National fail women

A blog post from Tumeke! by Bomber Bradbury

Government failing women - Labour
The National Government is failing women, Labour MP Sue Moroney says.
The biennial New Zealand Census of Women's Participation 2010, published today, tracks progress, or the lack of it, for women across the corporate and private sectors at governance and management levels.
It says women comprise 32 percent of MPs, 30 percent of Cabinet, 72 percent of teachers and 47 percent of school principals.
There are only three female editors out of the 26 daily newspapers, while 26 percent of the country's judges are women, as are 29 percent of the New Zealand police force.
Although 59 percent of the workers in public service are women, only six out of 34 public service departments have a woman chief executive.
The report identifies a 15.4 percent gender pay gap in the public service, which is greater than the total labour force gender pay gap of 13 per cent.
Equal Opportunities Commissioner Judy McGregor said in some areas women's participation had stalled and was sliding backwards.

It's not just in these stats that we see the National fail women, we see it in their destructive attitudes towards child care and we see it in their forcing Solo Mothers back to work based on flawed voodoo math from the Ideologically stacked Welfare Razor Gang.
The vast majority of NZers stay on welfare for a year, the vast minority stay on the dole for a decade, yet the ideologically stacked Welfare Razor Gang arrived at the $50 billion figure by claiming that if every person on welfare right now stayed on Welfare for their entire lives, as in no one got a job for the rest of their life, THEN and only then would it cost $50 billion.
What makes me so furious about the ideologically stacked Welfare Razor Gang is that they are making up bullshit numbers to justify attacking the most vulnerable in NZ while John Key hands over tax cuts to those who are already rich. Forcing solo mothers, the mentally unwell, the sick and the crippled back to work based on bullshit numbers is an obscenity.
Many of these users of Welfare are women so they are being let down at the bottom and at the top by National Party policy.
One way the Government are really letting women down though is with their despicable decision to cut ACC funded counselling for victims of sex crimes. Despite a damning report on the bullshit ‘Massey Guidelines’ policy ACC is still continuing to deny women counseling services for rape with no monitoring system put in place despite promises by Nick Smith and ACC to do it.
John Key appealed to female voters last election in the midst of the repeal of section 59 hysteria, now woman can see the reality of National's policy it will be interesting to see if they are still enthralled by him.

http://tumeke.blogspot.com/2010/11/national-fail-women.html

ACC's flawed review

A letter to the editor of the Dominion Post by Gordon Waugh

No wonder the report by the independent panel reviewing ACC sexual abuse claim procedures has been kept quiet.
The panel relied heavily on emotive sex abuse industry anecdotes, myths and misinformation.
It ignored good science and the interests of taxpayers who pay for ACC sex abuse claims.
It recommends a diluted, weakened and more costly process. Instead, the need is for fairness, healthy scepticism and robustness.
The panel made much of the supposed causal link between sexual abuse and mental injury. I understand no sexual abuse syndrome exists because there is no scientific evidence that sexual abuse causes any specific psychiatric, psychological or behavioural condition.
Disdaining such elementary science, the panel relied on the Massey Guidelines, which claim more than 700 symptoms or indicators of sexual abuse have been identified. That covers almost every human behaviour.
The panel accepted sex abuse industry myths that most victims never disclose their abuse, and only 9 per cent of sexual offences were reported to police. It is impossible to know about undisclosed or unreported events. The panel failed to apply critical thinking. It was a deplorable waste of our resources.

http://www.stuff.co.nz/dominion-post/opinion/letters-to-the-editor/4158659/Letter-ACCs-flawed-review

