Australian & New Zealand Infertility Counsellors Association

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ANZICA GUIDELINES FOR RTAC ACCREDITATION OF COUNSELLING SERVICES

The appointment of counsellors to Assisted Reproductive Technology Programs is an integral part of the service provided to all patients undergoing ART treatment.

Counsellors offer services, which include psychological counselling, information, crisis counselling and follow-up support. They may also provide psychotherapy for ongoing problems or arrange a referral to another service for continuing management.

The Medicare Benefit for stimulated cycles contains a provision for at least one counselling consultation per cycle. This level of funding must be allocated to the provision and support of the Centres counselling personnel.

(1). Membership Eligibility

Counsellors must be members of the Australian and New Zealand Infertility Counsellors Association.

The Australian and New Zealand Infertility Counsellors Association is an association of professional counsellors. It has established requirements for membership, which have been adopted by RTAC and the FSA Council as appropriate minimum criteria that clinic counsellors must meet.

The Executive Committee may admit to membership a person who has agreed in writing to be nominated for membership of the Association and who:

a. Has at least a four year tertiary qualification from a recognised institution and is
(i) registered to practise as a psychologist in a state of Australia or New Zealand.
OR
(ii) a member of, or is eligible for, membership of the Australian Association of Social Workers or the New Zealand Association of Social Workers (Bachelor of Social Work - 4 years)
OR
(iii) registered to practise as a psychiatrist in a state of Australia or New Zealand

AND

b. is counselling clients who are concerned about issues related to infertility.

AND

c. has at least two years full time or equivalent supervised postgraduate counselling experience

AND

d. has demonstrated current knowledge of infertility and infertility treatments. Counsellors may also be eligible for Associate Membership, that is they fulfil the requirements of a) to c) above but cannot yet demonstrate current knowledge of infertility and infertility treatments.

It is acknowledged that remote clinics may be in a position such that the only appropriate candidate for a position is only eligible for associate ANZICA membership. This person should be taking active steps to upgrade qualifications and experience such that full ANZICA membership may be granted. In the interim they must receive supervision from an ANZICA member. Access to the Internet is required to enable access to the ANZICA WebPages.

The ANZICA executive is available to Clinics for advice on such matters and in exceptional circumstances other professional counselling courses may be approved on request.

It is also the preferred practice that any selection panel established to appoint a new counsellor should involve any counsellor already appointed. In the event of there being no clinic counsellor or where a counsellor is being replaced, a suitable qualified external practitioner who is a full member of ANZICA, should be invited to participate in the process.

It is a requirement that RTAC is notified of any change of status to the counselling position in the clinic, eg. replacement of counsellor, change of hours, etc.

(2). The Role of a Counsellor

(2.1) ART counselling Professional counselling must be available for all patients attending the Centre, particularly at times of stress such as initial diagnosis, while awaiting treatment, after a failed treatment cycle, when deciding to stop treatment and after an unsuccessful pregnancy.

ANZICA requires that counselling be integrated into patient treatment. Clinics must be proactive in informing patients of counselling services via pamphlets, etc.

ART Counselling includes:

Crisis counselling: counselling must be available to patients who experience a crisis or adverse outcome whilst undertaking ART treatment, in particular pregnancy loss.

Decision making counselling: counselling must be available to patients at significant points in their decision making around management of ART treatment e.g undertaking treatment involving further parties to the treatment, stopping treatment

Implications counselling: this aims to enable the person concerned to understand the implications of the proposed course of action for himself or herself, for his or her family and for any children born as a result of treatment.

Counselling may also include:

supportive counselling: this aims to give emotional support at times of particular stress, e.g. when there is a failure to achieve pregnancy

therapeutic counselling: this aims to help people to cope with the consequences of infertility and treatment and to help them to resolve the problems, which these may cause. It includes helping people adjust their expectations and accept their situation.

(2.2) Donor counselling

Counselling of patients wishing to use donated gametes and those people who donate gametes requires special attention. Professional practice indicates that patients so involved should be counselled about the relevant issues such that they can make informed decisions.

