The Family Violence Intervention and Research Project was initiated in 1996 across two sites, Victoria and West Australia. This three and a half year project, will conclude in June 1999.

The Victorian component of the project is delivered by Relationships Australia (Victoria), whose existing Family Violence Prevention Program formed the core of the project.

The purpose of the project was to develop integrated approaches which deal with issues of violence in families, as they present primarily in the marriage/relationship counselling program. In particular, the project was to look at developing effective and cost efficient models of service delivery which:

• will offer support for adult victims (mainly women),
• will assist perpetrators (mainly men) to take responsibility for their violent behaviours,
• will support children and adolescents who are victims or witnesses of family violence, and
• will provide assistance to achieve the safety of all family members and the cessation of physical violence.

RAV has been addressing the issue of family violence in its couples and relationships counselling program since 1987.

It was proposed that the Project utilising the existing Family Violence service, would evaluate a number of different interventions either already being used or implemented specifically for the project in its six Victorian centres.

Four of these centres (Kew, Sunshine, Shepparton and Croydon) were to provide group programs for both perpetrators and survivors. Croydon and Kew also planned additional group interventions for children/adolescents. The two remaining centres (Ballarat and Narre Warren) were to provide a couples counselling program based on the Ackerman Institute model of working with couples where there is violence.⁽¹⁾

A seventh intervention is also to be trialed. As a joint endeavour between RAV and Catholic Family Welfare, this intervention is to be an ethno-specific program for the Vietnamese community.

At the beginning of 1996 it was estimated that within RAV, family violence represented 30% of the presenting cases. This is on par with other organisations providing similar services. Prior to this date no accurate family violence figures were kept.

Staff reported that this percentage had increased on previous estimates. This is a result of a) staff training and improved screening methods, b) gaining a reputation in the field for doing family violence work and doing it well where family violence services are scarce. In one centre, family violence referrals were as high as 40% with clients being identified in both the relationship counselling program and the "Break Even" gambling program.

The size of cases being managed can be skewed if we limit "client" identification to those who walk through the door. The program considers the non attending partners of those who use violence as important stakeholders in the program outcomes and all appropriate efforts are made to include them and/or address their needs. It is program policy that staff take appropriate steps to try to ensure the safety of the partners or children of those who use violence, even when they choose not to use the services available to them.

A feature of the service is the high percentage of self or family referrals. Only a small percentage are "mandated" to attend by the courts or an authoritative agency such as child protection.

Such a high "voluntary" referral rate indicates that a) the criminal justice system only responds to a small percentage of family violence cases (those involving physical or sexual violence) and/or b) many couples or families will seek help before resorting to the courts even when physical assault may be involved.

The large numbers of "non-mandated" clients also reflects patterns in the community where a) women are reluctant to use the courts as they want the violence stopped, not to punish their partners whom they still love and who are good fathers to their children, and b) an increasing number of men are seeking help for their behaviour. Community education and former participants in men’s programs talking to other men play a significant part in this process.

The outcomes of the research and evaluation are presented in two main sections: a) program outcomes and clients benefits and b) the identification of program features influential in shaping the current service delivery model.

Early indications are that many of the intended client benefits are achieved in the short term for both women and men. eg

• There is a noticeable reduction in the level of violence being perpetrated in the relationship by the man. This change is reported by both the man and his partner.

• The level of change in violent behaviour is greater for non-physical forms of abuse than physical abuse. This seems to be a consequence of the low levels of physical abuse presenting in client relationships.

• Men who use violence accept increased responsibility for their behaviour and women assumed less responsibility for their partner’s violence.

• The program successfully reduces the level of trauma symptoms (as measured by TSI sub-scales) experienced by women as a result of the violence.

• Women report an increased level of autonomy as expressed in the ability to make plans for themselves and their children. This may explain an unexpected program outcome where a high percentage of women have been able to leave the abusive relationship safely. It would seem that the program acts as a container to support the man who can often become violent around separation.

Other program outcomes and client benefits not expected but observed are:

• the programs, particularly men’s groups, are becoming an educative tool in raising awareness in the community about violence. Former participants are referring other men to the program;
• program staff are exploring gender and power issues in their own working relationships as they deliver the program.

A number of service features have been identified as contributing to an improved practice model and program effectiveness. These include:

Like many family violence prevention programs which began by targeting those who used violence, RAV has moved to a model of practice which addresses the needs of all members of a family involved in a family violence case.

