Secondary consultations

Responsibility 5 of the MARAM Framework is secondary consultation and referral. Secondary consultation can occur with a range of services, but for this report, our focus is on universal services reaching out to specialist family violence services to seek expert advice.

While we understand that seeking secondary consultation is an expected part of good, collaborative practice in the MARAM Framework, our consultations suggested there is a lack of structure, guidance and monitoring around secondary consultations at the system level. This includes a lack of specific guidance about what should happen where a specialist family violence service identifies a client as high risk through a secondary consultation.

Family Safety Victoria explained that secondary consultation models for particular workforces were the responsibility of implementing agencies, and that secondary consultations have not been raised as an issue in bilateral meetings with agencies nor by sector grants groups. We suggest, however, that the matter needs to be discussed with specialist family violence services and peak bodies, The Orange Door locations and family violence regional integration committees to get a better sense of some of the issues and to ensure a consistent and systemic approach to secondary consultations.

Within the MARAM Responsibility 5 practice guide, there is detailed information about why a service might reach out to another service for the purpose of a secondary consultation. It explains that ‘the purpose of secondary consultation with specialist family violence services is to seek support in:

• understanding the level of risk and intersectional needs
• determining actions in line with the assessed level of risk
• determining whether a referral is required for a specialist family violence response’.

The practice guide advises services that The Orange Door, where it exists, is a good point of first contact for a secondary consultation, or otherwise a local specialist family violence service. Family Safety Victoria also advised that the statewide contact points are Safe Steps and the Men’s Referral Service. Beyond this, we are not aware of a specific system-wide model for secondary consultations, and some stakeholders have suggested there should be one.

Increasing demand for secondary consultations

With universal services coming into scope for the rollout of MARAM and the information sharing schemes, many stakeholders expressed that an increase in secondary consultations with specialist family violence services was to be expected, as universal services build their capability in responding to family violence and their understanding of their new obligations. For example, during phase 1 of the reform rollout, EACH, a nation-wide provider of a range of social and health services, noted that ‘in one region secondary consultation requests from EACH to the regional specialist agency increased from 30 during the 2018/2019 financial year, to over 130 requests in the 2019/2020 financial year’.

As the Central Highlands Integrated Family Violence Committee noted in its 2020 submission to the Monitor:

In the context of significant difficulties with the roll-out and engagement of training, newly prescribed organisations are likely to turn to secondary consultation – as required by their MARAM practice guidance – to support them in understanding a family violence situation, assessing it and managing the risk. There is also likely to be significant overestimation of risk in some circumstances due to risk aversion amongst a very large workforce, leading to cases being referred for comprehensive response unnecessarily.

The Western Integrated Family Violence Committee has raised a similar issue:

Secondary consultation is a vital component of the collaborative practice outlined under MARAM, however there are substantial barriers to accessing secondary consultation within the western metropolitan region … the demand for secondary consultation will only increase when phase 2 organisations are prescribed under MARAM and the Information Sharing Schemes.

Anecdotally, incoming secondary consultations have been increasing for many specialist services and sectors such as Drummond Street Services, Safe Steps and specialist sexual assault services. The Rainbow Door and Seniors Rights Victoria noted that they also receive a large number of secondary consultations and are not adequately funded to do this properly.

Several family violence regional integration committees we met with were leading projects of various sizes to quantify demand for secondary consultations in their regions because it is not something that is otherwise measured. Safe and Equal is doing similar work, but a statewide view of demand and impact will be important to determine whether there are any widespread funding or service delivery implications. Given the critical role secondary consultation plays in the family violence system, we suggest it will be essential to quantify this demand and monitor it in an ongoing way across the system, including tracking where the requests are coming from and time spent on secondary consultations [relates to action 5]. This will assist in designing the most effective model(s) for secondary consultation and could inform training and capability building approaches for different workforces.

There has been some progress in tracking secondary consultations in recent years. Family Safety Victoria has advised that, since 2020, the case management platform used by specialist family violence services has included an option to record secondary consultations. A March 2022 enhancement to The Orange Door’s client relationship management system now also allows practitioners to record secondary consultations, including the time taken.

