ACC sensitive claims: Core concerns yet to be addressed

A press release by Kyle Macdonald

ACC has released today the six-month report by Dr. Barbara Disley, in follow up to the Independent review of the Sensitive Claims “new pathway” introduced in August 2009.
The report highlights a number of areas where progress has been made, however the key areas that initially led to the protests by the wider sector and professional groups are yet to be addressed: namely the ongoing requirements of an external assessment to access ongoing treatment and the need for claimants to be diagnosed under the DSM-IV.
From the report released today: “SCAG [Sensitive Claims Advisory Group] members are concerned that while access to immeadiate support has been addressed, there has been no change to the clinical pathway processes for clients returning to counselling or reactivating a claim.”
“These issues remain of deep concern, and it’s clear from counsellors and therapists working in the sector that we still struggle to navigate a system that is, at its heart, deeply flawed,” says Kyle MacDonald. “The initial outrage about victims of a crime being required to be diagnosed with a mental illness is yet to be addressed.”
“What remains encouraging is ACC’s ongoing commitment to work with the sector to resolve these issues, and I remain hopeful that we can find a way to re-instate a system that is safe for sexual abuse survivors and restores the sectors faith in ACC.”

http://www.scoop.co.nz/stories/GE1105/S00149/acc-sensitive-claims-core-concerns-yet-to-be-addressed.htm

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/

And now for the apology...?

A blog entry from Off The Couch by Kyle McDonald

I may be old fashioned, or conditioned by my profession to focus on “the relationship” but perhaps it’s now time for ACC to apologise.
In these times of “systemic failure,” independent reviews and Ministers who are unable (or unwilling) to take a position, there is still a lot to be said for a good old fashioned “sorry.” So what have ACC got to be sorry for?

Click here to read more.

Response from Denise Cosgrove

A letter to the editor of the Sunday Star Times

Your story "Academic with link to sex abusers silent on role in drafting ACC rules" (News, August 29) was misleading in some important respects. The article suggests that Dr Felicity Goodyear-Smith was involved with the development of the ACC clinical pathway for sexual abuse claims. She was not. Goodyear-Smith had no role in the development of the pathway. The report she and two other researchers produced five years ago was an inconclusive study which compared treatment rates provided to ACC sexual abuse clients by psychologists, psychiatrists and counsellors. So it was not relevant to the development of the pathway.
Yes, one of their recommendations was that there should be diagnosis before treatment, using an assessment tool called DSM-IV. Yes, that is what we've been doing. But we didn't do so because it was in their report. Far from it. We did it because it was internationally seen as best practice, because the courts in NZ had endorsed DSM-IV as an appropriate method and because no suitable alternative options have been put forward. Goodyear-Smith had no part in any of that.
The article also failed to mention the work that ACC is currently doing with the Sensitive Claims Advisory Group and others to ensure that, moving forward, we continue to provide the most appropriate services for our clients.
Denise Cosgrove
General manager, claims management ACC

Copyright Fairfax New Zealand Ltd 2010
http://findarticles.com/p/news-articles/sunday-star-times-wellington-new-zealand/mi_8185/is_20100912/sexual-abuse/ai_n55232011/

Sex abuse cuts "all about costs"

