Note: Where available, the PDF/Word icon below is provided to view the complete and fully formatted document
Finance and Public Administration References Committee
08/11/2017
Delivery of national outcome 4 of the National Plan to Reduce Violence Against Women and Their Children 2010-2022

LACHEVRE, Mrs Emily, Trauma Specialist Counsellor, Rape & Domestic Violence Services Australia

WILLIS, Ms Karen Lee, Executive Office, Rape & Domestic Violence Services Australia

[10:22]

CHAIR: Welcome. Information on parliamentary privilege and the protection of witnesses in giving evidence to Senate committees has been provided to you, I understand. You've lodged submission 57 with the committee. Would you like to make any amendments or additions to that submission?

Ms Willis : No.

CHAIR: I invite you to make a short opening statement, and at the conclusion of your remarks I'll invite members of the committee to ask some questions.

Ms Willis : Rape & Domestic Violence Services Australia holds that women, children and men who experience sexual assault or domestic or family violence have a right to expect—and we have an absolute obligation to provide—the best possible trauma counselling service to assist them in their recovery. By any measure, this is a service that's provided by Rape & Domestic Violence Services Australia. We provide an evidence based, internationally recognised specialist trauma counselling service to people who are living with or impacted by sexual assault or domestic or family violence. The organisation's clinical practices are supported by peer reviewed literature and are subjected to international best-practice standards of quality assurance and process and outcome evaluation. International evidence of best practice is clear that working with traumatised individuals takes time, requires a high level of professional skill and must be provided by qualified and experienced trauma specialists.

Before starting employment with our service, all of our counsellors must hold a minimum of a four-year degree in social work or psychology or equivalent. Most of our counsellors actually hold additional postgraduate qualifications. They must also have at least three years of counselling experience, with most currently having considerably more than that. All counsellors, upon employment, participate in a two-week intensive trauma specialist training program based on the best-practice counselling service manual, of which senators will be provided a copy, and they attend ongoing in-service training and professional development throughout their time with the organisation. All counsellors attend monthly clinical supervision and participate in vicarious trauma management.

Rape and Domestic Violence Services Australia has provided specialist sexual, domestic and family violence trauma counselling and services to 1800RESPECT's clients since it was established in 2010. One of the many challenges has been the difference in values between Medibank Health Solutions and Rape and Domestic Violence Services Australia. This stems from how each organisation defines its client. Medibank focuses on organisational reputation and ensuring that the needs of its client—that is, the government—are met, resulting in a service where meeting the government's KPIs is the absolute priority. The government's KPIs prioritise the number of calls processed and the time it takes to answer those calls. We'll hear a lot about numbers today which will reinforce the focus on those KPIs with an exclusion to all else.

Rape and Domestic Violence Services Australia defines our client as the person who is living with sexual assault, domestic or family violence and who contacts the trauma counselling service. Our approach to risk management therefore prioritises the risk to clients based upon a professional assessment of their safety, risk of harm to self and others and our professional duty of care to those clients, many of whom have children. Our priority is quality trauma counselling and client recovery.

Rape and Domestic Violence Services Australia recognises and upholds the codes of ethics of the professional standards established by the professional associations to which our counsellors belong. We recognise and uphold the higher standards established in various jurisdictions around privacy and confidentiality. It is our very strong view that those who are living with sexual assault and family and domestic violence have a right to expect that we will uphold the absolute highest standards when we are dealing with the trauma information that they are disclosing. This includes that we will not provide this information to anyone without the client's written and fully informed consent. As our focus in not on profit, it is always on achieving the best outcomes for clients—clients who deserve nothing less.

CHAIR: Thank you. Mrs Lachevre, did you wish to make a statement as well?

M r s Lachevre : I did, yes. I'm a qualified social worker who is currently employed at RDVSA as a specialist sexual, domestic and family violence trauma counsellor. My previous work history has included providing counselling and support to trauma victims, including those impacted by domestic violence and sexual assault. I have answered calls to 1800RESPECT prior to and since the implementation of the MHS triage system.

