ACC help for sexual violence victims

An article from the Manawatu Standard by Thomas Heaton

Client-focused changes to ACC's services around sexual violence have been a long time coming, Palmerston North counsellors say.
ACC officially launched the new Integrated Services for Sensitive Claims scheme on Monday. The new service puts greater focus on maintaining wellbeing and increasing the provision of support, including increased hours for support.
Palmerston North counsellor Paulette Berryman, who is also on the Sensitive Claims Advisory Group for ACC, said the new system was very different from what was brought in in 2009. A part of the advisory group for about 15 years, she had seen a lot of changes.
Berryman said the system enlisted in 2009 was really awful for clients, as many were unable to get counselling services.
"When survivors have already been rendered powerless, they don't want to engage in a more powerless system."
It was found ACC was turning about 90 per cent of claims away. In 2009 there were 282 claims while in the 2013/2014 financial year there were 369 in the Manawatu-Whanganui area.
"The biggest change I see is that there is a client-centred approach," Berryman said.
Clients will also no longer have to pay surcharges for the services of counsellors.
ACC expected an increase in the number of cases coming in, because of the change to the client-focused system.
Manawatu Women's Refuge manager Dr Ang Jury said it was a long time coming. A more sensitive approach to the realities of what victims went through was needed. Flexibility in treatment, allowing victims to enter, leave and return to assistance was important.
Jury said the change made sense, as some people may not want to deal with issues immediately, or they may feel they had already dealt with their problems.
"A little bit down the track, they might realise they need support," Jury said.
"People are individuals ... They need to be treated on a one-on-one, individualised basis, taken seriously for what's happening to them."
Ann Kent, manager of Abuse and Rape Crisis Support Manawatu, said the new system was promising.
"It's a new system to us and everybody is still learning ... They [ACC] seem to have looked at what hasn't been working.
"[They] have put in a concerted effort to put in place a system that will be positive," she said.

© 2015 Fairfax New Zealand Limited

http://www.stuff.co.nz/manawatu-standard/news/66972110/ACC-help-for-sexual-violence-victims

Sensitive claims sent to branch offices - ACC

An article from the New Zealand Herald by Adam Bennett

Hundreds of sensitive ACC claims - those related to rape and other sexual abuse - have been transferred out of the corporation's Sensitive Claims Unit to case managers in regional branch offices, the corporation has said.
Claimant advocacy groups are shocked by the move they say was made without consultation and in some cases without fully informing claimants.
Claims related to rape and sexual abuse are managed by the standalone Wellington based Sensitive Claims Unit (SCU) because of their "highly personal nature", ACC says.
The corporation has been under fire since claimant Bronwyn Pullar revealed a privacy breach in which the ACC sent her a file identifying sensitive claimants. The breach also raised concerns that sensitive claims information was being shared with ACC staff outside the SCU.
But after weeks of rumours that some sensitive claims were being handled outside the unit, ACC claims management general manager Denise Cosgrove said 12 case managers from elsewhere in the corporation had been seconded to the SCU.
"These seconded staff were located throughout New Zealand, near to the approximately 250 clients with long-term sensitive claims they were looking after."
The case managers are in 12 regional offices and had been dealing with sensitive claims since last November.
Ms Cosgrove said all the seconded staff underwent intensive training in sensitive claims management, including training around preserving client privacy.
"In addition, access protocols were agreed for claims and no paper files were transferred," she said.
Ms Cosgrove said care was taken to ensure clients were properly advised of the change.
But ACC claimant advocates Denise Powell, of Acclaim Otago, and Auckland-based Kyle MacDonald, said they only became aware of the move after one claimant learned by accident her new case manager was based in a branch office.
"That was quite upsetting for her."
Ms Powell understood affected claimants were advised they had new case managers, "but ACC didn't necessarily state that their case manager was no longer based in Wellington".
"My understanding was the SCU was set up to be a stand-alone unit and was specifically isolated from the mainstream of ACC in order to ensure the utmost protection of those people's information and identity," she said.
Mr MacDonald, who is a member of the Sensitive Claims Advisory Group, which ACC regularly meets with, said the corporation never raised the change with his organisation. "The reality is 250 claimants are now being managed outside of the Sensitive Claims Unit in regional branches by case managers who are not sensitive claims specialists."

