List of Attachments
Attachment A: Sample Intake Form
Sample Intake Form
UnitingCare Unifam Counselling and Mediation Service
Section A. Demographic and Statistical Information
Date of Request: _____/_____/_____
Name: __________________________________________________________
Address: ________________________________________________________
Contact Details: _________________________________________________
Occupation/ hours: ______________________________________________
Household configuration: _________________________________________
Section B. Presenting Issues:
What is the person’s explanation of their need? Attention should also be given to issues involving: substance use; mental health; cultural background; language/interpreters; and special needs – disability, literacy issues, Ftransport issues, child care issues.
Q. What are you concerned about at the moment?
Q. What do you think you need?
Q. Does your partner/ child/parent/ ex know that you are calling?
Q. Do you have children? …How much do they know about what’s happening?
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Genogram:
Q Who is in your family/ who lives with you/ how old are they? How long ago did you separate? Etc.
Circle the following presenting concern/need:
___Relationship information
Q. What relationship are you most concerned about? Are you looking for written information/ phone numbers/ places to go to talk about it?
- couple strengthening
- parent/child relationship strengthening
- separation from a couple relationship
- re-partnering – couple
- stepfamily formation
- other relationship ___________________________________________
___Relationship assistance (referral for counselling)
Q. Have you thought of talking to someone about these concerns? If so, who? If not, would you like me to give you some places you could go to talk with someone who can help?
- couple strengthening
- parent/child relationship strengthening
- separation from a couple relationship
- re-partnering – couple
- stepfamily formation
___Separation – (referral for mediation/ PDR or for COP in WA, Victoria and Tasmania)
After exploring the details of the separation: when, how, responses of each…
Q. Do you need help with how to sort out the property/finances, or around the children? What have you worked out about supporting your children? Have you thought about sitting down with a mediator to work this out? How well do you think your children are coping at the moment? What has been their reaction to the separation?
- working out a parenting plan: contact and residence
- property settlement
- child support payment
- child inclusive assessment
___Post separation conflict assessment (referral to COP)
Q. How often do you fight? What is the worst the fights have gotten? How much of the time can you come to a decision? How do you communicate around the children? Have you got any court orders in place? How are the orders working? How aware are the children of your level of conflict?
- resolving conflict over contact
- resolving conflict over residence
- resolving conflict around safety issues – domestic violence, children’s safety
- Resolving conflict over the ending of the relationship – why? e.g. an affair,
- Post separation parenting – communicating, decision making, future planning
Section C. Assessment of safety issues
___Level of conflict
Q. Have you ever been worried about your safety? Have the fights ever become physical? What’s the worst it’s gotten? Have the children witnessed heard about this?
___Risk of self harm, suicidal ideation, substance abuse
Q. Have you ever thought of hurting yourself? Have you ever wanted to die? How long ago? How are you feeling at the moment? Do you think you can keep yourself safe? Are there any other safety issues?
___Assessment of risk to others-threats of harm, homicidal ideation
Q. Are you concerned that he/she would hurt you/ the children? How? Does he/she know your address/ phone number? Have you got an AVO/DVO/Intervention Order? Have they ever threatened to hurt / take the children?
Q. Have you ever felt like hurting her/him? Have you threatened her/him? Have you ever threatened to withhold/take the children?
Violence (includes abuse: psychological, emotional, financial, sexual)
Q. Have you ever been hurt by your partner? Have you felt afraid of him/her, or their anger? Who manages the money? What happened when you separated, how angry were they? What did they do? What sorts of things have happened since you separated? How safe do you feel at the moment? Do you have a current AVO/DVO/Intervention Order?
- violence in the current relationship
- violence during the separation process
- violence after the separation
- other issues re violence, e.g. financial, emotional
Child safety
Q. What concerns do you have for the children? What has happened? Who else is concerned? Have ‘Child Protection’ been notified? How have they responded? Were any charges laid? What would you like to have happen?
- Current concerns for safety of a child, threats to abduct
- Current: sexual abuse, physical abuse, emotional abuse, psychological abuse
- Past allegations of abuse, substantiated/unsubstantiated
- Reports of child-at-risk of harm to State/Territory child protection authority
Section D. Assessment of children and young people’s needs
Q. How well does your child get on with your new partner? Have they got someone to talk to about this? What do you think they need?
- Children’s relationships with family members
- Children’s wishes re: separation
- Children’s responses to the separation
- Other concerns for a child or young person
- Other supports for child
Section E. Assessment of suitability for services at the Family Relationship Centre
What are the needs of the client?
__________________________________________________________
__________________________________________________________
__________________________________________________________
What decisions need to be made?
__________________________________________________________
__________________________________________________________
__________________________________________________________
What intervention/s would best fit their needs?
__________________________________________________________
__________________________________________________________
__________________________________________________________
What can the Family Relationship Centre provide for?
__________________________________________________________
__________________________________________________________
__________________________________________________________
What referrals need to be made?
__________________________________________________________
__________________________________________________________
__________________________________________________________
Procedural Outcomes: (What intervention was given?)
___Client given
information ___Client booked in for Family Relationship Centre
mediation ___Client booked in for Family Relationship Centre
group ___ Client case
managed referral:
___Client referred to domestic violence intervention
___Client referred to child protection intervention
___Client referred to Child Support Agency/ Centrelink
___Client referred to mental health intervention
___Client referred to other emergency service: ___________
(i.e. a refuge, doctor, drug and alcohol service, police)
External referral
___Client referred for relationship or family counselling to range of services
___Client referred for mediation to range of services
___Client referred for post separation counselling to range of services
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Attachment B: Possible indicators for child murder-suicide
POSSIBLE INDICATORS FOR CHILD MURDER-SUICIDE
- A history of violence.