Before the triage system we often took calls from people who appeared to be asking a question or seeking advice, however with further assessment it was often determined that these people were in need of much more than their initial presentation. People who have experienced trauma often present with a need in disguise or a reluctance to share the full extent of their intimate details on the first contact. An inexperienced counsellor or someone who is not adequately qualified may respond to the client's presenting problem, such as a request for information or advice, but miss the actual need. This means that this client would not receive the full level of support that they require and deserve.

The calls that we receive on the 1800RESPECT line are often about the most harrowing of human experience. I've spoken to a mother whose husband cancelled his life insurance policy and then drove his car into a truck, killing both himself and their two young children as a final act to end their domestic violence relationship. I've heard the cries of a 40-year-old man recounting the sexual abuse that he experienced as an eight-year-old boy. I've spoken to a woman whose voice was no more than a whisper due to the damage caused by strangulation during a sexual assault the night before. These are just a few examples of the thousands of calls that I have taken on the 1800RESPECT line. Whilst I have strong professional boundaries, it is only human to be affected by the content of these calls. Like all of my colleagues at RDVSA who also take similar calls on a daily basis, I found it vital to be able to share my experiences with my fellow team members and to participate in ongoing vicarious trauma management in order to minimise the impact of these calls.

Like many of my colleagues, I have also taken a call from an MHS first response worker who turned off the recording equipment on the phone and shared her concerns about the organisation being ill-equipped to deal with the content of the calls that she and her colleagues were receiving. She suggested that she had received just one day's training and had no prior experience working with traumatised people before she was allowed to triage calls for MHS.

This woman spoke about the isolation she experienced in working from home and the overflow system often employed by MHS to ensure that all calls were answered by diverting the 1800RESPECT number to other lines within their organisation, including the Quitline. I can only imagine how the experience of dealing with these calls is impacting not only on the clients of 1800RESPECT but on the people they employ to answer the phones who clearly do not have the qualifications, experience or specialist support they need to deal with the most terrible of human experiences.

CHAIR: Thanks. Senator Singh has some questions.

Senator SINGH: At the outset I'd like to acknowledge the work of RDVSA and your support for victims over many years. Thank you for your evidence today. I understand that RDVSA have been providing the 1800RESPECT national telephone counselling service since 2010. Is that correct? How did that come about in 2010? How did you become the sole provider?

Ms Willis : It was a tender process undertaken by the Australian government. I think there was an expression of interest and a tender process, and the government decided that Medibank Health Solutions, which was then a government agency, would be the lead agency because they had the telephony infrastructure. They were directed by contract to subcontract the trauma counselling work to Rape and Domestic Violence Services Australia.

Senator SINGH: I'm trying to understand the model structure. Since that time of its inception, it's been operating under that first-response model? Is that correct?

Ms Willis : From October 2010 through to 16 August 2016, all calls to 1800RESPECT came straight to our trauma counsellors. On 16 August 2016, the triage model was introduced. At that point all calls went to Medibank Health Solutions, and then they decided which of those calls would be forwarded through to us and which would be diverted to other locations, services, websites et cetera. That's continued through to 29 October, where we ceased to accept those calls, because we couldn't agree to the subcontract being offered.

Senator SINGH: I want to go into that a little bit. You've outlined in your submission the advantages or disadvantages of the two models. I wondered if you could talk about your understanding and view of the triage model compared to where the previous model sat in terms of resource needs, funding needs and operational structures.

Ms Willis : Right from the start we did have a concern about the triage model. We actually have looked at the national and international evidence around triage. There actually isn't a lot within trauma counselling or in human services or counselling services. Most triage is provided within a medical model within hospitals and so on: the idea that you see the triage nurse and they make a decision about whether you're going to be admitted or sent back out to the waiting room. What the evidence did tell us, however, is that over and over again it was identified that the best practice for triage was that that be provided by the service that would provide any subsequent specialist work. If you were going to have a triage service, it would be provided by the same service that does the trauma specialist work. What that means is that, if someone makes a call to 1800RESPECT and they need trauma specialist counselling immediately, that person who answers the call is capable of providing that. Alternatively, if that call can be triaged because there is currently high demand, that counsellor can also do that work, but it all is done by one organisation, and what's what the evidence tells us is best practice. That's not what has occurred here.

