Approaches for specific cohorts

Key findings

• While there are overarching design features that contribute to good practice, there are also specific design features that are appropriate for particular cohorts.
• For Aboriginal cohorts, cultural healing and connection to culture and country is an important feature, so they are able to first address their own healing from past trauma and grief, in order to subsequently address their use of violence. Further, engagement with Elders, sufficient time to deliver and implement the programs, meaningful partnerships and Aboriginal design and delivery are important success factors.
• The program for CALD participants delivered the program in a culturally appropriate manner, including applying a cultural lens to mainstream materials, and having facilitators who belonged to the two cultural groups. This enabled facilitators to explain concepts and information in a manner that could be better understood by participants. The Family safety contact was also an important feature of this program.
• There are some parallels for the LGBTI and women who use force cohorts in terms of enabling participants to heal from violence/trauma and the use of peer support.
• For people with cognitive impairment, the program is a more resource-intensive version of the MBCPs. This is because the small group size, slower pace, specialist workforce and closed group are important features contributing to participant engagement (but are also more resource intensive). Using prompts and visuals has also been beneficial.

5.1 Introduction

Based on the findings from the Royal Commission, FSV sought submissions from service providers to provide community-based perpetrator interventions specifically designed for the following target cohorts:

• culturally and linguistically diverse, including new and emerging communities
• gay, lesbian, bi-sexual, transgender and inter-sex communities
• Aboriginal communities
• females (referred to in this report as women who use force)
• fathers, and/or
• perpetrators with complex needs including drug and alcohol, mental health and cognitive impairment.[1]

This section examines specific design approaches adopted by providers to service the needs of the aforementioned target cohorts, and the effectiveness of these design features. It focuses on the cohort intervention trials, and the case management where the provision of case management targets these cohorts (i.e. Aboriginal case-management providers). As noted in Chapter 3, a gap still exists for a program for men with complex needs, including mental health and AOD issues, as FSV were unable to identify a provider with the required capacity and expertise to deliver this service. Nonetheless, a large proportion of the case management and cohort trial clients had a mental health and/or AOD issue (as assessed by the service provider).

Additionally, data obtained via the data collection tool shows the diversity of participants receiving services via the new community-based perpetrator interventions and case management trials. This is shown for each program type, in Figure 5.1 [2]. It must be noted that total numbers, rather than proportions, are reported due to the large number of blank responses in the data collection tools. Appendix D provides a more detailed view of the responses for each domain, including the total numbers for each response option in the tool, and the number of blank responses.

Participant demographic data – case management (total participant responses = 710)

• 432 are male, 6 identify as transgender
• 267 are under 40
• 336 identify as heterosexual
• 65 identify as Aboriginal and/of Torres Strait Islander
• 419 speak English at home
• 306 have children
• 93 have a history of homelessness
• 256 have mental health and/or AOD issues.

Participant demographic data – cohort trials (total participant responses = 159)

• 117 are male, 8 identify as transgender
• 105 are under 40
• 117 identify as heterosexual
• 17 identify as Aboriginal and/of Torres Strait Islander
• 109 speak English at home
• 126 have children
• 24 have a history of homelessness
• 87 have mental health and/or AOD issues.

Source: Deloitte Access Economics data collection tool

5.2 Culturally and linguistically diverse, including new and emerging communities

There were limited services targeting people from CALD communities that were able to be appointed as a cohort trial provider. FSV reported submissions from CALD communities typically focused on a community prevention response, which was not the intention of the trials. Further, there were submissions from numerous CALD community organisations that did not have the requisite skills in family violence, including working with people who use violence.

InTouch were awarded the tender to provide the CALD cohort trial to newly arrived migrants and refugees from the Hazara (Afghani) and South Asian communities. In 2019/20 this will expand to include programs for African and younger men (18-20 years). Their approach involves a trauma informed approach to address the identified needs of this cohort, related to the intersectionality of their violence from experiences of migration, war and racism, as outlined in Chapter 3. The Afghan groups are run in language and culture as many participants have not been educated in English. However, the South Asian groups are run in English and are open to men from eight countries across South Eastern Asia, including India and Pakistan. Motivation for Change participants receive weekly group work and case management. Effective elements of program delivery are outlined in the following sections.

