MDPP Case Study Twelve. Completed by Sexual Assault Services Victoria.

For this Case Study we spoke to a Senior Family Violence Counsellor, a Sexual Assault Counsellor and a Family Violence Specialist.

The case study

Jen* was sexually assaulted in the context of a new intimate relationship. The perpetrator was known to police with a history of extreme violence toward other women, and while currently incarcerated, they were likely to be released on bail. The Sexual Offences and Child Abuse Investigation Teams (SOCIT) were involved in the first instance, as well as the Orange Door and a local family violence crisis service. A referral was made to sexual assault services for potential counselling. 

The actions which were taken

Jen’s mobile phone was not operating, and it was critical to make timely contact with her to continue to ensure safety. The local family violence service was established as the clear lead and with the benefit of the Information Sharing Scheme (ISS) professionals shared key information such as the Tools for Risk Assessment and Management (TRAM), safety planning information and crisis accommodation addresses, to locate Jen. An email loop was established between professionals to aid communication however agreed to one person being the contact with Jen to simplify communication and to not overwhelm Jen, in part driven by implementing a more trauma informed response. 

Key Features of Multidisciplinary Practice

There were a range of key features that were critical to the multidisciplinary practice and outcomes achieved in this case example.

Centering the Client  

Enablers: 

• Coordinating services around the client’s needs and situation.
• The services involved also coordinated communications with Jen, with one practitioner nominated to lead communication

‘Because in that crisis space, they (the client) do not know who’s ringing them in the end. They forget who’s ringing them, they forget the information. So, the less people ringing, the clearer the information, the better for the client’

• For the client, multidisciplinary practice reduces burden on them, increases the responsiveness and agility of the services and the efficiency in which they are delivered.
• Multidisciplinary practice collaboration centred around the clients needs delivers better outcomes than a siloed way of working. It results in a deeper dive, that explores with the client their needs from a holistic perspective. Individual service models tend to do more shallow work, and work ‘with 10% of the problem’.  
• However, if a client chooses not to explore this option and want an individual services, ‘I will sit with them and walk alongside them.‘
• While there is the provision through MARAM to override consent in cases of high risk, the preferred approach is to always gain consent from the client because it builds a relationship with them that positions the practitioner as working alongside the clients rather than being directive.

Respectful relationships and ongoing communication  

Enablers: 

• Strong relationships built. Not just via interactions in clients but outside of that for example, heading to SOCIT and having a coffee. A culture of openness built through relationships that helps when needing to get things done. With strong personal relationships supported in formal and informal ways, people are more willing to support and assist.
• Relationships that build professional respect, respect for their role, their perspectives and their value to both other workers and to the client and this forms the basis to have the challenging conversations that emerge from differences.
• Being clear about what information can be shared and having boundaries about what can’t be and why, in respect for a client.
• When building these relationships, particularly with new practitioners or services, the approach should be gently and softly focussed on client outcomes.
• Relationships that support efficient and coordinated communication helped to locate Jen in the timeliest way and optimised risk assessment and safety. Within this, each service involved in the case contributed information that was critical.
• All involved build a better understanding of the service system and of the different frameworks that professionals work with which makes collaboration easier. This increased knowledge of the service system and options for service support was also shared with Jen which broadened her awareness. This also means that service provision is more efficient, as each practitioner isn’t chasing the same information.

‘You cannot work in silos, we cannot work on an island, especially around risk‘

‘If I can collaborate, I will always collaborate, if there is an opportunity there. If a client does not want to do that, and they want to work individually, of course, that’s where I sit with them and walk alongside them. But if there is any space for collaboration’

Challenges:

• Where trust is not in place, or tough relationships escalate trust can also be broken quickly because people feel their work is being threatened.

Clarity of roles, responsibilities and expectations

Enablers: 

• One lead and core contact point:

‘We’ve actually got one contact point for the client. We’re all working together, but there’s one contact point for the client so that she’s not being overwhelmed by three or four services, ringing her with exactly the same thing or same but different.‘

Specialisation

Enablers: 

• Values perspectives that see the importance of diverse specialisations working together to support the best outcome for the client. This requires understanding and learning where other specialists are coming from, the frameworks they work within and using this information to build positive relationships

‘Being really open to others people’s knowledge in that space, where practitioners are talking and mixing and having those conversations and different views are coming in, and different, different outcomes and an understanding of other people’s positions’

Challenges

• Where practitioners did not come from a position of openness to others expertise.

Leadership, Governance and authorising environment

Enablers: 

• The sexual assault organisation invested in an ‘integration’ role (Family Violence and Sexual Assault). This authorised a role so time could be invested into relationships and taking appropriate time to complete a task (40% of role)
• Resources, availability and continuity of workers (partly impacted by COVID, for example at the time two other services were at home 50% of the time due to COVID). This has had an impact on other work – e.g., other clients both actively working with and on waitlist for services. This is to establish the foundations for the integrated approach  

Challenges: 

• Needing to invest additional time at expense of other clients  e.g., moving other appointments (a barrier with regard to service impacts but also impact on worker with regard to values)
• Resources: everyone is busy and it takes time. Services can be in competition, which can have a siloing effect.  In this case, the main worker was away and it was difficult  to ensure another worker was allocated the role. Availability of workers can be a challenge. 
• This area is an innovative space, with many levels of change and development but this can also cause fatigue particularly given COVID.

Information and risk sharing

Enablers:

• Clear communication and opportunity to share information through ISS provisions meant that the practitioners compile and share their information which was critical for Jen’s safety, particularly given the high level of risk. This also enabled practitioners to share the risk across the team, and not carry it on their own. 
• MARAM enables sharing of information (with consent) to support management of risk and safety. Previously, there may be concerns about this information sharing

‘It’s important that you’re not holding risk on your own; that is actually a shared risk. I think that is really important in a high-risk space. You do not want to be holding that risk on your own as a worker it’s not healthy.‘