MARAM resources acknowledge that ‘vicarious trauma … is a common response to working with people experiencing trauma’, that staff with lived experience of family violence are more susceptible to this vicarious trauma, and that organisations need to be prepared to support their staff in a trauma-informed way. We note that in many of our consultations, stakeholders showed they were aware that a proportion of staff in their services would have lived experience of family violence.
“Universal frontline workers also need support to deal with these issues … to decompress if they come across something personally challenging … they need support to give support.”
- Sharon, victim survivor
Research conducted by the University of Melbourne has shown that among female health professionals, there are high rates of lived experience of intimate partner violence and family violence (see Figure 5), and these rates appear to be higher than for women in the general community. For example, in 2016, 2.3 per cent of Australian women aged 18 or older had experienced intimate partner violence in the preceding 12 months, versus 11.5 per cent of women in the hospital study.
Figure 5: Experiences of intimate partner violence (IPV) and family violence (FV) among health professionals in a major tertiary hospital, 2013
Source: The University of Melbourne, based on data from McLindon E, Humphreys C, Hegarty K (2018): ‘It happens to clinicians too’:an Australian prevalence study of intimate partner and family violence against health professionals, BMC Women’s Health, 18:1123.
Stakeholders told us that, in their experience, where staff have lived experience of family violence, they have a deeper understanding of family violence and are more likely to be driven to identify and support those currently experiencing family violence, but that sometimes past trauma acts as a barrier to engagement with family violence cases because of the risk of retraumatisation.
“I feel like my lived experience really helps working with clients, for example if a client is nervous or fearful I will explore and ask questions without fear of hearing what they have to say. I can listen to a client’s story and not cry or be overly empathetic in a patronising way. I can often pick up certain behaviours that indicate family violence. My experience I feel gives me the confidence to ask the tough questions and to listen to stories (so long as I have self-care routines in place).”
- Kelly, victim survivor
The University of Melbourne research found that, overall, lived experience among health professionals seemed to contribute to better clinical care for patients experiencing family violence.
Given the potential for vicarious trauma for those exposed to secondary family violence, and the known over-representation of victim survivors within the health workforce, organisations must provide adequate support for staff. Further, MARAM alignment, and any other efforts to improve the response to victim survivors, must cover both patients/students and staff with lived experience [relates to action 6].
The 2019 Census of Workforces that Intersect with Family Violence showed that staff in universal services had access to support if they encountered family violence cases or disclosures of family violence, but views on the effectiveness of these supports were mixed, and substantially lower for school workforces (see Table 4). Further, there is no breakdown of responses by those who are victim survivors and those who are not. It would be useful to further explore the quality of support available to staff and identify ways to improve its effectiveness.
Table 4: Staff access to support regarding exposure to family violence cases from the 2019–20 Census of Workforces that Intersect with Family Violence
|
Community |
Early |
Maternal and |
Public health |
Schools | |
|---|---|---|---|---|---|
| # of respondents | 328 | 136 | 135 | 565 | 82 |
| Proportion of respondents who have access to support if they encounter cases of FV or disclosures |
93% | 89% | 97% | 91% | 83% |
| Percentage of respondents who found the support very, or extremely, effective |
61% | 66% | 61% | 58% | 38% |
Source: Family Safety Victoria
MARAM Framework guidance suggests that alignment with MARAM should include a family violence leave policy, appropriate policies and procedures and a trauma-informed approach to supporting staff who are experiencing vicarious trauma through their contact with family violence cases, particularly those staff with lived experience. There is also a workplace safety plan template available for use with an individual employee experiencing family violence, to ensure adequate workplace supports are in place.
There are also more specific supports for individual workforces. For example, the Department of Education and Training and the Department of Health promote Employee Assistance Programs for individual counselling as needed and have family violence leave available. The Strengthening Hospital Responses to Family Violence initiative includes a Family Violence Workplace Support Program, which includes training around staff disclosures and a suite of resources to help hospitals and health services better support staff who are experiencing family violence.