5.2.1 Culturally and linguistically appropriate

Delivering interventions in a culturally appropriate manner for multicultural cohorts aids participation and engagement. InTouch reported that they were able to deliver the groups in a culturally appropriate manner by applying a cultural lens to mainstream materials, and that this helped participants to better connect to the program content and each other through sharing common cultural aspects. This also provided opportunities to dispel common ‘cultural’ and other myths and excuses that can often be used by some men as justification for their use of violence.

Delivery of the program in the first language of participants improved participants understanding and comprehension of family violence. One group (for South Asian men) was delivered in Dari; the first language of participants. This addressed a barrier to these men being able to previously access perpetrator services, and enabled facilitators to explain concepts and information in a manner that could be better understood by participants.

It’s done in English. But, at the same time, if somebody doesn’t understand things, they can explain in, say Hindi or Gujarati or a different language, because they’re multilingual.

It’s on our own language so we understand 100%. If course go to English rather than my own language, or go other languages, we might not understand. On other programs we just say “Yes, yes, yes” but don’t understand.

Further, the program incorporated shared cultural norms, including facilitators belonging to the two cultural groups. For example, South Asian participants connected over shared family rituals such as marital contracts, which is not possible in mainstream groups. This is turn eased group dynamics, so much so that participants had to be ‘pushed out the door’ at the conclusion of the group.

But, it helped because most of the people were in the programme because they were all Indians or from the same environment. It helped because people opened up. They would talk. Whereas, like, if they had come from different backgrounds – say you were with Australians – you wouldn’t have the same situation, you know? You wouldn’t be able to explain your side of the thing as Australians or some other nationality. If everybody were Westernised, it would have been a different way of doing things. A lot of people wouldn’t join the programme if they were different nationalities. Because it was all similar – I think that’s why it was more comfortable. People were talking, and that. Otherwise, I think a lot of people would have just kept quiet and been there but not actually participated. They wouldn’t have come out and spoken freely, you know?

5.2.2 Community perception

In communities where family violence is considered taboo or poorly understood, there are increased barriers to accessing a perpetrator intervention. This appears to be true for the multicultural cohort. Shame associated with being a person who uses violence appeared to be a reason for some individuals not wanting to attend the multicultural cohort specific groups. To avoid their community members finding out about their use of violence, these individuals attended mainstream groups where their community members would not be present.

InTouch also identified the need to build capacity in the communities with whom they work to understand what constitutes family violence. Community consultation showed there was uncertainty regarding the context of the program. As such, part of the funding was used to build community understanding of the need for family violence programs. Building knowledge of what constitutes family violence was also a core feature and outcome of the program, more so than other programs (see Chapter 6). This may reflect the level of readiness within the community as it relates to understanding of family violence and challenging behaviours.

5.2.3 Referrals

Most referrals for this cohort reportedly came from Magistrates Court or Child Protection (with a small number of intra-organisational referrals from InTouch’s victim service), which can provide an incentive to participate. The data collection tool showed that 19 of the 36 referrals were from the courts. Although InTouch undertook outreach work to educate the community about family violence perpetration, this reportedly had limited impact on creating referrals into the trial.

5.2.4 Family Safety Contact

A history of providing services to women experiencing violence was a strength of the InTouch model for two reasons. Firstly, having the perspective of the people experiencing violence meant they were able to understand the family and cultural context in which they were working with the people using violence. This allowed workers to apply their knowledge of how the family unit operates within the cultural context, and apply that knowledge to the design and interaction of working with men. Secondly, it contributed to the family safety contact worker playing a particularly prominent role relative to other programs Family safety contact workers regularly met with those who were experiencing violence. This feature was highly valued among the women who received the support, and provided them with confidence and strategies to improve their and their child’s safety. However, the role has been more intensive that initially envisaged, and resourcing for the role is currently being shared across other programs.