This development has been prompted by a number of important considerations:

• most of the referrals to the FVPP are still in an active relationship with a partner and/or family;
• the violence will not stop unless interventions are targeted to the perpetrators of the violence.
• those who are the target of violence or witness violence are the primary stakeholders in the program outcomes, ie. the one who uses violence takes responsibility and the violence stops;
• a primary policy commitment to partner safety requires that contact be made and maintained while the one who uses violence is in the program;
• the creditability of the service requires that the stakeholders be part of the accountability loop of the program;
• program staff have a responsibility to resource and support the stakeholders in order to deal with the impact of the violence;
• a relationship in which there is continued commitment and is recoverable may require additional work once the violence has ceased.

Family violence cases are unlike other counselling cases because of their complexity, the number of stakeholders involved and the level of distress encountered both in clients and staff. Family violence cases require to be managed with a degree of thoroughness and care not needed with other counselling situations.

Experience has shown that a management process is needed which is able to a) guide the client through a complex maze of interventions; b) hold and address the needs of a number of stakeholders; c) coordinate collaboration with other organisations whose involvement is required; d) ensure client information and progress is shared among staff involved in a case so that a integrated approach to a case is adopted.

Working with family violence is not a territory for unskilled and untrained staff. The variety of roles counselling staff must adopt when working with a case, the demand to sit with contradiction and paradox as revealed in the conflicting accounts and managing volatility and risk, are some of responsibilities program staff are required to shoulder.

A recent restructure of the program, from an all of staff involvement, to the establishment of specific family violence service teams in each centre, has highlighted the benefits of a team approach.

Staff feedback indicates that -

• they do not have a sense of working in isolation,
• being less isolated, they don’t experience the impact of the work as much when dealing with critical incidents or vicarious trauma,
• therapeutic input from other members of the teams is valued and supportive and leads to a tighter and strategic management of clients,
• they don’t have to carry the full responsibility for difficult and, at times, dangerous cases,
• there is a more cohesive approach to the work,
• there is increased capacity for learning and skill development "on the job",
• there is greater accountability when working in a team, particularly when that team is composed of male and female workers.
• there are clearer boundaries around the work itself and processes for referrals, information sharing and client management.

The clinical and theoretical insights gained over the last fifteen years have required interventions used in working with violence to become more sophisticated and varied. Successful outcomes in protecting clients and staff, in assisting those who use violence to change their behaviour and in supporting the targets of violence in their recovery, suggest that a cocktail mix of interventions are required.

Such a cocktail includes group work combined with individual counselling, couples and/or family counselling, child or adolescent counselling, telephone counselling, case management and, when necessary, the application of external legal or other protective processes.

The current research indicates that couples who are open to attending individual group work prior to, or in conjunction with couples counselling, progress much more quickly than those who attend only couples or individual counselling.

The application of such a "multi-modal" approach required if the service delivery processes are to be flexible enough that they are responsive to client needs and the attainment of program outcomes. Staff must be able to operate from a number of theoretical positions with a willingness to apply different strategies when necessary. Organisational structures and expectations need to support a "think-on-your-feet" approach.

A comparison of clinical interventions used in family violence programs indicates that group experiences are the more effective than individual or couple counselling for facilitating change. This does not imply counselling is of no value. In fact most practitioners increasingly favour a combination of all three.

Individual counselling allows the practitioner to address the personal, intra-psychic needs of the client. Couple counselling provides valuable information about the interpersonal dynamics of the relationship. Group work provides a socio-cultural context which is important when examining violent behaviour.

Features of group work which have been identified by both participants and facilitators as contributors to change are:

• the support received from being with other participants with similar issues. The "I am not alone" comment is often heard indicating a normalising process which occurs.
• the challenge issued to stay with and examine one’s behaviour. This is a challenge offered by both facilitators and participants
• the group experience is often new for many and provides an opportunity for having their story heard and validated by an audience. The level of disclosure is often very high.
• the opportunity to learn from others
• the use of action method such as role plays, toy work, psycho-drama, art work and discussion are often commented on as important.
• while demanding, group work is not so "in your face" as counselling, where many men feel uncomfortable and under scrutiny. Group work allows opportunity for participants to move in and out of the action as they need to and move at their own pace.

The stated goal of most family violence prevention programs is the cessation of violence and abuse in intimate and family relationships. When this is unpacked of course there are other equally important outcomes which are being sought for and by the client.

These include: the establishment of new non-abusive patterns of relating, dealing with the impact of the abuse on the partner and children and reshaping the relationship patterns within the family so that violence does not pass to the next generation. Current theory and practice of working with men who use violence describes the change process as deconstructing and reconstructing male socialisation patterns which underpin power and control behaviour.