Our view would be that the triage model that's been implemented, based on the evidence, is not best practice.

Senator SINGH: So your view is that the triage model itself is not a disadvantage model for a victim; it's just where it's being housed.

Ms Willis : We actually think the idea of triage in trauma counselling—you don't just wake up one morning and think: 'Oh, what'll I do today? I'll ring a sexual assault service and have a talk to them.' People who ring our service will often think about it for a very long period of time. I recently had an email from a counsellor who said that they'd taken a call and the caller wanted the counsellor to let me know that she'd rang and there was some information in the email. What became clear is that I had presented at a conference 11 months prior and, as a result of that presentation, that client had rung. It had taken that person 11 months to make the decision that she should ring a trauma counselling service. You don't just decide at the last minute or on a whim; it's often something that people think about for a very long period of time. The idea that, when they ring, they should be able to access immediately a trauma specialist is where we hold the problems. If there needs to be a triage, that can be introduced by that specialist service at times of high demand so that we can say, 'Okay, this person is at high risk and this person we can ring back.' As soon as demand and capacity to supply level out, you just go back to providing the trauma specialist counselling to every caller who calls in.

Senator PATERSON: You might have been here earlier when we had the ASU up. They said that, based on information you had provided to them, the increased funding as part of the 2015 budget resulted in a commensurate increase in performance in terms of answering calls. Can you provide us with the figures for what the improvements were?

Ms Willis : Yes, absolutely. One of the problems—and we did actually point this out at the time—is that the agreement for the additional funding was made in April of that year. It takes three months to advertise for, employ and train a trauma counsellor. That is three months from signing on the dotted line for the contract and actually getting people on the service to answer the phone. The money was provided in April. The direct response to that money occurred in June-July. I do have a sheet here that shows exactly that. I will provide that now. The graph at the top shows all the services that are provided under the 1800RESPECT umbrella. The line is the income, so you can see that certainly in 2014-15 there was an increase in income. But you can also see the black line there showing the increase in occasions of service. You can see that in 2014-15 and then 2015-16 there was quite a considerable increase in the occasions of service, and that directly resulted from that increase in funding in the April of the previous year.

We did explain that to Medibank at the time. We very clearly provided all of that information. They said they absolutely understood that it takes three months to recruit, train and get counsellors on the phone and that they did not expect to see the jump in occasions of service until the following financial year. I think it's fairly unfortunate that now that has been used to say that we didn't provide an increase in services as a result of that funding.

Senator PATERSON: To clarify: what did the 33 per cent figure from 2015-16 improve?

Ms Willis : That's actually another misrepresentation of the numbers. There are five different services provided under the umbrella of 1800RESPECT. If you look down at the second lot of dot points, you'll see that the first dot point mentions the claim that in 2015-16 we responded to 33 per cent of demand. What actually happened in that year is that overall demand across all of the services was 75,182. We provided 56,505 responses. That's a 75 per cent response. The 33 per cent is to one service only, not all of the services.

Senator PATERSON: Which service was that?

Ms Willis : It's the incoming 1800RESPECT line. It completely ignores the recontacts.

Senator PATERSON: Which is the one that the federal government funds.

Ms Willis : No, they fund all of them. They fund all five services and they expect us to respond to all of those. There's the recontact service—

Senator PATERSON: To clarify: is the 33 per cent response rate correct for 1800RESPECT calls?

Ms Willis : No, it's not.

Senator PATERSON: So what is the correct response rate for 1800RESPECT calls?

Ms Willis : It's 75 per cent, because all of those services are 1800RESPECT calls.

Senator PATERSON: And what did it improve to?

Ms Willis : I can take that one on notice. The graph at the top shows that. I don't actually have the figures for the following year.

Senator PATERSON: That would be helpful. I understand you don't agree with the 33 per cent figure but I'd be interested to know what you can demonstrate it improved to if it did. There is no reference I can see here into the wait time. What happened to the wait time? It was 10 minutes in 2015-16.

