The current capacity of services to meet the needs of women and their children is compromised across Australia because of insufficient funding. Insufficient funding prevents the widespread implementation and accessibility of services. The difficulties in recruiting and retaining appropriately skilled workers in this area compounds the effects of insufficient funding.
Immediate crisis services and on-going services for victims of sexual assault and domestic and family violence received a great deal of attention in the written submissions to the Council. The Council heard repeated stories about funding shortfalls for services, the lack of services, the inability of services to meet the holistic needs of the victim and her family, over-stretched and stressed services with long waiting lists, and a lack of skill and agency protocols that ensured compassionate, appropriate and timely responses to the requirements of women with more complex needs.
As disclosures and reporting of violence against women increases, the gap between demand and needs being met will only grow. Many in the sector, and the community, hold concerns that under-resourcing is already leading to limited service delivery, so that a consistently professional, high quality, and coherent response to sexual assault and domestic and family violence is, at best, uneven across the nation. Budgetary allocations must match the real size of the problem. Apart from these gaps we need to ensure that a social inclusion approach is taken seriously. Not only is more money needed to address gaps, but we need to find new ways of governing which include rethinking how policy and programs can be delivered across portfolios and between levels of government to wrap services around women and their children.
The ways in which women and their children experience violence, the options open to them in dealing with violence, and the extent to which they have access to services that meet their needs, are shaped by the intersection of gender with factors such as disability, English language proficiency, ethnicity, physical location, sexuality, Aboriginal and Torres Strait Islander status, and migration experience92. These factors increase the vulnerability of women and their children to the risk and effects of violence.
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Impact of under-resourcing
It is difficult to quantify precisely how under-resourced services are, but the key indicators that are apparent across the service system include:
- long waiting lists for women to access counselling support, particularly for adult survivors of childhood sexual assault because, by necessity, priority is given to women who are in crisis;
- difficulty for women, particularly in rural and remote areas, in accessing legal advice and representation for domestic and family violence applications and associated family law and child protection matters;
- inability of women seeking emergency accommodation or telephone counselling to access specialist support, particularly in rural and remote areas;
- inability of many services to demonstrate shared or cultural competencies for delivering high-quality services to specific population groups of women;
- inability of emergency accommodation facilities to meet basic physical standards for disability access, or accommodate women with complex needs such as those with an intellectual disability, mental health issues and problems with substance abuse;
- inability to provide timely forensic medical sexual assault examinations to recent victims of sexual assault (resulting from a shortage of doctors able and willing to provide this service given the costs involved; and the limited adoption of alternative providers such as Forensic Nurse Examiners);
- inability of women and their children to access safe emergency accommodation, being referred all too often to motels and caravans;
- insufficient services, forcing women and their children into unsafe or inadequate situations such as sleeping in cars or staying in overcrowded housing, and leaving them with no choice but to return home to the perpetrator;
- orientation of responses to the crisis end of the problem, with insufficient services available for medium to long-term support such as counselling and trauma recovery;
- limited resourcing to appropriately skill workers and services to deliver ongoing counselling and psychological support for children who have witnessed and/or experienced domestic and family violence.
The cost of violence
Current funding levels for services to meet the needs of victims/survivors also fail to reflect the economic costs of sexual assault, domestic, and family violence. In 2004, Access Economics reported that the cost of violence against women to the economy was $8.1 billion93. If no new actions are taken to reduce the incidence and the impact of violence against women by 2021-22, the cost to the economy of violence against women and their children will have almost doubled to $15.6 billion94. Domestic and family violence is one of the many causes of homelessness among women in Australia95 and has severe effects on women’s physical and mental health96 97 98. In 2004, VicHealth found that intimate partner violence was the leading contributor to death, disability and illness in Victorian women aged 15 to 44 years, being responsible for more of the disease burden than many well-known risk factors such as high blood pressure, smoking and obesity99.
Despite this, funding levels for programs and services targeting the needs of women and children who have experienced violence do not reflect the investment needed to reduce the potentially long-term burden on the Australian community. Budgetary allocations must also match the level of investment needed to reduce the economic costs.
The first door must be the right door
It is critical that a sustainable and responsive service system is in place to support women who experience sexual assault or domestic and family violence, and that service providers at the first point of contact are able to support disclosures of abuse and respond appropriately in a timely manner. 'The first door is the right door' means that for women who have experienced violence, their first point of contact should provide professional and compassionate assistance, and that the complexity and entirety of their needs are met. Recovery begins with the first point of contact. Access to quality legal, medical, and support services (both immediate and ongoing) is essential.