- Perpetrator’s inability to regard themselves as individual, separate from their spouse and children after relationship breakdown.
- A proprietary attitude to their children and partner.
- A history of intense and long term stalking (such as watching the ex-partner’s residence from a hiding place nearby).
- Perpetrator has previously threatened to harm himself and others such as children and other family members if his partner leaves.
- Obsessive and controlling personality traits which made the partner hard to live with prior to the separation and which deteriorate markedly after separation.
- Previous attempts by the female partner to leave were unsuccessful because of the reactions of the male partner or the fear of how he would react.
- Escalation of violence after separation when the female ex-partner shows signs of asserting herself.
- Signs of personality disorder or depressive illness which may or may not have been clinically diagnosed.
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Attachment C: Examples of questions on violence
Examples of Questions on Domestic and Family Violence Used by Australian Agencies
1. Taken from Domestic Violence and Incest Resource Centre
Does your partner, your boyfriend or girlfriend, your friend, your carer, or a family member:
___make you feel uncomfortable or afraid?
___often put you down, humiliate you, or make you feel worthless?
___constantly check up on what you’re doing or where you are going?
___try to stop you from seeing your own friends or family?
___make you feel afraid to disagree or say ‘no’ to them?
___constantly accuse you of flirting with others when this isn't true?
___tell you how the household finances should be spent, or stop you having any money for yourself?
___stop you from having medical assistance?
___scare or hurt you by being violent (eg: hitting, choking, smashing things, locking you in, driving dangerously to frighten you)
___pressure or force you to do sexual things that you don’t want to do?
___threaten to hurt you, or to kill themselves if you say you want to end the relationship?
___Have your children heard or seen these things or been hurt themselves?
2. Taken from Domestic Violence and Incest Resource Centre
Relationship Warning Signs
If you answer yes to any of the questions below, you could be in an abusive relationship, or your relationship could become abusive.
___do you feel nervous around your boyfriend, girlfriend, or partner?
___do you have to be careful to control your behaviour to avoid their anger
___do you feel pressured by them when it comes to sex?
___are you scared of disagreeing with them?
___do they criticise you, or humiliate you in front of other people?
___are they always checking up or questioning you about what you do without them?
___do they repeatedly and wrongly accuse you of seeing or flirting with other people?
___do they tell you that if you changed they wouldn't abuse you?
___does their jealousy stop you from seeing friends or family?
___do they make you feel like you are wrong, stupid, crazy, or inadequate?
___have they ever scared you with violence or threatening behaviour?
___do you often do things to please them, rather than to please yourself?
___do they prevent you from going out or doing things you want to do?
___do you feel that, with them, nothing you do is ever good enough?
___do they say that they will kill or hurt themself if you break up with them?
___do they make excuses for their behaviour, for example, by saying it's because of alcohol or drugs, or because they can't control their temper, or that they were 'just joking'?
3. Taken from Queensland Health Screening for Domestic Violence
- Do you have problems with anyone at home who makes you afraid for your safety?
- In the last year, has anyone at home hit, kicked, punched or otherwise hurt you?
- In the last year, has anyone at home often put you down, humiliated you, or tried to control what you can do?
- In the last year, has anyone at home threatened to hurt you or your children?
4. Taken from NSW Health Screening for Domestic Violence
- Within the last year have you been hit, slapped or hurt in other ways by your partner or ex-partner?
- Are you frightened of your partner or ex-partner?
5. Taken from Gold Coast Domestic Violence Service
Domestic Violence Service, Gold Coast Safety & Risk Assessment
HISTORY OF DOMESTIC VIOLENCE
CURRENT AND PAST PHYSICAL & SEXUAL VIOLENCE
1 . Describe the last incident of violence or abuse:
Incident Date: _____/_____/_____
__________________________________________________________
__________________________________________________________
__________________________________________________________
2. Has your partner's violence escalated or increased?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
2a. What do you think the change in their behaviour means? <
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
4. Have you ever required medical attention for injuries?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
.
5. Has your partner ever tried to strangle you?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
5a. Did you lose consciousness?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
6. Has you partner ever threatened to kill you?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
6a. Do you believe your partner is willing and capable of carrying out the threat?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
7. Has your partner ever killed or harmed a pet?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
7.a Do you think this was done to threaten?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
8. Has you partner ever been sexually abusive to you?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
9. Have you ever been threatened with a weapon?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
10. Do you think your partner may use a weapon against you?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
11. Has your partner ever hurt your children or threatened to abduct them?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
12 Do you think your partner may injure you or your children?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
13. Does your partner have a history of violence to others including a past partner?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
14. Has your partner ever been charged with offences related to violence?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
15. Is you partner jealous or obsessed with you? (Monitoring you or stalking etc)
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
15.a Can you describe the behaviour?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
16. Has your partner ever threatened suicide?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
17. Has your partner ever been treated for mental health issues?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
18. Has your partner experienced any unusual high stress in the past twelve months? (eg Job Loss, etc)
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
18a. Has this made him more dangerous to you?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
19. Does your partner drink excessively?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
19.a How is alcohol linked to his violence?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
20 Does your partner use drugs?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
20.a How does drug taking effect his use of violence?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
21. Have you ever felt the need to protect your partner?
___NO ___YES
(Describe) (Not laying charges, dropping charges, revoking Protection Orders etc.)
