Episode 3. Social justice and person-centred practice

In the third episode of Making Visible, Mim and Lis hear from two practitioners who step through stories that involve sibling sexual assault, elder abuse, family violence and disability.  These stories focus on social justice and highlight the importance of person-centred practice and an integrated model of care. Mim and Lis discuss least restrictive practice and reflect on the hidden work that happens behind closed doors.

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Welcome to Making visible, preventing and responding to violence, abuse and neglect. The podcast supporting you to deliver best practice in your work with people who have experienced domestic and family violence, sexual assault, child abuse and neglect. The Agency for Clinical Innovation acknowledges the traditional owners of the lands that we live and work on. We pay our respects to elders past, present and emerging and extend that respect to other Aboriginal people here and listening today. We would also like to acknowledge those with lived experience. We recognise and appreciate consumers, patients, carers, supporters and loved ones. The voices of people with lived experience are powerful. Their contribution is vital to enabling decision making for health system change. Information about accessing personal support is available in the show notes and at the end of each episode. This series is about preventing and responding to violence. We are making visible. This is a series that is about preventing and responding to abuse. We are making visible. This is a series about preventing and responding to neglect. We are making visible. From the Agency for Clinical Innovation... We are making visible. Violence, abuse and neglect network... We are making visible. In collaboration with the University of Wollongong. We are making... And the Social Work Stories podcast. We are making visible. This is making visible. We are making. Preventing and responding to violence, abuse and neglect. We are making visible. This is making visible. Hello, everyone. Welcome back to the Making Visible Podcast. So great to be here. I'm Dr Mim Fox and I'm here with Liz Murphy. Hi, Liz. Hello Mim and hello everyone. So nice to be back. This episode, Liz, is our Episode three in our four episode series of Making Visible, and it's really the episode where we've reached, I think, the peak of what is work in the violence, abuse and neglect sector. OK, so that's a big statement. It's a big statement. What are you thinking? What I'm thinking is this is the episode where we have two clinicians telling stories that actually really demonstrate that hidden work that happens behind closed doors, the hidden abuse that happens in the really complex family environment. And it also highlights the hidden work that they do as clinicians and the breadth and sophistication of their their their therapy, their work. I think I think yeah, I like that theme. The yeah, the hidden, the hidden stories. It's really the closed behind closed doors work and the work where they both these clinicians, they're so skilled that they're working from this principle of least restrictive practice, right? They're always coming back to the person centered practice where when they have those moments of ethical dilemma or complex, really complex, multifaceted variables, they always coming back to the client and the consumer's story. That's the heart of the actual work that they're doing, right? It grounds them. Indeed. And when you hear (UNKNOWN) when you hear these two stories, they are so different. Yeah. And you probably at one stage you'll think, why have we joined these ones together? But I think it all makes sense as you listen to these are two clinicians who are very skilled at describing what and why they do what they do. That's right. They step us through it actually. They step us through it. In fact, I think you and I have decided to take a least restrictive practice(CROSSTALK) in our way. In our podcasting. Exactly, because this is, these. They've done a lot of the work. I couldn't agree more they're masters at what they do, these clinicians. So we should give them centerstage. Absolutely. The there is a content warning for both the stories, Liz. The first story we're going to look at deals with sibling sexual abuse. And the clinician does speak us through a number of the things happening in the family environment. So content warning there, but let's listen to the story. And the other thing I'd say to people, because they are grueling stories, you can always pause your podcast, can't you? You can always just go (UNKNOWN) but just let that sit for a bit. Take a moment of self-care. Kind of go and make a cuppa. Yeah. And come back and listen to Liz and Mim for a little bit. Well, we did when we were going through listening to these recordings Liz, you need to pace yourself. You do. This is actually, I think, really integral to self-care in the (UNKNOWN) space, right? Is actually knowing when you reach your limit and knowing when you need time out. So if it if it gets tough listeners please take our advice. Pause, go for a walk, look at the sky, have a cuppa and then come back to it. But we'll see you on the other side of the story. I've worked as a trauma recovery psychotherapist for many years, using a variety of therapy modalities with my clients. I have had clients as young as three years old to my oldest client of 83 years old. Today, I'd like to talk about working with sibling sexual assault. It's actually the most common type of intra familial sexual abuse and the most underreported over 92% of those causing harm are males, usually teen boys and 71% of their victims are female. There's an average of a 5.5 year age gap between the older sibling and the younger victim. We know that there are often long term repercussions for the victim survivors including depression, drug misuse, revictimization, sometimes sexual dysfunction, shame and guilt, lowered self-esteem, poor focus and achievement at school, and more. I'll describe a typical case that's a de identified case made up of different cases that I've worked with over the years. Marie is in year seven and she's 13 years old when she's referred to our sexual assault service because she's been the victim of cyber bullying and is refusing to return to school. Marie's best friends Zarra told others about Marie's secret. Since