The first point of contact may be a specialist sexual assault or domestic and family violence service; legal aid or an individual solicitor; a health, mental health or telephone counselling service; Centrelink; a housing service; a child protection agency; the police; a Migrant Resource Centre; or one of the numerous government and non-government human service agencies100 101. The most effective responses to violence against women and their children are provided when the range of services required for meeting women’s needs operate from a client-centred model and co-ordinate their activities, as discussed in Outcome 6: Systems work together effectively.
'One of the benefits of the [Hospital’s] Leadership Program is the focus on defining violence, which develops staff confidence to recognise and name violent behaviour and then give women clear information about their choices. The Leadership Program gives staff the opportunity to debrief about their consultations with women and reflect on their practice. One of the key challenges for staff is to recognise that even when women do not want a referral to specialist violence services, the fact that she received a sensitive and appropriate response from a health professional increases the likelihood that she will seek support at a later date.'
Royal Women’s Hospital, Melbourne 2008
In addition to the range of general services that women and their children may need as a result of violence, there is a wide range of specialist services responding to particular needs. Such services include counselling (including meeting children’s needs around witnessing/experiencing violence), crisis intervention, court assistance, and safe accommodation. Although such service responses are specific to sexual assault or domestic and family violence, only a very small number102 have been established exclusively for particular groups of women. It is therefore critical that the general sexual assault and domestic and family violence services also have the resources and skills required to address the intersection of gender and other factors that shape women’s experiences of violence and help-seeking.
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Diverse responses are needed
Currently, the needs of many women are not met because services are not properly resourced to adequately recognise and respond to these other factors. Service agreements may also restrict the level and nature of service delivery that can be offered. Older women’s experiences of abuse, and their ability to end abusive relationships, are shaped by social and structural norms prevalent during their formative years, including greater tolerance for personal violence, attitudes towards marriage, and the socialisation of both men and women into specific gender roles103. Women, including older women and women with disabilities, face particular barriers to ending abusive relationships. These include: fears about the loss and the difficulty of rebuilding economic security; loss of social supports and alienation from family; and, particularly for Aboriginal and Torres Strait Islander women and women from diverse cultural backgrounds, being ostracised from their communities.
Multicultural and settlement services have increasingly highlighted the fact that many immigrant and refugee women, particularly those who are newly arrived, are more likely to disclose issues related to sexual assault, domestic and family violence as part of their settlement needs. There are also particular issues for refugee women and children related to trauma, resulting from experiences of armed conflict or prior exposure to violence, that mainstream services are increasingly challenged to meet.
Women who have experienced sexual assault, and domestic and family violence as a child, have particular service and support needs, especially if they are disclosing their experiences for the first time. They should also be able to access appropriate crisis counselling and legal advice, and expect to receive court support regardless of when the assault occurred.
Aboriginal and Torres Strait Islander women, and many immigrant and refugee women, are also living with the trauma of race-based oppression, alienation and intergenerational trauma, which must also be addressed. For women with disabilities, experiences and research indicate that, in addition to these factors, there is a wide range of possible perpetrators including caregivers, support workers and service providers104. Women with disabilities must be in a position to have control over the provision of services to them, rather than arrangements being made directly between funding bodies, disability service providers and care workers.
Women in correctional facilities are also particularly vulnerable to abuse and lack of appropriate service provision to meet their specific needs. A majority of women in prison have been physically and/or sexually abused prior to their incarceration; frequently the women have experienced child abuse; and many have been raised in families which featured drug and alcohol dependence, abuse, unemployment, and low levels of education105. Violence-related trauma (particularly from sexual assault) is exacerbated by the practice of strip-searching women when taken into custody and after receiving visitors.
Incarcerated women and their children have little or no access to counselling and support which addresses the trauma associated with the impacts of violence and re-victimisation, or associated drug and alcohol dependence. Women in prison also have very limited or no educational opportunities to help them gain employment after release. The result is commonly a persistent, generational cycle of violence-crime-prison-violence-crime-prison106.
