This is the second instalment of accounts from NZAP members of recent experiences with the SCU of ACC until February 2010. The stories which have been sent since the last report are included here.
While some claims were lodged before the introduction of the new pathway, they seem to be subjected to the same criteria as the new.
This is a very typical comment from therapists’ recent experience:
“At the Centre that I work from together with four other ACC registered psychotherapists, new ACC referrals are virtually non existent - and we are still having clients processed dating back to May with declines in almost all cases. These are the first declines ever in our history of over 15 years of ACC work!”
Recent experience of blocks to clients’ ability to access therapy are based on a number of factors. Some of these are listed here. The numbers relate to the itemised comments below from #53 onwards and in the previous post with stories collected until December 2009 from # 1 - 52.
No culturally appropriate Pathway for Maori yet established
• (43) (45) (66) (90)
No culturally appropriate Pathway established for Pacific clients
• (44)
No appropriate pathway established for children and adolescents
• (30)
Decline because of pre-existing or coexisting condition
• Rape in a mental institution meant pre-existing condition (22)
• Raped within a dysfunctional family (23) (37) (38) (39) (40) (86)
• (89)
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) (54)
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) (62)
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) (53)
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) (65)
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) (57) (59)
Claimants being processed under new pathway even though claim was lodged before the date this applied
• (5) (15) (61) (63) (70)
Claimants having no choice of therapist now SCU decides who they will see
(11) (12) (19) (31) (80) (82) (83) (85)
At the Centre that I work from together with four other ACC registered psychotherapists new 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)
• Change of approach for no therapeutic reason (56)
Claimants denied further hours because they are seen to have “had enough”, an administrative rather than a clinical decision.
• (27) (55)
ACC SCU Administrative processes inefficient
• Losing track of clients’ information (10) (58) (68) (69)
• Delays in responding to phone calls and emails (17) (64) (67) (84) (88) (90)
• 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) (80) At the Centre that I work from together with four other ACC registered psychotherapists new
No lists of suitably qualified counsellors who are still available for clients to contact
• (49) (51) (84)
53. An update - Client rang ACC again as was feeling incensed about this process. Said as much to call centre person, who checked to see if the DHB had been contacted for the psychiatric assessments. No they had not- despite it being very clear in my 290 of her recent history. So then I contacted case manager asking if they would still need the psychiatric assessment. The response- Triage likely to require it due to the client's complex history.
54. I have only put two claims in so far. We courier them down daily and 12 days on I am still waiting. What happened to the 7 day turnaround for those able to send in the 290? I did inadvertently send the ACC45 on its own with one of them and phoned to say this. They said they would put a note on the case. They did not so subsequently I got a letter asking for all of my notes and a formulation. I also got a copy of the letter that was sent to my client saying that the information collected from me would be sent to their team of psychologists, they would be accessing her GP notes and may send her for a psychiatric assessment. I will be stunned if she comes back. She’s 18 and has a difficult relationship with her mother where her phone and computer etc are accessed regularly and without her permission. She only disclosed to a few people one a friend who brought her in the first time. I would be stunned if she was able to cope with the violation of having her GP notes sourced given the intrusiveness in the family, the fact she hasn’t disclosed to him/her and her need to maintain some personal privacy in the family. Given the social standing of her family I’m sure there is no way she would willingly allow herself to have a psychiatric assessment and diagnosis. Perhaps if they send scarey enough letters no clients will return after the first one or two sessions anyway which would be interesting to canvas. In the meantime this client is in need of some sensitive support, not invalidation which is what also occurred when her other friend disclosed to some others at school.
EXTERNAL ASSESSORS OVERRIDDEN AND EXISTING THERAPIES TERMINATED PREMATURELY.
55. Of particular concern to me is having the recommendations of an external DATA assessor overridden by the ACC peer reviewer who has never met the client. I have seen one client for 8 years she has had the same DATA assessor 3 times. The DATA assessor and ACC have supported the work and the goals which have remained consistent until recent DATA review in consultation with me suggesting a further year for final stage. ACC says it is too long and will give 20 sessions spaced out fortnightly and that some of the previous goals are no longer their legislation (being bullied and not coping with now more senior role at work due to avoidance which assessor says is primary coping defence from sexual abuse. A flow on effect not their legislation. Client has had to resign and DATA says its important that she gets supported back to work before ACC termination) I am expected to change my treatment plan after all these years and ACC don’t mind that client at risk of not returning to work if therapy stops here.