Marie was eight years old, her older brother Jake has been touching her and making her perform oral sex. He recently forced anal sex on her she had got her period a few months ago and he said he was protecting her from getting pregnant. Her best friend Zarra and others have made this public on Snapchat and other social media. Jake is five years older than Marie, a star footie player, completing his HSC this year and wants to be a police officer. Marie has always been an excellent student, popular and thought she might be a nurse or a doctor. For the past two years, Jake has been getting Marie high on marijuana before he assaults her. She started taking marijuana from his bedroom and smoking by herself in the shed to cope with her anxiety and sense of alienation. Marie has been self-harming in the shed as well. Jake and Marie's parents separated before Marie was born due to domestic violence. Jake sees his father at his footie practices and stays during the school holidays but Marie hasn't wanted to visit Dad the last couple of years. Dad put down her mother and makes comments about Marie's breasts that Marie says she finds yucky. Martha Carly a chemist, was devastated to learn about the sexual harm. She wonders if Marie has exaggerated. Carly feels overwhelmed trying to hold down a full time job and to supervise Jake and Marie so they're never alone together. She's very concerned about the effect this will have on Jake's HSC marks and also his chance to get into the police force or other professions. She's actually pressured Marie to retract. Dad, Dusty punched Jake when he heard he refuses to have either child stay at his home any longer as he has a new girlfriend who's moved in and she has younger children. He blames the problematic, harmful sexual behaviors on the mothers sloppy, selfish parenting and on the deviant kids. Marie has attended counselling for over a year now. Jake attended new street services for counselling for his harmful sexual behaviors. Mom has been involved as much as she can in counselling for both children. Dad remains disconnected from the children. So, talking about the case, Marie retracted her first disclosures about the sexual harm that indicated she'd been harmed on many occasions and for a period of four or five years. So, retractions are very common with intra familial abuse, in particular where the victim survivor is protecting a family member. Marie said she doesn't want to ruin Jake's life. So, as a counsellor, I don't actually worry about her changing story. We're focusing instead on our work around the impacts on Marie and on her recovery. In counselling, Marie has discovered that she likes art and we often use colouring painting or clay while we talk to help her to relax and have something positive to focus on. In therapy, I use art with a lot of clients to help distract, sometimes to focus, to use as a self regulation tool in therapy and also at home, and to allow a non-verbal expression of their feelings and their trauma. Sometimes it's empowering to create an artwork. It's also a culturally safe practice and there are other reasons. Mostly, I use art because a lot of my clients, particularly the younger ones enjoy art and that helps them enjoy their counselling experience and as a clinician I enjoy it too. Another part of this work has been casework such as helping Maria to change schools. She had some really unpleasant events at her former school due to online and in person bullying. Her attendance at her new school has greatly improved and her anxiety is lower. There tends to be a lot of casework with sibling sexual assault cases and it often requires working with multiple family members, extended family, with schools and considering the many situations both now and in the future that are going to be impacted by the harmful sexual behaviours. So we do a lot of safety planning and considering family relationships. This case had a huge amount of case work up front but the payoff and improvements from multi agency liaison are enormous for our clients. Marie and her mother have engaged in family therapy with me. Some of this is to develop healthier communications strategies and also to expose the grooming that went on both of Marie and of her mother. We've also had some co-therapy sessions with Jake and his new street counsellors. Personally, I love family therapy work especially partnering with another clinician. It's dynamic, can be very unexpected sometimes it's tearful and it's often illuminating work. We have sexual assault service on new street who are the our government service who work with problematic, harmful sexual behaviours. We have case meetings together every couple of months to discuss things like the family safety plan or any new disclosures such as recently, there was a disclosure of the impact of the porn Jake watched at his father's home and with the father, and that Jake subsequently exposed Marie to porn as part of his grooming. I think it's gonna be very interesting to see the effects of COVID lockdown and an increased porn viewing on incidences of sibling sexual assault. Sadly, I'm betting that we're going to see quite a large increase in cases of sibling sexual assault because of unfettered 24 hour access to porn. And also parents who are trying to work from home and it becomes difficult to police all that the children are viewing. So, Marie has done some great narrative restructuring work in our counselling together. We've looked at moments of her resistance to help break down her sense of shame and guilt about the sexual assault. She had surrendered to the harmful sexual behaviours at times, she said to get it over with. We looked instead at two times when she would try to stay overnight at friend's homes to avoid the abuse, that she would try to sleep in her mum's bedroom, that she would turn her head away from Jake, that she would wear two pairs of pyjama bottoms and other types of resistance. We've done a lot of work unpacking aspects of her resistance and also understanding the power dynamics that were in place his age and his size and her young age when it began. That helps to de-shame Marie. My work in this area has been influenced enormously by the thinking of Allan Wade and Linda Coates from Canada on the survivor as active in resistance. I find that it shifts the survivor from a story of helplessness and passive victim mode which they're often quite ashamed about, to a