Many other women and their children are also denied an effective crisis response because they live in isolated, remote and rural parts of the country. Some governments, including the Australian Government, have funded or established 1800 telephone crisis lines in an attempt to overcome the issues for women in isolated, remote and rural areas. Generally, however, most of these services:
- do not have the capacity to directly deliver therapeutic counselling in support of women in areas where there are no counselling services;
- have not capitalised on technology to immediately connect women to local services where they are available;
- have an infrastructure which is frequently duplicated in terms of separate services for sexual assault and domestic and family violence.
Trauma associated with sexual assault, and domestic and family violence is the main mental health impact, and recovery from this trauma is essential to regaining health and wellbeing. Once safety is achieved, the impacts of trauma may limit a woman’s capacity to recover and move forward.
'Recovery from trauma resulting from violence must be offered by specialist trauma counsellors and be based on the following principles:
- Sexual, domestic and family violence are gendered crimes, a product of patriarchy and a human rights abuse. This violence impacts on all communities within our society.
- The responsibility for the offence is always with the perpetrator.
- The psychological injury resulting from sexual, domestic and family violence is based in trauma. The therapeutic process toward recovery begins at the first point of contact with support and recovery services. Such responses must be evidence-based and best practice.
- Client self-determination and empowerment are critical to recovery from sexual, domestic and family violence.
- All people who have experienced sexual, domestic and family violence have a right to receive compassionate professional assistance in their recovery, access to quality medical services and full redress for the crime, including where appropriate, timely access to forensic services through the criminal justice system.'
Karen Willis, NSW Rape Crisis Centre, 2008
Workforce capacity
Increasing the responsiveness and availability of services to respond to the needs of women and their children affected by sexual assault and domestic and family violence, will only be effective if there is an appropriately skilled workforce to deliver them.
The majority of community-based service providers responding to sexual assault and domestic and family violence are employed under the Social and Community Services Award. This provides for a service co-ordinator’s salary at a rate $20,000 per annum less than an Administration Officer in the state public service with similar responsibility and autonomy. Consequently, it is difficult to attract and retain professional and appropriately skilled workers to these specialist services. This difficulty increases in rural, remote, and isolated areas, and the costs of accessing such services makes them more unattainable the further one moves from the cities.
Within the purview of its social inclusion agenda, the Australian Government has commenced a process for developing a National Compact with the not-for-profit sector to improve and strengthen working relationships. The Australian Council of Social Services has been commissioned to undertake sector consultations as part of this process and the Community and Disability Services Ministers’ Advisory Council is also driving a Workforce Profile Project107.
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The critical role of informal support
In the course of developing the Plan of Action, the Council repeatedly heard about the heavy reliance on the ‘informal helping system’ of extended family and community members who support women and their children experiencing or escaping violence, particularly in Aboriginal and Torres Strait Islander communities. Informal ‘workers’ at the front line are rarely recognised or targeted for support, training, reimbursement or respite, despite heavy reliance on their practical and emotional skills by women and their children seeking safety. A focus on using the structures and resources already existing in communities, and on building the skills of natural helpers within communities, should also be funded to strengthen existing community capacity to service and support local needs. Building the local workforce, rather than ‘flying in’ external ‘experts’ will improve the employment opportunities for local people. It will also improve the continuity of relationships, the continuity of care and the skills within the local community.
Access to safe accommodation
Between 1985 and January 2009, the Supported Accommodation Assistance Program (SAAP), a joint Commonwealth-State and Territory initiative, was the major response to homelessness in Australia and the source of funding for women’s shelters and safe houses for women and children escaping domestic and family violence108. A recent evaluation of SAAP found there are both increasing numbers of people seeking support from SAAP services, and an increasing complexity of client needs109. These issues are dealt with more fully in the Australian Government White Paper on homelessness, The Road Home: A National Approach to Reducing Homelessness110.
Some supported accommodation models exclude women for substance abuse, disability, transgender identity, having male children over a particular age (in some cases over the age of 9 years), their migration status, lack of income and eligibility for Centrelink payments, and mental health issues111 112. While these issues must be addressed through increasing service capacity in terms of resources and expertise, increased access to safe, long-term housing is also essential. This is also addressed in The Road Home.