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

Sexual abuse treatment in shambolic disarray

An article from the Nelson Mail by Susan Hawthorne

"If this is supposed to be the gravy train, I'm on the wrong train." So said a colleague of mine about her experience of being part of the so-called "sexual abuse industry".
I echo her comments, applicable now to an even greater extent with the introduction last October of the New Pathway in the Sensitive Claims Unit of ACC. As a provider of treatment for injury from sexual abuse I am seen to benefit from this industry. It is, however, this experience which enabled me (and others) to predict with sickening foreboding likely developments if the proposed changes to the service went ahead. Every effort was made to warn the Minister of ACC, Dr Nick Smith, that the changes would be disastrous. He chose to rely on his policymakers, who appear to be pursuing ideological agendas which are favoured by this Government.
Chaos reigns in the SCU with staff overwhelmed, with therapists demoralised and many withdrawing their services, with potential clients left totally bewildered and lost. A tiny fraction of new claims only has been accepted since October. It has taken the independent review panel appointed by the Minister to intercede last week on behalf of clients to force the reinstatement of 16 hours to support each new claim. There is much confusion about who can submit claims, who can provide treatment or what will happen next if more sessions are needed. Apart from one media release, no further information has been forthcoming from ACC.
As ACC Minister, Dr Smith spent considerable time and energy blaming the previous minister for allowing policymakers to make apparently unwise property purchases and investments. Under his watch, the SCU has been all but destroyed.
Dr Smith has continued to claim that this process was begun under Labour. Indeed Massey University was asked to develop guidelines as a basis for therapy for treatment of sexual abuse. Under the current National Government, the guidelines were so badly misused that the authors of the report wrote to every newspaper in the country to distance themselves from the new pathway.
Dr Smith has repeatedly stated that "These changes are not about saving money." Presumably this is correct, as the result of deciding to require assessment for mental disorder for each new claim is that psychiatrists and psychologists have been flown around the country at vast expense to establish that the claimant is mentally ill rather than mentally injured. This gives each person accessing the service a mental diagnosis which goes with them for the rest of their lives. This policy still applies.
ACC is taking months to communicate decisions about whether they will or will not pay for sessions for clients in the system. Therapists face the dilemma of continuing to work at the risk of not being paid, or breaking our own ethical codes by stopping work with clients and leaving them feeling abandoned, isolated and unsupported.
For years now, sexual abuse clients have been specifically excluded from accessing mental health services because funding for their treatment was available though ACC. A proportion of our population has been abused, through no fault of their own and which untreated, can detrimentally affect them as individuals, as partners and as parents for the rest of their lives. The apparent overall plan under National is to cut back on social services to the community. Many such cuts are under the radar except for those people directly affected. More radical changes have been promised in their second term, should they win the next election.
Many therapists with specialist skills and years of experience in the treatment of sexual abuse have withdrawn their services and will not work for ACC again while current conditions apply.
Regrettably I am one of these. I am off the train.
(Susan Hawthorne is a registered psychotherapist, a member of the NZ Association of Psychotherapists, and a campaigner against injustice.)

© Fairfax New Zealand Ltd 2010
http://findarticles.com/p/news-articles/nelson-mail-the/mi_8062/is_20100821/sexual-abuse-treatment-shambolic-disarray/ai_n54911803/