__________________________________________________________
__________________________________________________________
__________________________________________________________
22. Does your partner show remorse/sadness about violence?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
23. Has your partner sought assistance to stop using violence?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
VICTIM’S PRIOR ATTEMPTS TO BE SAFE
24. Have you separated or attempted to separate from your partner in the past twelve months
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
25. Have you had contact with the Police in the past twelve months?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
25a Can you describe how your partner responded to this?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
26. Do you have a current protection order?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
Conditions:
__________________________________________________________
Expiry Date: _____/_____/_____
26a Does your partner adhere to the conditions on the order?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
27. Have you sought other assistance in the past twelve months (eg. Women's Shelter, Counselling etc.)
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
27a How did your partner respond to this?
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
.
................................................................................................................................................. .
28. Do you have a supportive network of family and friends?
___NO ___YES
(Describe)
__________________________________________________________
__________________________________________________________
__________________________________________________________
Gold Coast Domestic Violence Integrated Response
Domestic Violence Offender Program
RISK ASSESSMENT GUIDE
LOW
- No violent incident in previous week or threats suggested.
- Information consistent with facilitators perceptions and that supplied by partner / other sources.
- No change in situational factors signaled or suggested as being of concern.
- Evidence of clear conceptual understanding and position taking on non violence articulated through group participate
- No evidence of denial, minimization or blame.
- Safety strategies developed and demonstrated.
- No immediate action required.
MODERATE
- No violent incident in previous week or threats suggested.
- Some inconsistencies with perception of facilitators and with information supplied by partner or other sources.
- No change in situational factors signaled or suggested as being of current concern.
- Some evidence of conceptual understanding and position taking on non violence articulated through group participation.
- Some use of denial, minimization and blame.
- Some safety strategies developed and demonstrated.
- No immediate action required at present. Monitor any change next week. Maintain contact with female part
MEDIUM
- An incident reported in previous week and possibility of threats suggested.
- Some clear inconsistencies with perception of facilitators and with information supplied by partner or other sources.
- Possibility of change in situational factors signaled or suggested as being of current concern.
- Limited evidence of conceptual understanding and position taking on non violence.
- Continues to use denial, minimization and blame.
- Some safety strategies articulated but limited demonstration.
- Follow up required during next week to clarify risk concerns and to discuss appropriate safety strategic participant, partner and others (including relevant agencies). Contact with Female Partner.
HIGH
- An incident reported in previous week and possibility of threats suggested.
- Clear inconsistencies with perception of facilitators and with information supplied by partner or other sources.
- Imminent change in situational factors signalled or suggested as being of concern (e.g. separation, reconciliation, change in contact).
- Man discloses suicidal/self harm thoughts or plans. Concern over conceptual understanding, safety strategies position taking on non violence.
- Continued high levels of denial, minimization and blame.
- If the potentiality for violence exists the Area Manager Community Corrections must be advised.
Actions Required:
(a) Facilitator to inform the Coordinator Domestic Violence Service, the Area Manager of Community Corrections and the relevant Community Corrections Officer (CCO).
(b) Follow up meeting with man as decided in discussion between Community Corrections Area Manager, Facilitator and the CCO.
(c) Discussion between Coordinator of Domestic Violence Service, Area Manager at Community Corrections and the relevant parties of the Gold Coast Domestic Violence Integrated Response.
(d) Domestic Violence Service or Area Manager of Community Corrections to contact the Queensland Police Service to flag female partner address for prompt attendance.
6. From Domestic Violence and Incest Resource Centre (DVIRC), Victoria,www.dvirc.org.au
DOMESTIC VIOLENCE RISK ASSESSMENT SHEET
Domestic Violence and Incest Resource Centre, Victoria
STAGE 1 -SAFE PLACE TO CALL – Immediate Safety Assessment
Worker Tips:
- If concerned for caller’s safety, record her phone number if displayed (top of phone), or press Red Trace/MCH button (in red letters, on right-hand-side), noting the time pressed. This will enable the call to be traced at a later stage, if deemed necessary.
- To familiariseyourself withthisprocedure,discusswithTeamLeader orTelephone Service Coordinator (also see Team Leader folder)
A) Physical Danger:
Worker Tips:
- It can be helpful to reflect your concern around the caller’s lack of safety, the severity of the abuse, and the risk of further abuse. They may find the level of abuse 'normal' after living with it for so long.
Are you safe right now?
__________________________________________________________
__________________________________________________________
Do you have children in your care?
__________________________________________________________
__________________________________________________________
Is there anyone with you at the moment?
__________________________________________________________
__________________________________________________________
Are you in danger of immediate physical harm?
__________________________________________________________
__________________________________________________________
Do you think that you will be killed or injured?
__________________________________________________________
__________________________________________________________
Would you like me to call the police?
__________________________________________________________
__________________________________________________________
Worker Tips:
- If difficult, or impossible, for her to call the police – obtain her phone number and/or address – or utilise Trace/MCH button. Don’t forget that Police can attend a Phone Box.
How much time do you have to talk to me? Do you need to go to a Women’s Refuge?
__________________________________________________________
__________________________________________________________
Does anyone know of your situation that can offer further support?
__________________________________________________________
__________________________________________________________
Worker Tips:
- If only short time available, give relevant Crisis numbers – as listed on the DV SUPPORT/CRISIS SERVICES FOR WOMEN & CHILDREN sheet.
Does your partner have a weapon, or access to a weapon (obtain details) ?
__________________________________________________________
__________________________________________________________
Is the physical abuse getting worse? If yes, what is different now?