© 2012 APN Holdings NZ Ltd

http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10809718

Help is there for sexual abuse victims

An article from the Manawatu Standard by Stacey Kirk

Changes to the way ACC manages the claims of sexual abuse sufferers "are an encouraging step", says a Palmerston North sexual abuse counsellor. Counsellor Paulette Berryman, who sits on the Sensitive Claims Advisory Group (SCAG), said she "couldn't be more pleased" with rule changes making it easier for sexual abuse victims to gain support, but she was concerned that abuse victims were not aware of the help to which they were now entitled.
ACC tightened up the process for accessing counselling in October 2009, which triggered protest marches, intense lobbying and media scrutiny.
A report was ordered six months ago which recommended changes including a rule that new claimants and people waiting for a decision on whether they qualify for treatment could now get 16 hours' "support". Only some of the recommendations have been implemented, with the rest being carried out over the next year.
An independent report for the ACC board carried out last month found ACC was making "good progress" in changing the way it manages sensitive claims. Dr Barbara Disley, who also chaired the review in 2010, said the report found ACC had done a good job prioritising the more important tasks.
Mrs Berryman said it felt like the hard work of her and her colleagues across the country had paid off. She said she used to receive four or five inquiries a week about sexual abuse counselling, but those numbers rapidly dropped when claimants found their requests for counselling were being denied. Now, they are entitled to up 16 free sessions.
But Mrs Berryman said that she wasn't sure the information had filtered through to abuse victims. She is hoping to get the message out that help is out there for sexual abuse victims "and don't be afraid to ask".
ACC claims management general manager Denise Cosgrove said ACC recognised the importance of providing support to sexual abuse victims. "We recognise we have some way to go before delivering all the recommended changes but we were pleased to note Dr Disley's acknowledgement of our progress," she said.

© 2011 Fairfax New Zealand Ltd

http://www.stuff.co.nz/manawatu-standard/5192479/Help-is-there-for-sexual-abuse-victims

ACC sensitive claims: Core concerns yet to be addressed

A press release by Kyle Macdonald

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

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

Recent Sensitive Claims Advisory Group (SCAG) meeting

Information from the New Zealand Christian Counsellors Association

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

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

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

ACC independent review supports national outcry to stop pathway

An article from Te Whariki Tautoko by Ripeka August–Tampeau

Ka tangi te titi, ka tangi te kaka, ka tangi hoki ko au.
Kii mai koe ki ahau, he aha te mea nui o te ao?
Maku e kii atu he tangata, he tangata, he tangata.
(Author unknown)

You ask me “what is the most important thing in this world” and
I must reply “It is people, it is people, it is people”.

And that is exactly what the Independent Review Panel clearly concluded in their recommendations to the Minister of ACC, Nick Smith. The review concluded the pathway needed an urgent overhaul to its generic clinical pathway process to better support the needs of victims of sexual assault. ACC’s response was immediate with the introduction of the much needed counselling support sessions.
The review panel is also clear that immediate changes to the pathway are not possible. As a result ACC have supported the recommendations and started working with the Sensitive Claims Advisory Group (SCAG) to begin developing and implementing a new clinical pathway based on the recommendations.
The Independent Review panel addressed serious concerns to the poor response by ACC to Maori victims of sexual assault and their whanau. As a result of the clinical pathway many Maori counsellors refused to support this pathway further reducing the already under representation of ACC Maori counsellors. The damage of the clinical pathway was felt by many and was responded to by many. Recently, ACC general manager and SCAG members agreed to a separate working group to develop and implement a tikanga Maori pathway and this is to happen as soon as possible.  
Although Maori are happy that changes have begun, there is still the thought “will ACC follow through”. It is clear there is still further work for ACC to do and in consultation with Maori stakeholders to “get it right”.

