7.1 Summary
7.2 Policy issues and recommendations
7.3 Conclusion
7.1 Summary
This study has highlighted some of the dilemmas of staff working at WDVS. One of the major dilemmas identified was balancing duty of care to the client with legal and moral responsibilities, and personal values. Some of the dilemmas were:
- having to make decisions based on fragmented information;
- making the decision to contact FAYS re children’s welfare when they believe departmental intervention may do more harm than good;
- making the decision to contact FAYS when often their concerns are overridden by FAYS or court judgements that the children are not in danger;
- establishing whether the client has the mental competence to understand her behaviour and its consequences;
- respecting the client’s autonomy, even though this may not lead to the best outcome, i.e. respecting autonomy may continue to place the client (and her children, in some cases) in danger;
- whether to contact the police or encourage women to speak to police about their knowledge of criminal offences – this could compromise the woman’s safety, as police are interested in the criminal and the crime, not the woman’s well being;
- whether to encourage women to seek restraining orders – again, restraining orders may compromise the woman’s safety even further;
- whether to breach confidentiality;
- how far to explore sensitive information – issues of invasion of privacy and exacerbating the likelihood of more violence against the woman;
- ensuring all women provided with accommodation are treated the same in light of agency rules;
- how to prevent women’s social isolation by allowing visitors, but at the same time safeguarding all residents.
The workers’ main emphasis is on providing safe accommodation for women and their children who are trying to escape abuse, and going beyond this to formulate safety plans to enable the women to return to life in the community, armed with strategies to help keep them safe. However, it can be difficult for workers to help women whose behaviours and sometimes unreasonable requests put the workers in a situation where they are ‘damned if they do’ suggest particular helping strategies and ‘damned if they don’t’ (e.g. restraining orders). Workers may find themselves in situations of conflict between their duty of care to the client, including the client’s right to privacy and confidentiality, and their legal, moral and personal beliefs and obligations.
The study was restricted to women from bikie gangs, cults and those who use sex for favours. Section 6 highlights the enormity of the dilemmas faced by workers when trying to help women who are affected by severe trauma, mental illness, drugs, alcohol, homelessness and a persistent fear of repeated sexual, psychological and physical abuse. Workers identify lack of a supportive network as one of the major problems they face when trying to help these women gain safe housing and regain their life outside the agency’s accommodation. The women’s mistrust of helping organisations and agencies such as FAYS and the Drug and Alcohol Services Commission (DASC), their unwillingness to attend counselling sessions and their wariness about police intentions when they do seek help, make it difficult for the workers to devise helping strategies and effective safety plans. Lack of mental health and disability services for women such as those presenting to the agency add to the workers’ dilemmas, as they are not qualified to deal effectively with these women’s multiple complex needs. While these women are obviously in need of help, the services that do exist preclude them as not being severe enough cases. It became obvious from the workers’ descriptions that they were torn between doing what they thought was ‘right’ personally and professionally, and respecting the women’s right to autonomy, even though this was greatly impaired in some cases.
[ top ]
7.2 Policy issues and recommendations
7.2.1 Access to specialist treatment services
WDVS provides services to women and children with very complex needs. Many women come to such services with a history of child sexual abuse. These are not isolated events but the result of sustained sexual abuse as children. Some women also refer to rape and other serious sexual assaults in adult life. Women and children present with a range of mental health problems, including post-traumatic stress disorders, bi-polar disorders, suicidal ideation, depression and personality disorders. Some also have major health issues including diabetes, multiple sclerosis and addictions. Women and their children have been tortured. This may have been physical torture, or witnessing murders, rape or threat of death. Exposure to torture leaves women and children fearful and helpless. This form of trauma challenges the assumptions that people have about their world and relationships within it. There may be lack of meaning and failure to have a positive view about oneself.
Women and children are not accessing specialist mental health or trauma services. Where services are available, they are provided to other groups with more clearly defined needs. The perception in women’s services is that mental health services are rationed to those with a psychosis, and counselling for post-traumatic stress is provided to returned soldiers for war-related trauma and to refugees for political torture. Women’s needs and their children’s needs have not been addressed.
WDVS provides a 16-week specialist socio-therapeutic group for children, concurrent mothers’ groups and an activity-based program for women and children. It also provides train-the-trainer roles in this area for other regional services. WDVS receives no specific funding for this program and relies on limited resources to undertake this work, which can not be expanded to meet needs, thus resulting in a constant waiting list. Publicly-funded referral points for children with identified behavioural or emotional problems are virtually non-existent. Many South Australian domestic violence services undertake similar programs and face similar problems.