__________________________________________________________
__________________________________________________________
What injuries has your partner inflicted on you in the past?
__________________________________________________________
__________________________________________________________
B) Children’s Safety:
Worker Tips:
- Make it clear that you are also very concerned about the safety of her child(ren), and that whilst the responsibility for the violence lies with her partner, she is also responsible for their safety.
Where are the children now? Are they in any danger, or directly at risk of physical injury?
__________________________________________________________
__________________________________________________________
Can you describe how your partner gets on with the children?
__________________________________________________________
__________________________________________________________
Worker Tips:
- Sometimes womensaysuchthings as'Hehitsme, buthe isagoodfather ---'.An example of a response may be 'By abusing you, he is not being good to the children' or 'He is denying them a safe and happy childhood' etc etc.
- Remember that children ALMOST ALWAYSknow about the violence, and are ALWAYS AFFECTED BY IT.
Have they ever been hurt or badly frightened by the violence?
__________________________________________________________
__________________________________________________________
What do the children do during the violence (eg do they withdraw, try to ignore it, sleep, cry, scream or hide)?
__________________________________________________________
__________________________________________________________
How do you think that the violence is impacting on the child(ren)(eg indications may be difficult/aggressive behaviour, hyperactivity, bed-wetting, withdrawn, angry with mother etc)?
__________________________________________________________
__________________________________________________________
Would you like to explore (other) ways in which you may help and support your child(ren)?
__________________________________________________________
__________________________________________________________
STAGE 2 – OPTIONS AND CHOICES
C) Safety Plans -Staying with the partner
What sort of things are you doing to keep yourself (and the children) safe when you think your partner may get violent?
__________________________________________________________
__________________________________________________________
Would it be helpful for you to think more about how to keep yourself (and the children) safe?
__________________________________________________________
__________________________________________________________
Worker Tips:
- Some women stay and learn to live with abuse – this is dangerous and may result in serious injury. If she stays, changes cannot happen without the partner’s co-operation.
Do you have:
Any family members, friends etc. that you may seek temporary refuge with at times of violence?
__________________________________________________________
__________________________________________________________
Strategies which may reduce contact with your partner at times of approaching violence?
__________________________________________________________
__________________________________________________________
Worker Tips:
- Such strategies may include: leaving house for shopping, gardening, having a friend over, running outside &screaming loudly once violence starts etc.
Possible ideas/areas of exploration with the caller:
- Access to a phone, and a list of crisis numbers
- Emergency money (such as a secret bank account, or money stashed away); spare car keys; credit cards; pass-ports, educational certificates etc
- A secret safety-deposit box for valuables, documents etc.
- A secret Post Office Box or friend’s address – to receive private information
- An emergency suitcase containing essential supplies (eg. left with friend, neighbour; including change of clothing, photos, documents, treasured possessions, favourite toys etc.)
- A pre-arranged warning signal to friends/neighbours indicating potential danger which may require immediate help
- A good understanding of her legal rights, and how to access legal information, or work with the legal system
Important considerations:
- Establishing a Police contact person with some knowledge of the issues
- Arranging for the removal of dangerous weapons to a safe place (eg. guns, knives etc.)
- Establishing contact and support with a DV Outreach Service
- Keeping a diary/record of violent incidents, and other forms of abuse
d) Safety Plans – Leaving the partner:
Worker Tips:
- It can take enormous courage to leave someone, and especially someone they may still love.
Important considerations:
- Arrange Refuge accommodation via Women’s Refuge service
- Arrange alternative accommodation (eg rental, friend, family etc)
- Determining the safest time for leaving home – and organising removal accordingly
- Organising spare car keys, relevant documents (including credit cards, Health Care and Medicare cards, rental agreement, mortgage and/or car papers, educational & birth/marriage certificates, money etc. - hidden in safe place, with friend etc.)
- Organising support from friend/worker/police at critical times
- Making an appointment with Centrelink for financial support – where necessary (may be a good idea to talk to a Centrelink Social Worker initially – Crisis Payments are available if leaving the home due to D.V. - but only if she applies within 7 days of leaving)
- Establishing contact and support with a D.V. Outreach Service
- Establishing a good understanding of legal rights, and how to access information, and work within the legal system
- Recording as many violent incidents as possible, including dates and times, details of injuries, and level of severity – may also include other forms of abuse
e) Legal and Police/Court action:
Worker Tips:
- Remember to affirm and validate at each stage; that we hear from many women in similar situations; emphasis the seriousness of the situation, and that physical violence is a CRIME.
Have the police ever been called in response to your partner’s abuse?
__________________________________________________________
__________________________________________________________
If so, when were they last called, and what happened?
__________________________________________________________
__________________________________________________________
Is your partner scared of:- authority; the Police; going to jail?
__________________________________________________________
__________________________________________________________
Do you have a current intervention order? Have you ever had one?
If yes, obtain brief details of the order:
__________________________________________________________
__________________________________________________________
If no, ask if she would like more information about how to apply for one.
__________________________________________________________
__________________________________________________________
Do you understand what your legal rights are, and how to work with the legal system?
__________________________________________________________
__________________________________________________________
Worker Tips:
Explain that if she has been assaulted, threatened or property has been damaged, the Police have the power to:
- Apply for an Intervention Order on her behalf.
- Arrest the offender
- Search for and remove weapons (they MUST remove a gun ).
- Charge the offender with a criminal offense.
- The Police often tell you to go to the Magistrates’ Court. If she is too afraid to do this, she can insist on the police helping her with the application).
