Taylor says, it was stated clearly in the fee-for-service component that any savings made during delivery of the programme could be thought of as a management fee top-up and retained by the PHO.
Mr Taylor says the PHO wanted absolute clarity about what the money could be used for.
There were also clinician concerns about a different ACC issue - the new clinical pathway for sensitive claims.
The new pathway, begun last October, was designed to tighten controls over sexual abuse claims. Changes included a new requirement for a DSM-IV diagnosis in order to access ACC-funded therapy.
The organisation Doctors for Sexual Abuse Care says this has removed the ability of many individuals to access timely psychological support.
The PHO agrees.
Mr Taylor says: "At a time when we are endeavouring to grow the number of doctors and nurses involved [in this service], the uncertainty and concern make them think twice."
ACC's programme manager for SAATS, Kendra Sanders, says she was not told of concerns about the new clinical pathway.
The pathway and SAATS are two separate matters; the pathway deals with mental injury and SAATS deals with physical assessment.
The SAATS contract replaces what was previously known as the DSAC contract held and delivered by doctors trained by the DSAC organisation.
It is intended SAATS will continue to be delivered by DSAC-trained doctors or clinicians with appropriate training as the contracts are finalised and rolled out nationwide. Fourteen DHBs have finalised their contracts so far.
Ms Sanders says the new SAATS model was developed by ACC, the Ministry of Health and police after the DSAC workforce came near crisis point in 2006.
ACC's manager of treatment and rehabilitation services, Phil Wysocki, says SAATS is designed to be a more comprehensive model of care allowing consistent coverage across the country.
The SAATS contract is now held by DHBs, which contract providers to run the service.
DSAC national manager Hayley Samuel says this is the first the organisation has heard of clinician concerns about the clinical pathway interfering with the SAATS contract negotiations.
Bay of Plenty GP and DSAC coordinator Jillian Caisley was not aware of the concerns either, but Mr Taylor maintains there are clinicians not yet involved in delivering a service, for whom such concerns preclude involvement.
"The DHB is aware of our position and dialogue continues to occur," he says.
The DHB declined a request for an interview on the matter.
In a written statement, Grant Pollard, acting general manager of planning and funding, says the DHB is in discussions with another provider.
Meanwhile, as New Zealand Doctor went to print, ACC minister Nick Smith announced the new pathway would undergo an independent clinical review, with a report due back in July.

http://www.nzdoctor.co.nz/in-print/2010/may-2010/05-may-2010/disarray-in-bay%E2%80%99s-sex-abuse-service.aspx

Questions for written answer

19852 (2009). Lynne Pillay to the Minister for ACC: In terms of the preparation for the implementation of Sensitive Claims Clinical Pathway, have all necessary tools been developed, if so what tools, if not why not?
Hon Dr Nick Smith (Minister for ACC) replied: Yes. ACC has the tools it needs in place for clients, providers, and its own staff. Many of these tools are available online. These include processes and procedures, FAQs, forms, letters, data capture and reporting tools, and induction processes. These tools will continue to be improved on the basis of experience, and new tools will be developed as the need arises. For example, as part of the work with Corrections, tools will be developed specifically for use in the prisons. Further work is being done on tools specifically for use with children and young persons.
http://www.parliament.nz/en-NZ/PB/Business/QWA/9/0/0/QWA_19852_2009-19852-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

21300 (2009). Lynne Pillay to the Minister for ACC: In terms of the preparation for the implementation of Sensitive Claims Clinical Pathway, have all systems been clearly communicated enabling professionals in the field to advise clients on the process and what they can expect, including the timeframe for assessment and approval ?
Hon Dr Nick Smith (Minister for ACC) replied: Yes. ACC has kept in contact with its providers, and has provided information by email, post, workshops, presentation, personal communications, and online. Timeframes for assessment and approval are also available with the expectation that when a claim is made the required information is provided to enable a decision.
http://www.parliament.nz/en-NZ/PB/Business/QWA/e/d/f/QWA_21300_2009-21300-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

21476 (2009). Lynne Pillay to the Minister for ACC: Has ACC implemented the clinical pathway in advance of having in place the appropriate treatment plan for Maori?
Hon Dr Nick Smith (Minister for ACC) replied: No. Cultural competence is included in each treatment provider’s contract with ACC. Both the Code of Health and Disability Services Consumers' Rights, and relevant professional standards, require all health providers to take account of cultural aspects. ACC has published guidance on Maori preferences to ensure providers can meet these requirements. These are the Hauora competencies which can be found on ACC’s website at: www.acc.co.nz . ACC has a dedicated Pae Arahi (Maori Cultural Advisor) with the Sensitive Claims Unit and also works closely with Dr Catherine Hong (Manager of Cultural Services, ACC) to address issues for people of other ethnicities. Each treatment plan developed for clients takes into consideration the client’s clinical and therapeutic needs, as well as their context which includes cultural needs, geographical location, employment or other relevant circumstances.
http://www.parliament.nz/en-NZ/PB/Business/QWA/1/4/5/QWA_21476_2009-21476-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

