Tier 2 – Additional knowledge
Sections
Knowledge
In addition to Tier 1 knowledge, you need to know:
- victims and survivors have the right to choose the services they think will best suit them and the right to withdraw consent to these services at any time
- the importance of providing clear information about the service, treatment options, costs and length of engagement
- service provision should be flexible and accommodate the different needs of victims and survivors
- the impact that your cultural context and world view may have on victims and survivors
- it is important to engage with victims and survivors in a way that builds trust with you and your service.
Skills
In addition to Tier 1 skills, you can:
- provide written information and discuss what the service offers, as well as likely timeframes and wait-list management processes (where you are continuing to work with a person)
- avoid making promises that you can’t keep
- obtain informed consent in a way that is specific to your work context
- collect relevant information about victims’ and survivors’ circumstances and needs in a culturally safe and trauma-informed way and inform them about how their information will be stored and used
- enquire about any accommodations the person needs to access the service and take steps to accommodate these
- recognise when victims and survivors have intersecting needs and adapt your practice to make services responsive.
Tools to support you
Did you know?
Practice wisdom
‘I don’t promise anything I can’t deliver, no way. Because this is just, it’s basically re-doing to them what was done to them in the past.’
– Sexual assault counsellor, quoted on page 89 of a research report by Salter et al. (2020).
Informed consent is critical
The principle of informed consent refers to:
The act of agreeing to or giving permission for certain actions affecting one or more aspects of one’s life (e.g. legal, financial, health, lifestyle and social). To be informed a person must be given information about the proposed activity relative to the individual situation; including potential for an adverse outcome, other options and the possible results of alternative action or no action. To be effective, the person should be able to communicate an understanding of the proposed activity. Consent can be refused or withdrawn at any time.
The NASASV Standards of Practice Manual for Services Against Sexual Violence 3rd edition notes that obtaining informed consent:
- is central to demonstrating respect for a victim and survivor and can assist staff to demonstrate trustworthiness and their desire to work with victim and survivors in a collaborative way
- is not always a simple process and organisations must have a comprehensive and flexible system in place to ensure that all victims and survivors are fully engaged in the consent process, from initial contact through to the file closure.
Issues in focus: Challenges in rural, regional and remote locations
Victims and survivors living in regional, rural and remote areas can experience additional
difficulties in disclosing, seeking help and receiving appropriate services. These include:
Lack of services
In many rural and remote areas there is a shortage of specialist services, including forensic medical and sexual assault counselling services, and even generalist services may be limited.
Geographic isolation
The closest services may be hundreds of kilometres away from a victim or survivor’s home, and options for transportation, either private or public, may be limited or non-existent, and come at considerable cost. Physical isolation can also present barriers to accessing forensic medical services within the required timeframes.
Limited telecommunications access
In remote areas, there may be no reliable telephone and internet services and working services may be prohibitively expensive. Children especially may not have any access to technology to report sexual abuse or seek help.
Lack of anonymity and privacy
In small, close-knit communities it can be very hard for victims and survivors to remain anonymous and this may deter reporting of child sexual abuse and help-seeking. Fear of shame, community gossip and people ‘taking sides’ can make it difficult for people to remain in school and workplaces, particularly in public-facing roles.
Social barriers
Traditional gender norms can be strong in rural areas, which can result in the minimisation and even normalisation of sexual violence, particularly against girls and women. A heightened emphasis on self-reliance and privacy within families may also discourage disclosure and reporting.
Lack of culturally appropriate services
Support services are often not appropriate to the needs of Aboriginal and Torres Strait Islander peoples, people from culturally and linguistically diverse and faith-based backgrounds, and gender-diverse people.
Practice tip
Informed consent when working with people with intellectual disability
It is critical that people with intellectual disability are included in decision-making about their health and wellbeing. Many people with intellectual disability have the capacity to provide consent on their own, while others will need support. The Council for Intellectual Disability (Australia) provides the following tips for helping the person with intellectual disability understand and make their own decision:
- involve someone whom the person likes talking to
- talk about the treatment somewhere that is quiet and where the person feels relaxed
- try to use words the person knows. If you have to use difficult words, try to explain them simply
- if the person has an alternative communication system, use that
- use pictures that show the problem and the proposed treatment
- stick to the basic information. Do not overload the person with detail
- give the person time to think about the information and then have another talk.