ANZICA requires that appropriate educative and psychological counselling is a standard protocol for all donors and recipients involved in donor sperm, oocyte and embryo programs.

Counselling about the implications of receiving donated material must be offered separately from the counselling about treatment implications.

Treatment with donated material should not proceed until the patient(s)/donor has been given sufficient time for appropriate counselling.

All donors, donor's partners and recipients of donor gametes or embryos are required to have counselling.

Donors and recipients must have separate interviews with a minimum of 2 interviews for each party, one session each for information/treatment implications counselling and one session each for psychosocial/donor counselling.

Issues to be addressed in donor counselling include:

  • motivations of donor and recipients, in the context of their family and social history
  • recipients' and donors' feelings about non genetic parenting
  • examination of the risks and benefits of donation
  • short and long term consequences for all parties concerned, including that the donation may result in an adverse outcome.
  • exploration of the acknowledged importance that donor information be accessible for any donor conceived person and the future availability of donors for information about identity
  • attitudes to telling others and plans to disclose donor conception to children
  • relevant federal and state legislation
  • relevant RTAC/NHMRC guidelines

(2.3) Surrogacy

Counselling of all parties to a surrogacy arrangement patients requires special attention. Professional practice indicates that patients so involved should be counselled about the relevant issues such that they can make informed decisions.

ANZICA requires that appropriate educative and psychological counselling is a standard protocol for surrogates, their partners and the commissioning couple

Counselling about the implications of the surrogacy arrangement must be offered separately from the counselling about treatment implications.

Treatment involving surrogate arrangements should not proceed until all parties have been given sufficient time for appropriate counselling.

Surrogates, surrogate's partners and commissioning couples are required to have counselling.

All parties must have separate interviews with a minimum of 2 interviews for each party, one session each for information/treatment implications counselling and one session each for psychosocial/surrogacy counselling.

Issues to be addressed in surrogacy counselling include:

  • motivations of surrogate and commissioning couple, in the context of their family and social history
  • recipients' and surrogates' feelings about parenting arrangements
  • examination of the risks and benefits of the surrogacy arrangement
  • short and long term consequences for all parties concerned, including the possibility of an adverse outcome(s)
  • perception of the needs of any children born as a result of their donation
  • attitudes to telling others and plans to disclose conception to children
  • relevant federal and state legislation
  • relevant RTAC/NHMRC guidelines

(2.4) PGD Counselling

Counselling for PGD requires special attention. Professional practice indicates that patients so involved should be counselled about the relevant issues such that they can make informed decisions.

(3) Counselling Rooms and Facilities ANZICA requires that the clinics dedicate space appropriate for the purpose of conducting counselling consultations.

  • There must be counselling facilities on site with ease of access for patients.
  • The room(s) should be appropriately furnished.
  • Sound insulation to reduce noise/voice transfer is essential.
  • The room(s) should provide wheelchair access.
  • Reception and secretarial facilities should also be accessible.
(4) Documentation Documentation that the necessary counselling has been provided is essential and there must be a routine system of accountability back to relevant clinic staff.

(5) Referrals ART counselling must be provided by clinic counsellors.

Therapeutic counselling may be provided by either the clinic counsellor or by independent, external counsellors. ANZICA requires that it is part of a counsellor's practice to have developed a referral network appropriate to their caseload.

ANZICA requires that there be a system of backup in times of a counsellor's absence and for the occasion where it is inappropriate for the clinic's counsellor to manage the case. For example:

  • patient is personally known to the counsellor
  • patient requests another counsellor for specialist issues e.g. religion, ethics

(6) Counselling and Cultural/NESB Issues

ANZICA recommends that the counsellor take some responsibility in the interpretation of this guideline. Counsellors being aware of cultural and religious influences, can advocate for multicultural issues as well as offer to train clinic staff in working with interpreters.