21533 (2009). Lynne Pillay to the Minister for ACC: What sensitive claims, since 1 November 2009, are now pending with ACC that involve counselling for sex abuse victims and/or victims of domestic violence in Wairarapa?
Hon Dr Nick Smith (Minister for ACC) replied: Between 1 November and 11 December ACC received seven claims from the Masterton District. ACC has sought more information from providers for four of these claims and the other three are waiting for clinical assessment.
http://www.parliament.nz/en-NZ/PB/Business/QWA/2/2/1/QWA_21533_2009-21533-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

22490 (2009). Lynne Pillay to the Minister for ACC: Does the victim of a sex crime have to be classified as having a mental illness before ACC will fund any treatment?
Hon Dr Nick Smith (Minister for ACC) replied: Mental injury has always been a requirement, defined under legislation, in order for ACC to accept cover for a sensitive claim. There are two exceptions. These are intervention in the immediate aftermath of assault/abuse when the Doctors for Sexual Abuse (DSAC) and Sexual Assault and Treatment (SAAT) contracts apply, and treatment for physical injuries that have resulted from the assault. In these situations ACC contributes to a wide range of services, such as District Health Boards and general practice or other primary care services.
http://www.parliament.nz/en-NZ/PB/Business/QWA/a/c/e/QWA_22490_2009-22490-2009-Lynne-Pillay-to-the-Minister-for-ACC.htm

DSAC concerns over new clinical pathway

Press release from DSAC

Doctors for Sexual Abuse Care (DSAC) support ACC’s overall intention to improve the quality of its funded services for individuals who have a mental injury arising from sexual assault/abuse. However, DSAC does not support the implementation of ACC’s new Clinical Pathway for Sensitive Claims as it currently stands.
This Pathway is a selective implementation of some parts of the Massey Guidelines. It was designed by ACC and introduced abruptly (design completed 19 October, effective from 28 October 2009) and without effective consultation and input from expert clinicians working in the area or with patient advocacy groups. It thus has some predictable flaws.
DSAC’s main concern is that the new Pathway has removed the ability of many individuals to access, in a timely manner, psychological support as a consequence of the crime committed against them/sexual assault.
DSAC does not support the new narrow definition of a DSM-IV diagnosed psychiatric illness as a requirement for cover. ACC has chosen this as its “preferred diagnostic tool.” Thus individuals have to see a New Zealand Registered Clinical Psychologist or Psychiatrist for a DSM-IV assessment prior to commencing counselling. ACC have indicated that “other registered health professionals” with “specific training and experience in mental health diagnostics” may be acceptable to ACC to provide a DSM-IV diagnosis. ACC also state that “competency in this and other domains of practice is a matter for registration authorities.” This leaves the professional bodies to solve a problem that ACC could have averted had they invested in a collaborative approach in the design of the Pathway.
Section 27 of the IPRC Act does not limit mental injury to a DSM-IV diagnosis. Instead it defines “mental injury” as “a clinically significant behavioural, cognitive or psychological dysfunction.” ACC have therefore recently indicated that they are open to using “alternative diagnostic tools.” Which alternative tools will be acceptable to ACC have not yet been defined. This means many mentally injured distressed patients who cannot access a DSM-IV diagnosis, or do not fit these limited criteria, are unable to receive ACC-funded psychological support in a timely manner.
As yet there are no guidelines in place indicating how children and adolescents who have been sexually abused, and who require intervention, will access psychological support. The DSM-IV classification system has severe limitations for children and adolescents.
DSAC also has significant concerns about the informed consent and the new procedures ACC is using to request disclosure of additional information by doctors immediately after a claim is lodged.
These concerns have been communicated to ACC on several occasions. Meanwhile DSAC is fielding enquiries from doctors seeking advice on what to advise patients alleging sexual assault as to how they are supposed to safely navigate the complex bureaucracy which is the “new pathway” in order to access psychological support. This advice is particularly needed for those doctors working in rural areas and small towns where local support agencies may not have the necessary “qualifications” which ACC require in order to make a DSM-IV diagnosis.

http://www.scoop.co.nz/stories/PO0911/S00270.htm