ACC overhauls sexual abuse care service

A news report from Radio New Zealand News by Michael Cropp

The Accident Compensation Corporation has overhauled its sensitive claims service, with its minister saying it made big mistakes in the way it dealt with victims of sexual assaults.
Before 2009, ACC accepted thousands of sensitive claims, but after changes to the system that number plummeted, and in 2011 just 135 claims were accepted.
Survivors' advocate Louise Nicholas said the impact when ACC clamped down on the numbers of claims it accepted was devastating and in some cases victims committed suicide. Support workers no longer wanted to be part of the system, she said.
"We lost hundreds upon hundreds of counsellors who refused to work in such an inhumane system," she said.
"We lost survivors, and I mean literally, lost survivors. So people just backed right off and said 'we don't want a part of this'."
Ms Nicholas had been a member of a panel that worked to overhaul what she said was a highly bureaucratic process which re-traumatised sexual assault survivors and denied them the help they needed. Many struggled with ACC forms asking them what kind of accident they had had - while constant assessments to qualify for assistance wore people down.

More support
Under the new service, that is set to change. There will be a support package for people who have suffered sexual abuse or assault, access to therapy is free and people are covered for longer. People are also able to enter and exit the system for support at any time. As well as the person who was sexually assaulted or abused, family and whānau are also able to seek help free of charge. The form, too, has changed to reflect the sensitivities of the situation.
ACC strategy manager for sexual violence, Emma Powell, said the changes required a big re-think of how ACC dealt with clients.
"It's a tailored response and a tailored approach, trying to put as much control back into the hands of our clients."
The client is able to choose who they see and if things were not working out the Sensitive Claims team would arrange an alternative.
"We talk about the fact that the counsellor-and-client relationship is critical to success, so if it's not working we need to offer ways that people can seek other supports," she said.
The public issues Chair for the NZ Association of Psychotherapists, Kyle MacDonald, worked with sensitive claims clients and helped advise ACC on the changes. He said the new system was much more sympathetic to a survivor's needs.
"I think that ACC have engaged really willingly in the process of recognising that actually the system wasn't working and that they needed to fix it," he said. "they have essentially redesigned a services which looks to address a lot of the concerns raised [in 2012]."
ACC Minister Nikki Kaye, said the old system was not working, and she wanted people to know it had changed.
"There's a lot of work to do, both around how do we prevent these things from happening, but then how do we make sure people are cared for right throughout government," she said.
The Minister said the changes were just the start of a much bigger process, which she hoped would provide better care for survivors and help prevent the violence from happening.

* If you, or someone you know, is affected by sexual violence you can find out more about these services at ACC Find Support site or call the ACC sensitive claims team on 0800 735 566.

© 2015 Radio New Zealand

http://www.radionz.co.nz/news/national/267591/acc-overhauls-sexual-abuse-care-service

ACC privacy ruling welcomed for sensitive claimants

A press release from the New Zealand Association of Psychotherapists

Yesterday’s District Court ruling, that the standard ACC release of information form the “ACC 167” is illegal, has been welcomed by psychotherapists and clinicians working with sexual abuse survivors.
“The Disley Independent Clincial review of the ACC’s treatment of sensitive claimants, undertaken in 2010, outlined serious concerns about this form and the ACC’s approach to the gathering of health information. This decision is welcomed, but long overdue” says Kyle MacDonald, New Zealand Association of Psychotherapists Public Issues spokesperson.
The Disley review included a legal opinion, which noted concerns about the ACC 167, and explained the limitations that apply to the collection of health information. Those working with all ACC claimants, and specifically in the sexual violence sector, have long expressed these concerns.
“We’ve known for a long time that this form, and its implementation, has caused specific problems for sensitive claimants” says Kyle MacDonald, “it has been common practice for the ACC to request ALL of a claimants GP or Mental health notes, and not accept a health professional acting in accordance with the Privacy act by providing only those parts of the record relevant to the claim. Furthermore the ACC have quite explicitly declined to advance a claim if individuals refuse to sign the waiver due to quite legitimate privacy concerns.”
This has set up a perception that ACC have gone on “fishing expeditions” for reasons to decline claims, rather than sticking to the limits of the Privacy Act, like all other health professionals are required to do.
“Hopefully this decision allows people who have had their claim declined due
to the illegal acquisition of health information to have their claim revisited. It should also allow those who have had their claim declined due to their refusal to sign this form to also re-apply for cover and treatment.”