more active sense of themselves as a person with agency and courage in the face of the trauma. The Martha Carly has had extra support from both sexual assault services and new street counsellors to gain more insight into the dynamics of sibling sexual assault. Helping parents understand grooming and dynamics is essential to optimal work with the family. Quite often we find domestic violence is concurrent in families with intrafamilial sexual assault. Safety was the first issue we addressed with Marie and her family. Mom was unable to both work full time and adequately supervise the kids after the disclosure. As a result, Marie goes to her maternal grandmother's after school as part of the safety plan. She sometimes stays overnight as well. This actually hasn't been ideal as Marie feels excluded from the home and doesn't always like Nan's rules or Nan's cooking. Commonly though, we see the victim survivor having to make the accommodations regarding safety. In the past, the sibling with harmful sexual behaviours was often removed into out-of-home care or placed with another family member. But this isn't the trend any longer. Creating safety in homes where there's been sibling sexual assault can be quite challenging, especially where parents may have divided loyalties between the siblings or in the not uncommon situation where the sibling with harmful sexual behaviours is the preferred child. Or other cases where the victim survivor has been groomed to be isolated or is seen as different or difficult. This might already this might could be due to pre-existing problems or sometimes to the conditioning that's occurred. In this case Jake is Nan's favourite as the first born male grandchild, but due to his study and sports schedule, Marie stays at NAMS. There tend to be many compromises in both counselling and working with families where there's been sibling sexual assault. Often the parents' resources are strained by having two or more children attending counselling, by attending family therapy, by extra supervision and other changes in the routines and home life. We have to be respectful and realistic regarding family resources. I think in my work as a counsellor, I've actually been challenged by parents in cases of sibling sexual assault more than in any other counselling work that I've done and this is because of those factors. And every parent has those divided loyalties because both the sibling with the problematic, harmful sexual behaviours is their child and also the victim survivor is their child. And that's difficulty for them to straddle. So, sometimes there's a tendency to minimize or deny aspects of the sexual assault in order to protect the young person with harmful sexual behaviours. They may be protecting them from consequences that they fear such as police record, or it may be just to avoid the shame of incest in their family. Another aspect of this case is Marie was smoking marijuana and also self-harming as part of her strategies to self-medicate and to cope with the impacts of the sexual assaults. At the beginning of therapy we spoke openly about these as her ways of coping, but we also began to inventory and add new ideas to her repertoire. I assured her she would mature out of the self-harm cutting behaviours when she had more skills and less stress and also spoke to Mum about that because it was distressing for the from mum. We added journaling immediately to her stress tool kit. We made up a box with mindfulness and colouring in sheets and other distraction and coping methods that we practised in the therapy room. Then we would send home for use between sessions. Marie's self-harm extinguished quite quickly. I think self-harm is sometimes the flag to others that something is amiss in the young person's life. I try not to dramatize it and find that clients who engage in counselling and who are safe most often will find healthier ways to cope with their stress and emotion. Marie does continue to smoke marijuana as she's connected with some other kids with trauma histories who also smoke. Clients with histories of early trauma often gravitate towards others who have experienced trauma. Sometimes this is because they've used similar coping strategies such as smoking marijuana or cutting in. This can become bonding. With Marie, we're using some psycho-ed with marijuana in the brain and doing some motivational interviewing. If Marie Smoking continues, I may refer her to a youth drug and alcohol program as we complete with our sexual assault counselling. Marie's journey with me in counselling is going to be ending soon. Her brother is moved out of home into the army after finishing high school. There are still going to be future problems to face, such as seeing her brother at family events, funerals, holidays and I'd predict a possible increase in Marie's symptoms when the brother or Marie eventually have children. There's fairly often I have begun to see clients only as adults and that's when they have revealed sexual sibling sexual assault that occurred as children. And it often follows they have children or that person with harmful sexualized behaviours has had children and they're become concerned. For now, Marie has some solid new skills. Her life is a lot safer and her functioning in general is back on track. So, I personally, I really enjoy the challenges and breakthroughs that come with trauma work with individuals and families affected by sibling sexual assault. Sibling sexual assault exists within our dominant culture of gender-based violence and oppression. In my own years in this counselling work, I've seen a vast increase in the reporting of this type of case. Today, when I counted numbers on my caseload, sibling sexual assault made up 25% of the cases. Sibling sexual assault was always there before, it was just seldom reported. So, positively for all the Marie's out there reporting and receiving counselling is where change and hope begin. Thank you. What a creative therapist. I know. That's my first reaction is wow, how creative and how sophisticated she was in relation to how she paced out her work with not just Marie, but with Marie's family. Yeah And I think it's really nice you and I have often talked about. It's so exciting when we hear of clinicians who are working with family unit. As opposed to the individualistic model that you know, has kind of featured quite largely in people's practice for the past couple