Recommendation 7.2.1.1
It is recommended that consideration be given to provision of specialist services for women and children who have been subject to extreme forms of physical and sexual violence. These specialist services would include mental health services, specialist 46 counselling for PTSD, and drug and alcohol services. Similar child-based services should be available for children. Whilst this study has focused predominantly on women, their children are also in need of specialist services.
Recommendation 7.2.1.2
It is recommended that specialist services be provided for children who have witnessed or been subject to extreme forms of violence.
7.2.2 Prevention
Specialist services will assist women with existing problems but the goal of social and health policy is prevention of such incidents in the first place. This is a long-term strategy with gains made after many years of active intervention. Prevention may include working more actively with men, violence prevention strategies with young people in schools, a range of programs that work toward prevention of child abuse, identification and early intervention with women and families who are most at risk, and parenting programs. Government agencies that respond to reports of child abuse in the community may need to go beyond investigation and notification to actively develop prevention programs.
Recommendation 7.2.2.1
It is recommended that a variety of prevention programs be implemented to prevent violence and long-term harm to women and children.
7.2.3 Employment and education of workers
The dilemmas presented by workers at WDVS demonstrate that workers are required to assist with intellectually and emotionally complex issues. These issues demand sophisticated practice skills, and the ability to plan and coordinate multiple service interventions. Therefore, this sort of job is not suitable for a person with lots of life experience and common sense, but limited professional education, as perhaps was the case previously in early service developments. It requires people with maturity, an open mind, self-awareness about their values, and specific education and training in a range of areas. Workers will need knowledge of mental illness, PTSD, sexuality, sexual violence, dealing with disclosures, working with children and knowledge of the service delivery system. Workers will need the capacity to collaborate and negotiate with a variety of specialist agencies including the police, child protection and mental health. They are also expected to discuss a wide range of taboo topics, including common and not so common sexual mores. Thus they need a high level of training for interviewing about sexual issues. Workers also need the intellectual sophistication to separate personal values from workplace issues, and clinical supervision to help them create distance from the trauma of client issues, to work effectively with women, to deal with disclosures and to cope with vicarious re-traumatisation. It is also expected that workers’ supervisors will have a high level of training.
Current SAAP service funding, linked to the Community and Social housing (CASH) and Social and Community Services (SACS) Awards creates obstacles to recruiting and maintaining a highly skilled workforce, and precludes wage parity with State Government services. Domestic violence services require skilled tertiary graduates in human and social sciences with particular expertise in comprehensive case management and advocacy. State Government agencies have limited and particular responsibilities and authorities, whereas domestic violence services must respond to, plan, coordinate and advocate for the whole mix of complex needs with which a client presents to the service.
Recommendation 7.2.3.1
It is recommended that staff working in domestic violence services hold appropriate tertiary qualifications and that SAAP funding provides wage parity with professionals working in comparable roles in State Government agencies.
Recommendation 7.2.3.2
It is recommended that an audit is undertaken of the skills and competencies required to work with women in this sector and that this information is used to provide additional training for staff.
Recommendation 7.2.3.3
Working with women with high level needs is not only complex but it takes time. It is recommended that funding levels be increased to ensure that the agency has sufficient resources to fund workers to actively assist this client group.
7.2.4 Interagency work
Working effectively with women suggests a greater focus on interagency work. Layton (2003) has recommended an Interagency Case Management model be adopted for all child protection cases assessed as having very high, high or moderate risk. Little has been developed to date to address these issues for women, apart from some limited developments in relation to coordinated criminal justice interventions.
Recommendation 7.2.4.1
It is recommended that all services that these women and their children may need to access participate in round table discussions with WDVS about the range of service and practice issues identified as needing interagency collaboration. Participating organisations and service bodies would include other women’s domestic violence and crisis centres, disability services, mental health services, general health care services, counselling services, Indigenous services, housing services, Commonwealth and State Police Forces, FAYS, DASC and Centrelink.
7.2.5 Data collection
Recommendation 7.2.5.1
It is recommended the NDCA SMART 4 program be revised to include a more sophisticated program to be developed for agencies wanting to undertake better data collection and analysis of complex client needs and interventions.
Recommendation 7.2.5.2
It is recommended that the SMART data collection program be revised immediately to include recording of assessment, service provision, service gaps, referrals and outcomes to provide an accurate representation of the presenting needs of, and service responses to accompanying children and young people.
Recommendation 7.2.5.3
It is recommended that sectorial-based data collection trials be held in some states to facilitate multiple agency data collection regarding emerging issues related to high and complex needs.
[ top ]
7.3 Conclusion
While such strategies would not remove the dilemmas the workers face when dealing with domestic violence, they may at least lessen them. Workers would be able to feel confident that referring women to specialist services, FAYS or the police for help would actually create a safer, healthier environment for the women and their children, rather than increasing the danger.