http://www.scoop.co.nz/stories/PO1404/S00230/acc-privacy-ruling-welcomed-for-sensitive-claimants.htm

ACC assessments also key for sensitive claimants

A press release from the New Zealand Association of Psychotherapists by Kyle MacDonald

Last night’s shocking expose on TV3’s 60 minutes showed how even “insiders” from ACC admit that a deliberate process of using medical assessors favourable to ACC has lead to a clear and dramatic increase in the “exit” of long term claimants from the ACC’s books.
This approach also continues to detrimentally affect survivors of sexual abuse and violence, or “sensitive claimants” says psychotherapist Kyle MacDonald.
“What was not widely reported with the release of the recent monitoring report of the Independent Clinical Review of the Sensitive Claims treatment pathway was how the ACC’s independent assessors are also preventing New Zealander’s accessing counselling.”
To access ongoing counselling, beyond sixteen support sessions, the client must have a cover determination report, or an external psychological assessment. This is usually conducted by an ACC appointed and contracted assessor.
“What is shocking is to me is that the report details that less than 4% of claims have been accepted based on these assessors reports, in 2011 and 2012. This is down from roughly 60% in 2008.” says MacDonald. “I believe this is further evidence of the cynical management detailed by 60 minutes. The idea that only 4 out of every hundred clients require more than four months of counselling to recover from sexual abuse and trauma makes no clinical sense.”
“It’s also clear that from the clinicians and clients I talk to that all the problems outlined with 'hatchet' assessors, outlined in last nights report also apply to long term Sensitive Claimants and the ACC’s psychological and psychiatric assessments.”
The “Monitoring Report on the Recommendations from the Independent Panel’s Review of the ACC’s Sensitive Claims Treatment Pathway: 18 months follow up” was released on the 17th of July, 2012. The quoted statistics can be found on p. 29.

http://www.scoop.co.nz/stories/GE1209/S00048/acc-assessments-also-key-for-sensitive-claimants.htm

Dual investigations shows culture problems at the ACC

A press release from the New Zealand Association of Psychotherapists by Kyle MacDonald

Today’s dual reports from the Privacy Commisioner and the Office of the Auditor General into the privacy breaches at the ACC show deep concerns about the manner in which privacy is handled, and shows systemic weaknesses within ACC’s culture, systems and processes.
“This report will do little to reassure all those who were effected by the privacy breach and it is very clear that the ACC’s approach to privacy is still of deep concern and clear deficiencies remain,” says Kyle MacDonald of the New Zealand Association of Psychotherapists. “Along with the Auditor General’s report released today, I believe this underlines the fact that there have been, and remain, ongoing problems with the organizations culture.”
“It seems to me that despite ongoing statements by the ACC to the contrary, the blame for this massive breach of privacy and the subsequent frustrations of Ms. Pullar in trying to have her concerns heard, land squarely at the feet of the ACC and senior management. The ACC’s efforts to attack and dis-credit Ms Pullar should now also be called into question.”
The independent report commissioned by the Privacy Commissioner describes an “almost cavalier” approach to the management of private claimant information, and that “the importance of personal information and respecting individual’s personal information is not consistent and is often de-emphasised over dealing with the management of the claim/claimant."
Both reports emphasise the failures of Governance and the systemic and cultural issues that lead to the privacy breach and the way that subsequent events were handled.

http://psychotherapy.org.nz/dual-investigations-shows-culture-problems-at-the-acc/