of decades. Yeah. So, it's great to actually hear that here's someone who's working with family and from a Mim and I think you want to follow up on this particular issue, but but from a social justice lens as well. Yeah. So, I've thrown a few things on the table that we want to talk about in a little bit more detail. Yeah, you've thrown a lot there. I was just thinking about what you said about the individualistic perspective and had we gone down that path Liz like, let's just entertain that for a second, right? So we go down that path and we look at Marie and there she is self-harming and indulging in the marijuana to try and escape what's going on, Right? How easy would it have been to do the referral to the psych team? Yeah, get her on some medication and you know, we could have gone down that path and had that social had that therapist gone down that path what would have happened? Marie then sees the problem as herself. We haven't actually centered the issue within the family unit at all. We've done it within the individualistic summaries left within this enduring shame as opposed to really understanding how much of this is not within her control. Right? So, what the therapist described was these these moments of resistance. And the way the process of finding moments of resistance with Marie was about de-shaming. It was about actually like positioning her alongside her courage and her capacity for the future. What I loved about this story was that the whole time she had her eye not just on what was being presented right now, but what was Marie going to be like as an adult? Where was Marie going in her development and her sense of self? Right?And for me that was fundamental to the work that she was doing. Around that she had that integrated care so she's doing co family therapy, right? She's actually working with the other organisations in partnership around this family and around Marie. But that's the centre, the social justice issue of Marie being a person of courage and a survivor is actually centered her practice there. Perhaps I love how you describe it because, yes, Marie's her client but if she doesn't effect change in parenting behavior of sibling. If she's not involved in that work, Marie's not going to be safe for a start unless you say, Marie is going to see herself as the person to blame in all of this. The person that's causing the family disintegration or whatever it looks like. That's it. This is another very creative therapist. So she uses the narrative therapy, but the use of art, I love too.. Yeah. And again with the young person. So it's not featuring just talk therapy. We're actually engaging in some artistic and creative modes. And I love that that the clinician acknowledged that she loves working in that space too which I I would imagine is another sustaining. That's right. It's a hopeful space to work in and inspiring space to work in. Right? So, if we compare this story, Liz, with the story from our last episode where we watched what had happened 20 years ago in the van space and we saw a family where the children, the girls had not been removed from the family situation had there had was not an integrated care approach. And they actually then as adults were still dealing with the impact of that trauma in such a very present, visceral way right? Here what we've heard is how if you approach the scenario from this alternate perspective. If you come at it from a network of professionals and services surrounding the situation and working in partnership with the family in the centre, and the young person in the centre, you can already start to foreshadow what the growth could be. Right? And it's sharing the work. Yeah. So again back to that sustainable model of practice to you not having to kind of carry this load on your own. So, she's working with the new street therapist. She's working with you know, the school community. Yeah. She's perhaps even working with Carly and Carly's therapist the mom. Yes, the mom. So, it's also some sustainable practices. But the other thing I wanted to bring up was I really liked the way in which she paced interventions. So, you know, like for a family like this she could have just been overloading them (CROSSTALK).. and throwing everything at them. Therapist you know, get the get the psychiatrist involved, the drug and alcohol service... Yeah, The evidence school counsellor. But, I sensed a real discernment about who's getting involved and also when. Yeah. So not rushing in to address the marijuana use. Just watching that for a bit and knowing that if that does become the issue because at this stage she's framing it as a way in which Marie's been self-medicating given what she's been living with. Yeah. But knowing that, maybe in the course of my work with Marie further down the track I will get a drug and alcohol counsellor in here. But but thinking about it in terms of timing as opposed to let's just track everything at this, because this is a marathon that that the family are kind of running. Really? That's right. If this is an this is an 8 to 12 week case that can be solved. No. And for her to even acknowledge the sustainability for the mom, to be getting both of her children to their various appointments. That's right. Having to to rethink different parenting strategies to keep Marie safe, not, you know and how does she actually work with with Jake? I mean, there's this intense amount of work that this family having to do for a period of time. And so they're having to kind of think about it in a sustainable way And bringing their grandmother in as a resource, right? Yes. Yeah. Yeah. Really, really important. The other thing I just wanted to mention before we move to listen to the next story Liz, is that is the context of COVID on this case. Right? And the the work of the therapist was really clearly talking about the cyberbullying that had happened for Marie. I mean, back in the day that wasn't even something that would happen. It would be whispered in the playground, Right? Maybe not so whispery. Whereas now, you know, this poor girl is hearing this on every platform that she goes to a phone for to escape. And that's what she's hearing and that's what she's saying. Right? And and I think that's a very modern context for these sort of the experiences that young people are having now around this. It makes it not as private, makes it makes it much harder I think when it comes to the