http://www.tewharikitautoko.org.nz/portfolios/acc-scag

ACC backdown welcomed

An article from the Manawatu Standard by Janine Rankin

Sexual abuse survivors denied help under tough new rules introduced last October can look forward to better services in future now that ACC has backed down on the changes. Palmerston North counsellor Paulette Berryman says she is battle-weary but elated that ACC has accepted a caning from an independent panel condemning its approach and forcing a back-down.
The New Zealand Christian Counsellors' Association representative on the sensitive claims group told the Manawatu Standard that the quality of help available for survivors could become better than ever once all of the panel's recommendations were put into place. She said her hard work in protesting against the changes, including taking two of her clients to Wellington to provide evidence about the harm the changes were causing, had paid off. "For almost a year we have been fighting, but it's been worthwhile, with positive changes for sexual abuse survivors," she said.
The review found that the changes, which required clients to gain a diagnosis of mental injury before they could get treatment, were introduced "prematurely and precipitously". The ACC changes had discouraged survivors from seeking help and caused a halving in the number of claims submitted in the first three months of the cuts. Delays were unacceptable and ACC's communications with sexual abuse survivors and providers had often been "inappropriate and inadequate". The panel recommended fast-tracking of the introduction of 16 sessions of support for new clients ahead of the full report's release last week.
Mrs Berryman said the 16-session scheme was a "welcome measure, in the right direction", but the response from potential clients had been low key. She remained concerned that people who could benefit still had not realised how easy it was to contact an ACC treatment provider directly to begin the healing process. Mrs Berryman is continuing her fight to ensure survivors of sexual abuse get the help they need, and is involved in consultation in how other recommendations can be implemented. These include recognising alternative ways for diagnosing mental injury, dealing with the particular needs of children, providing support for Maori and helping people with complex health needs.

http://www.stuff.co.nz/manawatu-standard/news/4142528/ACC-backdown-welcomed

Response from Denise Cosgrove

A letter to the editor of the Sunday Star Times

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

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

Question for written answer

26479 (2010). Lynne Pillay to the Minister for ACC: Will ACC be contacting those people declined cover under the new clinical pathway introduced on 27 October 2009 to offer them 16 hours of counselling as per the media statement of 11 August 2010?
Hon Dr Nick Smith (Minister for ACC) replied: ACC has contacted all clients with a new claim already lodged, but still awaiting a decision, to advise them of the 16 hours of support and how to access them. ACC is still working through a number of details which are yet to be finalised with regard to this support. These details include what support will be available for people whose sensitive claim has previously been declined or reactivated. ACC is working closely with the sector via the Sensitive Claims Group (SCG) to determine an appropriate approach to this issue. ACC next meets with the SCG on 8 September 2010 and the resolution of this issue is a priority item on the agenda for that meeting.
http://www.parliament.nz/en-NZ/PB/Business/QWA/9/9/6/QWA_26479_2010-26479-2010-Lynne-Pillay-to-the-Minister-for-ACC.htm

Help still available for abuse survivors

An article from the Manawatu Standard by Janine Rankin

Support for sexual abuse survivors was increased this week, but Palmerston North counsellor Paulette Berryman is worried people might have given up hope of getting help, and aren't aware it has just become easier to ask. The New Zealand Christian Counsellors' Association representative on the sensitive claims advisory group has welcomed this week's ACC support package for sexual abuse survivors.
Mrs Berryman said since ACC tightened up the process for accessing counselling last October, most people had stopped asking for help, and some who had persevered felt "battered" by the system. She used to receive four or five inquiries a week about sexual abuse counselling, but since October, has had only one.
Some sexual abuse counsellors had been working for free and others had given up counselling during the 10 months when survivors of sexual abuse had to be diagnosed as having suffered a mental injury before they could get treatment.
Under the interim system introduced this week, new claimants and people waiting for a decision on whether they qualify for treatment, can now get 16 hours "support". The support isn't available to people already in treatment or who have been turned down.
Mrs Berryman said she expected there would be a surge of demand for help under the new rules, but it hadn't happened. "Sexual abuse hasn't gone away. My concern is that people who have been discouraged from applying don't know that there is support available now."
She said it had taken enormous energy to persuade ACC to provide more help for sexual abuse survivors. "We have fought robustly, because we understand how difficult it is for people with sensitive claims to stand up and tell the world they were sexually abused and need help."
As well as advocating for clients, she was part of the advisory group that would be making further recommendations about details of the future support package, particularly how to help children, previous claimants who relapsed, and people who had been declined treatment.
The independent panel appointed to make final recommendations on the future process for handling sensitive claims is due to complete its work next month.