Before the first time I have a –in the family violence I was really upset and I was really – I get confused and I didn’t know what then I do. Then I come to the [Provider] and talk with the lady…every month…it was really good and opened my mind, how I manage my life…how I’ve lifted myself and how can I protect my children…it was very good.

5.3 People who use violence who are LGBTI

Drummond Street services is delivering Futures Free from Violence, an intervention program designed for the trial for people who use violence who are cis women (heterosexual, bisexual and lesbian) and people who are transgender and diverse in the North Eastern Melbourne and Western Melbourne areas. The aim of this program is to engage women and trans and gender diverse people who use violence, address their underlying needs and identify individual drivers for change. A tailored response to address violent behaviour is developed for each individual participant, which includes both case management and group work. This response manages risk, increases safety for families and creates accountability, as well as addresses the trauma and victimisation many members of this community have experienced, which can lead to a mistrust of government funded and/or delivered services.

5.3.1 Community delivered and peer workforce

Community ownership and delivery has been a key feature of program delivery that has been highly valued by this cohort. Referrals reportedly stem predominantly from word-of-mouth within the LGBTI communities, resulting in high numbers of self-referrals. The data collection tool showed that 24 of the 27 referrals were self-referrals. Workers delivering the program identified as belonging to the LGBTI communities. Participants emphasised the importance of having specialised staff with lived experience to work alongside LGBTI people. This reportedly built trust and rapport between program staff and participants, and was highly valued by participants:

The two therapists that were running it, left the group and that changed. So, there's before that, it was very customised to everyone's needs and we all felt very seen and heard in that space, and then they changed the therapists to two people who weren't specialised in that area who didn't seem quite clear or didn't understand those needs, and so it did shift during the program.

Participants talked of the benefit of being in a safe and non-judgemental environment with other people from similar backgrounds. Having a safe space to discuss issues pertaining to family violence was seen as a crucial element of the program. One participant emphasised the importance of having a ‘community.’

It's actually very profound in a therapeutic sense because I think it's fundamental to being human, is being seen, especially when we're hurting, especially when we've caused hurt to other people. When you feel seen by, say, a community, something special happens, and that's why group is a powerful space.

More than anything, is building up a safety and a trust within the group who have similar lifestyles or similar viewpoints or similar upbringings and that similarity is the first thing that probably – and of course the absolute lack of judgement to people’s lifestyles that is going to be the first bond in any group.

5.3.2 Integrated service response and intensity of service

An integrated service response [3] with a high intensity of service provision, where required, was considered an important feature of the Futures Free from Violence program for several reasons. Firstly, it served as a risk management strategy, given participants could have also experienced violence themselves. This reportedly helped to create a more holistic picture of risk, as the provider was able to provide a range of suitable supports.

Secondly, for LGBTI participants, experiences of discrimination and/or judgement within the mainstream service system has prevented use of services, or distrust of some services. Providing more wrap-around support reportedly ensures that any additional needs can be identified and managed. Given participants have often been isolated from the service system, intensive wrap-around services are often needed.

Despite the intended benefits of the integrated service design, this model did present some significant issues in the delivery of this program. The level and intensity of the service being provided to each individual was greater than anticipated in the original design of the model. This meant that staff became overburdened, and case throughput was not being achieved. This resulted in the original target of 90 participants being reduced to 40. Further, the telephone response for clients was not implemented (initially part of the model design), which may have contributed to the intensity of the face to face support required.

One final aspect of integration has been that team members have worked across both the community-based perpetrator trial and the justice system perpetrator trials.

5.3.3 Healing from violence/trauma

One feature of the model has been its trauma-informed approach, as discussed in Chapter 4, recognising the ‘intersection’ between the experience of trauma and the use of violence in LGBTI communities. Participants noted that they had a history of trauma and violence, having experienced abuse themselves that influenced their presentation of family violence.

I was seeing [Case Worker], and she was probably one of the better kind of people that I've worked with in dealing with some of the trauma that over the past has accumulated and she was really incredible. Like, she knows the intersection of queerness and how we use violence and how that manifests.