Question to Minister: ACC

Hon ANNETTE KING (Deputy Leader — Labour) to the Minister for ACC: Does he stand by his statement on Radio New Zealand’s Checkpoint programme of 12 August 2010: “I’m not satisfied that ACC has handled the issue of counselling services for sensitive claims that well. I’m going to await the final report from the independent clinical panel before drawing final conclusions”; if so, why?
Hon Dr NICK SMITH (Minister for ACC): Yes, I do. I have been consistently cautious about interfering in the clinical decisions of the Accident Compensation Corporation (ACC) in this sensitive area. But given the level of concern from colleagues and the public I have established an independent clinical panel to review the corporation’s approach. That panel is doing a very professional and thorough job.
Hon Annette King: Does he now accept that he was warned by clinicians, by survivors, by he National Council of Women, and by 3,976 people who, last October, signed a petition that stated: “By doing nothing and allowing these changes to occur unhindered you are choosing to make recovery from horrific abuse harder for some of the most vulnerable members of this society.”?
Hon Dr NICK SMITH: I draw the member’s attention to the advice from the Royal New Zealand Colleague of General Practitioners, and I quote what it said in November last year: “All the clinical evidence suggests that the new approach ACC is adopting will be in the best interests of the patient”. Given that sort of advice I have been cautious about getting involved in a clinical debate where I am not well qualified, but in response to the concerns of colleagues like Chester Borrows, Jackie Blue, and Nikki Kaye, I have set up an independent clinical panel and I will be ensuring that the advice of that panel is taken by the ACC to ensure that we are providing proper care for people who are sexually abused.
Hon Annette King: Did the ACC advise him that the process to change the clinical framework or clinical pathway was started under a Labour Government as he has claimed many times; if so, when?
Hon Dr NICK SMITH: Yes, that is the advice I have received. There was concern in the research that was commissioned in 2003, at Massey University, by the previous Government. The key element — and I am not an expert on the clinical issues — is that the clinical concern in that research was that unlimited counselling would do more harm than good for sensitive claimants. I am advised by the ACC that the changes in the pathway were begun in 2008.
Michael Woodhouse: What steps has the Minister taken to try to have the issues over sensitive claims addressed as quickly as possible?
Hon Dr NICK SMITH: The independent clinical panel wrote to me on 16 July seeking an extension of time until September to enable it to provide a comprehensive report. My concern was that this delay would put back the addressing of the problems in relation to providing for sensitive and vulnerable claimants. I agreed to the extension until mid-September subject to the panel providing interim recommendations. On receiving those recommendations I immediately wrote to the ACC board seeking their implementation as quickly as possible, which the board has done.
Hon Annette King: In light of the Minister’s answer to my previous question, is he saying that the ACC was not telling the truth when less than 1 month ago, in answer to an official information request, it said: “No work was undertaken on either the clinical framework or the clinical pathway prior to 2009”, and when it also said that the clinical framework was developed by the clinical services directorate in 2009, long after a Labour Government had left?
Hon Dr NICK SMITH: I stand—[Interruption]
Mr SPEAKER: I apologise to the Minister. I believe that the member has asked a serious question, and the member’s colleagues should listen to the answer.
Hon Dr NICK SMITH: I stand by the advice I have been given by the ACC, which is that the work on the clinical pathways began in 2008, prior to the change of Government, as those documents make plain. Labour has tried to politicise this issue, but the changes in sensitive claims have been totally driven by the ACC’s clinicians, not by Ministers. They have not been driven by Cabinet but by clinicians trying to do their very best for sensitive claimants.