© 2010 Fairfax New Zealand Ltd
http://www.stuff.co.nz/manawatu-standard/news/4044143/Help-still-available-for-abuse-survivors

ACC matters - cautiously optimistic!

An article from ANZASW NoticeBoard by Cathy McPherson

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

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

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

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

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

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

ACC 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

ACC denies subsidisation of counselling for rape victims due to lack of “mental injury”

An article from Nexus by Hollie Jackson

The new rules regarding ACC-subsidised sexual abuse counselling has hit rape victims hard across the country. Now, in order to acquire funding for counselling, the victim must first be diagnosed with a mental condition caused by sexual abuse.
In February this year, a South Auckland mother of three died four days after her submission for ACC-subsidised counselling was denied. She had applied for help six months beforehand for sexual abuse she had suffered as a child, but was denied because she had not suffered “a significant mental injury”. She had reportedly suffered from suicidal tendencies and self-inflicted harm due to the sexual abuse.
Another victim, a 15 year old girl, is still awaiting a decision on her claim for counselling after she was raped over Christmas. The Association of Counsellors' representative on the ACC's sensitive claims advisory group, Elayne Johnston, said the girl hadn’t received counselling because ACC required her to be assessed by a psychologist to see whether she had suffered “a mental injury”.
ACC Minister Nick Smith announced last Monday that the new rules will be reviewed by a four person panel for efficiency. According to Dr Kim McGregor, the co-chair of the national sexual violence network, the four person panel fails to include any one of their “specialist experts that work day to day with survivors of sexual violence”.
Approved submissions for ACC-subsidised sexual abuse counselling has gone down from 472 in the first two months of last year to only 32 in the same period this year. Dr McGregor said almost all of the 600 to 700 private counsellors who were registered for ACC-funded work had also stopped taking applicants for ACC subsidies because of an ethical objection to labelling assault victims as mentally ill.

http://www.nexusmag.co.nz/news/acc-denies-subsidisation-counselling-rape-victims-due-lack-%E2%80%9Cmental-injury%E2%80%9D

Denied help for sexual abuse, dead days later

An article from the New Zealand Herald by Simon Collins

A review of new rules for sexual abuse counselling has come too late to save a South Auckland mother who died four days after her claim for ACC-funded counselling was rejected.
Counselling Services Centre manager Emma Castle said the mother-of-three's claim for counselling for sexual abuse she had suffered as a child was rejected by ACC two months ago on the grounds that she had not suffered "a significant mental injury".
"The counsellor who submitted the claim made it very clear that sexual abuse was the reason why she had suicidal ideation and was self-harming," Ms Castle said. "It took them six months to make that decision. Four days after receiving notification that the ACC claim was denied, the client passed away."
The new rules provide ACC-subsidised counselling only for victims with a diagnosed mental condition caused by sexual abuse, and generally only for up to 16 weeks before a further review.
ACC Minister Nick Smith announced yesterday that the rules would be reviewed by a four-person panel chaired by former Mental Health Commissioner Dr Barbara Disley. The other panel members are Auckland University psychiatrist Professor Graham Mellsop, Ruth Herbert of the lobby group Roundtable on Violence Against Women and psychologist Clive Banks of Porirua Maori mental health agency Rangataua Mauriora.
The co-chair of the national sexual violence network, Dr Kim McGregor, said the team did not include anyone who worked day to day with survivors of sexual violence.
The network had nominated Louise Nicholas, a high-profile survivor who is now an advocate with Rape Prevention Education, alongside psychologists Nicola Gavey and Fred Seymour, High Court Judge Ailsa Duffy and Maori lawyer Moana Jackson.
"None of our specialist experts that work day to day with survivors of sexual violence, and have done for decades, have been chosen to be part of this review," Dr McGregor said.
She said the rules had caused a virtual "collapse" of sexual abuse counselling, with cases approved by ACC down from 472 in the first two months of last year to just 32 in the same period this year.
The Association of Counsellors' representative on the ACC's sensitive claims advisory group, Elayne Johnston, said a 15-year-old girl who was raped over Christmas had still not received counselling because ACC required her to be assessed by a psychologist to see whether she had suffered a "mental injury".
Dr McGregor said almost all of the 600 to 700 private counsellors who were registered for ACC-funded work had stopped taking applicants for ACC subsidies since the new rules took effect because of an ethical objection to labelling assault victims as mentally ill.
Survivors were now going to rape crisis agencies instead, but the agencies could not cope because they had also lost funding.
The review panel has been asked to identify any changes required to "ensure that ACC is delivering timely decision-making and services to clients with a mental injury caused by sexual assault or sexual abuse".
It is due to report to Dr Smith by July 31.