issues of shame for this young girl. The other thing was that though, just when you think about therapy in the context of COVID is you know, are we able to get in there and see the family in their home environment? Are we able to actually have that face to face work with the different members of the family in the way that we need to be having it? Right? These are a lot of this work cannot happen over the phone. It can't necessarily happen over Zoom or Skype or any online platform. So, how are we actually getting into the this depth of work with families and environment when we have this public health issue around us as well? I know that both of us want to rail on about home visiting. Well, we will get to that but can I just say this is this type of work that that this woman's describing is she's a canary in the coal mine. So, what we hear from her in relation to changes in social impacts, say of COVID, they're experiencing it as we speak and having to adjust the therapeutic practice to address it. Yeah. But anecdotally we're hearing that domestic violence has increased. Oh, absolutely. And as you said off mic, a lot of the doors are shut. Yeah, A lot lot of the opportunities to be able to accessing help. Yeah. Were shut And this is something we've heard about all around the world, is that actually the issue around child protection and safety has been the closed doors that have come out as bad as a result of lockdowns. So, I wonder if we can talk a little bit more about this later, Liz, because I think the next story really also demonstrates how important home visiting is and listeners this next story, another content warning. This one isn't about children per se. It is about a family unit with their issues of disability and cognitive impairment. And I found this next one a bit tough to listen to, Liz, I have to be honest about that. So, I wanna put that out there for the listeners that yeah, just again take care of yourselves if you need to while you're listening. So, I'm a senior social work clinician and manager and I've worked in a range of clinical and supervisory roles with a specialisation in working with marginalised communities experiencing family violence and domestic violence. I'm currently working in a vain strategic management and policy position, but continue to provide clinical consultation and training around best practice responses to respond to being in at risk populations. One of the cases that comes to mind involves an adult in his forties with an intellectual disability who was living with his mom, who was in her eighties in their own home and he'd lived there his whole life and mom had been there for over 50 years. So, Tim's dad had recently experienced a quite a severe stroke. And he'd been placed into care from hospital. He was requiring 24-hour care and support and was not going to be able to return home. And it became apparent that perhaps Dad was doing a lot of the practical jobs in the home. And the hospital staff found that mom presented with some much cognitive impairment when they were attempting to get engaged with her around medical decisions and in hospital discharge planning for dad. Tim presented also with quite high care needs and there seems to be no other support involved. And so the hospital staff were quite concerned about them. And what also came to light at this time was some concerns that were reported by an extended family member about a history of family violence from their son or brother. And the extended family member disclosed some concerns regarding possible financial and emotional abuse and control and also some possible physical violence. So, I became involved and went out to see them in their home to undertake an assessment and a bit of an investigation but also to have a look at some potential support options for them. So, prior to any initial home visit like this where I've not been out to the property before, I would undertake a risk assessment and develop a plan for the initial visit. So I'll be clear about the approach that I would be using but also clear about the aim of the visits and had really thought through some of those safety aspects. And so in this case the alleged perpetrator was not meant to be living at the address. He was not expected to be there at the time. But I decided that a two-person visit was still needed to be able to better respond I guess, to the two clients who had both suspected cognitive impairment. And also I guess, as a safety precaution should something transpire to be able to better respond to an emergency. So, I took another colleague with me and on arrival found also that that the extended family member had raised the initial concerns or allegations was also present. And both mom and shall we say, the younger adult with a disability I'm calling him Tim for now were happy for their presence. So, on arrival I found this really thick chain wrapped multiple times around the front gate which I needed to untangle to get access to the property. And it was later reported that the chain was there that It actually stopped him getting out, which he was apparently trying to do consistently throughout the day and also stop the alleged perpetrator getting in. So, the home was basically bare. We had one mattress in each room where they slept, the bathroom had a toilet but the bathtub and vanity had been removed. Both Tim and mom were in clothes that didn't fit so Mom's trousers were tied around her waist with a piece of string and they were several sizes too big and were falling down and so she was tripping over her pants. Tim had a pile of clothing in the corner of his room, which were reported that he'd been collecting from the local clothing bin. There were two plastic seats in the lounge area and a really small couch. There was also a fridge in the kitchen that was empty. There was a few rotted food items but it was basically had no food in it. And other than that, you know, there was no belongings in the home. So in terms of their care needs, Tim needed prompting to undertake personal care. So to get dressed, clean his teeth, have a wash, Tim really hadn't developed any basic life skills, so he wasn't able to prepare food or make a cup of tea. And Tim had really been quite sheltered, I guess over the years by both mom and Dad and only really being taken up to the high street with them on occasions. So, Mum was mobile but reporting that she, you know, she still gets