5.4 Aboriginal communities

Bendigo and District Aboriginal Cooperative (BDAC) is delivering a culturally relevant program for Aboriginal men and non-Aboriginal men in Aboriginal families. The program’s delivery primarily occurs in bush settings with strong cultural healing underpinnings. The program is based upon the premise that before men can address their behaviour they need to heal from past trauma, loss and grief and that for some perpetrators their role as a parent is an important motivator for behaviour change. Healing is facilitated through 15 sessions that make use of programs, tools and resources.

Anglicare and VACCA are also delivering a program which includes participation of Aboriginal and non-Aboriginal fathers. The trial operates within a culturally safe and inclusive framework for the purpose of being accessible to a diversity of fathers.

Case management funding has also been provided to Aboriginal Community Controlled Organisations (ACCOs) to work with people who use violence who are Aboriginal. As is described throughout this section, some case management providers incorporated cultural healing elements into their case management program and interactions.

5.4.1 Cultural healing and connection to self-identity, culture and country

Recognising the inequalities and intergenerational trauma faced by Aboriginal people (see Chapter 3), a cultural healing component is an important design feature of interventions for people who use violence who are Aboriginal. Stakeholders identified it is necessary for participants to first address their own healing from past trauma and grief, in order to subsequently address their use of violence. [4] Several Aboriginal providers of case management and cohort trials expressed that this focus on healing helps to overcome the ‘root cause’ of violence. Addressing healing first was an explicit design focus of the BDAC cohort trial, while Anglicare adopted a trauma-informed model (Safe and Together) with a Cultural Therapeutic Framework to ensure a cultural healing approach featured in the program.

Different mechanisms were adopted to support cultural healing, such as story-telling, incorporating men’s business, and embedding cultural activities and practices and including Elders. Activities that supported connection to culture were identified as particularly critical for enabling cultural healing to occur (see case study). Components to support cultural healing were also combined. For example, one provider talked about how providing time for men’s business on-country enabled men to open up and talk about their experiences of family violence, facilitating the cultural healing process.

Case study

Through engaging with the local Aboriginal community, one of the providers of a cohort trial for Aboriginal people who use violence recognised that there was a strong desire to provide the opportunity for participants to create cultural items as part of the cohort trial. This feedback was then incorporated into the cohort trial through allocating participant time to creating cultural items - didgeridoos and clapping sticks. This time allocation was purposefully set in the afternoon, after the theme for the day had been discussed.

During this afternoon activity participants were provided with an opportunity to connect to culture. This alone was powerful for participants, particularly for men who had never had the opportunity to connect to culture previously. However creating cultural items also acted as an art therapy session. This is because the time spent creating cultural items facilitated the reflection process. During this time participants reflected on their trauma, family violence and how they had wounded and affected others.

The didgeridoos that the participants made were collected and saved after the session. They were then used again at the closing ceremony of the 12 week cohort trial. Elders participated in the closing ceremony and played the role of handing back the digeridoo to each participant after they had stated the changes that they wanted to make to their behaviour and ‘what they would like to let go of’.

Connection to country, including via program delivery on-country, was identified as an important design feature to support cultural connectedness, immersion and healing. Many Aboriginal case management providers and providers of Aboriginal cohort trials work outside, on-country, with participants. This work outside can be intermittent or regular. For example, one Aboriginal case management provider meets participants at an outdoor café, near a river on a regular basis, while the BDAC cohort trial is delivered on-country weekly. In contrast, Camp Jungai was used on an ad-hoc basis by both Aboriginal cohort trial providers and Aboriginal case management providers to enrich perpetrator interventions for Aboriginal men. Similarly, A Better Way intends to use Gathering Places and cultural sites for program delivery outreach with Aboriginal men. One case-management provider reported using brokerage funding to support on-country participation.

Generally, case management providers in regional areas found it easier to find space to work outside, on-country with participants compared to providers in metropolitan areas. One Aboriginal case management provider in a regional location commented that they are lucky that they could get back to country as much as they do, particularly when comparing their situation to the situation of metropolitan providers.

