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Helping Adult Survivors Of Child Sexual Abuse

ACC - Helping Adult Survivors Of Child Sexual Abuse

ACC is today releasing therapy guidelines for counsellors dealing with adult survivors of child sexual abuse at a launch in Auckland.

Written by Auckland Psychologist Kim McGregor, “Therapy Guidelines: Adult Survivors of Child Sexual Abuse” give New Zealand counsellors the latest and leading information on abuse and trauma therapy from around the world.

Therapists involved in the guidelines are welcoming the publication as thorough and valuable and of great help.

“Sexual abuse is a hidden injury that affects thousands of New Zealanders. ACC has an obligation to not only help survivors of sexual abuse, but to provide them with the best care possible”, Dr David Rankin of ACC Healthwise said.

ACC has accepted sexual abuse claims since the scheme’s inception in 1974. In 1992 ACC developed a special unit to deal specifically with sexual abuse claims. Data from 1 July 1992 up until the end of January this year shows ACC has accepted 47,000 claims for sexual abuse. Around 80% are adult’s now registering claims with ACC for sexual abuse during their childhood. Currently over 8,000 claimants are receiving treatment for the effects of sexual abuse.

ACC is able to accept claims for mental injury arising from sexual abuse, which occurred at any time in a person’s life.

The specialist type of help ACC offers is counselling, along with the regular entitlements that may be applicable.

“Last year ACC spent over $1.5 million on counselling and we want that counselling to be as effective as possible”, Dr Rankin said.

“Therapy has often been fragmented and incomplete due to the complexities of the personal injury. These guidelines will help therapists provide quality care for their patients”.

ACC will be providing free copies of the guidelines to all ACC contracted mental health providers; other providers will be able to buy the guidelines for $25.


For more information contact:

Kathryn Griffiths
ACC Media Communications Advisor
Phone: (04) 918 4291 or 025 281 6982


Sensitive Claims

Background
The Accident Compensation Corporation (ACC) is a statutory body responsible for administering New Zealand’s accident rehabilitation insurance scheme. The scheme is unique in the world in its scope and depth. Originating in 1974 it aims to reduce the impact of personal injury on individuals and the community. ACC’s main aim is to help people who have been injured by accident to return to independent living and work, promptly, sustainably and cost effectively.

ACC is able to accept claims for mental injury arising from sexual abuse (and some physical abuse) which occurred at any time in a person’s life, as long as they were a resident of New Zealand at the time. ACC refers to these claims as Sensitive Claims,

Sensitive Claims
Section 40 of the Accident Insurance Act 1998 allows for ACC-funded treatment of mental injury resulting from any act which comes under its Third Schedule. This lists Crimes Act offences of sexual assault and violation (but not public order offences), female genital mutilation and assaults by females on children under 14. Section 40 says that there is no requirement on the claimant or ACC to lay criminal charges.

A national unit for managing all Sensitive Claims was established in July 1992. Having a centralised unit offers claimants increased confidentiality and service from staff trained and knowledgeable about mental injury and sexual abuse issues.

After some years as a stand-alone unit the Sensitive Claims Unit was combined with the Wellington ACC Branch in 2000. It retains a separate identity and is physically separate from the rest of the branch. Most case management staff have relevant professional backgrounds – this ensures that sexual abuse claims are dealt with sensitively, efficiently and with consistency. The unit is unique within the Corporation in that its functions include the lodgement, screening and registration of claims, processing all payments to counsellors and offering a complete case management service.

Counselling
The Corporation pays for counselling which is carried out by Approved Counsellors. These are Counsellors who meet statutory requirements for qualifications, training, knowledge, experience and cultural awareness. The register of approved counsellors includes Psychologists, Psychotherapists, Psychiatrists, Counsellors and Social Workers. All must have relevant training and experience and be members of an approved professional organisation. ACC also contracts with agencies, groups and individuals to provide group counselling and community treatment programmes for the most seriously injured claimants. It has also contracting with Roopu to provide culturally relevant services to Maori.

Processing claims
To lodge a claim a person must visit an approved treatment provider (usually a counsellor or GP) and obtain an ACC45 certificate, supplemented by an ACC 290 Cover Determination form. These forms are sent directly to the SCU in a special sealed envelope.

Usually these two forms will contain sufficient information to enable the claim to be accepted or declined according to the requirements of the Act. If the claim is accepted an initial 10 hours of counselling is usually approved. These hours are available to be used in the 10 weeks following claim acceptance. Counsellors requiring more than this must supply a further report (ACC 291 – adult, or 292 - child ) after 8 weeks.