Abuse survivors struggling to access ACC

An article from Stuff by Paloma Migone, Stacey Kirk and Danya Levy

Therapists are having to "pick up the pieces" for the adult survivors of childhood sexual abuse because they are not getting the help they need from ACC, a leading psychotherapist says.
New Zealand Association of Psychotherapists spokesman Kyle MacDonald said progress made by ACC since changes to the way they handle sensitive claims were brought in has been too slow in coming.
"It’s fair to say there have improvements but it’s nowhere near enough. They’ve had 18 months to put these systems in place now."
Dr Barbara Disley yesterday released the second monitoring report of ACC’s progress on the development and implementation of 14 recommendations given by a 2010 Sensitive Claims Clinical Pathway review. She said there were concerns within the sector over the processes around independent assessment for cover.
"While there have been improvements, including the ability of the support counsellor to attend these assessments with the client, the narrow range of tools applied to determining mental injury and the limited number of professional groups who can administer these tools leads to bottle necks and delays in cover determination," she said.
"ACC needs to urgently review the assessment processes within the adult claims coverage context and broaden the range of tools and professional groups capable of undertaking these assessments."
Dr Disley said it was particularly important for adult survivors of child sexual abuse as the needs of the group were often complex and required specialist knowledge.
"A specific focus on the needs of this group needs to be now initiated," she said.
The number of clients that moved through the cover assessment process was low, falling dramatically from 5919 in 2007 to 235 last year.
Dr MacDonald said that was a "horrible number".
“This is clear evidence that the ACC’s policies are still failing New Zealanders and survivors of sexual abuse. And it’s worth remembering this report pre-dates the privacy breach of over 6000 ACC claimants, and subsequent events.”
Dr MacDonald, who sits on the Sensitive Claims Advisory Group, which ACC regularly meets, said the low number of successful claims was a direct result of the changes.
"This report demonstrates how victims of sexual abuse and assault are still struggling to access the support they are entitled to as a direct result of the National Government-led cost cutting drive in 2009. The fallout of this ill-informed policy is still being felt."
Among the changes that resulted four months later was a rule that new claimants and people waiting for a decision on whether they qualified for treatment could get 16 hours "initial support". These 16 free sessions have to be undertaken by an independent, but ACC appointed, assessor.
"The idea of going to talk to a complete stranger is sometimes one of the worst thoughts imaginable for our clients, and they have to go in there and open up to someone they barely know about some of the most traumatic experiences from their past," Dr MacDonald said.
He said clients were simply choosing not to go through with it.
"I think it was probably something that many psychotherapists and clinicians were expecting when the changes came into play. We’re essentially trying to pick up the pieces from an idea that was theirs in the first place."
The report said ACC urgently needed to review its assessment process for adult survivors of childhood sexual abuse with mental injury. In the report, Dr Disley also said Maori must be given priority as progress in that area had been slower than expected.
However, the process for children and adolescents in relation to accessing immediate support and moving through the cover process had improved. Overall, Dr Disley found ACC had made "excellent progress" implementing one recommendation and good progress on another six.
"There’s still work to be done in some areas," she said.
Greens ACC spokesman Kevin Hague said the Government and ACC had created a culture of "severe disentitlement" when it came to sensitive claims. ACC was purposely making it harder for clients to get their claims accepted following evidence released by the Greens showing ACC staff were paid bonuses for cutting claimants from the ACC books, he said.
ACC Minister Judith Collins said there had been progress on all but one recommendation but there was still more work for ACC to do.
"Obviously not everything that has been recommended has been completed to the level it should have been. I expect most of them will be completed in the next 18 months."
ACC was undertaking major changes in the area of sensitive claims, 范she said.
"Ultimately they have to make sure they make those changes sustainably and right through the organisation."
The 2010 review, requested by then ACC Minister Nick Smith, made 14 recommendations, including that a process be established to independently monitor the development and implement the review’s suggestions.

© 2012 Fairfax New Zealand Ltd

http://www.stuff.co.nz/national/politics/7297268/Abuse-survivors-struggling-to-access-ACC

ACC sensitive claims monitoring report a “fail” mark

A press release from the New Zealand Association of Psychotherapists by Kyle MacDonald

The 18 month follow up monitoring report of the ACC Sensitive Claims Clinical Pathway shows clearly that only three of the 14 recommendations have been fully met.
“I consider this a fail mark” says Kyle MacDonald. “This report demonstrates how victims of sexual abuse and assault are still struggling to access the support they are entitled to as a direct result of the National Government led cost cutting drive in 2009. The fallout of this ill-informed policy is still being felt.”
The report details some areas of improvement, but strong concerns remain around the use of external ACC appointed assessors, implemented in 2009 due to the ACC’s “reinterpretation” of the legislation. Also of concern is the manner in which the Sensitive Claims pathway often fails survivors of childhood sexual abuse.
Detailed in the report is the massive decrease from 40% of claims accepted versus claims lodged in 2009; down to 4% in 2011 and 2012. “This is a horrifying number.” says MacDonald. “This is clear evidence that the ACC’s policies are still failing New Zealanders and survivors of sexual abuse. And it’s worth remembering this report pre-dates the Privacy Breach of over 6000 ACC claimants, and subsequent events.”

