Recent experience of blocks for clients’ ability to access therapy are based on a number of factors. Some of these are listed here. The list and examples are not exhaustive. The number in each category refer to the account of the experience below. Terms CSA = Child Sexual Abuse
No culturally appropriate Pathway for Maori yet established
(43) (45)
No culturally appropriate Pathway established for Pacific clients
(44)
No appropriate pathway established for children and adolescents
(30)
Decline because of pre-exiting or coexisting condition
Rape in a mental institution meant pre-existing condition (22)
Raped within a dysfunctional family (23) (37) (38) (39) (40)
Unreasonable time delays in decision making by SCU
(11) (19) (21) (39) (51)
ACC seeking more information than necessary from GPs and other agencies
Claim denied - claimant had no GP from whom to obtain extra information (2)
GP would not have the information on the client, yet is asked anyway (21)
GPs not aware of the requirements of the new system (48)
GPs not confident in assessing for sexual abuse
More information sought than is available or appropriate (38) (39)
ACC deciding sex was “consensual” even when clearly coerced.
Victim underage at 12 years (24)
Shortage of clinical psychologists to assess
Having to travel to other areas for assessment (4)
Having to see an assessor of a particular gender (4)
(5) (8) (12)
Geographical location (36)
Psychiatric illness diagnosis implications for future employment, insurance, etc.
(9)
Confusion over which therapists are “qualified” to provide assessment
(5) (10) (16) (30) (32)
Psychiatric involvement
Referral to second psychiatrist after first recommended counselling for CSA (1)
(14) (52)
Therapists’ withdrawal from providing service because of ethical dilemmas
High probability of re-traumatizing clients (6)
Not being able to provide continuity of care (10), (20), (21) (36)
Not being able to establish trust with a client because of lack of time (35)(50)
Therapists’ withdrawal of services because of unreasonable amount of information required from first session
(5)
Therapists’ withdrawal because of not being paid for all the time involved in collecting and collating information
(7) (10) (17) (31) (35) (36)
Therapists’ withdrawal of services because they can no longer be confident of having claims accepted in spite of many years of experience and no previous declines
(13) (20) (22) (25) (29) (47)
Therapists’ withdrawal of services because of excessive (4 weekly) reporting
(7)
Psychotherapists’ withdrawal of services because their work is not seen as “good enough”, being evaluated and assessed by clinical psychologists, a different discipline
(34)
Claimants finding the process too daunting to continue
Disclosure of sensitive information under pressure proved too hard (3)
Having to tell sensitive information to too many clinicians (9) (14)
(29) (42) (43) (46)
Claimants being processed under new pathway even though claim was lodged before the date this applied
(5) (15)
Claimants having no choice of therapist now SCU decides who they will see
(11) (12) (19) (31)
Claimants’ experience of Clinical Psychologists’ appropriate treatment methods
A male suggesting he come to the home of a female claimant to assess her (26)
Sent exhaustive questionnaires to fill in ahead of assessment (28) (33)
Claimants denied further hours because they are seen to have “had enough”, an administrative rather than a clinical decision.
(27)
ACC SCU Administrative processes inefficient
Losing track of clients’ information (10)
Delays in responding to phone calls and emails (17)
Inadequate preparation of forms, codes etc before rolling out the new CP (17), (18) (31) (36)
ACC Staff blaming therapists or claimants for their own mistakes rather than admit a mistake has been made
(26)
Assessments required at the beginning of therapy rather than after several sessions
(37) (39)
No lists of suitably qualified counsellors who are still available for clients to contact
(49) (51)
1.A mental health social worker said that one of their clients was referred by a psychiatrist after an assessment, to ACC for csa therapy. Acc insists the person see a second psychiatrist to distinguish mental illness due to csa rather than some other condition. Client objected and consequently self-harmed
2. Someone at my practice has just had a client declined as they could not get information from his GP as he does not have a GP. What possible information could they possibly get from his GP for CSA as he is now an adult? It was lodged and received well before the 27th so should have been still under old system.
3. From a GP - A patient in her practice for some time finally and reluctantly disclosed sexual abuse. GP referred her to a Clinical Psychologist for 2 sessions to put in the claim. Patient has fled from the process finding it too pressured. She will not take it further.
4. As a psychologist I was phoned by a counsellor asking if I would do two ACC 290's for clients who had approached her for sensitive issues. I answered that I was not planning to do such work and suggested that she phone ACC to find out whom they had contracted to do it.I was astonished to learn that she was told the names of only two people: one local in xxxxxx, a male, and one (nearby city) based psychologist. Two issues: discomfort for many clients of being interviewed by a stranger who is the same gender as their abuser and inconvenience of perhaps having to travel two hours to have the initial assessment.