56. Peer reviewer changing tact on long term client within 3 months. I also notice the Peer review feedback forms have changed. July Peer Review says DATA is due but good reporting and progress reported by counsellor so not pressing at the moment particularly as reviewing the details of this case long term work will be necessary. This was also indicated in the previous DATA. November Peer review (after 10 phone calls and running out of interim hours twice), SAME peer reviewer says 10 hours spaced out until urgent DATA as its important to see what is realistic and what further progress can be expected so that she can move towards independent achievement of her gains. Again, I’m supposed to change tact and have my treatment plan overridden even though previously supported by someone who has never met the client or spoken to me.
57. UNWILLING TO HAVE NOTES ACCESSED
ACC declined claim because claimant didn’t want them to have access to her CMHC notes. Never mind the fact that I said I had liaised with the CMHC and for this young women it was a separate event (tragic loss of a large number of close associates at the same time) which obviously left her vulnerable to being impacted by a rape 12 months later. I articulated this to ACC but I expect she will not attempt to re-engage with them again as it is too exposing and very scary for a young person to consider having personal information being transported around the country to unknown people in organisations
58. TAKING UNREASONABLE AMOUNTS OF TIME, INSISTING ON ASSESSMENTS/DIAGNOSIS & QUESTIONING CONSENT ON AN ISSUE OF INCEST.& BLAMING THERAPIST FOR ACC ‘ERRORS’.
14 July 290 sent. Abused by cousin – 5 years older. No response for several months. Only when I become agitated and up the pressure I get an email asking if the adult sexual contact was consensual. Send in information and get nothing. More phone calls and get told they need more information – I say I’ve sent it and she says OK I will find it. Doesn’t get back to me so more phone calls and get told they need more information. I said we have had this conversation. She remembers and says she will email (new case manager) email address but doesn’t. More phone calls and finally send the information. By the end of October it is decided that she will need an assessment otherwise it will be declined. During this time my client has also called and been told that they have been trying to get hold of me to get some more information. Now I’m sure they log these calls and if I had more time I would put in a complaint about this one. My client does not want to be given a formal diagnosis so she won’t be continuing in therapy after the new year which has largely been unpaid.
OFFERING REDUCED SERVICE DUE TO ACC ASSESSING CLIENTS FOR WHOM IT IS UNREASONBLE AND UNSAFE
59. I am taking a client off ACC and will be reducing the frequency of the time I see her until hopefully she is able to one day manage to afford to increase the frequency. ACC have indicated that they will be assessing her even though I’m still waiting 21/2 months later and have not been funded. She has severe PTSD symptoms and uses marijuana to manage these. She has agreed to attend CADs and with supportive information from me she has agreed to go for a medication review with a doctor at her local CMHC. She has taken years to approach a therapist and struggles to stay in the room for each session. It would be unethical for me and unsafe for her to have an assessment. In addition she has a previous ACC claim which she did not initiate willingly and did not disclose the earlier and more severe abuse. I fear that any potential invalidation at this stage could cost this client her life and do not trust ACC the process to ‘do no harm’.
60. The reason that ACC pulled out of funding the 24 hr crisis service recently & after all of these years was because it takes 24 hours to diagnose a mental injury so it’s not under their legislation.
61. The claim was declined, the client informed and then I was asked to provide more info. I have since done this. It will be interesting to see if the case is accepted or declined a second time. The client in the meantime has overdosed on medication (not as a suicide attempt but to calm herself down !!!) been assessed by a local psychiatrist and discharged. Her levels of stress are going through the roof as she has struggled with her GP and WINZ to organise funding. She has even more nightmares than before!!
Dear Case Manager, I am wondering where you are at with this claim. I understand that you are the claims manager. There are several points I would like to make.
1.This claim was lodged under the old pathway and as such I expected the information I provided on the ACC290 sent to ACC on 13 October should have been sufficient for a decision to be made. Many previous ACC 290 forms submitted by me have contained similar information which has been sufficient.
2. I specifically enquired about the way claims would be treated in this transition period before I agreed to see the client at all and was informed by xxxxx (by email) that all ACC 45's received before October 12th would be processed under the old pathway and not the new pathway. The ACC 45 was submitted well before this cut off date.
3. Apparently the ACC 290 was only looked at at the end of the statutory time required for a decision to be made (60 days). I do not understand why the time was not extended so that you could ask for more information from me before declining the claim or how ACC can justify using up all the time to consider this claim and not consult me earlier in the process.
4.You will certainly be aware that the relationship with the client is of great importance. Given my experience with many previous claims I explained to her how the process would go and what was likely to happen having been assured that the changes would not affect this claim.When the client rang ACC to enquire why her claim was declined she was told that the report didn't contain enough information for a decision to be made.There was no acknowledgement from ACC that there were huge changes underway and that this decision to decline the claim was in any way influenced by that. The client is now angry and suspicious of my ability to help her and is at the point of giving up. Surprisingly her PTSD symptoms have not abated over this time and as is the case for many clients with childhood sexual abuse, the time following disclosure is extremely stressful and support is necessary.