If she is confused about the process, or afraid to go to court, suggest she contacts:
- Victorian Court Information& WelfareNetwork Inc. (CourtNetwork)on 96037433 – free service; may assistwithpersonal supportin court,information&referrals; they will explain the process&procedures of Intervention Order applications, or Family Court matters.
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Attachment D: Reasons for disclosure / non-disclosure
REASONS WHY VICTIMS OF VIOLENCEMAY DECIDE
NOT TO DISCLOSE OR TO DISCLOSE
REASONS FOR NON DISCLOSURE
The reasons victims of violence may choose not to disclose can include:
- not wanting to see their partner harmed, publicly shamed, or damaged financially;
- wanting to protect their privacy and sense of competence;
- being concerned about the effects on their children;
- fearing that their partner will try to get custody of the children;
- being concerned that multiple court appearances will lead to the loss of their job;
- fear being ‘cast out’ by their family or religious community.
REASONS FOR DISCLOSURE
The turning point for victims of violence to disclose can include:
- violence has escalated to such a point the victim feels they would be seriously hurt or killed;
- physical risks of staying with partner outweigh the risks of leaving;
- growing fears for their children’s safety;
- their children are being abused by the partner;
- concern about the longer term impact of violence on their children;
- belief that nothing is going to change;
- realisation that they cannot affect their partner’s behaviour and that they are not responsible for their partner’s behaviour;
- study and work leading to:
- increased self-esteem and confidence;
- critical reassessment of their situation at home; and
- realisation that their situation was neither ‘normal’ nor acceptable
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Attachment E: Sample questions on child abduction
Sample Questions on Child Abduction
- Has your partner/ex-partner ever taken your child without your consent, or not returned your child within a reasonable time of any agreement to do so?
- Has your partner/ex-partner threatened to abduct your child?
- Does your partner/ex-partner have such different beliefs about how your child should be brought up that they have disagreed strongly with you about this?
- [For the risk of international abduction:] Is your partner/ex-partner a citizen of another country?
- Do your partner/ex-partner and children have current passports? Who has the children’s passports at the moment?
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Attachment F: Sample questions on suicide
Sample Questions on Suicide
From Suicide Behaviour Questionnaire
- Have you ever though about or attempted to kill yourself?
- How often have you thought about killing yourself in the past year?
- Have you ever told someone that you were going to commit suicide, or that you might do it?
- How likely is that you will attempt suicide one day?
From Royal Australian College of General Practitioners
- ‘How is life going for you?
- Is this unhappy feeling so strong that you ever wished you were dead?
- Have you ever thought about how you might kill yourself?
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Attachment G: Risk assessment guide for suicide
RISK ASSESSMENT GUIDE FOR SUICIDE
Taken from training CD: Suicide Assessment and Intervention: Men at Risk, Crisis Support Services Inc., 2005
RISK ASSESSMENT GUIDE
Client: _________________________
[Circle answers]
A. Action or Intention
Has the client taken action to harm themselves or others?
No / Yes
If yes, implement emergency procedures.
If no, proceed to questions below.
Do they have a specific plan? No / Yes
If yes:
Does the client intend on harming self or others or have ideation only?
- Self
- Others
- Idea only
- Thoughts about possible methods
Specific method identified: _________________________
How immediate are their plans?
- Immediate
- Next 24hrs
- Week
- Non-specific
- Other ________________
How lethal are their plans? _____________________
Have access to means? No / Yes
If drugs: Name: _____________________
Quantity? _____________________
Dose? _____________________
Takes medication regularly? __________________
Action Plan:
__________________________________________________________
__________________________________________________________
B. Background
Has the client engaged in risk-taking or suicidal behaviour previously? No / Yes
If yes:
- Type of behaviour: ___________________________
- When did it first occur? ________________________
- In what circumstances? _________________________
- How frequently? ______________________________
- Last episode occurred? _________________________
What was the outcome? ________________________
Prior Diagnosis/Psychiatric Episode? No / Yes
Details: ___________________________________
Does the client know others who have engaged in suicidal behaviour? No / Yes
- Significance of relationship: _____________________________
- Outcome: ____________________________
Action Plan:
__________________________________________________________
__________________________________________________________
C. Current stressors
Are there current stressors affecting the client? No / Yes
If yes:
- Relationship break-up
- Family Conflict
- Disability or Illness
- Abuse or DV
- Injury or Accident
- Assault
- Job Loss/Unemployment
- Loss or Grief
- Other ________________
Significance for client:
Action Plan:
__________________________________________________________
__________________________________________________________
D. Distress Level
Is client significantly distressed? Yes / No
If yes:
What symptoms of distress does the client display?
- Emotional: Mood swings
- Anger
- Alienation
- Numbness
- Anxiety
- Deep sadness
- Other ________________
- Thoughts:
- Irrational
- Narrow
- Extreme
- Slowed
- Global
- Incoherent
- Other ________________
- Physical:
- Lethargy
- Panic
- Disturbed sleep
- Other ________________
- Behavioural:
- Withdrawal
- Crying
- Aggression
- Erratic
- Other ________________
Action Plan:
__________________________________________________________
__________________________________________________________
E. External /Internal Resources External:
Are there any external supports available? Yes / No
If yes:
Who is available for support?