An article from the Sunday Star Times by Tim Hume

A former senior ACC manager says the corporation's cuts to sexual abuse counselling are "all about costs", contrary to ACC Minister Nick Smith's claims they were about ensuring best practice for clients.
David Rankin, now Child Youth and Family's senior medical adviser, has also revealed an advisory group of eight eminent psychiatrists cautioned ACC against introducing a Diagnostic and Statistical Manual (DSM-IV) diagnosis of mental injury as the threshold for victims of sex crimes to access support. "They said, 'Be very careful, this is not what it's used for, this is not what it's all about'," Rankin told the Sunday Star-Times. "They said: 'It doesn't indicate severity, it only indicates the presence of a condition and it doesn't in any way tell you what treatment is needed."'
ACC controversially introduced the requirement last year, cutting access to treatment for hundreds, before partially restoring support last month. Two suicides have been linked to the cuts.
Rankin, who was ACC's general manager of health purchasing until 2006, says the main goal of the changes was to cut costs. "ACC's an insurance company. Its premium-payers are grizzling."
ACC was "under extraordinary pressure to reduce its costs" and "anybody that looks at the counselling costs for sexual abuse must come to the conclusion that there is wasted money," he said. Although sensitive claims represented only a small amount of ACC's total spending, it was an area where the corporation had "extraordinary exposure" to liabilities.
In 2004, Rankin commissioned research into sexual abuse counselling that was co-authored by Auckland University professor Felicity Goodyear-Smith. He said the research was commissioned because "ACC was concerned at the increase in cost in counselling".
ACC has been criticised for commissioning the research from Goodyear-Smith, who is married to a convicted sex offender and is the daughter-in-law of Centrepoint's convicted paedophile founder Bert Potter. She has been an outspoken critic of sexual abuse counselling, labelling it "a scam".
Her research included a recommendation that victims be assessed with a DSM-IV mental injury diagnosis, which later appeared as a requirement in ACC's "clinical pathway", despite not having been specified in the Massey guidelines, a widely accepted "best practice document" which ACC said guided how the pathway was formulated.
Rankin said Goodyear-Smith's research had set out to determine whether psychologists provided more effective treatment than less-qualified counsellors. He had been "stunned" when her research had not borne out their expectation that they would.
He said he had been aware of Goodyear-Smith's links to sex offenders and strong views, and for that reason stipulated "that I personally read what she said before we published it". He blocked a number of her recommendations. "We acknowledged the agenda and protected both herself and us against it," he said.
He did not feel her background disqualified her from objective research, stressing that the research was "numerical" and adding "most people researching in that area have got a bias one way or the other".
Green MP Kevin Hague said he believed the commissioning of Goodyear-Smith reflected the corporation's agenda to cut costs. "If it's a numerical analysis you want, the public health departments of our universities are packed with biostatisticians who could do that. Why would you choose the researcher with the most extreme view about the topic itself to do this neutral task?
"They used Goodyear-Smith because they knew she would recommend less treatment and less costs for people who had been sexually abused. That, to me, is a scandal."
ACC Minister Nick Smith said he couldn't comment on ACC's objectives in Rankin's time. But he insisted that changes to sensitive claims over the past 12 months had had nothing to do with cost-cutting, but focused on clinical care. He said an independent clinical panel came to the same conclusion. "There's been a lot of politics around trying to frame the debate around sensitive claims in context of bigger financial issues around ACC, but the paper trail and the involvement of the clinicians driving this makes it plain these are quite distinct."
He was "uneasy" about Goodyear-Smith's involvement, but had seen no evidence her work had influenced the pathway.

© 2010 Fairfax New Zealand Ltd
http://www.stuff.co.nz/national/4096892/Sex-abuse-cuts-all-about-costs

ACC adviser silent on links to sex abusers

An article from the Sunday Star Times by Tim Hume

Concerns are being raised over changes at ACC that denied sex crime victims access to treatment. Critics allege the changes were partly based on advice from an academic who is married to a sex offender.
Auckland University medical and health sciences faculty professor Felicity Goodyear-Smith was one of the authors of a 2005 paper on sexual abuse counselling funded by ACC.
She is the daughter-in-law of Centrepoint community leader and convicted paedophile Bert Potter. His son, her husband John, was jailed in 1993 on historic charges of indecent assault at Centrepoint. Her paper recommended a diagnosis of mental injury, as defined by the American Diagnostic and Statistical Manual, be made at the outset of treatment. Last year ACC accepted that criteria for those seeking support, denying hundreds of victims counselling and outraging counsellors, who said labelling sex crime victims mentally ill was stigmatising and unethical.
New Zealand Association of Psychotherapists' sensitive claims spokesman Kyle MacDonald said there were "obvious parallels" between the new rules and the research, and his group was opposed to Goodyear-Smith's involvement in ACC-commissioned sexual abuse research.
The mental injury diagnosis was not included in a 2008 Massey University guideline, a widely accepted document outlining best practice in the sexual abuse field, which ACC says guided its policy.
Last year's changes saw a drop in sexual abuse claims, prompting ACC Minister Nick Smith to set up a review panel that reports next month, but ACC has already reinstated 16 hours of counselling for victims.
Goodyear-Smith, who lived for years on Centrepoint land, working as the community's GP, is an outspoken critic of sexual abuse counselling, saying it can be as damaging as sexual abuse itself, and once telling a newspaper the "ACC scam's one of the biggest there is". She is the founder of a support group for men accused of sex crimes, and has acted for them in the courts and the media over the past 16 years.
Counsellor Barri Leslie – herself a former Centrepoint member – alleges Goodyear-Smith provides "an academic veneer" for attitudes similar to Bert Potter's. "It's outrageous she's been commissioned by ACC in the area of sexual abuse counselling," she said.
A special investigation in today's Focus outlines similarities between Bert Potter's and Goodyear-Smith's positions, including that not all sexual activity between adults and children is damaging.
ACC told the Star-Times last year it had not commissioned research from Goodyear-Smith but now admits it did. Smith's spokesman distanced him from the research, saying it occurred three years before he became minister, and that he had no information on the matter. "The minister does have concerns about the pathway and that is why he established the independent clinical review panel."
Goodyear-Smith would not be interviewed for the story.