Many stakeholders raised the lack of specific and sustainable funding for secondary consultations as a key issue. We understand that Case Management Program Requirements for Specialist Family Violence Services, released in December 2021, describe secondary consultations as an integral part of case management functions and include requirements that agencies have processes in place to respond to and seek secondary consultations. However, there are no service delivery targets connected to this, which results in secondary consultations being invisible within the current funding structure. It also makes it difficult to determine if services receive adequate funding to account for the increase in volume of secondary consultations that is expected as universal services start to identify more family violence. We were advised that the time taken for each consultation can be substantial, with No to Violence and Safe and Equal stating that 45–60 minutes for a secondary consultation would not be unusual; one Principal Strategic Advisor said consultations can be as long as 90 minutes.

While there is no specific performance target for secondary consultations, in the new funding model for specialist family violence services to begin in July 2022, funding explicitly covers secondary consultations and services will be able to count the time spent on secondary consultations towards their overall performance targets.

The role of The Orange Door

The Royal Commission saw a very clear role for The Orange Door in providing secondary consultations to universal services. As part of the introduction of The Orange Door, it was recommended that new advanced family violence practitioners be funded at each site to assist their colleagues with complex cases and to provide ‘secondary consultation to local GPs and health practitioners, schools and other service providers who have clients experiencing or at risk of family violence’. Under this model, ‘there is a defined role of secondary consultation and capability building with non–family violence services’.

These roles do exist as advanced family violence practice leaders across The Orange Door sites (see Table 6), and the responsibility for delivering external secondary consultations is documented in The Orange Door’s operating model as one of many responsibilities (see Box 4). However, Family Safety Victoria has advised that secondary consultations will usually occur directly with The Orange Door practitioners, while practice leaders primarily provide advice and guidance to practitioners. This may be appropriate, but we suggest there needs to be further examination of how secondary consultations are being managed and delivered within The Orange Door model, and that the approach be clearly documented [relates to action 5].

Table 6: Advanced family violence practice leader positions and vacancy rates, January 2022

*future sites

Source: Department of Families, Fairness and Housing

The case for a stronger system model for secondary consultations

As the Victorian Council for Social Service told us, effective system integration and collaboration needs to have a system-level solution. While personal, local relationships can be effective, they do not necessarily lead to sustainable improvement, nor consistent practice across the state.

As a prominent family violence organisation, Safe Steps is often contacted for secondary consultations, and sees itself as a logical contact point for universal services needing specialist advice, particularly after hours given it is a 24-hour service. However, incoming calls – many of which are estimated to be from third parties such as schools, doctors and hospitals – have increased substantially. In developing a model for secondary consultations, the role of Safe Steps needs to be included, and consideration should be given to introducing a separate phoneline for third-party calls from health and education professionals.

Western Integrated Family Violence Committee provided us with its project proposal for ‘embedding family violence secondary consultations in the western metropolitan region’. This document usefully highlights secondary consultation as:

• a mechanism to build family violence knowledge and practice across the service system
• supporting earlier interventions in family violence, thereby reducing harm to victim survivors
• a strategy for mitigating high levels of demand for specialist family violence services by empowering a system response before risk escalates
• supporting MARAM alignment for all prescribed services, fostering family violence knowledge, embedding collaborative practice, and strengthening referral pathways.

It also recognises that realising these outcomes requires adequate guidance and capability building in how to conduct high-quality secondary consultations [relates to action 4]. Local partnerships and strategies are important, but we suggest efforts to improve secondary consultations
need to occur at a higher level and focus on appropriate models for particular workforces – and, where appropriate, for particular geographic areas – to define how the specialist family violence sector, Family Safety Victoria and relevant implementing departments want universal services to engage with the specialist system. Victoria’s family violence regional integration committees will also have an important role, as will Aboriginal Community Controlled Organisations (to ensure a culturally safe response for Aboriginal people).