up to the shops to get the groceries but is needing to stop multiple rest stops along the way. She appeared pretty unsteady on her feet and admitted that she'd had a couple of recent falls. The extended family member said that mum was sleeping in her clothes the same clothes most days. Not really having a wash due to the lack of amenities in the property. Mum said that she was making simple basic meals for both her and Tim and that mum was making the financial decisions of the household. So during the initial visit information was gathered from mum, Tim and the extended family member that was present concerning some allegations of financial, psychological or emotional and physical abuse. And so what they told me was that the son, Tim's brother who is the alleged perpetrator here, had been taking most of Tim's moms, dad's and another elderly relatives pension each fortnight for a period of approximately three years, leaving them with really little money for food each week. Mom reported signing some bank forms at her son's request, later to finds out that he had drawn down on the mortgage to a point where they were really fearful that they were going to lose their property. The alleged perpetrator had also reportedly taken out credit cards in all of their names and used the maximum limits on all of these cards. Mom said that she knowingly agreed to sign the documents as she was really worried what he would do if she didn't. So, Tim Tim had saved pretty much all of his pension over the years and his brother had accessed and spent his savings to the sum of a few hundred thousand dollars. They also reported that the alleged perpetrator came over and actually cleared out the place. So, just after Dad went in to care, he came in and he literally had taken everything including the bathroom vanity and all of their clothes, all of mom's special positions and anything of any monetary value. So, Tim reported he was physically threatened by the perpetrator and pinned by the throat against the wall, for not wanting to give over his things. And as the conversations transpired, Mum reluctantly mentioned being physically restrained by the son, being tied to a chair with a rope and verbally abused during what she described as one of her sons, one of the alleged perpetrator's outbursts. So Mum also reported that a neighbour had been telling her to be careful as the neighbour had spotted the sun sitting in his car across the street watching the property. The neighbour reported that at one time the son approached her and actually told her that they were you know threatened, that they will get what what's coming for them. So the financial abuse and coercive control had been going on for several years. However, the timeframes around the the physical abuse was a little unclear. But it appeared as though the last incident of of violence had occurred probably 1 to 18 months approximately ago. And the extended family member felt that the violence had actually stopped following him, making a report about a month ago to the police. So on reflection, my practice or intervention with mom and Tim was really informed by trauma-informed principles around safety, trustworthiness and being transparent in my practice, enabling and facilitating choice, working from a person centred and strength based approach, working in collaboration and really partnering with the victims. So, I want to build rapport and really engage with mum and Tim before talking more directly about what had been happening. And I remember being conscious of my tone of voice and the choice of language that I used. For example, I tried to use really simple language with no jargon. And I recall I was reflecting on this at the time as I became aware of the level of cognitive impairment. I was adjusting my language on the spot so the pitch in which I was delivering information and what I was discussing with them. So through active listening, I was able to check in regularly at different at different points to assess if they were fully understanding and following the conversation. And I think this was informed from my past experience of working with clients who present with cognitive impairment. And also my many years of experience in engaging vulnerable clients to set up a safe space to have that open discussion around violence and abuse. And I was mindful at the time of my my body language and I was conscious to let them know that I was interested in their response. So I allowed time for them to tell their story and allowed them time also to grieve in that moment. So, at one point mom was crying and she was really sobbing and saying you know, what will happen to us if we lose our house? And she leaned in and put her head on my shoulder. And I was able to display support through that use of body language. So I worked to validate and acknowledge their experience. I gave messaging so they were clear they were not to blame for what had happened, that the son or perpetrator had made choices that really were not OK. And I endeavoured to normalize their experience, telling them that they are not alone, that what is happening to them is unfortunately really common and that family violence is common and that it's not just happening within their family. And I informed them that you know, what support options were available. And I tried to empower them by giving them some information and some options. But I also kept this pretty simple. Being conscious of their ability and impaired capacity. So, in working from a real person-centred approach, I was consulting with mum and Tim throughout my whole involvement. However, I was really aware of their limited capacity to understand options and decisions to be made at the time as well as they are impaired inside and around safety and around risk. So, following that initial visit with mom and Tim, I spent time weighing up all the issues with what they what they wanted. Mom and Tim were really set in their ways so that they had the established retains and mom particularly wasn't wanting to too much involvement you know, from the outside involvement. So they'd been really private until now as a family unit. So I knew we needed to intervene to a certain point. So they were quite cognitively impaired and very vulnerable and really in an unsafe situation. But it was really about weighing up the least restrictive practice and not racing in and trying to change too much and to soon. So, I