(7) Evaluation and Quality Control

Counselling input is an essential part of Quality Assurance within a Unit. Counsellors are to actively participate in the evaluation and quality control program within the clinic. Within clinics they should therefore attend relevant interdisciplinary meetings in order to provide their necessary professional input including regular feedback to the Centre about patients' experiences.

(8) Staff Training Programmes

ANZICA recognises the counsellor as being an appropriate resource person for the clinic staff to learn more about the psychosocial impact of infertility and to develop communication skills for staff-to-staff and staff-to-patient interactions.

(9) Counselling and Research. ANZICA recommends that counsellors contribute to the research projects undertaken at their Centres. Collaborative work among the professional groupings is to be encouraged. Further, counsellors working in ART have the unique opportunity to document the psychosocial aspects of this technology and publish in the wider network of the social science and psychological journals.

(10) Counsellors' Professional Development. ANZICA requires that in the allocation of time and tasks to the clinic counsellors, some time should be set aside for their ongoing professional development.

Counsellors should expect to attend relevant professional workshops and conferences. For example, FSA annual conference, ANZICA seminars/workshops. Counsellors must be supported by their Unit in attending at least one such professional development opportunity per year.

In the larger urban regions counsellors should meet regularly to exchange views and information about their work. In smaller centres it is essential for the counsellor to contact colleagues to remain well informed of recent professional literature and of technological changes. Opportunities for peer review should be investigated.

(10.1) Satellites ANZICA requires in relation to clinics with satellite programmes that the counsellor at the parent programme will have responsibility in the training, supervision and peer review of counsellors associated with the satellite programme. It is expected that the clinic will support this and recognise this in their contractual relationships with counsellors.

It is expected that the clinic provide at least an annual face to face, in house professional development workshop for all counselling staff attached to that clinic.

Checklist Information to be forwarded to RTAC counselling representative prior to visit

1. Counselling Questionnaire, including:
2. Any changes to counselling position since last RTAC visit
3. Available written information within clinic describing counselling services
4. Counselling protocols for gamete donation
5. Counselling protocols for surrogacy (if applicable)
6. Counselling protocols for PGD (if applicable)

ITINERARY FOR RTAC site visits 2005

UNITDueTo be done
Ballarat IVF & Bacchus Marsh Transport June Apr 2005
Melbourne IVFJuneApr 2005
Reproductive Services - RWH Melbourne June Apr 2005
Mercy Melbourne Assisted Conception June Aug 2005
Concept August Aug 2005
Fertility North August Aug 2005
Hollywood August Aug 2005
PIVET August Aug 2005
Keogh Institute August Aug 2005
IVFA - North Sept Sept 2005
IVFA - Central Coast Sept Sept 2005
IVFA - East/South & Transport Jan Sept 2005
Fertility First March/April Sept 2005
RPAH Sept Sept 2005
Westmead Sept Sept 2005
IVF NSW Sept Sept 2005

ITINERARY FOR RTAC site visits 2006

Units to be inspected 2006, ANZARD data are collected in March so we should move all RTAC assessments to later in the year to allow for the data to be fully processed.

UNITDueTo be done
Wesley Mar May 2006
Monash IVF Qld Sunny Bank Mar May 2006
Monash IVF Ipswich Mar May 2006
QFG Toowoomba Mar May 2006 (move to QFG 2007)
IVF Bundaberg Mar May 2006
Coastal IVF Mar May 2006
IVF Queensland Sunshine Coast Mar May 2006
Monash IVF Gold Coast - QFG Mar May 2006
Fertility Associates Hamilton Sept Sept 2006
Fertility Associates Wellington Sept Sept 2006
Fertility Associates Auckland Sept Sept 2006
Fertility Plus Sept Sept 2006
NZ Centre for Reproduction Christchurch Sept Sept 2006
Otago Sept Sept 2006
SIVF - Launceston Oct Oct 2006
Tasmanian IVF Oct Oct 2006
SIVF Canberra Sept July 2006
Canberra Fertility Sep05 July 2006
SIVF Lismore Mar/Sept Add to SIVF Satellites 2007
Albury IVF Sept July 2006

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