© 2010 Fairfax New Zealand Ltd

http://www.stuff.co.nz/sunday-star-times/news/4072453/ACC-adviser-silent-on-links-to-sex-abusers

Conflicting interests?

An article from the Sunday Star Times by Tim Hume

Professor Felicity Goodyear-Smith is a senior academic and doctor who was commissioned by ACC to research sexual abuse counselling. She is also the daughter-in-law of Centrepoint guru and paedophile Bert Potter, is married to a convicted sex offender and has controversial views on the workings of the 'sexual abuse industry'. Tim Hume examines allegations of Goodyear-Smith's influence in ACC's recent drastic cut in support for victims of sex crimes.
Last October, ACC changed the rules governing the support available to victims of sex crimes, introducing a heavily criticised new regime that severely restricted access to counselling.
But what most concerned critics was an apparent similarity between a requirement in the new "clinical pathway", and a recommendation contained in research ACC had commissioned from a controversial senior academic. The research was led by Professor Felicity Goodyear-Smith, who has been a vocal detractor of the field of sexual abuse counselling and who, as the daughter-in-law of Centrepoint founder Bert Potter, has ongoing personal relationships with convicted child sex offenders.
During the eight months following the clinical pathway's introduction, ACC paid out $7 million less to 2889 fewer claimants than it had over the same period a year previous. Approved new claims, running at 1313 in the eight months prior to the pathway's introduction, subsequently dropped to 240 over the same length of time. Among the hundreds to have their claims denied were two women believed to have later committed suicide.
Despite a record $4.8 billion loss sustained by ACC the previous financial year, ACC Minister Nick Smith stressed the policy was not an attempt to cut costs, but was driven by a desire to implement best practice for sexual abuse victims, known as "sensitive claimants". Critics dubbed the new pathway a "rapists' charter".
The scheme's many detractors were primarily concerned by a new requirement that, before they could access ACC counselling and support, claimants had to be diagnosed formally with a mental injury as defined by the American Diagnostic and Statistical Manual (DSM-IV). Whereas previously, ACC might have accepted a GP or counsellor's description of symptoms such as flashbacks, panic attacks or nightmares resulting from a sex crime, now a formal diagnosis of a mental illness such as post-traumatic stress disorder was needed.
It's unclear exactly why. Nowhere was a DSM-IV mental illness diagnosis specified in the so-called "Massey guidelines", the widely accepted 2008 best practice manual which ACC had commissioned from Massey University researchers, and which it cited as having guided the formulation of the pathway ...

Click here to read more.