Elders also played a role in connecting program participants to culture and country, because they were acknowledged and respected community members due to their contribution, cultural integrity and ethical practice. This meant they were in a unique and respected position in the community to relay cultural knowledge:

Elders (especially those who are traditional landowners) have a significant, sacred relationship with the environments where the groups are meeting. Their strong connection to this land permits them to conduct an official Welcome to Country ceremony, show and present historical landmarks and features of the land, and demonstrate how to respect the land in harmonious unity… It can be extremely difficult for one to attain such knowledge, especially if there are no connections to local Aboriginal Elders.

This focus on cultural healing was important for the Aboriginal participants, and enabled them to engage in the content. In one example, a service provider commented that one participant was attending both a mainstream MBCP because it was mandated, and their program because it was culturally safe. They commented that not having a culturally appropriate program for Aboriginal people increases risk to people who experience violence.

5.4.2 Engagement with Elders

A number of cohort trial and case management providers engaged Aboriginal Elders to either guide the development of interventions or to actively participate in the delivery of case management and/or cohort trials.

Engaging Elders in the design phase of cohort trials for Aboriginal people who use violence ensured that cohort trials were appropriate for an Aboriginal cohort. For example, one cohort trial engaged an Elders Advisory Group when deciding the framework to use for the cohort trial, including through direct consultation with the Safe and Together Institute. Elders informed the BDAC trial for the on-country component.

BDAC also included Elders in the delivery of their intervention. They considered having the presence of Elders was at the ‘heart’ of what they do. One of the roles of the Elders was to share their cultural knowledge and artefacts with the group. This led to conversations about different types of trauma and a conversation about how participants had wounded others. Elders were also involved in the closing ceremony for this intervention. Their guidance and physical presence commanded respect from the group and was highly valued by the provider and participants. They considered Elder’s involvement to be vital, and that the work would not be possible without the involvement of these men.

Given the critical role Elders play in the design and delivery of the programs, providers reported it was important they were appropriately compensated for their time, or costs be covered (for example taxi vouchers to provide transport).

5.4.3 Community engagement and referral pathways

Community engagement is paramount in providing an intervention for people who use violence for an Aboriginal cohort, both in case management and the cohort trials. As one case management provider stated – “if we are not seen in the community people will not engage with us” . This provider reported investing considerable energy and time engaging with other ACCOs, men’s groups and the community more generally. However as multiple case-management providers mentioned, this work is not included in KPI measurements or funding allocations.

Community connection was a key mechanism for facilitating referrals. Providers reported it was important for programs to slowly establish a positive reputation in the community in order to attract referrals (predominantly word-of-mouth). An implication is that it may take longer for providers of programs to Aboriginal people to recruit participants if trust and reputation of the program needs to be built first, and evidence of its success visible to community members.

It was also noted that the connection with community could, in certain situations, place pressure on Aboriginal workers who also serve as trusted members of their community. This dual role of worker and community member means they are accountable to the community outside of work hours and could be personally affected if there was an adverse effect of the program. A consequence of this is that it may take more time for a program to become fully operational, as workers need time to familiarise themselves and develop deep trust in the program before they feel comfortable promoting it. This also elevates the responsibility of the worker delivering these programs. These challenges can also contribute to staff burnout and vicarious trauma. Self-care strategies, including support from providers, may therefore be particularly important for Aboriginal workers to prevent burnout and vicarious trauma.

5.4.4 Aboriginal designed and delivered

Case management and cohort trials for Aboriginal people were designed and/or delivered by Aboriginal Community Controlled Organisations and/or workers. This has been necessary for ensuring the cultural appropriateness of the program and for building acceptance and trust (and subsequently uptake) of the program within communities. One mechanism to enable Aboriginal-led program design has been through governance structures. For example, one provider has established a Cultural Advisory Group to provide advice and guidance on cultural practice and knowledge. Further, all case management providers targeting Aboriginal participants are delivered by ACCOs, have an Aboriginal worker or have auspiced an Aboriginal organisation.

