ACC responds to independent review of services

A press release from ACC

Last year’s changes to how ACC manages sexual abuse claims were designed to achieve two goals. They were to ensure we targeted our services to those people who were actually covered by our legislation and to improve the outcomes those people achieved. We still believe those are reasonable goals.
The changes were never about saving money. Year on year, our total expenditure in this area has hardly fallen and it is only a tiny part of ACC’s total expenditure.
However, it became clear that the changes we had introduced had excluded more people than we expected and, more importantly, there was little else available for them outside of ACC.
“ACC has already acknowledged this situation itself and had begun working with the sector to put in place whatever support we appropriately can. For example, we recently introduced up to 16 hours of support for people with a new sensitive claim, or who are awaiting an assessment”, said Denise Cosgrove, General Manager, Claims Management, ACC.
The report of the Independent Review Panel, released today by the Minister for ACC, raises a number of serious issues and ACC has already begun responding to them.
“ACC met with the Panel to discuss its findings. We agree that action is required in some areas, and believe the initiatives we have already put in place will go some way to addressing their concerns.”
“However, we continue to believe that, for those who are accepted by ACC, the current Pathway offers considerable advantages over the previous process. It ensures people get a proper assessment before treatment is undertaken, that there is a plan in place for that treatment and checks that progress is being made towards set objectives. This represents sound clinical practice.”
“Nonetheless, to ensure we make good decisions moving forward, we have begun regular meetings with the sexual abuse treatment sector, including clients, to make sure that they are involved and their voices are heard. The feedback we have received from them and the Independent Panel about our early work has been very positive”.
Ms Cosgrove said work was continuing on the development of separate processes for children and other groups such as Maori. A workforce development plan for counsellors, to ensure they provided a high-quality service, was also being developed. “But I have to emphasise that not all of the answers sit with ACC. We are just one of a number of agencies with responsibilities in this area. The Government’s response to the Report of the Sexual Violence Taskforce will provide a ‘whole of government’ approach, which is a sensible way to ensure that the right solutions are put in place”.

http://www.scoop.co.nz/stories/PO1009/S00101/acc-responds-to-independent-review-of-services.htm

Minister welcomes sensitive claims clinical review

A press release from the National Government

ACC Minister Nick Smith is urging ACC to adopt the recommendations of an independent clinical review into the sensitive claims pathway released today.
“I initiated this review because I was concerned about the claims process for sensitive claimants but wanted expert independent clinical advice,” Dr Smith said. “The Sensitive Claims Pathway Review Panel has done a good job and I am confident that with the changes underway and those recommended, survivors of sexual abuse will receive timely and best possible clinical support.
“While I acknowledge that managing sensitive claims is very challenging, I am not satisfied with ACC’s handling of this issue. There are important lessons for ACC to learn from this report. As recommended, I will be implementing an independent monitoring group to ensure ACC delivers on the report’s recommendations.”
Chair of the Panel Dr Barbara Disley said it had heard from about 50 survivors of sexual abuse, 30 organisations representing psychiatrists, psychologists, psychotherapists and counsellors, received nearly 180 written submissions, and met all the relevant key government agencies. “Virtually everyone who made their views known to us told us of the major difficulties that have been caused by the Pathway,” Dr Disley said.
The report proposes some initial changes and gives a series of recommendations that ACC will need to carefully work through with stakeholders.
“I am heartened that ACC has listened to our early concerns and made initial changes” Dr Disley said. “As a result, survivors who make a new claim or have a claim already in the system now have 16 hours with a treatment provider available to them immediately. This has been welcomed by many people.”
The Panel’s proposals cover the thorny question of how ACC should make sure it operates within the law while still making certain that survivors can get ready access to high quality support and treatment that meet their individual needs. There are recommendations aimed at improving how ACC involves stakeholders and communicates with clients and with treatment providers.
The report also recommends that attention is paid to quality at all levels including the practitioners who deliver treatment and assessment services, the appropriateness of the type and length of treatments, and the timeliness and responsiveness of ACC’s own systems.
To view the report, click here.

http://www.scoop.co.nz/stories/PA1009/S00141/minister-welcomes-sensitive-claims-clinical-review.htm

Questions for written answer

29295 (2010). Hon David Parker to the Minister for ACC: What is the list of working parties, advisory groups and review bodies, if any, the Minister or ACC have set up since November 2008?
Hon Dr Nick Smith (Minister for ACC) replied: The Government has facilitated the formation of the Ministerial Inquiry into Disclosure of Funding Shortfall in ACC Non-Earners' Account and the Steering Group for the Stocktake of ACC Accounts. I also initiated the Independent Clinical Review into ACC's Clinical Pathway for Sensitive Claims.