Ms Willis : There is nothing there. Off the top of my head, I'm not sure of that. We do have information again from our counsellors about wait times.

Mrs Lachevre : It fluctuates throughout the day.

Senator PATERSON: Of course. But we are looking at averages because that is the only way we can measure it. What would be the average fall? If it was 10 minutes, what did the average fall to?

Mrs Lachevre : I can't give you those exact figures but, as a counsellor taking the calls, it is very unlikely. We normally respond except if it is in the middle of the night and there are fewer counsellors on. Our response rates are generally very—

Senator PATERSON: I understand that but on average?

Mrs Lachevre : What I have personally heard from an MHS worker is that they answer the calls but they often put them on hold as well. So they may be looking to answer the call but that person is not actually receiving a service at that moment.

Senator PATERSON: I'm interested to know because we heard evidence that the funding resulted in a commensurate increase in performance. One performance measure is the wait time that someone has to wait on the line before it is answered. It used to be 10 minutes. What was the improvement? If you have to take it on notice, I understand that.

Ms Willis : The improvement was in indications of service, not necessarily in wait time.

Senator PATERSON: So the wait time might have been the same or worse?

Ms Willis : It still is. That is what the triage people are telling us. In times of high demand, people would get the answering service and would be put on hold. Currently in times of high demand, yes, they get a person but then they are put on hold and they will wait to 10 minutes before the triage service can get back to them. So there is no difference except that is a tick-a-box exercise.

Senator PATERSON: We heard evidence that an increase in funding to your organisation improved your performance so I just wanted to know how much the performance improved given the increase in funding.

Ms Willis : Occasions of service, yes.

Senator PATERSON: I understand there were 42,000 people during 2015-16 who were unable to get through.

Ms Willis : That is incorrect. I am not quick enough on the ads but the difference in that year was between 56,000 and 75,000 that couldn't get through. Where the figures perhaps have been—

Senator PATERSON: Sorry, just to clarify, are you saying 56,000 people weren't able to get through?

Ms Willis : No, they were. We provided 56,000 responses.

Senator PATERSON: How many weren't?

Ms Willis : The difference between 56,000 and 75,000 is 19,000.

Senator PATERSON: Where does the 42,000 figure come from?

Ms Willis : I have no idea.

Senator PATERSON: Perhaps on notice you can provide some clarity around that. Let's move onto another issue. RDVSA uses voicemail for people who are contacting and can't get through. Is that right?

Ms Willis : We had an answering service, yes, but not anymore, not since the triage.

Senator PATERSON: Obviously I meant previously. So if someone was calling and they were in an immediate crisis, would they potentially get a voicemail?

Ms Willis : Sorry I need to clarify that. One of the other services under the 1800 RESPECT is the recontact service. The recontact is for people who are experiencing complex trauma.

Mrs Lachevre : Our recontact clients ring and leave a voicemail message and we use that as a therapeutic tool to help them to manage their distress, to learn to sit with that and to use their tools to help them. We then provide them with the counselling call at a later date.

Ms Willis : The people who are referred in to the recontact service are those who are experiencing complex trauma. It is most commonly trauma resulting from childhood sexual assault then further sexual assault and domestic violence in adolescence and adulthood. This creates quite extreme trauma impacts.

Senator PATERSON: I understand that. Sorry to interrupt. I am getting a hurry-on from the chair so I'm trying to get to the questions that I have. Just to clarify, obviously if someone gets a voicemail, you don't know what they are calling about so it may be an immediate crisis and the response they may get from you is a call back eventually from their voicemail but the initial contact with you is a voicemail message.

Ms Willis : With the recontacts, we do know what they are calling about because we have already engaged in a therapeutic process with them. We have worked with them to establish therapeutic plan.

Senator PATERSON: I am a first-time caller. All your people are engaged in phone calls. My call is not answered, it goes to voice mail and I need immediate assistance.