In particular, The Road Home and the Plan of Action focus on the need to increase the application of ‘ouster’ or ‘exclusion’ orders provided for in all State and Territory domestic and family violence laws. These legislative provisions enable perpetrators of domestic and family violence to be removed, and women and children to remain in the family home where it is considered safe and desirable for them to do so. As identified in The Road Home, the effective implementation of these legislative provisions requires specialist services to assess the safety risks for, and support needs of, women and their children; brokerage funds to stabilise housing or increase home security; and seamless criminal justice, health and community services policies and protocols to support women and their children to secure safety at home
The needs of children
Children also experience domestic and family violence through witnessing it, and living in a household where their mothers are being abused. Some children also directly experience violence themselves. Whether witnessing or experiencing violence, children are profoundly affected113
Although some women’s refuges and other domestic and family violence services provide responses specifically for children, the majority of services for women are not able to provide for the counselling and support needs of children. This gap in service provision must be properly addressed to minimise the impact and trauma of exposure to violence on children’s long-term health and well-being. Indeed, there is little research that improves our understanding of the long-term impacts of continued exposure to trauma on the psychological, physical and brain development of children, or how this exposure impacts their personality, impulse control and, ultimately, their propensity to perpetrate violence in the future114.
The intersection of child protection and family law in terms of the safety and protection of women and their children was raised constantly to the Council. There was an elevated level of concern and urgency throughout the written submissions, community meetings, one-on-one interviews with survivors and the expert roundtables around this issue. It is specifically raised under Outcome 4 of this Plan. It is vital that the needs of children in relation to their mothers’ experience of violence do not fall into a chasm between legal and service systems.
Any services responding to children affected by domestic and family violence must interface appropriately with the services for their mothers. The importance of this issue to the long-term safety of all women and their children warrants a particular recommendation by the Council to government (Recommendation 9 of the Plan):
Recommendation 9: That the Australian Government work with State and Territory governments to ensure the National Framework for Protecting Australia’s Children meets the needs of children who witness and/or experience domestic and family violence.
The National Framework for Protecting Australia’s Children and this Plan must be harmonised to mobilise investment and services to ensure that no law, policy or practice jeopardises the safety and well-being of women and their children.
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Strategies and actions
To make sure that services meet the needs of women and their children, the Plan of Action identifies four key strategies:
3.1 Strengthen service and workforce capacity.
3.2 Increase access to safe accommodation.
3.3 Undertake specific responses to ensure equitable access to services.
3.4 Build the evidence base.
3.1 Strengthen service and workforce capacity
3.1.1 Develop and implement a well supported and funded workforce strategy to support the attraction, recruitment, retention, development of and succession planning for staff working in sexual assault, domestic and family violence services. The strategy should address: recognition of the complexity and the true market value of the work undertaken in the fields of sexual assault, domestic and family violence; whole of workforce issues, including skills and qualifications, career pathways, training and development, networking and professional support; resourcing requirements, which are to be met as part of funding programs and services; and strategies to build the competency of people within communities (particularly rural and remote communities) to be engaged as the service providers.
3.1.2 Develop and implement a comprehensive strategy to acknowledge, support, train and reimburse community members who form the informal helping system for women and their children experiencing domestic and family violence, with the early focus for support and investment on the helpers at the front-line in rural, remote and isolated communities.
3.1.3 Ensure that all undergraduate students enrolled in law, medicine, social work and relevant allied academic courses, undertake compulsory course work covering the nature and dynamics of sexual assault and domestic and family violence, and relevant law.
3.1.4 Expand training and support to rural practice nurses and Aboriginal health workers in sexual assault and domestic and family violence assessment and referral.
3.1.5 Develop and implement multiple training and accreditation strategies for medical and allied health professionals, legal practitioners and community service workers to develop their understanding of the structural nature and impacts of sexual assault, domestic and family violence on women and their children, taking account of factors such as age, ethnicity and disability.
3.1.6 Develop and implement model codes of practice to ensure that there is consistency, transparency and accountability between sectors (health, community, legal) in delivering services that respond to sexual assault, domestic and family violence. The codes of practice should apply to a range of front-line workers, and include core principles and values to guide service delivery that reflect the diversity of women experiencing violence, and ensure approaches that focus on intersectionality to address the compounding factors that increase a woman’s vulnerability to violence.
3.2 Increase access to safe accommodation
3.2.1 Governments at all levels support the full implementation of strategies concerning domestic and family violence articulated in The Road Home: A National Approach to Reducing Homelessness and in Outcome 4: ‘Responses are just’ of this Plan of Action.