http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10641028

Open Letter to Nick Smith, Minister for ACC

A letter from the New Zealand Association of Psychotherapists

ACC Changes in Funding of Sexual Abuse Counselling

24 August 2009

Dear Minister, we speak for the members of the New Zealand Association of Psychotherapists as well as for other counsellors and therapists who have lent their support to presenting this document to you.
Over the last two weeks ACC has presented providers of sexual abuse counselling and psychotherapy services with imminent changes in delivery of sexual abuse counselling effective from 14 September 2009. These changes have been made without consultation with relevant professional bodies. Even groups that have been in dialogue with ACC about improving services (TOAH NNEST: Te Ohaakii a Hine-National Network Ending Sexual Violence Together, and SCAG: Sensitive Claims Advisory Group) have not been consulted.
The planned changes have sent shockwaves of disbelief through the counselling/therapeutic and survivor communities. The Minister for ACC will have been aware of these changes. We would like the opportunity to present a different point of view and have some vital questions answered.

Legacies Of Childhood Sexual Abuse (CSA)
Sexual abuse takes many forms, it can be a single episode involving someone who is ordinarily healthy and well functioning; it can be multiple episodes in the context of physical violence; it can take place in childhood over long periods and in single episodes. Our concern, in addressing the proposed ACC changes, is mainly with those who suffer most deeply from the experience of abuse, most especially those who have suffered abuse as children or from continued abuse as adults. This is not to minimise the effects of frequently highly traumatic events occurring to adults.
The sexual abuse of children causes the arrest or disruption of the development of the self leading to complex clinical presentation of impaired performance of ‘self-functions’ such as cognition, autonomy, selfresponsibility, emotional regulation, distress tolerance, identity, and social functioning (1) (2) (3) (4). For this reason the onset of abuse is significant (earlier onset leads to more severe problems) whereas people who are abused later in life show less severe problems. Survivors receiving counselling or therapy early in childhood show little or no disturbance later on. When CSA goes untreated survivors problems accumulate over the years leading to impairments in self-regulation, social functioning, occupational functioning, cognitive disturbances due to abuse-based beliefs, and shattering of internal psychological functioning. The cost of sexual abuse to the individual and to New Zealand society was estimated in 2001 to be $2,465m annually (5) and is probably higher for 2009.

ACC’s Responsibility For Victims Of Sexual Abuse
Independent of the question as to whether ACC is the best agency to provide services for survivors of sexual abuse, current regulation (IPRC 2001) demands that ACC “is to enhance the public good and reinforce the social contract represented by the first accident compensation scheme by providing for a fair and sustainable scheme for managing personal injury that has, as its overriding goals, minimising both the overall incidence of injury in the community, and the impact of injury on the community (including economic, social, and personal costs)”

Comment: Under the proposed changes ACC will not meet required responsibilities set out in the act! According to ACC 's injury statistics counselling/medical fees are about $2m for 2008 (6). The costs of financial entitlements such as Independence Allowance and Weekly Compensation raise the total claimantrelated costs to $19m. Costs for running the Sensitive Claims Unit alone are about $30m. It is clear that the costs of adMinistering the organisation exceed by far the services it is supposed to fund.