Hon Annette King: I seek leave to table a document from the ACC, dated 30 July 2010, that points out that no work was done on the clinical framework or clinical pathway prior to 2009.
Mr SPEAKER: Leave is sought to table that document. Is there any objection? There is no objection. Document, by leave, laid on the Table of the House.
Hon Annette King: I raise a point of order, Mr Speaker. The Minister said that he had quoted from official documents from the ACC. I ask that he table them.
Mr SPEAKER: No, I do not believe that the Minister had an official document in his hand when he was answering that question.
Michael Woodhouse: What were underlying concerns that the ACC had that led to the changes, and has the Minister received any advice on whether those concerns were valid?
Hon Dr NICK SMITH: The concern that the corporation’s clinicians had, backed up by comprehensive research, was that ongoing unlimited counselling of victims of sexual abuse could lead to more harm than good. The clinical panel has confirmed the validity of this research and the need for professional oversight by psychiatrists and psychologists to ensure that long-term counselling is both beneficial and appropriate. I am advised by the clinical panel that where the corporation erred was in requiring such an assessment for all claimants when insufficient professional support was not available, resulting in unacceptable delays in providing care. I am confident that with the support and advice of the independent clinical panel we can improve the support provided for sensitive claimants.
Craig Foss: I raise a point of order, Mr Speaker. During that exchange, and prior to it, the member Darren Hughes questioned whether the Minister was telling the truth, quite a few times. Members cannot do that; all members are honourable. I ask that the member reflect on that and withdraw.
Mr SPEAKER: The member has taken offence, and, strictly, the member should not imply—
Hon Darren Hughes: I was very careful in what I said, Mr Speaker. I—
Mr SPEAKER: The member will not repeat what he said. I heard very clearly what the member said. Another member has taken offence. A member should not imply that another member is not telling the truth. I ask the Hon Darren Hughes to stand, withdraw, and apologise.
Hon Darren Hughes: I withdraw and apologise.
Mr SPEAKER: Lynne Pillay; a supplementary question. [Interruption] I say to the Labour front bench that I have called one of their colleagues. I expect them to show some courtesy to their own colleague.
Lynne Pillay: Will the Minister now require the ACC to identify the estimated 2,000 people who were unable to participate in his Government’s accident compensation process because it was too traumatic; and will he offer them counselling?
Hon Dr NICK SMITH: As of Monday the corporation is offering 16 counselling sessions for those people who seek the services of counsellors. The corporation will work through a final solution when the full report is available from the independent clinical panel. I point out to the members opposite who are interjecting that way in excess of 2,000 accident compensation claimants were turned down for counselling during the time of the previous Government. In fact, when Labour was in Government, half of those who sought counselling were turned down.
Hon Annette King: When the Minister said in the Nelson Mail last week that “Some days I’m in politics and I think, ‘What the hell am I doing?’”, will he now accept that the victims of his bungled policy are asking the same question?
Hon Dr NICK SMITH: It is a pity that the member chooses to selectively quote. The overwhelming point I would make—[Interruption] Well, the comment was made in reference to visiting an oil rig in Tasman Bay, and I am not sure that that is particularly relevant to the issue of sensitive claims. Members opposite have attempted to play politics with this highly sensitive issue. [Interruption] They have—they have played it for all it is worth, when all the papers show that this issue is, in essence, a clinical issue in which neither I as Minister nor the board, for that matter, has made substantive decisions.