If you are concerned that the person with intellectual disability is unable to give informed consent, you should consult any relevant policies or procedures your organisation may have or seek information from your local Public Advocate or guardianship tribunal. The Australian Guardianship and Administration Council provides a list of state and territory member organisations.
Informed consent when working with children and young people
People have the legal capacity to consent if they have the mental ability and maturity to understand the nature and effect of what they are consenting to. It is important that you are aware of the guidance about seeking consent from a child or young person in your state or territory. The NSW Office of the Advocate for Children and Young People, provides a comprehensive handout with a checklist of questions about issues to consider when seeking consent from a child or young person.
What do victims and survivors tell us?
Rural and regional
These 2 excerpts, taken from a case study from the Royal Commission, shed light on the challenges of reporting and seeking help for child sexual abuse in small rural towns:
‘Mr Troy Quagliata talked about his experience of being sexually abused as a young boy by the local cricket club coach in rural Queensland. Mr Quagliata described the difficulties he faced living in a small town, trying to overcome his fear of judgment or ridicule and finding support he could trust: “The shame and thoughts of the abuse are with you all the time. You don’t know where to look for help. In town, all the school teachers live in the community. I didn’t feel comfortable talking to them.”
“I think it is harder for kids in smaller towns to report abuse. It hasn’t changed much over the years. It was hard for me to report the abuse because everyone knows everyone. It is still the same today. People gossip all the time. If you stand out, people talk about you.’
A research project by Australia’s National Research Organisation for Women’s Safety notes that women in rural and regional areas who experience child sexual abuse have a higher risk of experiencing sexual re-traumatisation later in life.
Knowledge
In addition to Tier 1 knowledge, you need to know:
- support from family, kin, partners and friends can enable victims and survivors to access services and receive an appropriate response
- some family, kin, partners and friends will find it easy to be supportive, while others may find it difficult
- children and young people may rely on parents, carers, guardians and supporters to help them engage with services and take them to appointments
- the key messages you can share with family, kin and supporters are:
- your support is important
- the only person who is responsible is the person who perpetrated the sexual abuse
- it is okay to be upset and you may need your own support.
Skills
In addition to Tier 1 skills, you can:
- encourage family, kin and supporters to offer the victim and survivor information about services that are available and how to access them if they would like to
- provide information to family, kin and supporters about how to seek help for themselves
- provide the following key messages to family, kin and supporters for them to share with the victim or survivor:
- I believe you
- it is not your fault
- I am here to support you
- there is support available.
Tools to support you
Did you know?
Barriers to help-seeking
There are a range of potential personal barriers to help-seeking for family members, kin and other supporters, including:
- disbelief of the victim or survivor’s disclosure
- concerns about family dissolution
- feelings of shame and fear of social stigmatisation
- fear or experience of a negative response
- distrust of institutions and authority
- concerns about privacy and confidentiality.
There are a range of structural barriers to help-seeking for family members, kin and other supporters, including:
- lack of information regarding available support
- referral process
- lack of affordable services
- lack of accessible services
- lack of appointment availability
- hidden costs of seeking treatment (time off work/school, cost of travel)
- lack of coordination between support services.
Practice tip
Sensitive practice requests
The Sensitive Practice Request form is an example of a tool that could be provided to victims and survivors when they first contact your service to help give them control over how health care can be provided to them safely. It could be adapted by your agency for victims and survivors to use when they engage with other services.
What do victims and survivors tell us?
The examples of good and poor practice are taken from a study by Gallo-Silver et al. (2014) where male adult survivors of child sexual abuse were asked to recount instances of poor and good practice when they had accessed medical care.
Example of good practice:
‘I passed out in the street and cut my face up when I hit the pavement. I woke up in the emergency room, and I was very scared. The thorough examination included a rectal exam. I began to shiver; I guess I was nervous, and I refused the examination. The ER [emergency room] doctor explained that he needed to see if I was bleeding and if that was why I passed out. Crying, I told him that my brother forced me to have anal intercourse when I was a kid. He was really cool. He said it was my choice to be examined. He told me if I agreed I would feel some pressure, but he would be very brief. So, I agreed. After, he asked me if I was okay and if I wanted to talk to a social worker.’