However, there are gaps in the coverage of this support. For example, Early Childhood Australia noted that many staff in early childhood education and care settings did not have direct clinician supervision, lacked opportunities to debrief and did not have access to an Employee Assistance Program. Similarly, one victim survivor we spoke to explained that although she worked in a public hospital, she was a casual ‘bank’ midwife (that is, she worked across multiple sites, as needed) and therefore did not have access to family violence leave.
Even where support does exist, it appears that there is a real reluctance among staff to disclose their experiences of family violence. Within the hospital study, many staff with lived experience were uneasy about accessing family violence support such as family violence leave within their organisation; their ‘primary concern was that to access leave would require disclosure to somebody in authority who might not respond with sensitivity and discretion’.
Feedback from victim survivors, including those working in universal services and even specialist family violence services, was that there is still a substantial amount of stigma associated with experiencing family violence; that victim survivors are judged as having an inherent weakness and are less desirable as an employee.
“There is still a lot of judgment, victim blaming, and shame placed upon victims of violence.”
- Lily, victim survivor
The midwife we spoke to expressed a very strong reluctance to disclose her family violence to her employee and to access the Employee Assistance Program. She did not feel that her workplace would be supportive, and she commented that in her 13 years with the employer, she would have thought she was the only one who had experienced family violence. Beth’s experience (see Beth’s experience below) is also one of feeling alone and unsupported in the workplace.
“Barely anyone [at work] knows about the family violence I am experiencing. I am very cautious of who I reveal the family violence to as I fear this will
be used against me.”
- Lily, victim survivor
“If you’re open about your situation you do get discriminated against when opportunities for progression arise.”
- Ilona, victim survivor
There is clearly a need to ensure workplaces are truly trauma informed, don’t intentionally or inadvertently discriminate against people with lived experience, and make employees feel safe to disclose if they wish to do so. The work to improve the way universal services identify and respond to family violence must extend to employees as standard practice.
Beth's experience
Beth lived in a small town with her husband, Peter. There were early signs that Beth was experiencing family violence. He contacted her constantly throughout the day, but she put it down to him demonstrating affection for his new wife.
Peter’s drinking and abuse impacted on her mental health, especially once they had children, and he made her an appointment with the local GP. He came along to the appointment where a referral to a psychologist was made, and attended the first appointment with the psychologist. Peter told Beth that he spoke to the doctor who promised to keep him updated on her progress. Because of this, she did not feel safe to speak freely to either the doctor or psychologist.
Their kids attended the local kinder and school. Beth believes there were signs that should have been questioned – like her daughter’s drawing of the family showing Beth looking sad and grumpy. Beth prided herself on being bright and bubbly to the outside world. Although no one asked if she was alright, she was not sure she would have said anything anyway.
Beth believes that despite being good at hiding what was happening, the signs were there for others too. She worked at the local hospital and Peter would call eight or nine times during her shift and no one questioned this. Even after she left the relationship, he would visit her at work and stand at the counter talking to her for hours at a time. Beth wished the nursing supervisor or emergency department doctor had told Peter to leave as she was trying work, but the behaviour was ignored, leaving her to deal with it alone. She felt it was safer to just let him talk. When going through court proceedings, her employer said that she’d taken too much time off work (utilising family violence leave) and that she was not welcome to apply for any other leave. Beth does not believe the hospital had any organisational approach to identifying and responding to family violence.
The only institution that said anything was the university, after she went back to study. When she was struggling to complete her assignments, one lecturer asked her about what was going on at home and referred her to the university psychologist. Another lecturer saw the signs, as they were a victim survivor themselves. This was the first time someone told her that she needed to make sure she was safe. The lightbulb moment for her was when she was tasked with writing an essay on the mental health impacts of family violence. She finally comprehended that she was experiencing abuse. This along with the realisation of the impact it was having on her kids was the catalyst for her to finally leave the relationship.
Source: Family Violence Reform Implementation Monitor, based on a direct victim survivor account.
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