Ms Willis : It was very clear to us that, while we were answering 75 per cent of the calls, that was the other 25 per cent. We were very distressed by that—there's no question about that. The Full Stop Foundation is our fundraising arm, and the No. 1 call of that service is 'help us answer every call', and we were fundraising to employ additional counsellors. During the period of time that we offered the service, from 2010 to 2016, there was a 186 per cent increase in funding, and we were incredibly grateful for that. That was a great commitment by government. At the same time we had a 191 per cent increase in occasions of service. So we were commensurate with the funding. But the problem was that there was a 234 per cent increase in demand. That's where the gap was. It's not that we weren't providing quality services or that we were sitting around filing our nails; it was that demand was much higher than capacity.

Senator PATERSON: I understand that. Did you count voicemails in occasions of service?

Ms Willis : No.

Senator PATERSON: So occasions of service is just the call back that someone gets after having left a voicemail?

Ms Willis : Occasions of service are directed by our subcontract. We actually had considerable disagreement with the way measures were counted. The subcontract itself actually tells us that these are the things that we have to count, and that is what we provided. That's also why when we reported we also reported on the statistics from our client file data base, because that actually gave you the exact number of times that we spoke with a client.

Senator PATERSON: If someone rings and doesn't leave a voicemail, that presumably is the difference between the 75,182 and the 56,505. So that means that that 20-odd thousand are people you couldn't call back because you didn't have any contact details. But if someone rings and leaves a voicemail and you call them back, do you count that as them receiving a service?

Ms Willis : Yes.

Senator PATERSON: So, in fact, the 42,000 figure is correct—that is, people who don't get immediate assistance when they call?

Ms Willis : No; because that also includes people who rang the Recontacts Line and left a voicemail message, which is the process that we have established. Counsellors can then look at the client file notes, look at the therapeutic plan and ring the client back and provide a continuous service. So that includes that number. That's why I am saying that it is a bit inaccurate.

Senator PATERSON: But the 42,000 are people who, in the first instance, don't have their phone call answered.

Ms Willis : But with the Recontacts Line they never would—that was the idea. They would be people who would ring through on the 1800RESPECT and, in that process, counsellors would identify that they were experiencing complex trauma and we needed a much more tailored and targeted therapeutic plan to work with those clients. We developed with them a therapeutic plan, and part of that would be to redirect their calls to the Recontacts Line. They would be informed that they would always get an answering service and that they were to leave their contact details. That allowed the counsellor to look at the file notes, look at the therapeutic plan, look at what happened in the last couple of calls and ring them back and provide them a counselling service. That's part of that 42,000.

Senator PATERSON: Yes, I understand that, but I'm just trying to get to the bottom of that unmet demand. So it would probably be most accurate and fair to say that about 20,000 people who contacted your service got no service at all?

Ms Willis : And that's that 234 per cent demand. We were very unhappy about that, and we raised that with the minister and DSS. And, as I said, the No. 1call for the Full Stop Foundation was 'help us answer every call'.

Senator PATERSON: And the increased funding wasn't able to fix that 20,000 people?

Ms Willis : Every single time there was an increase in funding there was an increase in demand—234 per cent over seven years. When the current Prime Minister, Mr Turnbull, came into office, 10 days post him becoming PM, he made his first policy announcement which included a whole range of things about respect for women. He said that disrespect doesn’t cause violence but all violence starts with disrespect. People might remember that speech. It was a great speech, and we were really excited about it. We had a seven per cent increase in calls that afternoon as a direct result of that speech. That then came back to about a 344, but it never dropped back to the original. Every time there's a leadership issue, there's some horrendous violence that occurs in our community or there's a positive media statement, that results in people ringing. The royal commission into institutionalised responses to child sexual abuse created a massive increase in calls. We were very distressed that we couldn't answer those calls—absolutely.

Senator PATERSON: Understood.

Ms Willis : But the issue was that 234 per cent increase.