http://www.scoop.co.nz/stories/PO1207/S00197/acc-sensitive-claims-monitoring-report-a-fail-mark.htm

Survivors' trust in ACC at rock bottom

A press release from the New Zealand Association of Psychotherapists

ACC has once more shown its lack of understanding of the needs of survivors of sexual abuse. Whilst it is clear that the privacy breach this week of 6000 individuals' private health information is of concern to all New Zealanders, of particular concern is today’s admission by ACC that the details of sensitive claimants has been circulated outside of the sensitive claim unit for “a number of years.”
“This is a clear breach of trust by ACC, and contrary to all policies and previous understandings of how sensitive claims should be handled,” says Kyle MacDonald, of the New Zealand Association of Psychotherapists.
The Sensitive Claims Unit specifically handles the claims related to sexual abuse and assault, and all information is required to remain only with that unit, an additional level of privacy required due to the sensitive nature of these claims.
“The trust that sexual abuse survivors have in ACC is undoubtedly at rock bottom. Sensitive Claimants have already had to endure incompetently implemented changes to their treatment pathway in 2009 and now despite an independent review and multiple assurances from ACC, we discover that the ACC continue to act with blatant disregard for the rights of survivors.”
The Sensitive Claims treatment pathway, for survivors of sexual abuse and assault is in its final phase of being reviewed, a process that commenced in 2009 in response to the ACC’s changes to their treatment pathway and subsequent protest from all professional groups involved in the provision of treatment.
“ACC have breached their own internal process by circulating sensitive claimants information outside of the unit set up specifically to protect their privacy. To ensure this thoroughly investigated I have made a specific complaint to the privacy commissioner asking her to investigate and review the privacy of the sensitive claims unit.”

http://www.scoop.co.nz/stories/GE1203/S00081/survivors-trust-in-acc-at-rock-bottom.htm

Survey for the ACC sensitive claims 18 month review

An email from Kyle MacDonald

Dear Friends,
This email relates to a survey for ACC Sensitive Claims Providers ("Counsellors") and clients. If you are neither, I apologise for taking your time. Please feel free to read no further and delete this email.
The last step of the Independent Clinical Review of the ACC Sensitive Claims Treatment Pathway is nearly upon us, namely the 18 month follow up review. As part of that process representatives of the various professional bodies will be meeting with Barbara Disley, the review's lead author in late March to discuss how ACC are going with implementing the changes mandated in the initial review report.
As part of my role as the New Zealand Association of Psychotherapists (NZAP) representative I am circulating a survey open to all Sensitive Claims treatment providers and clients. All individual responses are anonymous, and it will only take about 5-10 minutes of your time. See this link for the survey:  https://www.surveymonkey.com/s/VVXGXXS
Please take the time to complete this survey, your responses are important and it will be the last chance we all have to give feedback to ACC before the review is officially completed. The survey will be closed midnight on Friday March the 9th.

Kind regards,
Kyle MacDonald
www.psychotherapy.org.nz

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/

Psychotherapists welcome review report

A press release from the NZAP by Kyle MacDonald

The New Zealand Association of Psychotherapists welcomes the Independent Review Panel´s report into the ACC´s failed new clinical pathway and its recommendations for changes.
"The report is clearly an indictment of both the intention and application of the change process ACC embarked on in October last year," says Kyle MacDonald, NZAP spokesperson. "It is validating for all clinicians and survivors that the review panel´s report echoes the concerns that we have had since the very first draft of this new pathway was released."
Most damning is the review panel´s view that "the Panel found no evidence of formal planning for implementation ... Evidence obtained from presentations and submissions was that implementation was poorly planned without adequate consideration of the impact on clients and the Pathway was introduced prematurely and precipitously." They further have grave concerns about the fact that ACC failed to follow rudimentary processes about change implementation required of State Services.
"The picture is one of grave incompetence, and New Zealanders deserve to now know how this was allowed to happen," says MacDonald.
Of most encouragement to clinicians and survivors will be the clear recommendation that ACC cease using the DSM-IV as the measure of a mental injury, and that the legal opinion obtained by the review panel states that ACC have "over-reached" in their interpretation of the law justifying this. Furthermore the review states that the higher level of proof of "causality" is not supported by the current common law.
"The key thing now is for ACC to quickly implement all the recommendations, and remove the unreasonable impediments to survivors wanting to access treatment. While some moves have been made in the right direction, we will wait and see how the actual implementation of these recommendations plays out over the net few months."