http://www.scoop.co.nz/stories/PA1008/S00258/questions-and-answers-17-august-2010.htm

Questions for written answer

9554 (2010). Lynne Pillay to the Minister for ACC: What, if any, papers has the Minister taken to Cabinet, relating to sensitive claims and or ACC’s Sensitive Claims Unit since 1 January 2010, by date and title?
Hon Dr Nick Smith (Minister for ACC) replied: I have taken no papers to Cabinet relating to sensitive claims or ACC Sensitive Claims Unit since I became Minister. The changes to the management of sensitive claims have been made entirely by ACC, involving medical practitioners based on the guidelines produced by Massey University and launched by Hon Steve Maharey in March 2008. The only decision I have made is to initiate an independent clinical review.
http://www.parliament.nz/en-NZ/PB/Business/QWA/9/0/e/QWA_09554_2010-9554-2010-Lynne-Pillay-to-the-Minister-for-ACC.htm

9589 (2010). 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, if any?
Hon Dr Nick Smith (Minister for ACC) replied: I refer the member to the answer to Parliamentary Written Question 09590 (2010).
http://www.parliament.nz/en-NZ/PB/Business/QWA/4/3/9/QWA_09589_2010-9589-2010-Lynne-Pillay-to-the-Minister-for-ACC.htm

9590 (2010). Lynne Pillay to the Minister for ACC: How many sensitive claims, if any, have been declined by ACC that involve counselling for sex abuse victims and/or victims of domestic violence in Wairarapa since 1 November 2009?
Hon Dr Nick Smith (Minister for ACC) replied: Claims, commonly known as ‘sensitive claims’, receive cover under the ACC scheme when there is a significant mental injury as a result of certain criminal acts, dealt with in the Crimes Act 1961. Section 21 of the Accident Compensation Act details the cover provisions for such claims. The twenty specific criminal acts covered by ACC are stipulated within Schedule 3 to the Accident Compensation Act. ACC does not keep specific data on claim numbers for counselling accepted, declined or pending. Data is kept on claim numbers of which counselling may be one of the treatment options.
http://www.parliament.nz/en-NZ/PB/Business/QWA/0/b/6/QWA_09590_2010-9590-2010-Lynne-Pillay-to-the-Minister-for-ACC.htm

9591 (2010). Lynne Pillay to the Minister for ACC: What sensitive claims, if any, 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: I refer the member to the answer to Parliamentary Written Question 09590 (2010).
http://www.parliament.nz/en-NZ/PB/Business/QWA/0/7/b/QWA_09591_2010-9591-2010-Lynne-Pillay-to-the-Minister-for-ACC.htm

ACC - Clinical Pathway to Lala Land

A blog entry from K1W1 by Jax

Like a few people I imagine, I'm pretty much playing "catch up" on the ole ACC saga. Sure, I saw the protests on TV some months back and yeah, I've heard rumbles from some about the "hideous" recommendations, but I never really thought more about it until I flicked through emails sent to me by another member.
Within two days of sifting through her copious emails I was livid. She's not a reporter but she sure as hell could give some of our current ones a run for their money. She's a nurse, a psych nurse, and she's deadly passionate about the changes not only in the legislation but in the effect it's having on those close to her. This is a woman who entered into the health profession with a sense of pride and today, she's "gutted" by her own health professional's unethical decisions. In short, she feels ashamed of them.