- Family members
- GP
- Friends
- Colleagues
- Partner
- Mental Health Worker/Service
- Other ________________
Level of support received:
Contact frequency _________________
Time of next contact? ______________
Anyone present/contactable? No Yes
Action Plan:
__________________________________________________________
__________________________________________________________
Internal: Does the client have coping strategies? Yes / No
Strengths / Coping mechanisms: ________________________
Strategies used/Crises managed: ________________________
Connections that give client a sense of meaning or belonging: __________________
Reasons client identifies for living: ___________________________
Action Plan:
__________________________________________________________
__________________________________________________________
RISK OF SUICIDE ATTEMPT
(Count the number of underlined/bolded Yes or No answers circled)
- Low (0-1)
- Moderate (2-3)
- High (4-6)
- Emergency (4-6) + Immediate Plan
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Attachment H: Family Law Regulations 62 - 64
FAMILY LAW REGULATIONS 1984
REGULATIONS 62 TO 64
Division 1 Family Dispute Resolution Practitioners
62 Family dispute resolution practitioners — assessment of family dispute resolution suitability
(1) Before providing family dispute resolution under the Act, the family dispute resolution practitioner to whom a dispute is referred must be satisfied that:
(a) an assessment has been conducted of the parties to the dispute; and
(b) family dispute resolution is appropriate.
(2) In determining whether family dispute resolution is appropriate, the family dispute resolution practitioner must be satisfied that consideration has been given to whether the ability of any party to negotiate freely in the dispute is affected by any of the following matters:
(a) a history of family violence (if any) among the parties;
(b) the likely safety of the parties;
(c) the equality of bargaining power among the parties;
(d) the risk that a child may suffer abuse;
(e) the emotional, psychological and physical health of the parties;
(f) any other matter that the family dispute resolution practitioner considers relevant to the proposed family dispute resolution.
(3) If, after considering the matters set out in subregulation (2), the family dispute resolution practitioner is satisfied that family dispute resolution is appropriate then, subject to regulations 63 and 65, the family dispute resolution practitioner may provide family dispute resolution.
(4) If, after considering the matters set out in subregulation (2), the family dispute resolution practitioner is not satisfied that family dispute resolution is appropriate, the family dispute resolution practitioner must not provide family dispute resolution.
63 Information to be given to parties before family dispute resolution
(1) At least 1 day before family dispute resolution is started under subregulation 62 (3), each party to the family dispute resolution must be given a written statement that sets out the following information:
(a) that the process of family dispute resolution is one by which the parties involved, together with the assistance of the family dispute resolution practitioner:
(i) isolate issues in the dispute; and
(ii) develop and consider options to resolve those issues; and
(iii) if appropriate — attempt to agree to 1 or more of those options; and
(iv) if a child is affected — attempt to agree to options that are in the best interests of the child;
(b) if the dispute involves a child:
(i) that each parent has parental responsibility for the child, within the meaning of section 61B of the Act; and
(ii) that the best interests of the child are the paramount consideration in any decision that affects him or her;
(c) that it is not the role of the family dispute resolution practitioner to provide the parties with legal advice (unless the family dispute resolution practitioner is also a legal practitioner);
(d) that family dispute resolution may not be appropriate for all disputes, particularly if a dispute involves violence that renders one party unable to negotiate freely because of another’s threats;
(e) that family dispute resolution must be attended if required under section 60I of the Act, before applying for an order under Part VII of the Act;
(f) that a party has the right to obtain legal advice at any stage in the family dispute resolution process;
(g) that a party has the right to terminate the family dispute resolution at any time;
(h) that, provided section 10J of the Act applies, evidence of anything said, or an admission made, at family dispute resolution is not admissible:
(i) in any court (whether exercising federal jurisdiction or not); or
(ii) in any proceedings before a person authorised by a law of the Commonwealth or a State or Territory, or by the consent of the parties, to hear evidence;
(i) the family dispute resolution practitioner’s confidentiality and disclosure obligations under section 10H of the Act;
(j) the qualifications of the family dispute resolution practitioner to be a family dispute resolution practitioner;
(k) the fees (including any hourly rate) charged by the family dispute resolution practitioner in respect of the family dispute resolution.
Note Sections 12G and 63DA of the Act may impose additional information-giving obligations.
(2)Before starting family dispute resolution, each party to it must certify on a copy of the statement that he or she has received the statement.
(3) A family dispute resolution practitioner must not start family dispute resolution until subregulations (1) and (2) are complied with.
64 Obligations of family dispute resolution practitioner — general
In providing family dispute resolution services under the Act, a family dispute resolution practitioner:
(a) must ensure that, as far as possible, the family dispute resolution process is suited to the needs of the parties involved (for example, by ensuring the suitability of the family dispute resolution venue, the layout of the family dispute resolution room and the times at which family dispute resolution is held); and
(b) must ensure that:
(i) family dispute resolution is provided only in accordance with this Division; and
(ii) any record of the family dispute resolution is stored securely to prevent unauthorised access to it; and
(c) must terminate the family dispute resolution:
(i) if requested to do so by a party; or
(ii) if the family dispute resolution practitioner is no longer satisfied that family dispute resolution is appropriate; and
(d) must not provide legal advice to any of the parties unless:
(i) the family dispute resolution practitioner is also a legal practitioner; or
(ii) the advice is about procedural matters; and
(e) must not use any information acquired from a family dispute resolution:
(i) for personal gain; or
(ii) to the detriment of any person.
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Attachment I: Model for screening for joint sessions
Model for Screening for Domestic Violence for Dispute Resolution -Louise Lamont
Introduction
Screening for the presence of domestic violence in clients presenting to Dispute Resolution Services is critical to maximizing client and worker safety. Extensive screening procedures, have the potential to identify risk, inform assessment of suitability for mediation, and minimize any potential harm to either clients, their dependants or significant others including workers. Although an intake screening process can not guarantee that domestic violence will always be identified during that phase, if screening is extensive and the appropriate questions are asked, then clients experiencing domestic violence will more likely be identified earlier at the point of intake. In addition, if a program is operating according to good practice recommendations then screening will continue throughout mediation. Please note that the process of mediation can be concluded at any time, should any issues present later that are of concern in relation to fairness or equity, power balances, personal safety, or future risks.