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

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/

ACC admits new guidelines introduced too quickly

A report from Radio New Zealand News

The Accident Compensation Corporation (ACC) says it may have moved too quickly in changing the way it handles sexual abuse claims.
New guidelines for sexual abuse sufferers introduced by the Government last year legally require the ACC, when considering the cases of people who say they have been sexually abused, to concentrate only on those who have a diagnosed mental injury.
Official figures show that only 15.6% of claims for sexual abuse counselling have been accepted: 178 out of 1137 since last October.
Labour's victims rights spokesperson, Lynne Pillay, says the figure is alarming. She says the new assessment procedures actually make the situation worse for sexual abuse victims.
ACC's general manager of claims management, Denise Cosgrove, says it might have moved a bit too quickly towards implementing the new approach.
Nearly 90% of the members of the Psychotherapists Association have chosen not to do assessments under the new guidelines and are questioning whether they are ethical.
An independent clinical review of the sensitive claims system is due to be provided to the ACC Minister next month.

Copyright © 2010 Radio New Zealand

http://www.radionz.co.nz/news/stories/2010/06/18/12480a348789

ACC failing to help most sex abuse victims

An article from the New Zealand Herald by Simon Collins

Almost 90 per cent of accident compensation claims for sexual abuse counselling have been either turned down or held for more information since tough new rules came into force last October.
Official figures from the Accident Compensation Corporation (ACC) confirm reports from counsellors that hundreds of victims of rape and other sexual abuse are being turned away from counselling.
Thousands more have been scared off applying for counselling, as the numbers applying have halved from a reported 550 a month last year to an average of 250 a month in the first six months after the new rules came into force on October 27.
Only 178 of the 1498 victims who applied for counselling in the six months to April 30 were accepted for counselling, an acceptance rate of 11.9 per cent.
Comparative data for recent years is no longer available on the ACC website, but ACC said in 2001 that 93.8 per cent of the sexual abuse claims received in the year to June 2001, or 5229 claims, were accepted.
A panel appointed by ACC Minister Nick Smith to review the new rules has agreed to attend what is said to be the world's first "sexual abuse survivors' summit" to hear submissions at the Auckland University of Technology's North Shore campus on Sunday. Written submissions to the panel close today.
Rape Prevention Education survivor advocate Louise Nicholas said the summit was initiated by counsellors who were concerned that they could no longer help many of the victims of sexual crimes who came to them. "It's inhumane what's going on," she said. "The good thing about it is that this review panel want to attend the summit so they can talk to survivors face to face. We are looking at anywhere between 100 and 300 people if not more."
The new rules restrict ACC counselling to victims who have "a diagnosed mental injury resulting from sexual abuse or assault".
ACC claims manager Denise Cosgrove said this was laid down by law, but ACC was for many years "acting beyond its mandate and providing services to people not covered by its legislation". She said almost half (46 per cent) of the claims rejected in the six months to April came through a new emergency health service for sexual abuse victims and were declined "because at the time of lodgement for most people there is no mental injury, only an acute event".
Other claims were rejected because the client decided not to accept help (18 per cent), did not provide enough information (18 per cent), had "no new or clear mental injury" (7 per cent), the mental injury was not clearly due to the sexual abuse (6 per cent) or the sexual abuse was not established (4 per cent).
The Psychotherapists' Association representative on the ACC's sensitive claims advisory group, Kyle MacDonald, said even where a victim had been diagnosed with a mental illness, it was often difficult to pin the illness solely to being raped or sexually abused. "With childhood sexual abuse where there may be a 20-year or 30-year delay between abuse and presentation [for help], ultimately you can always find a reason to decline claims if you look hard enough," he said.
Counsellors' Association representative Elayne Johnston said ACC assessors did not seem to realise being raped was different from breaking a leg. "We're talking about people who've had a crime committed on them," she said.
Dr Barbara Disley, the former Mental Health Commission head who leads the four-person review panel, said the panel had met several professional associations and planned further meetings next week. She said the panel hoped to report back to Dr Smith by July 31.