Question For The Minister: How does the Minister justify the expenditure of a system where the administration of services is 1 ½ times the cost of the service it administers; and where is the Minister’s commitment to improve funding for services and prune the top-heavy administration?

Comment: To make huge changes in the recovery pathways of mainly female victims of sexual abuse by relying only on one study which was funded by ACC is highly questionable. A study burdened with such funding bias can hardly be deemed trustworthy (7).

Comment: Studies conducted by world experts (1) (8) (2) (9) (10) (3) (11) as well as New Zealand research (12) have delivered evidence that the therapy relationship is the main factor behind positive outcomes. The provision and/or restoration of social support is a major buffer against the destructive force of stress and trauma. Social support and closeness with others helps survivors with the integration of difficult experiences and are vital for survivors’ recovery (3) (12) (13). “Emotional attachment is probably the primary protection against feelings of helplessness and meaninglessness; it is essential for biological survival in children, and without it, existential meaning is unthinkable in adults”(11).
Within the therapeutic relationship survivors’ recovery involves the (re)establishment of trust, development of self-confidence, development of social connections, meaning, hope, and self-agency. This will and always has taken time (2). These qualities can not be gained through a drug, a book, or in short term work of a few months. Recovery from sexual abuse can not be compared to a broken leg which heals by itself in 6 weeks. Recovery from sexual abuse takes place through caring and supportive interactions with others (2) (14) (12). However, these studies seem not to have been considered or given adequate weight.

Question For The Minister: How is the Minister going to convince the public and survivors of sexual abuse that he has considered a broad range of paradigms before he sanctions budget cuts that will impact detrimentally on CSA victims’ quality of life?

Much of the research that leads to a preference for short term intervention focuses on isolated symptoms i.e. depression without looking at underlying causes. This may work in controlled situations where study participants are carefully selected to meet well-defined inclusion and exclusion criteria; it is certainly not working for many survivors of CSA. That this paradigm is not working for survivors of CSA is shown in the public mental health system (32)(12). Between 50-80% of patients in psychiatric care have a history of sexual abuse that is not acknowledged and not considered in their treatment (15) (16) (17)(33). Public mental health treats symptoms e.g. depression with drugs and short term therapeutic input (if at all), a route ACC is now proposing. The ballooning costs for mental health show that this approach is not very effective. Instead patients are sentenced to a life of misery and poor social and occupational functioning. (12)

Comment: Up to this point ACC has failed to explain on what grounds the decision has been made to propose and then hurriedly push through a change in clinical pathway especially as ACC has not collected any outcome data regarding the quality of currently provided counselling services. (18)

Question For The Minister: What is the Minister’s basis for the assumptions that the current clinical pathway is not satisfactory?

Survivors of sexual abuse are marginalised in the following ways according to the statutes of the act:

1. establishing as a primary function of the Corporation the promotion of measures to reduce the incidence and severity of personal injury:

Comment: ACC has cut the funding for prevention education from $170,000 2006/2007 to $27,000 estimated for 2008/2009 (19).

Question For The Minister: How does the Minister explain these cuts given John Key’s speech (15) in April 2008 at the Sensible Sentencing Trust Victims Conference where he promised substantial increase of funds for victims of crimes? Are CSA survivors no longer considered victims of crime? How is the Minister going to justify the continuous victimisation of CSA survivors?

Comment: The new scheme requires vulnerable clients to visit three different therapists in the first five sessions. Research has shown that attending assessments and telling one’s sensitive and painful life story to a stranger is retraumatising (12).

Question For the Minister: How will the Minister guarantee that the process will not increase the severity of personal injury?