On receipt of this report the basis for cover is reviewed and a decision made about the expected duration of treatment. The essential nature of the abusive incident must be disclosed by the claimant to meet the requirements of the Act for acceptance. The level of proof required is the 'balance of probabilities' that an act actually did occur rather than the level of evidential proof required for criminal proceedings. There must also be “Mental Injury” (defined by the Act as a “Clinically significant behavioural, cognitive or psychological dysfunction”) which clearly relates to the abuse, and which requires treatment.

The Corporation will accept transcripts of CYFS or Police evidential interviews as proof of an offence occurring but will still require a counsellor or GP’s assessment of the psychological consequences. However, the Corporation is constrained by law in only funding claims where there is a clear disclosure of abuse.

On receipt of the 8 week report, claims are separated into High and Low Impact on the basis of clinical experience and research. Low impact claims are allocated no more than 20 additional hours counselling, whilst High Impact claims require a full Assessment and Treatment Plan before being allocated more than 30 hours. The Corporation also assesses the claimants need for other rehabilitation options to help the recovery process.

Treatment
The main treatment, paid for by the Corporation, is counselling. Claimants often commence counselling with the counsellor who provided the initial report, but this need not always be the case, especially where there are specific needs relating to culture, age or serious dysfunction. One weekly one hour session is usual but this may vary according to the stage of the therapy. Group counselling/therapy may also be funded, as may be work including the family or whanau, where this is directed towards the claimant’s rehabilitation.

In High Impact claims –the counsellor must provide progress reports to the Case Manager. Further counselling is approved or declined according to this report. A review of counselling progress is made by an independent reviewer (an experienced sexual abuse counsellor, psychologist or sometimes a psychiatrist) when the counselling becomes longer term.

Most claimants receive less than 20 hours of counselling, with a very small number (around 3% of claims) receiving over 100 hours.

The consequences of sexual abuse vary according to a great many factors, including culture, whether help was available immediately, the age of the victim, their previous psychological health and the severity of the crime. It is often difficult to identify if a wide range of emotional, behavioural or psychological effects have resulted from the sexual abuse incident/s or from other experiences or developmental difficulties that the individual has encountered, often over a long period of time. SCU Case Managers, with the support of Clinical Advisors, may need to negotiate with claimants and their counsellors regarding the proportion of counselling which is funded by ACC.

Meeting the needs of the claimants, the professional, ethical and therapeutic requirements of the counsellors and the business requirements of the Corporation (in terms of an equitable distribution and responsible use of limited funds) is a difficult and demanding task.

Rehabilitation
Often, claimants’ recovery may be assisted by ACC making various forms of rehabilitation available. This can range from child care (whilst the claimant is at the counsellor’s rooms), help with transport costs, and home help; to intensive community and residential programmes for those whose mental injury is assessed as serious. Claimants whose treatment and/or rehabilitation is assessed as extending over thirteen weeks or more will be asked to agree to an Individual Rehabilitation Plan. Claimants who are eligible for earnings related compensation may also apply for vocation rehabilitation to enable them to return to employment.

Unit Operations
The Unit is staffed by Case Managers, most of whom have qualifications in Social Work, Nursing or Counselling. They operate in three teams: Cover and Early Intervention; Rehabilitation; and Intensive Management. Their work is complemented by Payments Officers and Special Payments Officers, who are responsible for payments to claimants. Clinical Advisors, who are qualified and experienced in counselling, psychotherapy or clinical psychology, provide professional support and advice. The Case and Claims Management staff are managed by three Team Managers. Other staff operate the systems for payment of treatment fees.

The unit operates a freephone number to facilitate communication from claimants, treatment providers, general practitioners, lawyers, etc. Most contact is by telephone and letters. However, the value of personal contact is recognised and staff will take available opportunities to meet counsellors and claimants around the country. There are occasional opportunities for staff to attend workshops and conferences, as well as increasing their knowledge through both in-house and external training.

The nature of sexual abuse and the consequent psychological effects represent a demanding facet of the Corporation's work. The Unit therefore takes great care to minimise the potential for burnout and organisational dysfunction. It does this through developing a supportive and positive work environment in which staff receive clinical supervision and have frequent opportunities for debriefing. The risk of dysfunctional relationships with both claimants and providers is reduced through the encouragement of a culture of three-way partnership.

Research
The SCU is responsible for holding a great deal of information about the circumstances and treatment of sexual abuse across a whole population. There is great potential for research on the effects and treatment of sexual abuse. Recent improvements in data handling are beginning to generate statistical data. Further work, within ethical guidelines, will add to the body of knowledge in this important area.

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