used my senior colleagues to sound off in sorting out my thoughts at the time in working through the next steps. But the first thing I did was to address the immediate the immediate risks. So access to food. I organized food vouchers and arranged for a family member to do some shopping in the interim. And so services could be arranged. And the same family member agreed to check in daily to prompt Tim's personal care and to ensure that they were eating and offered some support around meal preparation if it was needed. So I arranged an urgent locksmith to change the locks as the son of a perpetrator still had a key to access the property. And we had the chain removed from the front gate as it was a major fire hazard. I liaised on the day with the police, who had already involved the Ageing and Disability Commissioner and from there really worked in collaboration with the police and the ABC. The police advised, they took statements from all involved and they had the evidence around the credit cards and also the access to the financial information that they needed. But at this point there was some questions surrounding Tim and Mom's capacity to sign documents and to give consent at the time that they were signed. So, whilst obviously being very vulnerable and being fearful of what would happen if they didn't sign. Mum was able to articulate the place that she had signed the documents and given consent for the alleged perpetrator to access the accounts. But there were lots of questions surrounding their capacity. So, the police took out an ADDO and agreed to do some compliance checks and I organised an urgent geriatrician assessment looking at capacity for mum in making decisions around her care, accommodation and finances and also referred Tim to a specialist service that works with intellectual disability to assess his capacity, but also to look at developing a behaviour management plan, to look at the urgent issue of him exit seeking. I also worked in collaboration with the ADC to submit an application to Incat, so the New South Wales Civil and Administrative Tribunal and we had a guardian and financial manager appointed for both mum and for Tim. So, the police were pursuing the criminal investigation and ADC and the public trustee were working on getting what transactions could be reversed, reversed and working through trying to ensure that they didn't lose the home. So at the same time, I also referred to the NDIS into the Aged care assessment team and arranged both interim and then longer term disability and aged care services into the home to assist them with those activities of daily living. But this was also in a way to monitor the home situation, decrease the isolation and overall level of vulnerability to further abuse occurring. So lots of work went into coordinating and linking the NDIS workers with the age care providers and the appointed guardians. And you know, the systems don't naturally talk to each other and recommendations sort of surrounding team being placed into maternity care, accommodation was being made in isolation from decisions for mum and not not really seeing them as that family unit. So Tim and mum were so vulnerable, they were there, was very agreeable and so easily influenced and led by others. So for me it was a real ethical dilemma in working out what interventions were necessary and when. And I think I was really reflective on this in, in, in terms of working out my thoughts and ideas but also challenging other professionals around around some of the recommendations that were being made for mum and Tim to do with safety, care and future accommodation options. So, I think what was so confronting about this case was the level of vulnerability of both mom and Tim. They were both so visually vulnerable and you know, they were sitting in this environment that was was empty. You know, they had nothing left. They had been really, you know, the perpetrator had taken everything. And I remember being aware of my own value systems and beliefs about you know, what's right and what's wrong, and being quite conscious of the desire, I guess, to to want to get justice for what has happened to them. And so I was aware that this was my stuff and really conscious and I guess, you know, reflective on me throughout my involvement with them in ensuring that this didn't influence my work and my practice. Liz for me, this story is such an amazing story. It really speaks to the heart of coming back and grounding yourself in the client's everyday experience and thinking about coming from a social justice perspective, right? Like for me, the issues around vulnerability and the need for advocacy and for you know, this social worker spoke about coming from a strength based approach, partnership approach, being collaborative in her work, the way she stepped that through every step of the way just made that really clear to me. It's a it built on the moments of resistance that our first therapist spoke about. And in this one, you know, really took that advocacy angle and brought us back to the social justice needs at the heart of this case And using a trauma informed lens. Absolutely. I mean, at first I had to kind of pinch myself and think this sounds like an eight cat home visit. Right. Because this would be the type of home visit that many of our age care social workers do day in, day out. Yea. So at first I thought, wow, this path and workers is actually doing a home visit. Yeah. And doing what we would call a really, really thorough social psychosocial assessment, but not panicking because you could have walked in to that household and just well, I would imagine her first reaction would have been one of overwhelming, so confronting to locate her home.