BOPDHB_Memo_TOP Counselling services

Memorandum To: General Practices, Lead Maternity Carers (LMC), BOPDHB Maternity, OB GYN staff, Family Planning NZ, Whanau Ora providers, Family Start providers. Please feel free to share onwards.

From: Sarah Stevenson, Portfolio Manager- Population and Women’s Health -Planning and Funding – BOPDHB Sarah.Stevenson@bopdhb.govt.nz

This is a notification of a change of service provision for Termination of Pregnancy Counselling.

Previously this service was provided by BOPDHB- Social Work Services. This service will now be provided

by EAP Services Ltd. Under the changes to the Abortion Legislation Act (hereafter ‘the Act’), all women considering a termination of pregnancy (TOP) should be offered (non-mandatory) counselling. We have procured EAP Services to provide this service for the whole of the Bay of Plenty. A TOP process map including the new counseling pathway has been included in Appendix 1 and will be uploaded to Bay Navigator.

EAP Services will provide timely and FREE access to counselling services for any BOP domiciled woman as per section 12 of the Abortion Legislation Act 2020 (excerpt included below).

Counselling 1) A health practitioner must advise a woman of the availability of counselling services if the woman— a) seeks advice or information about whether to continue or terminate a pregnancy; or b) advises the health practitioner of the wish to terminate a pregnancy; or c) has terminated a pregnancy.

2) A qualified health practitioner may not, as a condition of providing abortion services to a woman, require the woman to attend counselling before or after the provision of those services.

Counselling has been defined as ‘the process of enhancing a subject’s ability to assess and understand the index situation, evaluate options and make an informed choice or decision. This entails sensitive provision of comprehensive information in a nondirective or non-judgmental manner.’

Service Users (‘Clients’) Any woman eligible for publicly funded healthcare services and their significant others (partners and whānau) who reside in the Bay of Plenty District Health Board region and requests: • • •

pre-decision/pregnancy options counselling pre-abortion counselling post-abortion counselling.

Please note there is no limit on foetal age to access counselling. However, there are certain navigational aspects that will require consideration. These are covered in the FAQs at the end of this memo.

Service Access Women can access this service freely, through self-referral or referral from a health or social service professional. Counselling is not a requirement to receive a TOP, however all women considering their options regarding their pregnancies should be offered counselling. If they wish to take up this offer, it should be made freely available to them.

Self-Referrals to EAP services: Women can request a counselling appointment online or by phone 24/7.

Website: https://www.eapservices.co.nz/request-an-appointment Free Phone: 0800 327 669 (anytime) – quote BOP customer number 16619.

How to Refer to EAP services via email: If a woman would like you to make the counselling referral on her behalf, referrers should send a request by email to Simon.Diprose@eapservices.co.nz with the following information (enter information required highlighted in GREY). EAP have a secure email server.

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Subject line: Bay of Plenty District Health Board – TOP Email body: I would like to offer the TOP counselling to the following person/people if multiple referrals (whether they take up the offer or not is not clear at this point in time).

Please provide an EAP reference number for each individual: Client name

NAME

EAP Reference Number:

Client location

LOCATION

(EAP TO COMPLETE)

Number of approved sessions

Up to (1-4) sessions

ENTER Referrer name and details.

The referrer will get an email back which will look like: Kia ora NAME, Many thanks for your recent request.

We have created a file reference number 123456 for NAME. Could you please advise [NAME] that they can now seek individual and confidential support directly through their EAP Services by contacting us anytime 24/7 on

0800 327 669 and quoting reference number 123456.

Sign posting and partnerships At the end of a decision support counselling session, the counsellor will support the next steps of accessing support around the decision made in relation to:

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• • •

continue with the pregnancy proceed with adoption access a Termination of Pregnancy

The counselor is not expected to arrange terminations or the clinical requirements of accessing a termination (such as ultrasound scans, pregnancy tests) or provision of social work services or service navigation functions.

Termination Providers for BOP The Ministry of Health maintains a database of Abortion providers in NZ on their website. https://www.health.govt.nz/your-health/healthy-living/sexual-health/considering-abortion/abortionprovider-locations Family Planning NZ Early Medical Abortions for 0-9 weeks.