Copyright 2010 APN Holdings NZ Ltd
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10652658&pnum=0

Public submissions welcomed for review of ACC’s sensitive claims pathway

A press release from the New Zealand Association of Psychotherapists

In October last year in response to an online petition signed by nearly 4000 New Zealanders, the Hon Dr Nick Smith promised the new clinical pathway for the treatment of sensitive claims would be subject to an independent clinical review. That day has now arrived.
Professional bodies around New Zealand are currently organising to make both written and verbal presentations to the review panel, headed by Dr Barbara Disley, past chief executive of the Mental Health Foundation and the inaugural chair of the Mental Health Commission.
The review panel is also hoping to receive submissions from members of the public and anyone affected by the changes to the treatment of sensitive claims by ACC.
Individuals’ submissions can be made in writing, or via audio or video recordings. These submissions can be sent via email to ClinicalPathwayReviewSubmissions@researchnz.com or mailed to: Independent Clinical Review Panel, PO Box 1039, Wellington 6140.
It is imperative that ACC and the National Government receive a clear message: that this new clinical pathway has been an unmitigated disaster, and led to the destruction of a world leading system for the support and treatment of those affected by sexual abuse and assault in Aotearoa New Zealand.
For more information about how to make a simple online submission to the review panel please see www.psychotherapy.org.nz

http://www.scoop.co.nz/stories/GE1006/S00007.htm

Clinicians reject Smith’s ACC abuse guidelines

A press release from the Labour Party by Lynne Pillay

The New Zealand Association of Psychotherapists has overwhelmingly rejected ACC Minister Nick Smith’s imposed guidelines on sexual abuse, Labour’s Victims Rights spokesperson Lynne Pillay says.
“Since National became the Government the number of people approved for Government funded sexual abuse counselling has fallen from nearly 300 a month to less than 12,” Lynne Pillay says.
“It is disgraceful that people who have suffered sexual abuse are being denied assistance based on guidelines that are not supported by clinicians or Massey University, the organisation Nick Smith claims wrote the guidelines.
“Labour recently received a letter from Nick Smith inviting us to take part in a belated review of the ACC sexual abuse guidelines.
“We have rejected Mr Smith’s offer, because it is already clear that the changes he has made to the ACC sexual abuse guidelines have resulted in victims of crime being re-victimised and have lead to systemic failures in this area of ACC cover.
“Nick Smith needs to stop his sham review of the guidelines and admit they have failed to support people have been sexually abused.
“It is time to support people who need sexual abuse counselling and stop the political grandstanding and time-wasting that Nick Smith has undertaken.
“Victims of crime are not an area for cost cutting. The Minister has failed victims and survivors of sexual abuse and he needs to get on and fix the problem he has created,” Lynne Pillay said.

http://www.scoop.co.nz/stories/PA1004/S00028.htm

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

A letter to Nick Smith, Minister for ACC

10th November 2009

Dear Dr Smith,

ACC changes in the processing of sexual abuse claims and the revision of ACC legislation.