5.4.5 Meaningful partnerships

Where partnerships between the ACCO and non-ACCO delivery organisations has occurred, these have taken time to establish, and require mutual trust and respect. This is because the organisations bring different perspectives and knowledge, and working through these differences can take time. When it works, it can be an important enabler of success. For example, both Anglicare and VACCA respectively wrote the submission together, established governance arrangements and held working group meetings together. The different ways of working, and challenges in bringing together two organisations in a short period of time to deliver a program, contributed to the partnership between BDAC and Centre for non-Violence discontinuing.

Co-location enabled creation of meaningful partnerships, recognising it is important supervisory and accountability lines are clearly understood where co-location occurs. VACCA reported that the physical office of Anglicare is welcoming and culturally safe for Aboriginal people. This provided VACCA with the confidence to co-locate an employee within Anglicare. Anglicare also offered to co-locate at VACCA which represented to VACCA a genuine commitment to an equal and respectful partnership. An unintended benefit of this is that it has reportedly helped in building collective knowledge and expertise between Aboriginal and non-Aboriginal services.

Cohort providers reported that while the establishment of these meaningful partnerships may have lengthened the implementation process, it created a trusted and respectful foundation upon which the program has continued to be built.

5.4.6 Time to deliver and implement programs

A common theme was the length of time it takes to appropriately deliver and implement programs for Aboriginal cohorts. As mentioned in Section 5.4.3, cohort trial providers reported it was necessary to establish recognition and trust of the program within the community to aid the flow of referrals; something that takes time. Similarly, as outlined in 5.4.5, meaningful partnerships between ACCO and non-ACCO also take time to establish but are critical for program success. Providers reported there has been an inherent tension between having a 12-month pilot and the need for sufficient time to ensure the programs are culturally safe and create referral pathways. Twelve months is seen as a relatively brief period with an arbitrary end date.

Further, it was reported that an extended length of time for content delivery is important. Anglicare and VACCA’s submission notes that “programs with Aboriginal men are most effective when operating in non-time limited environments”. Similarly, BDAC extended the number of sessions it delivered because it found more time was needed to cover the content.

5.5 Women who use force

One program targeting women who use force was initially funded, with a second program (Futures Free from Violence) subsequently including women who use force into their program. Positive Shift is a perpetrator intervention program for women who use force in the Central Highlands, North East Melbourne and Western Melbourne. The intervention is being delivered by Baptcare in partnership with Berry Street. The +SHIFT program uses a different approach to Men’s Violence programs, as the literature indicates that women’s use of force is guided by different dynamics to men’s.

The feedback provided by these participants was consistent with the views provided by the LGBTI participants. A majority of women who use violence in intimate relationships are also victims of violence [5]. Considering this, specific approaches are required for this cohort which are sensitive to experiences as a victim, yet also empathise accountability.

5.5.1 Healing from violence/trauma

Baptcare adopted a strengths-based approach to working with women who use force, recognising that most or all participants have past experience of violence. By drawing on systems theory and a feminist framework, the program enabled women to understand what led to their use of violence and the relationship between past trauma and current acts of violence. Many participants discussed how the program helped them to understand their own behaviour, and improve their knowledge of family violence more broadly for example, that it does not pertain only to physical abuse.

It's for women who were at a point in their relationship where there's some type of family violence and they have now lost control of how they would respond to that situation, and respond out of desperation, which in turn, makes them do things that they wouldn't do under normal circumstances.

I saw lot of family violence as a child, and there are things that I do to try to protect myself from those happening, that also is a form of family violence. So like, I did those things because I'd seen so much.

5.5.2 Peer support

Many participants emphasised the importance of feeling a sense of belonging within the group. Having a safe space for women to discuss family violence was appreciated by participants, with many noting that they were not aware of other programs that specifically serviced women. One participant discussed that there is minimal recognition that women can use violence, noting that this limits opportunities for change:

I think having a safe place for women to be able to talk about it is really good, because society thinks that, 'Oh no, only men. Men only do this' but it's not true… it's nice to give girls a chance to change as well.