Most practitioners in the field would agree that the change process can be eighteen months to two years in length. Those offering opportunities to clients to stay involved report more substantial change. Feedback from clients who are able to remain longer in a program would support this observation. Both men and their partners bemoan the fact that groups, for instance, are too short.

The identification and assessment of violence as a presenting issue is a critical first step. Prior to 1996 this was a hit and miss process with few screening processes in place for either the administration staff who take initial calls from clients or for counselling staff who would see clients at intake.

Training has raised staff awareness and administration and counselling staff routinely ask about violence and abuse in the relationship and the existence of Intervention Orders.

An emerging challenge because of the raised staff awareness of family violence is that abusive and controlling behaviour can be found in most presenting cases. Because there is a risk of devaluing the family violence currency, more precise assessment procedures are needed to separate out chronic violent or controlling behaviour from poor conflict resolution behaviour found in most "normal" couples or families. By not maintaining clear boundaries family violence figures may become inflated.

The assessment and evaluation process introduced as a feature of the research project have focused staff attention on achieving client outcomes and whether the program may be achieving those outcomes.

The assessment process, while alien and difficult to implement for many of the longer serving staff, has had some evident benefits, both for the staff themselves and for the clients. Reports indicate that

• the assessment forms focus task of inquiring into the violence and help in assessing safety and risk;
• the assessment process has been an educative tool for clients, particularly the women;
• it prepares participants in the group more quickly to begin the work of talking about their behaviour.

The number of referrals to the Family Violence Prevention Program and the positive achievements of program outcomes to date support the importance of such programs. However, there are a number concerns which directly affect client benefits and put at risk the overall effectiveness of prevention programs such as these.

The historical development of FV services can be characterised as a process which has been ad hoc, crisis driven, ideological or politically divided, simplistic in its analysis of the problem and poorly funded. This is not unexpected for cutting edge services. The result however is a response to family violence which is fragmented, and poorly integrated.

In spite of the developments in the field that have taken place, there is still evidence both in policy development and program delivery where the left hand does not know what the right hand is doing. State or Federal programs cut across one another or duplicate what is already being done. Resource are allocated to regions or specific programs without consultation as to the best use of those resources for the client.

Fortunately there are positive signs of change with the establishment of State interdepartmental working groups such as the FV Reference Group here in Victoria; the Federal/State "Partnerships" task force; and the various service sectors (eg women and men’s services) willing to talk with one another and work more closely together.

However, for those of us who deliver services on the ground this lack of policy infra-structure and program integration continues to be a problem as we are called upon to manage complex cases across a range of services or departments. For those of us who take a whole of family approach, the complexity of cases is even greater and therefore the management of these cases even more demanding.

Family violence work increasingly demands a level of sophistication both clinically and systemically to hold and address the interplay of forces and stakeholders involved in a case. Staff are expected to adopt a number of different roles with their clients (advocate, educator, counsellor, case manager) and work therapeutically providing a range of interventions (individual, couple, family, child or adolescent counselling and group work). They are also expected to work systemically linking and managing clients across a range of services and agencies who may also be involved - the courts, police, child protection, mediation, contact services, drug and alcohol, just to name a few.

As the number of staff, interventions and service departments associated with a case increases so does the likelihood of the family falling between the gaps as they are navigate their way through the system. The current frustration for staff and clients is the provision of manageable and user-friendly pathways. For organisations and staff in particular, the other frustration is the lack of adequate resources to manage and support clients through this maze. On our current estimates staff require an additional 25-30 minutes per counselling interview conducted to attend to case management demands both "in house" and between agencies.

As we have discovered from our own program which provides a small number of "in-house" services for FV clients, the establishment of manageable user-friendly linkages between those services is essential if clients are to survive and achieve sustainable outcomes.

Moreover, there is a real danger of the current system as in our own small program, replicating the abusive dynamics with which couples and families present. Clients already traumatised are sent from one service to the next, having to retell their story over and over again and feeling unsupported in an environment which is often unfamiliar and unsafe.

Thankfully we have bridged the ideological divide between men’s and women’s services. There is a growing acceptance and recognition of men’s services as an important intervention in the prevention of family violence. How better to stop violence than go to its source.

It is estimated that in Victoria alone, over the last ten years, 5000 men have been through behaviour change programs.⁽²⁾ These have been predominantly "voluntary" programs, unlike some State and overseas programs which are more closely linked to the criminal justice system. This lack of integration with the courts is a limitation in that linkages to the justice system are important in supporting the message that some violence is criminal. However, the "voluntary" nature of these programs is also important in that the non physical forms of abuse and control don’t come before the courts and many couples and families don’t wish to proceed down that path.