2. Providing for a framework for the collection, co-ordination, and analysis of injury-related information:

Comment: The client is required to reveal sensitive personal data to three different professionals in the first five sessions. Not only has research shown this to be re-traumatising (12), it also violates clients’ rights to privacy (Right 1 + 7 ACC Code of Claimants Rights) and the IPRC 2001 Act. Being granted a maximum of 16 hours (of which four will be for discussing progress reports) will effectively end the hope of recovery from CSA for many and will mean great struggle for survivors. This violates the IPRC 2001 Act that requires that the primary focus of ACC should be on rehabilitation to restore health, independence, and participation.
The assessor/provider split has been favoured by many managed care agencies overseas because it alleviates bureaucrats’ fear of assessment bias (therapists could over-diagnose to feather their own nest). Besides being insulting and causing significant interference with the therapeutic process (12) (20) (21) (22), assessor/provider split is not practical because the therapist responsible and liable for the outcome of treatment will need to make their own assessment and plan the treatment to work effectively.

Question For The Minister: How does the Minister envisage the clients being kept safe? Who should, according to the Minister, be liable and responsible for potential self-harm, suicide or psychiatric emergency, or any other form of harm that could befall the client?

3. ensuring that, where injuries occur, the Corporation's primary focus should be on rehabilitation with the goal of achieving an appropriate quality of life through the provision of entitlements that restores to the maximum practicable extent a claimant's health, independence, and participation:

Comment: Childhood sexual abuse (CSA) causes the arrest of self-development and interrupts healthy selffunctions leading to common symptoms such as mood disorders, anxiety disorders, or dissociative disorders (1). Ethical and professional practice has to address the cause of the symptoms to assure lasting improvement. A treatment protocol based on symptom reduction will not be able to rehabilitate clients with self-disturbances (1) (12) (3). Cancer is not treated with paracetamol, although it may help with the headaches.
Trauma specialists have conclusively demonstrated that persons abused in their childhood suffer complicated problems that often require long-term treatment (1) (19) (7) (3). About 90% of counselling for sexual abuse in New Zealand has been provided by counsellors and psychotherapists (18) in the last 20 years. They unanimously agree that it will be impossible for most survivors of CSA to complete their rehabilitation within 20 hours. They have delivered good and cheap services which in 2004/05 did not even come near $1m. (12) That deserves respect and not the patronizing restrictions imposed by ACC.

Question For The Minister: How does the Minister justify the marginalisation of two respectable professions who have done 90% of the CSA work in the last 20 years by refusing them their due recognition? How does the Minister justify that counsellors and psychotherapists are regulated by psychologists and psychiatrists, two professions who don’t even have sexual abuse training in their compulsory training curriculum and whose practical experience is limited to only 10% of the total ACC work? Furthermore, how will the Minister justify survivors of sexual abuse not being given the opportunity for recovery and thereby passing on the detrimental effects of trauma to their children?

4. ensuring positive claimant interactions with the Corporation through the development and operation of a Code of ACC Claimants' Rights:

Comment: According to the IPRC, Section 27, a mental injury means a clinically significant behavioural, cognitive, or psychological dysfunction. This is interpreted by ACC as “Mental injuries (as defined in Section 27 of the IPRC Act) must meet the criteria outlined in “The Diagnostic and Statistical Manual (DSM-IV™) of the American Psychiatric Association" in order to be eligible for ACC cover”.

Question For The Minister: Who authorised ACC to convert a clinically significant dysfunction into a DSM-IV diagnosis?

This effectively excludes survivors from accessing ACC funding for counselling who may have significant impairment in daily functioning yet not qualify for a DSM-IV diagnosis. Those who do fit DSM criteria will be disadvantaged and could be re-traumatised by seeing numerous health workers, being offered limited time with a counsellor, and then being referred on to public mental health services who even now don’t have the capacity to address CSA.
Receiving a diagnosis of mental illness is also problematic because it effectively shifts the responsibility for abuse away from the perpetrator (a crime was perpetrated causing a context specific response) towards the victim (she needs to see a shrink, she is crazy) (2). Failing to place psychiatric disturbances in the context of abuse is discounting the violation and injustice survivors have experienced (2) (20). Both the discounting and the pathologising of their trauma symptoms by attaching the label of mental illness is a withholding of survivors’ rights to have the injustice of the abuse recognised and to receive treatment that leads to recovery (12) (23).