Clinic location: 17 Courtney Road, Gate Pa Shopping Centre, Tauranga 3112 Contact: tauranga@familyplanning.co.nz or 07 578 8539 How to Refer: Women can self-refer by phone, walking in to the clinic or request an appointment online: https://www.familyplanning.org.nz/clinics/ask-for-an-appointment Lakes DHB- Rotorua Hospital Vacuum aspiration is available up to 14.6 weeks under light sedation and local anaesthetic (awake).

Clinic location: Te Aka Tauwhi Tangata - Women's Clinic (Tauawhi), Rotorua Hospital, Cnr Arawa & Ranolf Street, Rotorua.

How to refer: Women or referrers can call 0800 726 447 or 027 615 3547 or 07 349 7918 or via email: tops@lakesdhb.govt.nz Epsom Day Unit Epsom Day Unit provides surgical termination between 13 and 18 weeks for women referred to an independent specialist contractor service.

Clinic location: Greenlane Clinical Centre, 214 Greenlane Road West, Epsom, Auckland How to Refer: BOPDHB Social Worker service will support the referrals for BOP women who require this service. 07 5798460 or SWOT.referrals@bopdhb.govt.nz BOPDHB: Tauranga Hospital Surgical and medical terminations for Fetal abnormalities only. All gestational ages.

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Clinic Location: Tauranga Hospital, 829 Cameron Road, Tauranga How to refer: Refer to NZ Maternal Fetal Medicine- Auckland, if the woman then decides to have a TOP they will refer to BOPDHB Obs & Gyn. TOP admission form will be completed. https://www.nationalwomenshealth.adhb.govt.nz/ Referral form: https://www.nationalwomenshealth.adhb.govt.nz/healthprofessionals/referrals-andinformation/maternity/ NZMFM: phone 09 367 0000 extn 24951 for referral enquiries

FAQs Q: Will EAP Services provide counselling Termination services are available by gestational stage for BOP women?

A: EAP will provide pre and post termination counselling for Bay of Plenty residents with pregnancies of any gestational stage, including those who have fetal abnormalities or are over 18 weeks with no fetal abnormalities and are unable to source a termination in NZ. Q: What are the TOP options for Bay of Plenty Domiciled women by gestational age?

A: 1) 2) 3) 4)

0-9 weeks gestation. Early Medical Abortions are provided by Family Planning NZ – Tauranga.

Up to 14 weeks and 2 days – Lakes DHB (Rotorua Hospital) 13 to 18 weeks – Epsom Day Unit Auckland (bookings made through BOPDHB- social work) 18 to 20 weeks - without fetal abnormality – currently no defined service options for BOP women but attempts to find a solution will be made on a case by case basis. (refer through BOPDHB Social Work) 5) Fetal abnormality – BOPDHB (Tauranga hospital).

Q: What are you doing about service options for women over 18 weeks to align with the Act? A: As BOPDHB have not been a direct provider of TOP services until the recent fetal abnormality service, it has been difficult to establish clear pathways for BOP women for all gestational ages covered under the Act (up to 20 weeks). We are currently working with neighbouring DHBs and our workforce to meet our legal obligations regarding travel times to a 1st trimester TOP and the 18 to 20 week pregnancies, with no fetal abnormalities where the woman has requested a TOP.

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Q: Who will coordinate pathology and radiology (scan) report required for terminations?

A: If a woman is self-referring, then the TOP provider (eg. FPNZ, Lakes DHB) will advise.

If a woman has chosen to have counselling: After counselling, if a woman is certain of her decision to have a TOP, depending on gestational age, the following steps are required.

0 to 13 weeks gestation: •

Pre decision counselling undertaken via EAP services

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Woman to contact referrer or TOP provider as detailed above, to request a TOP appointment.

Referrer will book an appointment and forward required pathology and Scan report

13 to 18 weeks gestation: In the case of 2nd Trimester terminations (13 - 18 weeks) for those using the Epsom Day unit, BOPDHB Social Work services will support women with organising clinical information required, travel and accommodation assistance for the 2 days in Auckland.

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Pre decision counselling undertaken via EAP services

•

If a woman is certain of her TOP decision, she can be referred directly to the BOPDHB Social Work services to request a TOP appointment. Pathology and Scan reports will need to be forwarded with along with a referral Email to: SWOT.referrals@bopdhb.govt.nz

If you have any further queries or feedback regarding the details in this memo, please email these to Sarah.Stevenson@bopdhb.govt.nz and I will endeavor to navigate a response for you.

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Appendix 1: TOP Process Map including Counselling