© 2010 Fairfax New Zealand Ltd

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

Victims of sexual abuse are feeling the effect

An article from the Taranaki Daily News

Some of those most affected by ACC's harder line are victims of sexual abuse.
"People who are victims of sexual crimes don't have a voice. They speak with their feet. They're not turning up for counselling, referrals are right down. People are not prepared to come in and be given a label of mental illness," New Plymouth Safer Centre counsellor Bob Stevens says.
The New Zealand Association of Counsellors is agitating across the country, he says.
"When do you suddenly become a mental health patient because you have been sexually assaulted?"
Since October, ACC has started to lay on an "unsuspecting public" new clinical pathways.
"They've decided arbitrarily, because there had been no change to legislation, that the only way you can fund ACC counselling is to have a diagnosis under the American psychiatry bible DSM-IV. Those of us who have being doing this work for half a lifetime, 18 years for me, are sidelined because we are not trained to use the diagnostic criteria, therefore we can't do assessments."
To become ACC approved, sexual abuse counsellors had to "jump through more hoops than a circus", he says. And yet now they are not deemed qualified enough to make the assessments.
He's appalled at the new approach.
"People come in here and tell me I can't take this any more."
Under the new rules, people who are victims of sexual abuse have to tell their stories to a sexual abuse counsellor, who passes on the information to ACC. The claim is then assessed by a psychiatrist and psychologist, out of the area, who make the decision whether or not to accept it, without meeting the clients. However, sometimes, an extra assessment is required by ACC and then the client may end up telling their story to a number of different people.
The psychiatrists and psychologists are "hell bent" on looking at whatever psychological problem they can find - to hell with the event, Mr Stevens says.
ACC senior medical adviser Peter Jansen says there has been a lot of coverage lately of the new "pathway", much of it uninformed and negative.
"It's important to understand that ACC is not cutting services to people who are entitled to them. Our legislation is very clear: we can provide cover only for injuries. The entitlements that follow from an accepted claim will depend on the nature of the injury."

So to pay for psychological treatment or therapy such as counselling for sexual abuse or assault victims, ACC needs to be satisfied that sexual abuse or assault has caused a mental injury. This is a clinical diagnosis, which can be made only by registered health professionals with appropriate training, qualifications and experience, Dr Jansen says.
"In the past, we have not followed this requirement as closely as we should have. The result is that we have paid for counselling and other benefits for some people not entitled to it. This is not to say that these people do not have psychological needs; it is simply that ACC cannot legally cover them. Other agencies such as Health and Social Development often can."

http://www.stuff.co.nz/taranaki-daily-news/features/3352813/Victims-of-sexual-abuse-are-feeling-the-effect

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 Minister Defends “Rapist’s Charter”

Press release from Kyle MacDonald

As the author of the petition submitted to parliament on the 27th October, signed by nearly four thousand people opposed to the new clinical pathway for sensitive claims, I am greatly concerned about the Ministers ongoing defence of a clinical pathway seen by providers of sensitive claims to be unethical and a “rapist’s charter.”
In a letter thanking me for the petition, dated the 11th of December, the Hon. Nick Smith defends this new pathway as follows:
“The Corporation's decision to review its guidelines is driven, not by funding, but by the implementation of best practice for managing clients with a mental injury. This process began in 2008 with the Massey Guidelines… ... After consultation with providers, ACC issued its revised Clinical Framework in July 2009, and held a new series of workshops.”
The minister is yet to explain how it is that ACC have stated publicly “that it is ACC policy to reduce the number of Sensitive Claims” despite his assertion these changes are not driven by funding.
The minister is also yet to answer the concerns of experienced providers. A recent survey showed that: less than 10% intend to continue to provide counselling services under this new pathway and 83% disagree or strongly disagree with the compulsory use of the DSM-IV under this new pathway.
How does this government continue to contend that these decisions will be made by “clinicians not politicians” when clinicians continue to be vehemently opposed?
The minister is failing in his duty to protect the New Zealand public and monitor the activities of ACC. Recent figures show a 57% reduction in claims accepted since the introduction of the new pathway, when compared to last year.
What does the Minister say to those victims of childhood sexual abuse who have dutifully paid taxes and their ACC levies who will now suffer without care, unable to access funded counselling, unable to afford private care and unable to access mental health services?
Six months is too long to wait for a review when lives are at stake. I implore the minister to urgently review the current situation within the sensitive claims unit before lives are lost.

http://www.scoop.co.nz/stories/PO0912/S00227.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