As to the idea that we could be more efficient by cutting clients off at the legs or just taking their first piece of information and referring them, and not sitting with them while they decide whether they are going to trust our service with their trauma stories, sitting with them during the period of time it takes for them to talk about what the real issues and impacts are and how we can best assist them towards recovery takes time. That just can't be time limited. It can't just be 10 or 20 minutes and that's it. Prior to the trauma service coming in, our average call time was 20 minutes. Since the trauma service was introduced—and the 25 per cent of calls that came to us were at that much higher end of clients who were experiencing trauma—our average call time, our average counselling time, has increased to 33 minutes. This is because those clients needed that extra time. We can't reduce that. That would be a shameful thing to do to someone who deserves nothing less than absolutely the best trauma response we can offer.

Senator RICE: There is a lot of very useful evidence in your submission. Thank you very much. I want to go to the privacy of your data. From your submission, I understand that this was one of the deal breakers as to why you couldn't sign the contract. We have had other evidence saying that that's not such a big issue because that information wouldn't be used in court proceedings because they could apply for privilege. Why is that a deal breaker?

Ms Willis : Communications privilege is just one part of it. That is in relation to subpoenas. We receive maybe half a dozen subpoenas a year. We have provided counselling to 77,000 individual clients, so that is a fairly small percentage. It is an issue but it is a very small part of our concerns. The bottom line is that when someone experiences sexual assault, family or domestic violence and makes the incredibly difficult decision to trust someone with what has occurred and what they're feeling and what they want to do—and we work with them in a therapeutic process towards recovery—implicit in that trust is an absolute guarantee from our perspective that we will respect that information and contain it to the service. One of the things that we know about sexual assault, domestic and family violence is that, overwhelmingly, the violence is inflicted by someone known to—and, often, trusted by—the person experiencing that violence. The impact in relation to that person's capacity to trust is quite extreme. That is one of the reasons people take so long to contact services. What we need to do is respect that impact, respect those people and respect the trust they place in us to keep their information highly confidential. So we will always do that. The information is confidential to our service; it's above the requirements of any privacy acts. Our counsellors also adhere to the codes of ethics of their professional associations. Emily, you might like to talk about those.

M r s Lachevre : I am a social worker who is eligible for membership of the AASW. They specify a code of ethics that we work to. One of the highest of those ethics is client confidentiality. At the beginning of each call, I say that to the client. I let them know what the limits of confidentiality are. I would never say that this information could be shared with a private health insurance company.

Ms Willis : As Emily said, there are a number of limits. So where there is a duty of care, where there is a risk of harm, and also where the client gives written consent, we will absolutely provide that information to other providers. That often happens where clients who have worked with us for a while move on to a face-to-face provider. The client may give us written consent to have a three-way conversation as a handover with the face-to-face provider. We will absolutely do that. But to hand over en bloc 77,000 individual clients' file notes without any written consent would be a total breach of the trust that those clients—people who have already experienced the most appalling breaches of trust—have placed in us.

CHAIR: Senator Kakoschke-Moore, do you have one last question?

Senator KAKOSCHKE-MOORE: I do. I'll ask it, but you'll probably have to take it on notice. Could you give the committee a breakdown of the number of people employed by RDVSA, perhaps since 2010. How many were counsellors? How many were support staff? How many were full-time? How many were part-time? Also, could you give some clarity around what's eventuated with redundancies. There were some quite different numbers being quoted in the lead up to this hearing—I've heard 50, 70, 110 redundancies. How many redundancies did take place? How many of those were counsellors? How many of them were full-time, part-time—you get the idea.

Ms Willis : Absolutely. We can certainly provide that.

CHAIR: Thanks very much, Ms Willis and Mrs Lachevre. You have an enormous amount of information, and the committee's very interested in it. We probably could have talked for another hour, but it's also the case that the documentation you've provided is very detailed, and we've all got it and processed it. We're very grateful for your contribution to the inquiry. If there are follow-up questions the secretariat will be in touch. It may be that senators provide additional follow up on things we're interested in in the days that follow the hearing.

Mrs Lachevre : When you have a chance, please do have a look at that.

Ms Willis : That's actually the evidence based counselling model. It's what our practice is based on. It's internationally recognised. It's been implemented in the UK as the world's best practice model in trauma work.

Proceedings suspended from 10:56 to 11:05