3.2.2 Audit crisis accommodation services to determine their accessibility and safety for all women experiencing violence with a particular focus on rural women, girls and young women, older women, women with adolescent boys, Aboriginal and Torres Strait Islander women, women with disabilities, women with no income, immigrant and refugee women. and women with mental health, alcohol and/or drug dependence issues.
3.2.3 Following the audit of crisis accommodation services, increase service capacity and revise eligibility criteria, where required, to ensure equitable access to crisis support and accommodation for women and their children regardless of circumstances such as geographic location, cultural background and English language proficiency, disability, sexuality, presence of male children or addiction.
3.2.4 Develop and distribute information on a range of models for safe accommodation that can be applied or adopted based on local circumstances, including safe places, outreach support, removal of perpetrators, or assistance with relocating women from communities where there is no safe haven.
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3.3 Undertake specific responses to ensure equitable access to services
3.3.1 Following consultation with the sector, establish a professional national telephone and online crisis support service for anyone in Australia who has experienced, or is at risk of, sexual assault and/or domestic and family violence. The service should integrate and coordinate with existing services in all States and Territories, offer professional counselling, provide information and referrals, use best practice technology, link with other 1800 numbers, have direct links with relevant local and state services, and provide professional supervision and advice to staff in services in isolated and remote areas.
3.3.2 Provide funding to support a national network of locally developed healing centres and other emerging initiatives and support services for Aboriginal and Torres Strait Islander communities in urban, regional, rural, remote and isolated areas, to address their experiences of trauma and violence.
3.3.3 Explore best practice, develop responsive models and increase funding to women’s domestic and family violence services to enhance responses to children affected by domestic and family violence, especially in relation to strengthening the mother-child relationship in the aftermath of violence.
3.3.4 Ensure children who are living with, or have lived with, sexual assault and/or domestic and family violence do not have their safety, wellbeing, support and counselling needs compromised, and that all interventions are in accord with the safety and wellbeing of their mothers.
3.3.5 Ensure adult survivors of child sexual assault, domestic and family violence have access to counselling, court support and practical assistance whenever they choose to disclose their past experiences of violence.
3.3.6 Provide access to funding schemes for women with disability to enable them to control and manage who is employed to provide care and support for them in their home.
3.3.7 At every point in the service and justice system ensure services are adequately funded to provide professional interpreting to victims who are not confident in their English language competency.
3.3.8 Ensure interpreter services for women experiencing violence (including interpreters competent in Auslan) receive training to ensure interpreters understand issues related to sexual assault, domestic and family violence and are able to interpret in a sensitive yet impartial manner.
3.3.9 Support the effective delivery of mental health services to women and their children who have been victims of sexual assault and/or domestic and family violence. This should include enhancing the capacity of existing mental health services to support women in times of crisis, as well as increasing access to subsidised ongoing counselling services.
3.3.10 Create a brokerage funding program for local service providers in order to ensure early access to emergency services to ensure the safety of women and their children, regardless of where they reside.
3.3.11 Ensure community awareness and education programs are provided in language, and through media, which are accessible to older women, women with disabilities, and women not competent in English.
3.3.12 Ensure services (legal, medical and community) recognise and understand the extra complexity experienced by migrant and refugee women and their children in order to improve their capacity to respond appropriately and effectively.
3.3.13 Explore the feasibility of providing a Medicare payment to rural general practitioners for the provision of forensic medical sexual assault examinations in order to encourage more rural doctors to undertake training and provide these services.
3.3.14 Provide access to specialist trauma and recovery counselling services for women in prison and their children; provide access to educational opportunities for women in prison; and strengthen post-release services for women to ensure they have access to safe and supported housing, education and training, employment assistance and counselling.
3.4 Build the evidence base
3.4.1 Develop a national evaluation approach to assess the effectiveness of service responses to women and their children who have experienced violence, including women with disability, living in a range of settings (at home, in the community and in supported residential accommodation).
3.4.2 Include in funding agreements a requirement, and sufficient resource, to undertake rigorous, independent evaluations of all government-funded initiatives and programs, and make the results publicly available, as a condition of continuing funding.
3.4.3 Fund research and develop excellent practice models which enable women to transition from emergency accommodation to more stable medium – longer term housing.
3.4.4 Undertake research on the specific needs of older women affected by violence, especially sexual violence, to ensure services are responsive to their particular needs.
3.4.5 In partnership with peak bodies and the sector, review, update and promulgate standards and good practice guidelines to support programs for women and their children who have experienced violence to assure quality service.
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References
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