Nikki Kaye picketed by sexual abuse survivors

Press release from the End Rape Culture Now! Collective

An End Rape Culture Now! Collective member today enters the third day of her hunger strike outside National MP Nikki Kaye's office. Sexual abuse survivors have been camping outside the Auckland Central MP's office since Tuesday to protest ACC cuts to sexual abuse counselling. Survivors will hold a public rally outside the MP's College Hill office at 12.00 noon this Friday 30th Oct where Louise Nicholas will speak.
The End Rape Culture Now! Collective asks that:
(1) Nikki Kaye advocates for counselling for sexual abuse and assault survivors in parliament, and discusses this with John Key.
(2) ACC supports the ACC-registered counsellors to develop a New Zealand tool to assess survivors for counselling
(3) ACC ceases to require the DSM-IV as the only diagnostic tool to assess mental injury and that a public announcement is made by ACC to this effect
Hunger Striker Eliana Darroch said "Our hunger strike is symbolic of ACC denying nourishment to survivors of sexual abuse, sexual assault and rape. To take away the counselling we need to recover, is like taking away our food. Nikki Kaye is my local MP and should advocate for survivors."
As of Tuesday, survivors have already been receiving letters from ACC stating that their applications for treatment are declined, and that required to attend a formal psychiatric assessment with a psychiatrist. "Restricting counselling access delays recovery and prolongs the trauma" says Darroch.
End Rape Culture Now! Collective are wanting answers:
With 1 in 4 women and 1 in 8 men experiencing sexual abuse in their lifetime, this is a societal problem, not a personal one, and therefore needs to be addressed by the government. “This is an issue of crave public concern. ACC and the National Party need to be held accountable for the changes they have put through. What advice would John Key give a rape survivor who was refused treatment or made to wait indefinitely? What are people to do when they can't afford counseling” said End Rape Culture Now! Auckland spokesperson Priscilla Penniket.
No funded alternative system of counselling support has been proposed to replace ACC's current system, for those who do not qualify under ACC's changes.
ACC Minister Nick Smith yesterday announced that the counselling access restrictions would be reviewed in six months. "Survivors do not have six months, they need counseling now" says Penniket. One sexual abuse survivor has already committed suicide rather than submit to a psychiatric diagnosis. "Survivors do not want a psychiatric mental illness label, it's all very well to review this pathway in six months, but these DSM-IV labels affect peoples lives in the long term" says Penniket.
DSM-IV stands for the American Diagnostic Statistical Manual. New Zealand ACC counsellors are wanting to offer alternative assessment models that are more appropriate to sexual abuse survivors.
Hunger striker Eliana Darroch is feeling physically weak but in good spirits with strong support from family and friends. It is her birthday today.
A public rally in support of sexual abuse survivors, and against the changes to ACC, will begin at 12.00 midday, Friday 30 Oct, outside Auckland Central MP Nikki Kaye's office, 82 College Hill, Auckland.
For more information,
www.stopcuts.blogspot.com
www.youtube.com/endrapeculture
www.endrapeculture.org

http://www.scoop.co.nz/stories/PO0910/S00420.htm

Unethical new ACC Sensitive Claims Pathway

Press release from Kyle MacDonald, NZAP

The Northern Branch of the New Zealand Association of Psychotherapists (NZAP) would like to publicly state their opposition to the new treatment pathway for sensitive claims clients released on Monday the 19th of October and due for immediate implementation on the 27th of October.
The new pathway claims to be amended to reflect the concerns and feedback of the professional community and continues to insist that the changes are to provide “clients with the most effective treatment possible to enable them to achieve timely return to everyday life…”
ACC has failed to hear the loud and clear voices of protest from the skilled clinicians who provide this treatment and they have chosen to ignore the vociferous protests in the streets of our nation on Monday.
Clients will still be required to see more than one treatment provider before treatment is approved unless they see an “appropriately trained clinician” which excludes counsellors, social workers and many psychotherapists; professions that have competently provided treatment to this vulnerable client group for many years.
The focus on short treatment, limited to sixteen sessions, and a mandatory requirement for a DSM-IV diagnosis of a mental illness remain.
Psychotherapists in the Northern Region believe that the Massey Guidelines have been misrepresented to justify less treatment, despite ongoing claims by ACC and the Minister for ACC, the Hon. Dr Nick Smith that this new pathway is “best practice.” Already many clinicians are withdrawing their services stating that these new guidelines are in breach of their professional code of ethics.

http://www.scoop.co.nz/stories/PO0910/S00372.htm