The emergence of short "anger management" courses presents a real problem for leaders of Men’s Behaviour Change Programs as they can be used as a soft option by some men. There is a need for monitoring, program standards and clear accountability structures to regulate the provision of services for men.

The work with men over the last ten years is highlighting the fact that for many men violence is only one aspect of the problems they are struggling with. Drug and alcohol abuse, suicide, grief and separation, general relationships skill deficit, work and unemployment and parenting are some of the emerging concerns. The recent Men and Relationships conference reinforced this and the initiatives of the federal government are to be welcomed.

The complex nature of the work and the mirroring of that complexity in the use of interventions and resources has already been highlighted. Family violence work is time consuming and costly for the organisation providing the service. With the squeeze on funds available for this work the cost is inevitably passed onto the client.

Sadly however, the complex nature of the work and the profile of clients underscores the dilemma that family violence programs can not rely solely on client fees to sustain themselves. No program that I know of recovers its cost from its clients.

The RAV program has found that a greater percentage of attending family violence clients tend to be of a lower socio-economic group than the average profile of our counselling clientele. An analysis of client fee income shows that family violence counselling interviews are on average $10-$12 lower than counselling interviews.

Moreover as I have already pointed out, as most of us suspected that there is a strong correlation between the length of time a family remains in the program and the achievement of program outcomes. However, the longer the involvement a couple or family have in the program, the greater their financial burden. A review of program practice has shown that staff prefer to reduce the fees clients are required to pay to avoid them dropping out for financial reasons. This may help explain the lower average fee.

Couples and families, where all members of the family may be involved in counselling and/or group work experience greater hardship under the user-pays approach. The cost is often prohibitive for them to remain beyond an introductory program. Even where a man presents on his own the cost of attending the program can be prohibitive where his is the sole income and he is supporting a partner and children. Country clients experience the added burden of distance and travel and child-care costs.

The adoption of a user pay approach which discourages clients staying engaged for a substantial length of time raises very real concerns and dilemmas for providers when faced with questions about the effectiveness of these program.

Family Violence services place unseen demands on the provider which are not readily acknowledged by the funding bodies. These hidden demands eventually impact on productivity, income and staff morale.

Such hidden costs include:

• Family violence cases have a higher proportion of cancellations and "did not arrives" which places an additional load on administrative staff and affects productivity as relationship counselling sessions (organisation’s core work) go unfilled.

• Family violence cases tend to move up the waiting list ahead of other clients because of safety concerns or crisis. Those clients who are able to pay drop out and go elsewhere.

• The time and staff resources required to manage family violence cases is underestimated as there is no clear model of service delivery established.

• Staff training and supervision are often over looked until occupational health and welfare issues begin to emerge or staff feel deskilled for the work.

• Staff and client safety concerns requires organisations to respond by ensuring a safe working environment.

As a result of these program costs, RAV has had to reduce its family violence service from 30% of its case load to 15%. Naturally this places additional demands on staff who must refer high risk or crisis clients on to already over stretched services.

In conclusion, a word about evaluation and research projects such as this one. Research into family violence programs is fraught with methodological and ethical issues which makes any evaluation of effectiveness very difficult. Moreover, the very question of what do we mean by "effective" is a source of heated debate.

Ongoing evaluation of family violence services and interventions is essential if we are to push the boundaries of understanding about violence in the family and how to intervene to prevent it. There is no question that providers and programs must be accountable to the stakeholders, both the client and the community which funds them.

However, we must ask ourselves whether we haven’t reached a point in our understanding and responding to family violence where the limited dollar may not be better spent by governments in providing and resourcing core services. Often with project work such as we have encountered with this project, the service is expanded, expectations within the community are raised, staff skills are developed and infrastructure put in place to support the service.

Such projects are then terminated with little consideration of consequences for the client, the organisation or the community. We know the benefits of these programs and where the deficits are. With an estimated 1400 individuals, couples and families being serviced during the life of the Family Violence Intervention and Research Project, the question needs to be asked "what is the potential cost of NOT providing intervention programs for violent men… (and their families)"?⁽³⁾

NOTES
(1) Goldner, V. (1992), Making room for both/and. The Family Therapy Networker 16(2): 55-61.
Goldner, V., Penn, P., Sheinberg, M. and Walker, G. (1990), Love and violence: Gender paradoxes in volatile attachments. Family Process 29: 343-364.
(2) V-Net survey 1998
(3) Frances, R. (1966), Ethical, Methodological and Gender Issues in Assessing Intervention Programs for Violent Men. Paper presented at the Australian and New Zealand Association of Psychiatry, Psychology and Law Symposium.