5. The local community mental health service has to date been unable to provide the support the client needs and she has also been unable to obtain funding from WINZ as that process is stressful for someone with acute PTSD symptoms. To date she is still not able to pay to come and see me and has also run up a large debt with her doctor. Her situation is now worse that before she approached me for assistance through ACC.
I would appreciate a speedy conclusion to this claim and expect that the further information I have provided to xxxxxx is now sufficient for the claim to be reprocessed.
62. I had a phone call from a woman wanting to know my qualifications and experience working with c. s.a. I did my spiel about why I can't work with ACC and she responded that she hadn't even imagined seeking ACC funding (because of these changes).
Another client chose not to seek funding from ACC because she does not want to invite a DSM IV diagnosis. She had a bad experience with Acute Mental Health Services last year when she was misdiagnosed as bi-polar and had an adverse reaction to the medication she was given. She wants nothing to do with a mental health diagnosis.
Otherwise, there is a distinct lack of calls from clients seeking counselling for sexual abuse.
63. I have a 3 year old whose return to counselling was dealt with under the new clinical pathway, even though it supposedly doesn't apply to children. He was not given a DSM IV diagnosis, the letter from ACC refers to "psychological trauma", and he has been given the usual 10 sessions given to child clients. I have been sent a self-management plan for him to complete, and he has to see a clinical psych at termination. Thought I'd give him the form and a crayon! Have no other experience to report.
64. One of my clients has had to stop coming because of Acc's failure to respond to the data. She was going to bring a hard copy of the form to our next session but she's decided she has to stop for now. She says she's so frustrated with ACC that she doesn't care.
65. Copy of email to ACC: “I am not prepared to meet with client and do the equivalent of a 719 report without pay. This is an accepted claim and I imagine you have information on xxxx regarding her mental injury. Can you please let me know how I am to be remunerated for this if I go ahead with your request? Also, under the new pathway, I am apparently not competent to make an assessment even though I have been doing this for some time. I suggest that if you want an assessment, you request that someone you deem as competent do it.”
66. I also have had the same concern with Maori claimants. Although I informed ACC at the hui on Thursday that I haven't got any claimants through since the new process began, they are adamant that nothing has changed in terms of claimants seeking help from ACC. I am not sure how they can say that considering we are struggling to get them through the door at this end.
Maybe they need to do a survey from the provider perspective e.g. how many have come through our doors but have not completed the ACC or 45 or have not had their claims accepted. Huge gaps in this process. What are they basing their statistics on? I cannot be the only one having problems getting themin the door.
67 This is case under the former scheme.
In March 2009 I completed an ACC 290 report for a man in his mid 30s, who had been raped and beaten frequently as an 8-year-old over a 6 month period, and was suffering with severe depression and PTSD. I offered ongoing counselling with some assistance from Winz funding while approval was sought.. The client was too afraid that he may get into debt so declined counselling unless he could be guaranteed ACC funding. On 6th August I received a letter stating that an Independent Psychiatric Assessment was required and I would be informed about this. I heard nothing so rang case manager in early December and was told a psychiatrist was asked to provide this on 5th October. I heard subsequently that the client had to postpone the psychiatric appointment set for late November, as he was recently diagnosed with a "serious illness" and was having tests. The Assessment was postponed indefinitely. So his ongong situation remains. His ACC claim has still not been approved. He was seeing a pyschiatrist for medication every 2-3 months but not receiving counselling for his severe PTSD symptoms of rape in childhood.
68. A counsellor at my practice sent in a Cover Determination beginning of April. In June he phoned to see what the hold up was- to be told it had been misplaced but located it and said she would process it but run it past Tom Neisser who might recommend an early DATA. (so obviously the new system was already in place) - still no response. Client had left town in meantime so he didn't chase it up. Client resurfaced some months later expecting to begin counselling- no response i n the months elapsed. He sent an e mail off today- we are now in December- and heard back to say the report has been sent off for peer review and is still there!!!!!
A 9 month gestation so far...
69. I heard yesterday that two of the 290's I sent in August and September are unfindable - who has them? Is there a count of recently lost reports somewhere?
Two others have had no action, one since July - although they are saying September; the other since October.