http://www.parliament.nz/en-NZ/PB/Business/QWA/1/3/b/QWA_29295_2010-29295-2010-Hon-David-Parker-to-the-Minister-for-ACC.htm

29026 (2010). Lynne Pillay to the Minister for ACC: Which entry in the document tabled on 17 August 2010 "make plain" the work on the clinical pathways began in 2008, prior to the change of Government, as he claimed in the House on 17 August 2010?
Hon Dr Nick Smith (Minister for ACC) replied: The entries dating 2008 and preceeding it that show significant workstreams were under way prior to the change of Government on changing the way sensitive claims were managed by ACC.

http://www.parliament.nz/en-NZ/PB/Business/QWA/f/e/8/QWA_29026_2010-29026-2010-Lynne-Pillay-to-the-Minister-for-ACC.htm

Sex abuse cuts "all about costs"

An article from the Sunday Star Times by Tim Hume

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

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

Complexity in abuse viewpoint

An article from The Press by Rosemary McLeod

Someone up there must love Felicity Goodyear-Smith, but some do not, and I guess her life would have been less complicated had she never met her husband. Goodyear-Smith is Auckland University's medical and health sciences professor. More controversially, a change in ACC policy, now reversed, that impacted on help for victims of sexual abuse has now been partly sheeted home to her door.
Her critics are amazed that she was commissioned to provide input on this sensitive area. They see her as stigmatised by close association with the family of former Centrepoint guru - and convicted child sex and drugs offender - Bert Potter. She is married to his son, and was formerly the GP for the controversial community, where the consensus on sexual relations between adults and children seems, in hindsight, to have been not only potentially damaging, but loony, and the use and manufacture of drugs there downright reprehensible.
At the core of criticism is the view she has put forward that sexual contact between adults and children may not necessarily be harmful. To be fair, she cites research which could point to that conclusion. To be fair to her critics, there are compelling counter-arguments.
Goodyear-Smith also attacks the idea of recovered memory, famously featured in retrospective sexual abuse claims made following counselling, which, by the way, she is not convinced does much good. You can see why she could be unpopular.
I rather like mavericks, and for that reason I admire Goodyear-Smith's perversity in taking up the cause of the injustices done to some men by false claims of sexual abuse of children. I expect this false reporting does happen, especially in custody disputes: it's hard to prove or disprove, and the harm caused by an accusation would be almost impossible to shake off.
She acts as an expert witness for accused men, set up a group that specialises in that area, and can hardly be surprised that some people see that as tending to minimise what her husband (convicted of sexual contact with a child) and her father-in-law (who got a stiff jail sentence) were charged with.
Because of her academic standing, that background may not have occurred to her as being a problem when she agreed to help ACC. But academic credentials aren't everything: perception counts, too.
It would have been wiser of her to see the big picture and opt out, and much wiser of ACC not to ask her in the first place, since her views are well known, and polarising. If you disliked her, you'd say it was a bit like asking a ferret to give advice on the care of chickens. If you supported her you'd advise her against it because it was sure to rebound on both her and the corporation, for whom she does other, less controversial work.
I'll give her this: we have lived in strange times with our attitudes to sex, and history may well look back at all of us and laugh. Plenty of seemingly sensible people supported the teachings of Bert Potter - who is unrepentant - in the commune's heyday. Adults were bonking all over the place, coupling at his direction, and in front of the children. Solemn TV documentaries were made, and clever people joined up, handing over their worldly possessions to the former pest controller's wise governance.
Then, seemingly in no time at all, there was a complete reversal of attitude, and we became obsessed with child sex abuse. What was all Arcadian innocence yesterday suddenly had a dark side, and ACC began shelling out $10,000 payments to women who claimed they'd been sexually abused, without asking for corroborative proof. Women swiftly signed up for this by the tens of thousands, to nobody's great surprise, and against that background Goodyear-Smith told a newspaper the "ACC scam's one of the biggest there is".
Not the most useful view to have on record when contemplating research destined to impact on policy in that very area. How odd - and perhaps revealing - that Goodyear-Smith didn't see that for herself.

© 2010 Fairfax New Zealand Ltd
http://www.stuff.co.nz/the-press/opinion/columnists/rosemary-mcleod/4086350/Complexity-in-abuse-viewpoint