Question For The Minister: How does the Minister justify that victims of sexual abuse are discriminated by being labelled mentally ill?

5. ensuring that persons who suffered personal injuries before the commencement of this Act continue to receive entitlements where appropriate.”

Comment: After 16 hours of therapy/counselling the client will be referred to public mental health service who don’t provide counselling, or to a psychologist for a maximum of 10 hours focused work. The new changes do not guarantee that clients will receive their due entitlements for recovery. Clients do not primarily seek financial compensation, they seek to be able to live a life worth living. The new scheme does not provide that opportunity.

Question For The Minister: How does the Minister plan to respond to victims of CSA who struggle to make ends meet financially, mentally, and emotionally knowing that he has sanctioned the cut of services of mainly female victims of crime while other sectors receive additional funding?

Conclusion
Counselling and psychotherapy have a long history of practice embedded in ethical values that include commitment to the physical and emotional well being of clients, their right to confidentiality, privacy, selfdetermination, and a secure therapeutic working relationship (NZAP, 1986). As Saakvitne and Abrahamson stated “The goal of psychotherapy is to understand the complex meaning of psychological and interpersonal events, largely through the creation of meaning in the therapeutic relationship” (24). In working with those suffering mental injury from sexual abuse, psychotherapists work towards repairing the internal sense of self and functioning that has been shattered by abusive experiences.
Research has repeatedly confirmed that 40% of positive outcome in therapy is due to client factors, 30% is due to the relationship between client and therapist, 15% is ascribed to the placebo effect, and only 15% of outcome is due to therapeutic modalities, and training (25) (26). It is nonsensical to construct a complete new approach to dealing with CSA around a questionable benefit of 15% given that meta-studies have proven that all therapeutic approaches are equally effective as long as therapist and client can establish a working therapeutic relationship.
Improvement would not come about by restricting hours that are clinically justified but by enabling a collaborative working environment in which the different services recognise each others qualities and support each other in the fight against sexual abuse and child abuse. It needs to be kept in mind that counselling is not the big expense in the ACC Sensitive Claims Unit. Instead, the surveillance mechanisms put in place give very much the impression of paranoia that led to millions being spent to save $500,000. This does not make good business sense and would probably be impossible in the private corporate world.
Rather than setting up a complicated system of separate people doing assessment, treatment, and review of treatment those counsellors who do not already use assessment and diagnostic tools could be encouraged and taught to do so. Many psychotherapists who currently provide services to Sensitive Claims Unit are practiced in assessment and treatment planning.
Our concern is for the well-being of those who have been victims of abuse, as children and as adults. Counsellors and psychotherapists may feel some financial effect with the new regulations, but they will be able to compensate for any income losses they may suffer. The tragedy is that clients do not have that luxury. Unless they can afford to pay privately for their counselling, they will be marginalised being bereft of recovery from sexual abuse and the attainment of quality of life, something the Minister and many others who will read this paper take for granted.
It is not enough for the society to be horrified at the number of children who get abused and killed in this country. Society needs to set aside funds to help victims of sexual abuse to rehabilitate so they can provide for their children and grandchildren and break the hideous cycle of abuse.
We, the undersigned, request on behalf of the organisation we represent that the Minister halts the implementation of the proposed changes and meets with CSA survivors and with the representatives of those who have worked at the coal face of sexual abuse recovery to hear our views, to increase his understanding of the complexity of the problem, and to support policies that reflect the social responsibilities the government has towards victims of childhood sexual abuse.

Eileen Birch (President NZAP)
Susan Hawthorne (NZAP SCAG representative)
Dr Gudrun Frerichs
Miriam van Dingenen
Sean Manning
Ondra Williams
Lesley King
Suzanne Johnson (Chair of Public Issues NZAP Council)

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