70. I first saw a new client on the 13th Oct.(old pathway I assumed). I sent off the 290 at the start of November and then waited until today for ACC's response. Before I say more, I had continued to see this client because a) I understood she was in the 'existing pathway' b)she had a clear diagnosis for her 'injury' (anxiety disorder) c)she is young and vulnerable and needed 'holding' and consistency and safety to stabilize her anxiety in the 1st place. So we have had around 8 sessions to date; we have a firm working alliance and she is gaining confidence.
Net result of my report: ongoing sessions approved for 'anxiety', but not with me, a clinical psychologist instead. (Also, obviously no reimbursement for the sessions undertaken).
A new 'Manager' now in charge of my client, informed me in no uncertain terms that the triage thought my goals were not streamlined enough....Yet I had specifically targeted helping her to manage 'overwhelm', to learn to 'self- soothe' and breathe properly. I am at an absolute loss as to how ACC can actually proceed in this manner.
80. Around a month ago another 290 was declined, and I continue to see this client for a small reimbursement whilst she awaits a 'Psychological assessment'(if she has the emotional capacity to actually go to be 'assessed'. (This is the client with 2 years of ongoing childhood sexual abuse.)
I have 'lost' a further client a few weeks ago, because ACC wished her to have a psychiatric assessment before saying yes or no to further funding (this client was raped by her brother as a child)!
I have had 2 significant turn-downs…
81. First, a client who suffered years of incest with force by the father perpetrator from 8 years to 23 years!!! I am in the process of getting alongside Michael Watson too to see if there can be some shift on ACC’s part on the decline. Will write it up when this is further progressed. One thing of note is that Michael Watson phoned this client himself first, and told her without any contact to me!! I had thought there was supposed to be some agreement that ACC would at least do the bad news contemporaneously with the provider, so we could support the client ??? I wonder what happened to that notion?? This person was supposed to be under the old system too !!
82. Another… a latency age child, whose parent has been persuaded by a case manager to agree to a clinical psychologist, following a long delay, and just after the family was offered 10 sessions with me !!! I will follow up and find out the ‘official’ reason next week!!
It does seem that childhood s.a. is now too hard to prove, so declines for all of us who are not clinical psychologists, seem to be the order of the day!!
83. at the moment Diane, in 'complaints dept.' at ACC is looking into some questions I have posed which contradict MW's reasons for referring my client to a psychologist. I haven't heard from her for a week or so; I find it hard to feel optimistic. MW's main thrust with me is that my client was referred on, in the OLD PATHWAY. Diane is concerned that if this is the old pathway as he states, then she wouldn't be referred to a psychologist.
84. In Dec. I realised I had 2 supervisees describing the same client to me. I think the client was just naive [and desperate] so had accessed all the therapy she could, both short term-3 and 6 sessions. This had followed a very distressing rape which had disturbed her, her family and community. I wrote to ACC and I explained the client had already seen 2 therapists, neither ACC registered, and would need to see an ACC registered therapist. I felt it important , given she had already seen 2 people, that she start with someone with whom she could carry on. I understood that under the new pathway, she might need to see a clinical psychologist in order to ensure this, and could she tell me who was available in Dunedin that would fit this criteria. ACC replied the same day [1-12-09) letting me know she would refer the query to Kate Newrick. There was no response from Kate.I emailed her, expressing increasing urgency as the clients short term therapy [with both therapists] was running out. I sent emails on3-12-09,7-12-09and 9-12-09.
I received a reply from Kate on 10-12-09 saying it would be easier for her to answer the question if she has the clients name and claim number.I replied on 10-12 09 and re-iterated my request explaining there was no claim number because my supervisee did not want her to refer her until she knew who would be available to continue with her.I wrote again on 12-12-09 and then gave up.
I am really shocked by that latest news of ACC trying to stop anyone even having a chance of any cover for abuse pre-1974. Perhaps I shouldn't be. I am no longer taking on clients under the new pathway, but this is my experience of 3 clients who presented in August/Sept last year and whose ACC290s were filed under the old.
85. Client with an intellectual disability caused by head injury as a young child. Long ACC claim for these impairments. Sexual abuse counselling with me declined on basis that her exising provider could do this work and that I did not have the expertise. I did challenge whether they had asked the client if she wanted her existing provider to do the SA counselling which client agreed to. I also challenged their assumption that as a registered psychotherapist I could not work with someone with an ID, but was asked to provide major proof of my training etc, and at that point gave up.
86. Client woman in her 60s, abuse dating back to the 30s. Reason for seeking help, assistance with poor sexual relationship with husband, in context of otherwise loving, functional marriage. At present she has not been declined under this new regime of ACC's but I am waiting for that. She was declined as the effect on her sexuality was ignored and she did not "meet the criteria for depression". Also main abuse, a clear Schedule 3 event (rape when she was six) but as I put in extra information (as they ask) about further sexualised play with a close-in-age brother, contact with whom is part of the triggering event for contact now, they have ignored the rape and said the other doesn't constitute a Schedule 3 event. I am challenging both areas of decline and waiting.
