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

For this Case Study we spoke to a Counsellor Advocate and a worker form a sexual assault service.

The case study

Tom* had been sexually assaulted by his partner and was referred to an after-hours sexual assault team as part of a hospital crisis care response. Tom had experienced significant injuries because of the sexual assault which required surgery. Police were involved and were investigating the assault.

Tom was unfamiliar with the service system and was overwhelmed by professionals which was compounded by his experiences of trauma while navigating a complex health system. Tom was on a lengthy waitlist for surgery which created increased stress. Tom had also been experiencing thoughts of suicide. The long-term outcomes for Tom are not clear.

The actions which were taken

Specialist sexual assault, family violence, police, General Practice, mental health, crisis housing and brokerage services, and both general and surgery hospital staff were involved. Coordination between numerous services was required within a short timeframe, thus creating the potential for miscommunication and the risk of replicating a loss of control central to trauma. Numerous services and professionals were involved with Tom in a condensed period which increased the potential for miscommunication and confusion between professionals. Responsive collaboration and advocacy resulted in Tom being offered a range of services through a more cohesive referral process. Clear processes and cooperative information sharing, with Tom’s consent, contributed to positive outcomes throughout Tom’s journey. Tom’s experience of trauma could occasionally present as agitation, so a key function of support from the sexual assault service was to elevate a trauma informed lens when conceptualising Tom’s responses. Furthermore, advocacy with professionals ensured consent and empowerment were central to Tom’s care. A key component of the support was to find out how Tom wanted to be supported including which conversations he was able to have with other services and which ones he felt comfortable to have himself

“You know, when sexual assault or family violence occurs, people’s rights are impacted, their choice is impacted, and their sense of control is impacted. It’s taken by away by the behaviour of the perpetrator. And so, any step that we could take where a person can feel like they could choose and can exercise their rights‘

Care team meetings were established with professionals, and input from those unable to attend were sought prior to meetings to ensure their input would be included. Communication that reduced the need for repeated communication from Tom, including re-telling traumatic detail, was key.

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: 

• A multidisciplinary practice approach means the transition between any of these services becomes seamless from the client perspective, allowing them to access the diverse services they need without barriers or restrictions.
• Prioritising consent, and empowerment for Tom throughout this process. For example, Tom was able to determine which services he felt able to engage with himself, and which he felt he needed support to engage with.

‘So, it was about bringing the information together so that everyone had a sense of what the support needs were a lot more clearly rather than this person having to tell the story and this being increasingly disturbing and distressing for them.’

• Coordinating communication across the team and with the Tom reduced the need for repeated communication from Tom, preventing Tom from being required to re-tell traumatic details.

Respectful relationships and ongoing communication  

Enablers: 

• Clear communication across services allows for improved understanding of the services and their roles.
• Having knowledge of the roles of other professionals, positive working relationships and even stronger relationships between services contributes to the support of positive client outcomes.
• The multidisciplinary practice approach and the strong relationships which were built across the Care Team. “It was good to have that collaboration and to have…. specialist services (including) the police … to make sure… when at a time we were concerned about safety, we were able to kind of escalate that really quickly.

Challenges:

• While clear understanding of roles of other professionals is improving there is still more to be done. For this, the practitioner felt that co-location is a key component … it’s it definitely is like colocation and just getting to know people so that there’s a face to a name rather than ringing up a service cold calling, actually having a relationship.
• Ensuring communication and sharing of information supports practitioners to be well-informed and up-to-date about the service landscape, and programmatic changes over time. This ensures that referral pathways are clear, clients receive up to date information and there is a better understanding of the barriers a client may face.

Clarity of Roles and Responsibilities

Enablers: 

• Comprehensive understanding of the roles and responsibilities and capacity of other services. This enables practitioners to understand who to speak to, which services to refer to and for what purpose – so that you know you are referring and speaking to the right teams or the right people having a clear understanding of the landscape of who does what?

Challenges:

• Services across and between regions are not necessarily uniform, and can often change frequently, which added to confusion about what services and supports were available for Tom.

Specialisation

Enablers: 

• Sharing of resources and specialist skills means that practitioners can work together drawing on their diverse skills to better support clients, learn from each other and overall get better use of resources to support the best outcomes for clients.  It’s really taking the best of the skills and the assets of individuals teams, and programs, and bringing them together.

‘I think for all practitioners, it’s nice to know that there’s someone there because the service user is getting more support but also that that you’re not left trying to kind of do things that you don’t have the time, the ability or the agency to do.‘

Leadership, governance and authorising environment

Enablers: 

• Relationships and co-locations, such as the Orange Door or outposts for periods of time can support the strength of relationships and a more continuous flow of information rather. This can be more upskilling than one off trainings for example.

Challenges: 

• Complexities with services having different funding and packages impacting clear understanding and information about services.  

Information and risk sharing

Enablers: 

• Gaining diverse specialist expertise and engagement from across the multiple services supports greater understanding of the client’s needs and support available for practitioners to have greater confidence in their contribution, support in making judgements and decisions. This in turn ensures that practitioners are not holding the risk alone.