Example of poor practice:
‘I went to a urologist due to prostate symptoms. I was not able to find a woman urologist that would see adult male patients. I told the urologist about the sexual abuse when I was a kid, but he seemed not to get it. He told me to “drop ’em” (meaning pull down my pants) when he wanted to examine me. When he did the digital rectal examination, I winced due to the discomfort, and he joked: “And I didn’t even buy you a nice dinner.’
Resource
Working with abuse and violence for medical practitioners
Medical practitioners may wish to look at the relevant sections in the Royal Australian College of General Practitioners’ guideline Abuse and violence: working with our patients in general practice, 5th edition (the White Book).
Knowledge
In addition to Tier 1 knowledge, you need to know:
- there are different views about healing and recovery and each victim and survivor will have a different perspective on what healing and recovery looks like for them
- Aboriginal and Torres Strait Islander approaches emphasise trauma-aware culturally safe, healing informed practice as a strengths based approach to healing
- a strengths-based approach conveys hope and focuses on the strengths and resilience of the victim or survivor and most effectively ensures your response is victim and survivor-centred.
Skills
In addition to Tier 1 skills, you can:
- view the person holistically and get to know them as a person
- communicate your belief in the victim and survivor’s recovery and maintain a sense of optimism in the face of setbacks
- provide information about the recovery process
- provide reassurance that the impacts on the victim or survivor’s life can lessen over time
- offer encouragement and communicate hope when victims and survivors are feeling they are not healing
- help victims and survivors to recognise and use their existing strengths, skills and resources in their everyday life.
Tools to support you
Did you know?
An approach to the trauma recovery process
Recovery is often not linear; however, a phase-based approach to trauma recovery is a helpful way of conceptualising this process. The graphic below identifies three phases of recovery based on the influential work of Judith Lewis Herman.
- Phase 1 - Safety and stabilisation
The person is safe and able to cope well. - Phase 2 - Remembrance and mourning
The person is able to make sense of the past. - Phase 3 - Re(connections)
This person is able to move forward with life beyond trauma.
Content adapted from Transforming Psychological Trauma: A Knowledge and
Skills Framework for the Scottish Workforce, NHS Education for Scotland
Factors to consider when being victim and survivor-centred
Shame
Shame can have a particularly debilitating impact in small communities such as regional or remote areas, where it can be difficult for victims and survivors to seek support anonymously.
Intersectionality
Many people experience the cumulative and intersecting effects of racism, sexism, class oppression, transphobia, ableism and more. The concept of intersectionality is an important way to understand the multiple effects of these abuses of power, the meaning people make of their experiences, and the decisions people make in relation to reporting and help-seeking. Read Our Watch’s factsheet on intersectionality and violence against women.
Key issues and evidence gaps for LGBTQIA+ victims and survivors
LGBTIQ+ Health Australia identified some key issues and evidence gaps around child sexual abuse and LGBTQIA+ communities:
- Education and building child safe cultures:
Many educational environments are not safe for young LGBTQIA+ people. Transgender and non-binary students in particular report experiencing elevated levels of harassment, bullying and physical or sexual violence in school, predominantly from classmates. - Supporting and empowering victims and survivors:
Mainstream organisations providing support for LGBTQIA+ people need appropriate training. - Improving the evidence base:
The absence of quality and robust demographic information on LGBTQIA+ people, as well as lack of inclusion in the national census, inhibits the ability of service providers to develop sophisticated and targeted program initiatives for LGBTQIA+ people.
What do victims and survivors tell us?
‘It seems like after things like this happen, and it’s like “oh that person’s broken” or “something awful’s happened to that person”. It’s like for that person to know they are whole, they are this person, they have all these things about them, they have their own personality. That’s happened to them, yes, but that hasn’t affected who they are as a person. You’re still who you are. You can still be whoever you want to be after this has happened to you.’
– Female victim-survivor, quoted on page 162 of the Making Noise Project full report.