87. 3) Client 3, applying for both income compensation and counselling for acquaintance rape in July last year. Had to undergo psych assessment for income compensation - diagnosed as Acute Stress Disorder which "lasts" for 28 days - did not approach ACC till a couple of months after rape, so turned down for income compensation accordingly and my 290 apparently completely ignored and only psychiatrist's diagnosis taken into account. Client looking at whether she wants to challenge that at present.
88. This claim got accepted however I put it in in the first week of November 2009. Technically I can fill in the 290 so should be fast-tracked and get a response in 7 days – they did not indicate they wanted more information. Many phone calls later and its still sitting with the second Triage psychologist waiting for an agreement with the first triage psychologist. I spoke to them in mid January and was told it had gone to Elisabeth Broom and they don’t know why – so I spoke to her and she didn’t know why because it wasn’t supposed to be with as case manager. I said I’d been waiting since November and heard nothing – apparently people had been away for xmas etc. I said that I hadn’t. The claim was approved. I asked for 50 sessions and got 10 with 4 sesssions for the four weekly reports. The diagnosis for PTSD was accepted. This client has a court case in May – after the sessions will have expired. The sessions were given exactly 14 weeks to be completed from January – well after November when I lodged it. Only goal one (safety) was accepted. No stage ‘two or three’ work is allowed. This client is has been rejected from her family and community (a culture with an arranged marriage) for divorcing her husband and pressing charges. She still has flashbacks and nightmares and will be more isolated and at risk after the court case. She is suicidal and has no support. I would feel that it is completely unethical and dangerous to work in this system for clients if I didn’t have back up funding from my agency currently. Even still I believe getting the letters from ACC which generally read ‘your treatment provider xyz did not provide enough information or we are referring you to a clinical psychologist or or we are happy to advise that we have allocated 10 sessions of counseling’ generate a serious lack of safety and trust in the therapeutic relationship (something which the Massey guidelines say is fundamental).
89. One client whose claim was accepted as of April last year has now had her claim revoked. This happened without any discussion with me or the client. The 20 sessions were up but my progress report letter crossed with their rejection letter. Fortunately the client is in The Ashburn Clinic so there is no immediate crisis. She was however hanging onto the fact that she would return to work with me upon her discharge. ACC did not know this circumstance so effectively they have just cut her dead. A letter arrived announcing that 'ACC has now fully reassessed .......,,'s claim for cover for mental injury caused by sexual abuse. We have revoked cover under this claim, as the new information received indicates that mental injury was caused by sexual abuse which occurred outside N.Z.' They already knew at the time the claim was made that substantial abuse had occurred outside N.Z Substantial abuse also occurred in N.Z. but apparently this no longer counts.
90. I meet with a Tane in his mid 30s mid June 2009 who took 6 sessions to fully disclose and allow me to write a 290. Due to the torture he suffered, the first disclosure ever and all the noise ACC was making re new changes I thankfully was able to find other funding for him to continue until xmas. (Since then we maintained contact via phone and text and have had emergency sessions to support his anxiety). So the 290 is in ACC's hands in mid August and when I finally got some sense from them in late September when they said they were waiting on his doctors report (who has been very supportive), they then said early October they had another 3 weeks to decide which took them to early November. Finally they sent him a letter stating he had to have a psych assessment first. He didnt hear from them again until yesterday '(02/02/2010) and they have told him they have been trying to contact him and now he has to wait until the 10th of APRIL. Meanwhile my client has maintained almost daily contact with me, sometimes brief but still contact so he is extremely pissed to find himself feeling accused of not being available by phone (taking into account he is a solo dad of 2 young boys and very involved with his hapu...I won't even go into the cultural issues arising) and I am feeling rather defeated! We are currently waiting on WINZ funding, (DHB won't touch this as the mention of sexual abuse means they refer to ACC and helpful doctors can unwittingly jeopardise this). He is suffering and has given up hope many times, his PTSD sypmtoms are high and his whole mauri is deeply effected. He is the only new client I have taken on and to be honest I may be suffering finanically but am extremely glad I did or my whole practice would have been taken up with people suffering because of this stupid system and working for $25 an hour on WINZ disability allowances
Last time I reported one good news story. That may have been a bit premature as to date there has been no follow through of a referral back to the initiating counsellor, in spite of the recommendation by the assessor.
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