5. The following communication is between a psychotherapist and the Claims Administrator:
CA: ACC has received an ACC45) for the above client. To assist ACC to process this claim appropriately, please provide us with the following information: Detailed narrative description of the event and its context. Detailed narrative description of the symptoms that xxxx is presenting with as a result of the event,. Please provide this information within 5 days of receiving the request.
P: I am a little unclear- is this information instead of a 290 report, or are you indicating that such information should be included in the ACC 45?? To expect this information having seen xxxxx only once seems a tall order? Hope you can clarify this for me,
CA: Thanks for your prompt response. You are welcome to provide an ACC 290 if you are qualified to provide a DSM 4 diagnosis. (Definition attached to email). If you are not qualified to give this diagnosis please provide us with as much information that you can provide f rom your consultation with xxxxx when you submitted the ACC 45. We need a detailed narrative description of the event and its context and a detailed narrative description of the symptoms that xxxxx is presenting with, as a result of the event. I hope this helps. If you have any other questions, please feel free to contact me.
P: I am surprised at this given that the ACC 45 was sent to you well before the new revised clincal pathway began. I expected that only new claims after the 27th October would be subject to such processes. I await your response.
CA: The claim for xxxx was received in the unit on the 27th of October and thus falls under the new clinical pathway. Hope this answers your question.
P: As the ACC 45 was posted on the afternoon of 20th October I amsurprised and concerned that it was not received earlier.This client is unlikely to continue through this process, but if he chooses to who are the people in (city) who i can refer him to for
assessment? He has been abused by multiple abusers of both genders from the age of two to eighteen.
CA: I note that the 45 was signed on the 20th, but was only received by us on the 27th. In regards to the assessment, ACC needs to collect all the information possible at this point to determine whether the need for an assessment is necessary .That is why it is so important for you to send ACC the notes you made when you had the consultation with xxxx. Please send this information to us as soon as possible so that we may refer the client to an appropriate assessor where necessary.
P: Who are the assessors available in (City) so that I can possibly "warm him up" to the process? I see him again this week as I need more detail of the events to be able to provide the information you require. Just got a broad view in first session.......too much for him to handle.
CA: Unfortunately I am not able to provide you with a list of assessors available in your area, please see your professional body for advise on who is qualified to give a DSM IV diagnosis. You advised that you will be seeing XXXX for a second session, would you be able to advise if you are qualified to give a DSM IV diagnosis please, otherwise ACC wont be able to re imburse for sessions that have not been pre approved. However if you are qualified, please provide us with an ACC 290.
P: As I try and cope with having done an ACC 45 sent on 20/10/09 which was not logged by them until 27/10 and have to battle with the new system....asked who I could refer the client for assessment to someone local. This response.I will not begin work with anyone else, and would not have with this one if I had realised it would be under the new pathway
6. I have no experience to contribute, because at this stage I am not introducing any new client to a pathway that may open them up to disclosure, waiting, more disclosure, more waiting, and then maybe being rejected. I believe that such a pathway has a high probability of retraumatising people, and my first rule is to do no harm. Given that there are many practitioners who have taken the same stance, then it is quite possible that a half empty "pathway" has gone smoothly for Dr Jansen. But (1) where is the empirical evidence that this has been smooth for the clients? and (2) Is this a fair sample?
7. So not only have they halved time and money for acc290s, demanded free reports every 4 weeks and stopped payment for 291s, they also expect a 719 equivalent for free as well? So, if you see a client and do not realised - maybe they do not realise – they have already had a acc sensitive claim, you will not be paid for your assessment time?
8. Have requested up-to-date information from Peter Jansen plus four others at ACC re situation in xxxxx District and have had no specifics at all;
9. One client, recently applied for ACC, but still under old pathway has completed initial sessions but is now likely to pull out – she is extremely afraid of being given a diagnosis and what this will mean for her future employment, mortgage, insurance, etc, prospects. She is also angry that she may need to tell her story again to someone else within a few months and is currently says she will not be doing so. Rang ACC to clarify – her claim had been declined under the new pathway six days before the 290 was due. Confusion reigns.