Read the rest of this entry at http://k1w1jax.blogspot.com/2010/05/acc-clinical-pathway-to-lala-land.html

Question to Minister: ACC - New sexual abuse clinical guidelines

LYNNE PILLAY (Labour) to the Minister for ACC: Is he satisfied that the new sexual abuse clinical guidelines used in ACC’s Sensitive Claims Unit are offering “the best treatment possible”?
Hon Dr NICK SMITH (Minister for ACC): The new guidelines are a consequence of work initiated under the previous Labour Government. The launch of the Sexual Abuse and Mental Injury: Practice Guidelines for Aotearoa New Zealand was done by Steve Maharey in 2008. I have consistently refused to interfere in clinical decisions in this sensitive area, other than to emphasis the importance of Accident Compensation Corporation (ACC) complying with the Act and ensuring these vulnerable claimants receive the best possible clinical treatment. To ensure I am satisfied, this month I am initiating a clinical review.
Lynne Pillay: When will the Minister admit that the new imposed ACC guidelines were not designed by *Massey University, which has publicly disassociated itself from those guidelines; and that those new guidelines do not give the best treatment possible; rather, they re-victimise victims of crime?
Hon Dr NICK SMITH: It is quite the contrary, I assure the member that ACC’s clinical guidelines were based on the research report launched by Steve Maharey and done at Massey University.
Michael Woodhouse: Who has he offered to consult on the membership and terms of reference for the independent clinical review of ACC’s sensitive claims?
Hon Dr NICK SMITH: In the House and in writing I have offered to consult with the Labour Opposition on both the personnel and the terms of reference for the clinical review. I am disappointed that Labour has refused input, and this shows that Labour is more interested in politics than the genuine clinical care of sexual abuse victims.
Lynne Pillay: Does the Minister not understand that Labour will not participate in this sham review of the ACC pathway, because it would be a complete waste of time and taxpayers’ money, given that ACC’s figures show that 18 months ago some 300 people were approved for counselling each month and now fewer than 12 people are approved in a month?
Hon Dr NICK SMITH: I think what might differ between members of the Government and the Opposition is our view that clinical decisions should be made by clinicians. I am disappointed that when the Opposition was offered a role in the appointment of the independent clinical review, it refused. When I offered to consult with the Opposition about the terms of reference of the review, it refused. It is a bit rich for those members to say the review is a sham when it has not even started.
Lynne Pillay: Is the Minister aware that the New Zealand Association of Psychotherapists passed a unanimous resolution at its annual conference calling for the imposed ACC sensitive claims pathway to cease and to return to a system that ensures that survivors of sexual abuse receive the support they need and deserve?
Hon Dr NICK SMITH: I get different views from different clinical professionals. The view I have taken is that my expertise is not in this sensitive area. That is why I have said that the best way forward is an independent clinical review of those guidelines that were launched as a consequence of work, including that by Steve Maharey, done when Labour was in Government.
Mr SPEAKER: The Hon Lianne Dalziel.
Lynne Pillay: Point of order—
Mr SPEAKER: I apologise. The member was calling a point of order, but it is withdrawn.
Hon Lianne Dalziel: Is the Minister saying—
Hon Dr Nick Smith: I raise a point of order, Mr Speaker. I think that Lynne Pillay had the call prior to Lianne Dalziel.
Mr SPEAKER: The Speaker is the sole judge of who will be called. I apologise for that interruption.
Hon Lianne Dalziel: Is the Minister saying that in fact there has been no change to the operation of the guidelines since the National Government has been in place, and has he received any representations from the Minister of Justice about the impact the changes in implementation have had on the work he has been doing in respect of victims of sexual violence?
Hon Dr NICK SMITH: The first point I make is that the Government, as in Ministers, has had absolutely no influence on the work of the clinical guidelines, because I have taken the quite appropriate view as a Minister that it is not for me to be involved in setting—
Hon Lianne Dalziel: I raise a point of order, Mr Speaker. I asked a very straight question: “Is the Minister saying that the guidelines are being implemented exactly as they were prior to the change in Government?”. The Minister is attempting to talk about whether he has had any interference. There was nothing in my question that asked whether there was ministerial interference. I would have to assume that that would be—
Mr SPEAKER: The member will resume her seat. The member’s point of order is perfectly fair up until that point—
Hon Dr NICK SMITH: Point of order—
Mr SPEAKER: —I am on my feet—questioning whether the Minister was answering her question. The question asked whether the implementation of the guidelines changed, as I understand it, from those being administered by the previous Government. The member wanted to raise a point of order in response, and I will hear the Hon Dr Nick Smith.
Hon Dr NICK SMITH: I raise a point of order, Mr Speaker. The difficulty with the member’s question is that she asserted that the Government had changed the process of the guidelines, implying that Ministers had. I wanted to make it plain to the House that that assertion—
Mr SPEAKER: The Minister is entering into debate. I suggest that the easiest way to resolve this is to ask the member to repeat her question without penalty and for her to keep it brief. If she adds further phrases to it, the Minister is at liberty to pick on whatever part he chooses.
Hon Lianne Dalziel: Is the Minister saying that the guidelines are being implemented exactly as they were being implemented prior to the change of Government, and has he received any representations from the Minister of Justice about the impact that the change in implementation has had on the work that is being done with victims of sexual violence?
Hon Dr NICK SMITH: Yes, I have had a number of discussions with the Minister of Justice about this sensitive area. In respect of the guidelines, the new ACC guidelines were based on the guidelines developed by Massey University, which were launched by Steve Maharey in March 2008.
Hon Lianne Dalziel: The Minister has done exactly the same thing again. I asked whether—
Mr SPEAKER: The member will resume her seat. I listened very carefully to the member’s question. I have warned the member about adding two parts to a question. The Minister picked up on the second part of the question and answered it perfectly fairly and properly, and that is as far as I can assist the member. The remedy is in members’ hands when asking questions.
Lynne Pillay: I seek leave to table a copy of a resolution that was passed unanimously by psychotherapists calling for a halt to the imposed ACC pathway, and a return to—
Mr SPEAKER: Leave is sought to table that document. Is there any objection? There is no objection. Document, by leave, laid on the Table of the House.
Lynne Pillay: I seek leave to table my correspondence to the Hon Nick Smith stating that Labour would not participate confidentially in an ACC review process—
Mr SPEAKER: Leave is sought to table that document. Is there any objection? There is objection.
Lynne Pillay: I seek leave to table correspondence from Massey University* stating the rules for sexual abuse claims were not developed by Massey University, but by ACC itself.
Mr SPEAKER: Leave is sought to table that document. Is there any objection? There is objection.
http://www.scoop.co.nz/stories/PA1004/S00029.htm