(CROSSTALK) It's so sad, isn't it? And it took me right back to doing home visits and actually never knowing what's gonna be behind the door when you first knock. Right? And, you know, being met by that huge chain at the front and then hearing the story that unfolded like I think we've got to really take a bit of a broader lens on how violence, abuse and neglect actually presents, because it can present so differently for different people depending on the issues that they're facing with depending on the life stages that they're at. Right? Like, it's so multifaceted, this work. And I once again, here's another person who paces herself beautifully. Yeah. Like, thinks it through. And as you say, Mim works with Tim and his mom and the relative to work out how are we going to do this together? Because you really could have thrown, again, many, many, many services at the one time we could do this. You could have separated Mom and son. You could yeah. I think the fact that she wanted to work with the family unit.... Yeah..In an integrated way. But also look at issues of safety. Yeah. And just a little by line here. I really appreciated her talking through how she assessed her own safety going into. Oh, I love that, Liz. I love the way she stepped us through the risk assessment that she did before she went into the home. Right? Because actually, that's the issue. More and more, we're seeing less workers doing home visiting. And if there's anything that COVID has taught us, it's that there are some issues that need to be seen. You have to be able to get in there and see how families are actually living in order to be able to assess the level of need. Liz. Like so much is hidden. And to see the level of violence that has taken place, I mean, the vanity unit... I know The bath. I mean having to cut out nice food? Yeah. No clothing. Like she's having to start from the real basics. You can just imagine if this family had ended up an ambulance had been called and they had come into emergency. Right? You can guarantee what would have happened. They hadn't seen the home environment in and of itself. So firstly, they may not have had a true picture of what was happening at home. Secondly, then they would have gone down the medical route where the next thing you know, we've got a guardianship application, we've got nursing home placement for the mum and we've got a group home for the son. Right? And an eye on the family unit has actually been completely ignored. Liz could they have to fit into that system. That's right as opposed to the system working for them. That's right. And, and listening to the thinking behind how she was bringing in various services according to the need identified by working with the family. It's incredibly skilled, isn't it, Liz? Like tailoring those interventions, actually. Yeah. I think the other thing I was thinking about, she didn't talk about in in the recording but this is a family that's also lost their home. Yeah. The father and the partner, probably the primary carer of the family unit. And so, again, if they'd gone down that route. Mum could have been placed somewhere different to where her partner, his son could have been removed from both parents. Yeah. And then they're all picked off individually. And then they've also got an abusive sibling and son out there that's you know, perpetrating financial and physical abuse. Yeah that's right. That's right. I think the compartmentalizing of this family would only have been to their detriment. So to actually continue to have that family perspective was really, really essential. And it comes back it does come back to where are the strengths in this family. And actually, the strength is in the connection between that mum and son. Right? So actually being able to recognise that and then draw on that and harness that I think is really, really clever actually in the intervention. Also then pulling in the different services as they went along as they needed. So you know, in the same with the first story, the pacing of those services. So, then we've put in the police when it's necessary, pulled in the Aging Disability Commission when necessary, right? Like these different components coming in at the points that actually support the family and what they need. Every so often we work with stories where they're beautiful examples of the talking through the step by step, the methodical approach, and the reasons why great for new practitioners, all practitioners, students. And this is one of them. Yeah, I think she's very sure footed around the reasons for the intervention. She had a very, very clear sense of a framework around the why she works in the way that she works. Beautiful, beautiful description of her, her work with this family. Yeah, I would completely agree. So I think we need to wind up this episode, sadly. I mean, we could talk a lot more but I again, I don't think we need to because hopefully you listeners have seen the the reasons why we connected these two very different stories together. So, the things that just finishing up we wanted to highlight was the breadth of the work of these workers, the way in which they engaged with families using an integrated model, thinking through the the steps that they were using, not panicking, not throwing multiple services at the family, working with as opposed to on or to being quiet reflective on the reasons why they chose to work with the families in the way that they did. It's a this is one of those ones that I think there's lots of layers to the learning. I think so as well. And I think just that focus on social justice is the mission statement of this work. And coming back to where the client in the family that really, really important. So in our next episode, Liz The next episode is actually episode four. It's the final episode in the Making visible series, which plays with our final episode. We're going to be focusing on the Justice health context. We're gonna be looking at substance use in pregnancy, I've got two clinicians speaking in that episode and that's going to be great. So tune in for that, everyone. Before we go though, can I just remind all of our social workers, psychologists, health care professionals out there who are doing this hard work every single day. If you want to stay up to date with innovations in this area, come and join the Agency for Clinical Innovations, Violence, Abuse and Neglect Network. Great, great community of practitioners. And the website is in the show notes. Thanks so much, everyone. We will see you in the next and final episode in the Making Visible series. Bye for now. Thanks. Bye. Thank you for listening to this episode of the Making Visible Podcast. All client experiences discussed in Making Visible have been de-identified. The content discussed in this podcast may be distressing if you live in Australia and need support, please contact 1800 Respect 1800 737 732 or lifeline on 13 11 14. Making Visible is produced by the Agency for Clinical Innovation, Violence, Abuse and Neglect Network in partnership with the University of Wollongong and the Social Risk Stories Podcast Team.