10. Another client transferred to me under old system because old counsellor left suddenly. Client was unsafe so I worked with her but ACC were so far behind that it took some months before decision to decline new cover with me because they want a psych assessment before any further cover - therefore I am not to be paid for the work I did (several weeks’ worth). Client stopped worked with me. However recently client again calls to say she wishes to return to see me and client is saying she is awaiting psych report as ACC requested. ACC are saying that she appears to have moved (she hasn’t) so they can’t proceed with anything. No-one knows if anyone is available in our area to do such reports and if so how long the waiting list is. Case manager is now on holiday for the next week.
11. A client applied to work with me – filled in ACC45. They took several weeks to give the go-ahead and in the meantime I have a waiting list. The date they give for completion of the 290 is so close to the date we begin the four sessions that I ring and ask the case manager for an extension given the circumstances caused by ACC’s delay. Case manager says she cannot grant extension now and perhaps if I ring just before the deadline I might get an extension. Client is already convinced this means they will decline her application which underscores her life script of being unworthy.
12. Last week I saw client who had previous counselling with a local clinical psychologist. She chose to return to counselling with a psychotherapist because she felt the previous counselling did not go deep enough and she required more in depth work. I sent the 719 report in (I was told by the call centre that they were still accepting these) and the response she got had this to say:
“in order to determine further treatment for you, your claim will be reviewed by a Clinical Psychologist employed by us… following this review, we may be able to make a decision on your claim or we may need you to have an assessment with an independent psychologist or psychiatrist.” They then go on to say “We will write to you to let you know: what our decision is, or who you will be assessed by (the emphasis is mine) and what the assessment will involve” There aren't many clin. psych in xxxxxx, will she need to return to the person she didn't want to return to? Will she have a say in this? And why can't they accept my own assessment of the situation?
13. in the last two weeks two clients have had claims declined, the first time I have ever had a claim declined. I have done this work since 2001.
14. One was one of my very typical clients, over 3 separate incidences of abuse, including rape. She has symptoms of PTSD and depression, spent years avoiding doing anything about the abuse until her daughter was raped. I outlined the symptoms which fit with my diagnosis, and a treatment plan that involved some education about the effects of abuse, building safety and building feelings awareness so as to develop affect tolerance. She has been told she requires a psychiatric assessment, and does not want to tell her extensive abuse history to another person. Fortunately, my work allows me to continue to see her without ACC funding.
15. The other client was not unexpected with their new rigour, as she had extensive mental health issues and is also intellectually disabled, so I suspected they would put her symptoms down to these factors rather than the abuse. Both clients had claims put in in September, and took more than 6 weeks to process. I can't help thinking they held them up to go through on the new pathway.
16. I have also had at least 2 inquiries to engage in ACC counselling, and am suggesting to clients they contact ACC to find someone in the area who is DSMIV qualified, so they don't have to repeat their story, or I offer to see them without it being ACC funded.
17. I have had some communication from ACC. I find they take about 10 days or more to answer emails! I am finding the re-entry process very time consuming, yet we only get paid for 1 hr. Last week I had a very distressed client, the session took 2 hrs, to do some work to stabilised her as well as get the information. Then another hr and a half to right a 'letter' to acc about her. So for 3 1/2 hrs I get $78.41 gst incl.
I wrote to them about this as well, and they said: If a session is going to take longer, to talk with the triage psychologist about it. My thinking is: How does one know if it is going to talk longer until you have the client with you, especially if it is a person you have never met before. (as was the lady in question.).
Below is the response from ACC re re-entry, and the code number. If a client needs to seek further help from ACC (a re-entry) we require a report outlining why they need to return, the details of their relapse, current situation and proposed treatment. We have withdrawn the ACC719 because we want the referrer to describe the circumstances behind the request. At this stage ACC wishes to receive such a request in a letter of referral. There is no guideline but once again the individual circumstances more information you can provide the earlier it will be for the Multidisciplinary Assessment Panel to access the need. The payment for this session is one hour Code PSYS01 - $78.41 (GST Inc)
18. This one is what would have been 719. In Both cases I have been asked to write a letter stating reasons for client to re-engage. When
I asked what code would the letter be under for payment. I was told they didn't know, it was a good question and that 'it' would be put on hold until it was decided. Not sure what other private business would be expected to accept this as a response to "how will I be paid for the work". The question might be interesting but the response is even more so.
19. I have several stories from clients, where I have submitted, with clients’ permission, Psychiatric notes rather than have ACC do it, in order to speed up process for client, only to be told 5 - 6 weeks later that the client will given 10 sessions with psychologist, start date or who this might be unknown at present. The actual response is not really the issue here, but rather the way and delay in delivery is of great concern. One particular client has required further support by way of their Psychiatric nurse to help de-escalate the anxiety of 'not knowing' what might happen next. So many dynamics of abuse client has already experienced in the past.