I had the pleasure of meeting you in your caravan in Nelson on 17th October with a group of colleagues. At that meeting I felt that you listened carefully to our concerns about the new administrative processes for ACC “Sensitive Claims”. You were careful to draw distinctions between what was in your power as a parliamentarian and minister and what, you felt, were the responsibilities of ACC.
At the meeting we explained our concern that ACC were distorting the so called “Massey Guidelines” in ignoring the distinction between the psychological consequences of adult sexual assault and of childhood sexual abuse. I note that Massey University have now distanced themselves from ACC in a press statement (attached). Also both the New Zealand Psychological Society and the College of Clinical Psychologists have, in a joint statement, voiced their concern (attached), thus joining the voices of the Psychotherapists, Counsellors, Social Workers, community sexual abuse agencies, the Council of Women of New Zealand and many others in a universal condemnation of ACC’s new pathway. You will thus note (contrary to ACC’s assertions) that there is no basic disagreement between the various professional groups.
At the meeting we were also concerned that ACC are interpreting a court decision (Judge Cadenhead in ACC v Geerders (decision number 188/2004)) as a legal imperative that forces them to require a clinical diagnosis in order to consider claims for mental injury. You said that one of the things that Parliament can do is to change law.
The IPRC Act provides cover for mental injury: “mental or nervous shock” (Part 2 Section 21A) caused by certain criminal acts. Section 27 defines Mental Injury as: “a clinically significant behavioural, cognitive, or psychological dysfunction”.
ACC are saying that the court judgement interprets this as an injury that is diagnosed by a clinician trained at a tertiary level in psychiatric diagnosis. As you said at our meeting, ACC is concerned with Injury, not Illness. Injury is related to impairment, or dysfunction: the consequence of an accident that affects the ability to work, to make and sustain relationships, to participate in sport or education, to participate in ordinary life. This is surely the basis of ACC, not illness, whether physical or psychiatric.
The online medical dictionary defines injury as follows:
“1. Damage, harm, or loss, as from trauma.
2. A particular form of hurt, damage, or loss.”
It defines illness as:
“Disease of body or mind; poor health; sickness.”
(http://medical-dictionary.thefreedictionary.com)
Although some illnesses arise from injury it is the primary injury that is the basis of the ACC scheme.
I believe either that Judge Cadenhead was wrong or that ACC has been poorly advised on the consequences of this decision. I am concerned that this interpretation has forced the hand of ACC in making them rely on the assessments of psychiatrists or clinical psychologists before they can accept any claim for sexual abuse mental injury.
Experience since the new “Pathway” has been introduced is that there are insufficient clinicians willing and/or available to do this work and that the ACC Sensitive Claims Unit is swamped by calls from survivors of criminal acts who are unable to find clinicians acceptable to ACC. There is also serious and understandable concern in the community that the labelling of victims of crime as mentally ill is inhumane and potentially a human rights violation.
As a clinician I am not averse to the use of diagnosis. However, its use has to be carefully
considered, especially in relation to the consequences for the client/patient. I think it has a place in the treatment of more deeply entrenched and disabling dysfunction, usually involving long term work. Even then it is not central to the work, only part of a “formulation” where causative factors are considered, as well as properly thought-out plans for treatment.
I ask you, as Minister for ACC and sponsor of the ACC changes currently before Parliament to consider a change in the wording of the Section 27 definition of Mental Injury so that it is clear to ACC that it does not have to rely on a psychiatric diagnosis in order to accept a claim for mental injury from criminal acts.
My suggestion is that the definition read:
Mental Injury is defined as a significant impairment in everyday cognitive, behavioural, emotional, psychological or social functioning that bas been described by, and is amenable to treatment from a suitably qualified health provider; and which, following treatment, would normally improve to a degree that is over and above any improvement that would be expected to occur naturally over time.
I would be pleased to discuss this further with you, or your representatives.
Regards
Eric Medcalf
Convenor Ethics Committee
New Zealand Association of Counsellors
Council Member
New Zealand Association of Psychotherapists

http://www.ncwnz.org.nz/assets/Action/Dr-Nick-Smith-from-Eric.pdf

Presentation of Petition to Parliament:Delay implementation of any changes to the Sensitive Claims Scheme

Press release from Kyle MacDonald, NZAP

Over the course of the last six weeks nearly four thousand concerned professionals, clients and members of the general public have signed the online petition : Urgent Action: Delay implementation of any changes to the Sensitive Claims Scheme hosted at http://www.petitiononlinecom/ACC0909/ which asks ACC and the Minister for ACC the Hon. Dr. Nick Smith to delay implementation of the new treatment pathway until adequate consultation can take place.
Despite this ACC has continued to push for implementation of a new pathway which focuses on short treatment, limits treatment to sixteen sessions, and requires a mandatory diagnosis of a DSM-IV mental illness.
ACC claim to have allowed adequate time for consultation on this matter; they have not. ACC claim to have followed a recent research report “The Massey Guidelines” to develop best practice treatment; they have not.
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.
Tomorrow, Tuesday the 27th of October a rally has been organized on the Parliamentary Forecourt at Parliament Buildings to present the Hon. Dr. Nick Smith with the petition. The National government and ACC must be held to account.
Throughout this process the Minister has repeatedly said that this decision will be made “by clinicians, not politicians” yet the pathway is not supported by the professional bodies, or individual clinicians who provide this treatment, and this petition reflects that. We invite the Minister to hear what clinicians really think of this proposed change by ACC.

http://www.scoop.co.nz/stories/PO0910/S00376.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