Screening for domestic violence at intake is usually conducted so that mediators or workers responsible for an intake role within a program can assess the appropriateness of dispute resolution. The outcome of a screening assessment is usually:
- Mediation is considered a suitable process for the parties seeking dispute resolution.
- Mediation is considered suitable but only if it is conducted with special conditions attached to the process, and that both parties are willing to agree to, and cooperate with these special conditions.
- Mediation is not considered a suitable and/or safe process for the parties seeking dispute resolution.
This ‘model’ has been developed specifically as an ‘example’ and to demonstrate the type of process, and questions that could be asked in face-to-face interviews with clients seeking dispute resolution. This ‘model’ is specifically focused on identifying the presence of domestic violence, (not other relevant issues) and the ‘model’ also incorporates the essential elements of good practice.
This ‘model’, advocates where possible conducting these interviews face-to-face rather than resorting to telephone interviews, or written questionnaires, except for when face-to-face interviews are viewed as not being feasible.
This ‘model’ screening process begins by asking more general and open-ended questions that can then lead on to more specific and direct questions. The initial phase of interviewing allows an intake and screening worker or a mediator time to build a rapport with clients before asking the more direct questions aimed to identify any history of domestic violence or risks to safety.
Below are ‘samples’ of the types of questions that could be asked. Obviously, not all of these questions would need to be asked. However, the more comprehensive the process undertaken, the greater confidence intake and screening workers and mediators can have that their practice has provided clients with the best opportunity to disclose, and that they have obtained enough information to be able to make a reasonable assessment that maximizes safety.
Phase 1. Joining & Rapport Building: (Examples of questions)
- How did you hear about this program/service?
- Has anyone explained to you what dispute resolution/mediation is?
- Would you like me to give you more detailed information about mediation, and what we offer here in our program?
- Have you ever had any sort of dispute resolution/mediation before?
- If yes, did you find that helpful?
- Did you initiate the idea of using dispute resolution/mediation, or was it someone else?
- What are your expectations from dispute resolution/mediation?
- What are your expectations of the mediator during the mediation process?
- What are your expectations of your partner during the mediation process?
- Do you have any particular questions about mediation?
- Do you have any particular concerns about mediation?
- Are you confident that you can negotiate for your needs in mediation?
- If no, what are you unsure about?
- What would you hope will happen during mediation?
- What would you hope would not happen during mediation?
- How long have you and your partner been separated/divorced?
- Was it a mutual decision to separate or was it initiated by one of you?
- Was there very much fighting/conflict during that time?
- Is yes, is there still a lot of fighting/conflict now?
Phase 2. Exploring the Power Balance: (Examples of questions)
- When you were together with your partner how would you describe what it was like to live with them?
- Before you separated, and when you were still together, how well were you able to manage conflict then?
- When you were together how did you make decisions about things related to the children, finances, other responsibilities etc?
- If one of you couldn’t get your way on something that was important to you what would happen?
- When you and your partner were together, how would you argue if you disagreed about something?
- Did you ever feel unsafe when you both argued?
- How did you generally resolve these arguments?
- Have you had any problems negotiating things with your partner since you separated?
- If you were to get upset or angry with your partner during mediation how would you handle that?
- If your partner was to get upset or angry with you during mediation how do you expect they would deal with that?
- If your partner were to get upset or angry with you during mediation would that change anything for you?
- If your partner was to get upset or angry with you during mediation would you feel unsafe after the mediation session was finished?
- What would need to happen so that you could feel safer?
- Are you generally afraid of your partner?
- If yes, what are your reasons for being afraid?
Phase 3. Specific Questions About Domestic Violence
(Examples of questions)
- Did/has your partner ever stop you from doing something you wanted to do?
- If yes, can you provide more detail about that?
- Did/has your partner ever stop you from seeing family or friends?
- Has your partner ever prevented you from having access to money?
- Has your partner ever been verbally or emotionally abusive to you?
- If yes, in what ways has your partner been abusive?
- Has your partner ever frightened you?
- If yes, in what ways has your partner frightened you?
- Has your partner ever threatened you?
- If yes, in what ways has your partner threatened you?
- Does your partner own or have access to any weapons? (eg gun, hunting knife etc)
- Has your partner ever threatened you with these weapons?
- Has your partner ever hit you or used any other physical force towards you?
- If yes, can you tell me more about what happened?
- How often has your partner been violent towards you?
- When has this happened, e.g. when you were together, since you have separated, or both?
- Have you been physically injured by your partner’s violence?
- If yes, what type/s of injury have you had?
- Did this injury require you to seek medical assistance or be hospitalized?
- Was the doctor or the hospital aware that your partner had inflicted your injury?
- Has your partner ever damaged your property?
- Has your partner ever threatened to hurt any of your pets?
- Has your partner ever actually hurt or killed a pet?
- Does your partner abuse alcohol or drugs?
- Has your partner ever had any financial problems, e.g. gambling, unemployment?
- Is your partner extremely jealous and/or possessive?
- Has your partner ever followed you, harassed you with unwanted phone calls, letters, or other unwanted contact?
- Does/Has your partner ever had a mental illness?