20. I have just had a sensitive claim (290, old pathway) turned down, where the client's symptoms of flash-backs and suicidal thoughts clearly relate to 2 yrs of ongoing sexual abuse when she was a child. What do I do next to get this re-dressed? Bearing in mind this client would probably lack the ego strength to go through a psychological assessment having been 'not believed' by a team at ACC. And by the way, I also spell out in the report that she recently disclosed the abuse to her parents and they have withdrawn contact with her pretending the abuse never happened.
21. My client had been given 4 sessions after her GP filled in ACC45. It was some time before she gained courage to see me. She was supported by another to come to first session. I saw her for 4 sessions filled in the ACC 290, did not use DSM1V, but diagnosed Complex PTSD with Borderline traits, and Depression. My report included details to substantiate my diagnosis and to clearly link the injury with the sexual abuse. I also included details of immediate safety issues between client and partner which needed attention. I expected that this information would have alerted claims manager to need for rapid response and client's need for immediate psychotherapy.
Client's abuse included incest by a family member (age 3-14 yrs), and as an Adult, of her first two long term relationships one involved violent rape, and in the second she was unable to stand up for herself against dominating threatening behaviour. Current relationship is better but the week I met her she owned she provoked partner into hitting her and she retaliated. On this basis I decided to see her anyway irrespective of cover as safety issues involved and because she has her two teenagers living with her.
23.08.09 Sent ACC 290. Heard nothing. 23.09.09 Phoned Told 4.6 weeks delay. Relayed to phone person my concern re safety issues and asked that when cover approved if it might be backdated. I also left message on Claims Managers phone and asked she phone me. No reply. 8.10.09 Phoned. Same again. No email or phone reply. 14.10.09 Phoned Same. This time the phone person left the Claims Manager another request to email or phone me. No reply.
23.10.09 Received an email from Claims manager saying needed more information from her GP "due to high level of psychosocial stressors in her life". This to help ACC establish if mental injury direct result of abuse events. They asked me to provide GP details and provide more details re contact with the mental health sector. (GP was away for three weeks which I relayed. How ACC thought he would have been able to establish this better than I, who had interviewed her at depth, I have no idea! Nor why they did not have his details since he provided the ACC45,) I gained and sent more details than given at initial interviews, (likely due to her anxiety) these included CAT referrals for suicidality, and contact with other Mental Health organisations. Was given acknowlegment of the inconvenience of the delay.
14.11.09 Still nothing heard. It is now almost 3 months since my report was sent .I am continuing to see my client who is making good progress, no thanks to ACC! I note that my 290 report was received by ACC in August some time before the Guidelines were put due to be put into practice.
22. A woman in her 40s was raped at age 16 while she was a patient in a psychiatric hospital. Because there was a diagnosis recorded on her admission notes, which ACC sourced, indicating mental injury, and because there was an overlap of symptoms, the claim was declined. There was no denial that the rape had occurred, but it was held that mental injury could not be connected to it.
A woman abused in childhood in the setting of a dysfunctional family. Claim declined because it was the dysfunctional family that caused the injury, not the sexual abuse specifically.
24. A client's claim submitted under the old system included as one count that she was coerced into a sexual relationship at the age of 12 by an 18 year old boy who used shows of violence (eg punching walls) to intimidate her into providing sex. This sexual contact continued for 8 months, her dysfunctional parents treated them like a married couple and she didn't know she could make it stop, though she detested every moment. This claim has been declined on the basis that the sex was consensual. What about the Crimes Act? What about the evident impact this had on her? Who is this person making these preposterous decisions?!
25 I have now had a claim declined – under the old system I was given a due date. This due date fell after the new system began. I rang up for an extension before that date because the client was nervous about being given a diagnosis and wanted time to think about it. During this phone call I was informed that the claim had already been declined because of lack of information and that I would have to re-apply for my client under the new pathway. If I had not rung, I would not have known of the early refusal. There appears to be no path of appeal.
I am wondering if this puts ACC in legal breach of contract? I have a letter giving my client and I until a particular date to complete the paperwork and ACC have unilaterally broken that agreement.