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

Sensitive Claims Unit changes raise concern

An editorial from the Otago Daily Times by Sandra Buchanan

Today, ACC minister Nick Smith is expected to announce that levies will rise and entitlements will be cut. Sandra Buchanan takes a critical look at the proposed reduction in counselling through the Sensitive Claims Unit.
Since 1972, children, women and men who have been mentally injured, as a result of sexual abuse, have been able to access counselling funded by ACC's Sensitive Claims Unit. ACC has recently announced policies to change and substantially limit this - their new Clinical Framework.
Today, ACC Minister Nick Smith is expected to reveal about 20 areas across ACC's purview where it is looking to cut back entitlements.
As a registered psychotherapist and ACC-registered counsellor, I have grave concerns about the proposed Sensitive Claims Unit changes. These concerns are shared by the majority of the providers of services, both clinicians and NGOs.
Since the changes were first proposed by ACC in early August, we have been providing thorough, research-based evidence to support our claim that these changes are poorly conceived and potentially dangerous to clients. Professional associations are united in their opposition to the plans.
ACC has denied the changes have anything to do with cost-cutting and in fact the greater report-writing and external assessments being proposed will have higher administrative costs. It is already the case that for every $19 million spent annually on administrating the Sensitive Claims Unit, only $2 million actually goes to counselling.
Some minor changes have been made to the new framework since it was first proposed. One such change means there will no longer be a categorical divide between the clinician assessing the client and the clinician providing the treatment - such a separation could have meant that a client saw up to three health professionals (including first disclosing to a GP) before any actual treatment began.
It appears ACC is also backtracking on providing two sessions only for the therapist and client to produce a report which determines cover. Four sessions has been the norm till now but even that was quite limited. It is not simple for someone to disclose very personal and traumatic information that they may not have spoken of previously at all.
Of most concern however, and there seems no sign of ACC rethinking on this, is that most clients will receive 16 sessions only, with any further treatment needing to be approved by an external assessor or internal ACC multi-disciplinary panel. ACC note in their latest document that it is unlikely there will be many clients in this group.
ACC says it is basing these changes on research undertaken for them by Massey University last year, the so-called Massey Guidelines, although many of their conclusions cannot be drawn from this work. ACC states that best clinical outcomes for the majority of clients can be achieved through shorter-term programmes of focused intervention.
Clinicians and other experts in the field take issue with this statement. Sixteen sessions of brief, focused psychotherapy may well assist previously functional adults who have sustained a one-off sexual assault, to recover their lives. It is totally insufficient for the clients that I typically work with, as a psychotherapist.
Individuals unfortunate enough to face childhood sexual abuse (particularly that which has occurred frequently and at the hands of a trusted family member or friend) will typically have experienced such profound assaults on their sense of trust, that their ability to form an attachment with others will be impaired.
In such a situation it may take the full 16 sessions and many more for the client to form the necessary therapeutic relationship for any treatment of the trauma to occur.
It is also of great concern that ACC is demanding that every client now have a psychiatric diagnosis to be eligible for ACC-funded counselling.
Many sexual abuse survivors do, of course, struggle hugely with depression, anxiety or post-traumatic stress disorder, which are psychiatric diagnoses - some, however, require assistance to reclaim their lives and do not have symptoms such that they would meet the criteria for such a diagnosis.
In general, therapists prefer a more holistic approach that sees the person, with their strengths and struggles, rather than a diagnosis.
At present, ACC typically requires progress reports after every 20 sessions or so, and an external assessment after about 50 sessions.
This system, to my mind, has generally worked well for years. It is now proposed that reports be done every four weeks and external assessments much more frequently. It feels as if those of us in the field are not being trusted to make our own decisions, regarding our clients' treatment.
All counsellors belonging to reputable professional bodies already have regular clinical supervision where assessment of our treatment plans for sensitive claims clients could be reviewed.
It is already the case that there are insufficient ACC-registered counsellors, particularly in specialist areas such as working with children or Maori/Pacific Islanders. There is also scarce provision outside of the major urban centres.
Therapists are so concerned about the possible dangers to clients of these changes that discussion has been given to whether it will actually be ethical to continue this work at all.
It is highly likely some counsellors will no longer provide services to ACC under these circumstances, making it even harder for clients to access therapy. (It is important to stress however that no-one is suggesting treatment of existing clients will be affected.)
The new system depends either on NGOs, such as Rape Crisis, or the public mental health services, being able to step in to provide safety for clients during extensive delays while decisions are made by the Sensitive Claims Unit.
Both NGOs and public services are already extremely stretched, as we well know. A client has to be very psychiatrically unwell to meet the criteria for services within the public mental health system, whose brief is to cover the 3% of the population with moderate to severe psychiatric disorders.
We hear a lot in the news about limited provision of services to victims of crime as opposed to offenders. ACC's system of providing counselling to those who have been victims of sexual offending was a fantastic example of actually providing some help before the ambulance at the bottom of the cliff.
It did mean assistance for victims and was about empowering individuals to recover their lives after abuse. It is also clearly minimally expensive compared with the costs of keeping offenders, many of whom have suffered their own childhood abuse, in prison for years.
None of these arguments has made any difference to the policy makers at ACC or the Government, which has been very quiet on the issue. This is a real concern for democracy.

http://www.odt.co.nz/opinion/opinion/77958/sensitive-claims-unit-changes-raise-concern

GPs welcome evidence-based care guidelines

Press release from the Royal NZ College of General Practitioners

The Royal New Zealand College of General Practitioners has welcomed moves by ACC to follow evidence-based care guidelines for sensitive claims clients.
College president, Dr Harry Pert, said the new guidelines will ensure patients receive best practice care that has been proven to deliver optimum results.
“The team approach has been proven to be the most effective in cases of mild to moderate mental injury.” Dr Pert said.
“Recent pilot programmes have shown that very good results come from doctors working together with counsellors, psychologists and others.”
“ACC’s practice guidelines for sexual abuse and mental injury will strengthen these results still further. All the clinical evidence suggests the new approach ACC is adopting will be in the best interests of the patient,” Dr Pert said.
“By working with psychologists early on, GPs, counsellors and others will be able to provide the best and most focussed care possible.”
ACC’s new treatment framework is in line with the recommendations of the Massey guidelines for the assessment and treatment of mental injury as a result of sexual assault and sexual abuse.
Published in 2008, the Massey guidelines outline a clear, evidence-based approach for the most effective treatment and rehabilitation of people who have suffered sexual abuse.
“The provision of safe, quality treatment and care that suits patients’ needs and provides them with the very best health outcomes, is a major goal of the College. It is very pleasing to know that ACC’s new approach is based on extensive research and clinical evidence,” Dr Pert said.

http://www.scoop.co.nz/stories/GE0911/S00005.htm