- Has your partner ever threatened suicide?
- Have you ever threatened suicide?
- Have you ever been violent to your partner?
- If yes, can you describe what happened?
- Have your children ever witnessed you or your partner being violent?
- Have your children ever had the violence directed at them, been caught in the middle of the violence, been injured trying to protect you or your partner, or tried to stop the violence?
- If your partner has been violent have they taken responsibility for their actions?
- Have the police ever been called to a violent incident between you and your partner?
- Have criminal charges ever been laid against your partner in regards to any violence towards you or your children or others?
- Have you in the past, or currently do you have a Protection Order against your partner?
- Has your partner ever breached the conditions of that Protection Order?
- Is your partner still violent towards you?
- Has your partner ever threatened to kill you or your children or other family members?
Phase 4. Assessment of Suitability for Mediation:
Process to undertake and what needs to be considered in that process
1. Inventory of Violence – review of information obtained from client/s
- History of physical violence past and present
- History and patterns of non-physical forms of domestic violence
- History of the frequency and severity of physical violence
- History of threats, property damage, involvement of children etc
- History of the use of weapons, or ownership of, or access to, weapons
- History of substance abuse, and/or mental health issues
- History of legal or criminal justice interventions/convictions past or present
- History of current or past Protection Orders including breaches
- History of any Family Court orders
- History of any medical intervention for injuries sustained
- History of secrecy surrounding the violence
2. Risk Assessment – determining the level of dangerousness
Indicators:
- Current Protection Order or history of breaches of past orders
- Existence of current or past violence that is frequent and/or severe
- Presence of current or past threats to kill or harm their partners, their children, themselves, or significant others including workers in a service
- Presence of stalking, or behaviours that constitute intimidation or harassment
- Presence of threats to damage property, or harm/kill pets
- Presence of weapons or access to weapons and threats to use them
- Presence of denials, minimizations or rationalizations of the abuse perpetrated
- Presence of current alcohol or drug use, or current or past mental health issues
- Presence of child abuse allegations or lack of concern by user of violence for children having witnessed past/present violence
- Level of fear reported by the victim, and inability to feel safe in presence of perpetrator
- Level of harm/fear experienced or reported by children
- Separation is very recent, and partner using violence is not accepting of separation
- Avoidance of acceptance of responsibility for violence by the partner using violence
3. Responses by workers to high level risks to safety
- Seek urgent supervision or debriefing if necessary, or as in accordance with service policies
- Assess clients as unsuitable for mediation
- Provide crisis intervention if necessary
- Develop a safety plan with the victim
- Determine if additional support is required and make appropriate referral/s
- If the screening process reveals that a crime has possibly been committed or threats to commit a crime are made, then ensure the victim is informed about their options in relation to reporting, proceeding with charges or seeking protection.
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Attachment J: Draft Guidelines for Management of Cases Involving
Violence in Family Relationship Centres
Screening and assessment processes will be conducted at Centres to identify a range of issues including domestic and family violence. When violence is identified, Centres should have a policy that determine how to handle such cases, whether any form of joint sessions is appropriate and, if so, under what circumstances joint sessions can be held.
The suggested process for proceeding to a joint session where there is a history of violence follows:
- An extended assessment and intake process to ensure that it is safe to proceed and that effective participation is feasible:
- Assessment needs to conducted at individual, not joint sessions, including a more extensive assessment of the history and extent of violence identified
- The Centre needs to be satisfied that:
- the threat of violence is not current
- safety can be assured and that any children of the parties are not currently at risk or likely to be put at risk by the process, or the presence of past violence
- the client who has reported being subjected to violence is giving genuine and informed consent (this includes helping them to consider other options where they feel they have no real choice but to participate)
- The client who has been subjected to violence, and the practitioner, needs to be confident in their ability to be able to negotiate on their own behalf.
- The person using violence is prepared to accept the ‘ground rules’ set for this process, to ensure that the process is fair and safe and does not allow further intimidation or disadvantage into the process.
- Undertake safety planning:
- with the client subjected to violence — for example, contingencies in the event of an incident (including pre and post service)
- with the person using violence — for example, a cooling off mechanism
- contracting with the person using violence that any further use of violence will result in discontinuation of service and potentially the incident may be reported to police if it is a breach of a protection order, or constitutes criminal behaviour
- Build links with crisis and support services and refer to violence prevention services as appropriate:
- Victim support
- Perpetrator programs
- With the clients, design the most effective and safe process. This may involve shuttle mediation or video-conferencing in which the clients do not have to meet face to face. (Note: physical separation of the clients may not eliminate the patterns of fear and control that may be present in relationships where there has been a history of violence. A person who has been subjected to violence may also fear that the person using violence will manipulate the practitioner, or that the practitioner may collude with any minimisations or denials, or may not recognise the signs of intimidation or control. Indeed some victims of violence may feel safer in a face to face session as they can then directly observe their partner and the practitioner.)
- If using face to face sessions, the following guidelines are suggested:
- Use short multiple sessions.
- Allow for individual follow up between sessions, or consider having short pre-mediation session before each session.
- Include break out private sessions (caucus) during sessions, and always have a private session to do a reality and safety check before moving towards finalising an agreement or parenting plan.
- Consider drafting up a draft agreement/parenting plan and encourage the parents to discuss this with support people before returning to ‘finalise’ — ie sign and date - the agreement.
Staff involved in such sessions must have special training and be appropriately skilled in dealing with cases in which violence has been identified. These staff must attend regular professional supervision for these cases, and must be supervised by someone who is experienced in working with domestic and family violence.