26. Have you heard of this new clinical pathway interpretation yet?
This morning my 60yr old patient was rung out of the blue with a German accented man telling her she had an appointment at an unknown (to her) address. The person introduced himself as an ACC assessor but gave no name or phone number to ring back. She rang me feeling appalled that someone unknown to her had details of her life even her family didn’t know about.
I rang ACC's complaints department and laid a complaint. Someone called David (I didn’t catch his last name but I think he's the manager (who was earlier, when I rang in a meeting...) of complaints. I told him that ACC's approach was unprofessional, unethical and unsafe. He tried to make out that I was at fault because I hadn’t written in the original ACC290 7 years ago that her childhood abuser was a German. I told him I may not have known then and I couldn’t remember when exactly it was put down in an ACC 291 report. This seemed to make him feel very righteous. I told him it was irrelevant anyway as an appointment with a man alone at an unknown address was unsafe and potentially traumatising even without the German accent.
I thought it laughable that he held to the ACC line that "they are holding the clients interest uppermost and whatever she wants will be considered." Again the fake we are only trying to do our best for people...I am outraged and very angry. Although my patient has been seeing me for some time, she has also needed every one of those sessions and tells me she would not be alive today had she not had the help. She is the first to acknowledge ACC's contribution towards that. Is there a human rights violation here? PLease advise me
27. I don’t want to make any assumptions but it seems to me that there is a "clean up" called for any people who, in ACC's view, have been in the system too long. This is the 3rd DATA that I have had in recent times, all of them recommending completion.
28.My client received several pages of questions from a Psychologist that were to be posted back before meeting him. She felt most anxious and daunted by the questions and needed support as to how to answer. She also felt nauseous at meeting a male and felt she was being "punished".
29. Client Y (18 year old) presented early October 09 after referral from GP. We heard nothing from ACC until I received an email last week, herewith: “This claim has been reviewed by an internal panel and it has been decided to decline the claim on the grounds that there is no clear evidence that there is a clinically significant mental injury caused by sexual abuse. I will try to contact xxxxx today to advise her of this decision and will send a copy of the decline letter to you”
2 other clients have rung me in the last 2 months or so wanting to re-present for counselling. I informed them of the current ACC systems and suggested they contact their case managers to clarify their positions. I also suggested they persist in their task to seek further funding. I have yet to hear from either of them.
And I do get this stated and unstated message from potential clients. “I don’t think I will bother..”
30. I need to vent a bit and tell you another “new pathway” story. I have just had a 12 year old in my office who was referred through her school guidance counsellor. This girl was sexually assaulted by her 15 year old boyfriend. I was under the impression that we were to fill out an ACC45. However, upon her arrival, her mother (who came in support) told me that they had just come from the hospital where the girl had had a medical and the medical team had filled in the ACC45. With the old pathway, I could have done the first assessment session and provided my client with support. Today, I had to inform them that even though I feel competent to perform an assessment and have done these before, I am now not allowed to do this (as I am only a provisional member of NZAP) and she will have to go away and wait for ACC to allocate someone to perform her assessment. Hasn’t the poor girl been through enough? Her mum was a bit confused about that and rang the CYFS worker involved who has just rung me. She is as confused as they are. This is the most disempowering process for the girl, her mum, the social worker and myself. In the meantime, I have referred the girl back to her school guidance counsellor for support while we find out what ACC wants to do about this. I have talked to the guidance counsellor who does not have a background in trauma counselling and feels a little out of her depth.
31.I recently a new ACC client was referred to me by her Pastor. She came very fearful and highly anxious about talking, common situation. Her abuse had been extensive and had aspects of extreme cruelty, which her Pastor told me about.I filled out the 45 and spent most of that first session creating some sense of safety for her. ACC rang me. They now wanted the equivalent of a 290, although not with a DSM1V diagnosis, I would not be paid for that, they wanted as much abuse history as possible plus her GP\'s name so they could check that there was no pre-exisitng condition/s. Far too much required out of one session. The client then rang ACC and was told that she\'d have to see a psychologist or psychiatrist and it was not guaranteed that she\'d be returned, after considerable time, to me. SO much for creating safety, trust and the beginning of a therapeutic relationship. The info they want they said i could use a 290 as a \'guideline\', in other words, do a 290 and 45 in one session. Ridiculous. I was left feeling very frustrated with the whole thing.
32. I have heard that some psychotherapists with DSM IV training have recently had their 290's returned by ACC
33. My client received several pages of questions from a Psychologist that were to be posted back before meeting him. She felt most anxious and daunted by the questions and needed support as to how to answer. She also felt nauseous at meeting a male and felt she was being "punished". My client reports it's for an assessment. She had 2-3 pages of questions- 1 page covering 150 questions. She laid it aside for 2/52 and then tackled it. She reports it was like an exam and was degrading. "All my trauma was laid out in front of me and I could see visions of all the perpetrators. I felt yuck and exhausted afterwards."
Now, she feels "labelled" and is angry.
34 I have just heard about the cover decision on a 290 put in under the old system. Due to certainty that there would be trouble I have not met with the client after our 4 sessions (luckily I judged her well-supported enough to manage this). They received report on Oct 13th – today I hear that the peer reviewer has decided clinical psychology input the only way to go, and I will have 5 sessions to complete with the client! This client has an intellectual disability, so that may be part of the decision but if they have decided that psychotherapists are incapable of working with people with any cognitive impairment I find that quite insulting. I will challenge the decision, once I understand how to do this – have never had to do it before.
35.I was contacted yesterday by a claimant who has relocated from another town and is looking for a therapist. The new process is that I email sensitive claims with a referral. I have done this but have not met this client we have only talked over the phone. At least with the 719 report, the client and I could make face-to-face contact and make a more informed decision to work together. Now, I find myself reluctant to do this as I would not be paid for an hour’s session. I’m in a bit of an ethical quandary about this. I guess the new pathway is about making sure that people don’t attach to each other initially, but isn’t this the point to our work? I guess I’m just thinking out loud to you and haven’t really thought too deeply about this all as yet but I feel a bit conflicted about the process I’ve just been through regarding this. I would be interested in your thoughts…
36. In the 2 weeks since I returned I have had 3 new sexual abuse referrals - one 16 year old female recently raped - 2 males in their 50's both raped and abused over several years as children, and only recently disclosed.
Already the difficulty of the process is apparent... ACC tells me (phone conversation) I have to send a narrative of the effects, copies of my clinical notes and any other information I have.
I see this as inappropriate and very different from giving relevant information in agreed form format. Also the time involvement to do this after the session is not factored by ACC
I have decided to send in the ACC45s to register the claim, with a 'narrative', without my notes.
I have written a disclaimer on the bottom saying it is done under duress and I am opposed to the new 'clinical pathways'.
I am happy for anyone to use this 'form' or adapt it. (attached)
I am also logging the time taken to do the 'narrative'.
I am emailing to SCU that I object to this, that it was part of ACC290 etc. takes time/not paid etc. Will forward email when sent.
I believe the new system is unethical, unsafe and abusive to clients yet believe ACC has to be held accountable to support them.
If we withdraw ..if clients stop coming forward we have no awareness of the process to fight against on a practical level.
I may write the disclaimer on all correspondence with ACC..
Hers on the West Coast(SI) I know of only one psychologist able to do an ACC assessment..if I already have 3 clients for assessment...how long will this take..or yet again will ACC be flying psychologists in from Dunedin or Wellington to assess.?
37. A 13 year old girl who disclosed sexual abuse by her father when she was 5 years old. The disclosure wasn’t believed by authorities, father was allowed to return home and then abused her for another 7 years and involved her two younger siblings. A.C.C approved counselling, after a delay of 6 weeks, but have ordered an early D.A.T.A (Diagnostic And Treatment Assessment) because “the Peer reviewer has commented that there must be significant family issues as well and the DATA would also help identify what it is ACC's responsibility to address”. Given the abuse happened within a family setting and started before she was 5, it is going to have an impact on the family and require some disruption of relationships to enable it to happen over this time period. How can anyone distinguish between the effects of “family issues” that are the result of the sexual abuse (or deliberately created by the offender to “keep the secret”) and other “family issues”? There are many issues that need to be addressed that constitute a “significant mental injury” as a result of the years of sexual abuse. In the past D.A.T.A.’s happened after a large number of sessions. For this young person, who has also been through the Police process and is awaiting a Court Case, another assessment by yet another person is the last thing she needs.
A 16 year old girl who has been sexually genitally touched by her father from around the age of 10/11 to 16 years has had her claim “declined at this stage as we do not have enough information to determine cover as this information is not enough to determine a Schedule 3 event has occurred”. (If this doesn’t constitute sexual assault I am not quite sure what does!!) A.C.C. asked for more detail and also said they would access CYF and C.D.H.B. notes. CYF was only involved after she disclosed the abuse and a counsellor reported it to them. She has been treated and discharged by 3 C.D.H.B. agencies for depression and suicidality, which began after the sexual assaults began. They do not see her depression as serious enough to receive ongoing care. Unfortunately she was not able to disclose the sexual abuse to those agencies, so other explanations were looked for i.e. a family pre-disposition – which recent experience suggest will be used to say she has a pre-existing mental illness therefore no cover from A.C.C. While A.C.C. has already declined the claim, they are still requesting these notes and I have been asked is there domestic violence in this family i.e. is this a “dysfunctional family”. From recent experience this is about collecting information to facilitate confirming the declining of the claim, not to aid treatment. Is this ethical to collect information for the purpose of declining someone treatment? The girl commented that the “declined letter” would have triggered another suicide attempt if we had not been meeting for counselling in the interim while we waited for the decision (for which I will not be paid).
23 year old woman who has been subjected to several events of sexual abuse as a teenager and fragments of memories of sexual abuse as a child by her father (she also knows a report was made to either CYFS or the family doctor at this time). Initially when the decision was delayed I was told that À.C.C. was waiting to receive the mental health notes form the Anxiety Disorders Unit. When I commented that the person had not disclosed the sexual abuse to the Anxiety Disorders Unit staff, I was told that the reports from her time there will give us a really good, in-depth background to her mental injury. This extra information also helps further down the therapy track when we send clients for independent assessments. My concerns are (apart from the delay in approving cover leaving a young woman in a vulnerable state having disclosed the sexual abuse for the first time) that wanting this information seemed to be more the task of overseeing someone's entire mental health care. My other concern was that the Health Information Privacy Code is clear about only gathering information that is necessary for the current purpose, and that a possibility of using it at some time in the future for another purpose (many A.C.C. Sensitive Claims clients do not get referred for independent assessments) is outside the provisions of the Code. It is now 3½ months since I submitted my Cover Report and A.C.C. have still not made a Cover decision and recently decided to send her for another psychiatric assessment to determine cover. No counselling has been approved as yet.
I supervise a worker from another centre who has had three children’s claims from different families declined on the basis that they have been taken into care by CYF and placed with foster parents, and before or after had disclosed sexual abuse in their original family setting. The claims have been declined because the CYF involvement is evidence of “dysfunctional families” and therefore this is the source of the children’s difficulties not the sexual abuse they have experienced, even though the symptoms are consistent with those experienced by children who have been sexually abused.
I had a phone call today from a grandmother who has recently taken over care of her 14 year old granddaughter after the girl disclosed sexual abuse by her step-father. When I outlined the new A.C.C. process to her, her response was that they would never get her to go through that. The girl has only just agreed to go to counselling after 6 weeks of talking about it, and her grandmother believed she would never agree to go through the new process of assessment. She was really despairing that her granddaughter wouldn’t get any counselling help and would not be able to recover from what has been done to her.
42 There have been NO new referrals for ACC therapy to any of the four of us in Whanganui in the past month.
43 . I am greatly concerned that whilst no new clinical pathway appropriate for Maori has been developed, that Maori claimants are being treated under the new clinical pathways. I am the only ACC approved counsellor in the xxxxxx region identifying as Maori, and with about 70% of my ACC Sensitive Claimants being Maori.The new clinical pathway is not appropriate! I suggest that a 'diagnosis' based on the model of wellbeing, Te Whare Tapa Wha, would be a culturally appropriate means of assessment for injury. This would be an assessment that I am well capable of providing. I request that until a culturally appropriate clinical pathway is developed, that Maori claimants are seen under the previous guidelines.
44 In terms of Pacific consultation, I have heard nothing at all from Peter Jansen despite emails phone call messages left. I find it shattering, despite all the past SCAG presentations of Pacific models and proposal (to no avail and feedback yet).. - almost like a lone voice in the wilderness at the moment and yet holding onto the faith and hanging in there on and behalf of our remaining ACC Pacific Counsellors.
45. I would like to look at the lodgement and assessment process which isn't working based on the struggle to get Maori into the system. Therapy will not be possible if we haven't got the 1st stage right as yet. Another opportunity to repeat the same mamae experienced under the clinical pathway. When selecting counsellors who ACC considers appropriate to provide therapeutic intervention once claim is accepted, will the cultural context be taken into consideration? For those claimants that seek out a maori counsellor in the first instance, will they also be on the selected list they present to claimant?
46 XXX is the first client I have taken on in this new process and I am saddened to discover that this new process, "Pathway" is untenable, as we have feared. My client is choosing not to go ahead with ACC's Pathways. He has stated that "What you are offering is no where near adequate. It does not make me feel confident or safe to undertake healing with this process you have. You are provided by my Government for people like me to be able to use your service. I would love to be able to use ACC for counselling'.
47 With 15 years experience I used to be able to very reliably predict the acceptance of a claim by ACC. I no longer can do so. This now becomes dangerous for both myself as the clinician, opening up the client to reveal painful material with no follow-up, and for the client, who could be likely left in a very fragile state. I therefore have decided to no longer take new referrals
48. I must say that I horrified at these changes and will bring it up for discussion at my Peer review meeting next week. Perhaps as s group we could contact the College.
49. The lists of eligible providers on the ACC website are completely out of date - by several years in some cases - so are useless to help anybody find a provider.
50. Although I am putting my hand up as one ''safe harbour'' that clients may access for at least the initial two steps (ACC 45 and ACC290), one of my biggest concerns is that I KNOW I cannot create safety, trust, connection and relationship AND gather ALL the pertinent data required in 2-3 sessions (considering the ACC 45 is one session). Unless I've missed something along the way, I am under the impression there are only 2 sessions authorized to complete the 290.
51. I haven't taken any new ACC clients since August when they announced the new pathway and that gets scary when my private work is getting more and more quiet but I am very clear that it is not okay to work in the way ACC demands. I had a call from a woman recently asking to see me and it was hard hearing her distress at not being able to get a therapist. All I could do was acknowledge that and ask that she ring ACC. I still haven't heard about the last 290 I sent in on 5 August in spite of regular calls to ACC. I suspect that client will be a casualty of the new system when we finally do hear back. So much for the quick turn around!!
52. Should be old pathway, but after initial 4 sessions, client sent immediately to a psychiatrist
Did you know that ACC are 'catching up' with old files. I had two clients Feb and March last year 2009 that had the initial 4 sessions and a 290 sent in.I was paid for these. Both clients decided that they would not proceed further. One was a mental Health Patient. As the decisions made to not progress came after the 290 were sent in, I put the clients files in my concluded file and thought no more about them. This last week, I have had a call from ACC asking me for phone numbers of the Mental Health Patient. I do not know what ACC has decided to do about this person. The second client I was told this week, has been given 6 sessions with a psycharist and thank you for all my hard work! Yea Right! If counselling had progressed with both these people then I would have followed up the 290's. I tend to think that all old files that do not have a 291 end of counselling doc are being processed to tidy things up, possibly as a precursor to closure for the unit??????? I have been an ACC counsellor for 10 years and am very alarmed that people will have no way to address these problems in the future. I have a practice in Milford.
Posted by: Yvonne Elliott | March 10, 2010 at 05:45 PM
Funny I saw you on face book today and almost messaged you. Our conference went well. We had 40 attendees. I personally was able to take so much out of it and have integrated so many insiders since then.
I think you would do well to have one. I know you have enough connections and places to get the word out.
A suggestion, find an event promoter to do it PRO BONO for you. As you know many people have a heart for survivors. They are out there, use your network to find them. It will take alot of the headaches away.
I wish you success. I sure wish I could attend. I would be willing to speak about a variety of things if you can find the funds to get me there. LOL
I know that is not possible but it would be nice.
Smiling at you, Silver
Posted by: Silver | March 10, 2010 at 05:27 PM
Lovely to hear from you again Silver. You are not the only one sickened to the stomach about this. But we will not give up and soldier on!!! I've been thinking ob you this morning and wondered how your conference last year went. I'd like to hear from you about it if you have some spare time. I am thinking of something similar here. Although I saw that the new conference in August this year has much more therapist's involved. I thought it was more survivor driven??
Posted by: Gudrun Frerichs, PhD | March 10, 2010 at 12:51 PM
I was forsed to develop so many different personities as a result of my abuse, I wonder how long I would be given to heal the personalities under your system. I am an exptremely hard worker but you can't rush this stuff. I really feel for you and your clients. Yes, this new process is unbelievable to people in the States but with the proposed Health Plan supported by Obama, we will be in exactly the same position in America. Jackasses all of them. Silver
Posted by: Silver | March 10, 2010 at 11:17 AM
My gosh, this is an absolute nightmare. As i was reading this, I wondered how long I would be given to complete my therapy under your rules. I am now starting my 24th year in therapy because of my extremely long history of abuse with SRA being the worst abuse I esperienced from age 4 months to 17 years. Silver
Posted by: Silver | March 10, 2010 at 11:12 AM