5.6 Fathers

Most program participants across the cohort and case management trials were fathers. Seventy-four per cent of case management participants were reportedly fathers and of cohort trial participants. One cohort trial was specifically designed for fathers – Aboriginal and non-Aboriginal – and is the focus of this section.

Anglicare and VACCA are trialling the Safe & Together Model which is a flexible community-based intervention program, based on internationally recognised best practise. The model has the intention of finding a better way for fathers who have been using violence to be in their children’s lives. The trial offers tailored responses to the needs of fathers and addresses the underlying drivers of behaviour. There are three phases of the intervention which include:

1. engagement and motivation
2. assessing underlying drivers and intersecting factors which includes psycho-social-cultural assessment, individualised intervention (one-to-one and face-to-face), case management and referrals, cultural healing and mid-point review
3. generativity and looking to the future.

A key feature of the cohort trial for fathers is that it focuses on the whole family unit (including children). Rather than delivering the program in a group with other people who use violence, it is delivered as more of a case management model with each family unit including the children where appropriate. This encourages people who experienced violence to be involved in the program, and they were more involved in support compared to other programs. Some participants indicated they would have appreciated even further engagement with the child.

I wanted to make the best choices… and get the help that not only I needed but that [daughter] needed. And the program provided that

It also means that the family safety contact function is a strong feature of the model, noting that the family safety contact worker is also the case worker for the person using violence (unless the person experiencing violence has a preference otherwise). The service provider reported that this has assisted them having a complete picture of the situation to manage risk.

Sessions for people who used violence were not dissimilar from the other perpetrator intervention programs, apart from having a greater emphasis on parenting skills in the context of family violence. Participants reported that most of their discussions with their case worker centred on how to be a better father, with this being a key focus/goal of the program.

[Case worker] just talks about good parenting, being a role model to your children…like being a protector, and being a good partner.

[A typical session] Basically [involves] talking of what I did for the last week or the last fortnight with the kids, with the children. Was there any hiccups, was there any arguments, how did I react if there was?

The service provider reported that focusing on parenting and children can be an important motivator for engaging program participants.

5.7 Cognitive impairment

Bethany Community Support is providing an intervention program for perpetrators who have a cognitive impairment. In the past, Bethany have found that many perpetrators referred to them via police active referrals present with complexities that influence their use of violence, including an estimate of 20-30% with cognitive impairment. To address this gap in service provision Bethany Community Support engaged a specialist disability practitioner to adapt group work and individual session activities and materials to suit the needs of perpetrators with cognitive impairment.

Peninsula Health’s intervention addresses the needs of male perpetrators of family violence with cognitive impairment primarily due to brain injury. Like Bethany, Peninsula Health has recognised in the past that as many as three to four men in each Men’s Behaviour Change Program group demonstrate low levels of participation and facilitators have questioned whether this may be due to participants’ ability to learn. These needs are addressed through a modified MBCP group as well as one-to-one cognitive behavioural therapy and Good Lives Model case management.

5.7.1 Group design – slow pace and small, closed group

Service providers and people who used violence with cognitive impairment identified that the smaller group size relative to mainstream MBCPs was a beneficial design feature for engaging with the group. A few program participants identified that the group had a smaller number of participants compared to ones they had previously been involved in, and noted that it was difficult for them to integrate in larger groups. Participants felt that the people who were involved in the program were those who would struggle being part of a larger group.

The first group they didn’t do – arrange one on ones as such… this one I’m in now is focused on those perhaps struggling a little bit more. Or perhaps feel uncomfortable in a bigger group. And it’s the kind of guys who perhaps need more mediation and support than the average Joe.

There was this program and a similar one, a bigger group, but they insisted that I do the smaller group because I would get lost in a bigger group being autistic. It's easier for me to associate in a smaller group.

The smaller group size, coupled with the closed group, has reportedly assisted program participants to ‘open up’ more and talk about their violent behaviour. Service providers reported this is because the small closed group means they feel safer to talk about their violent behaviour, and consequently are more engaged in the program itself. Further, the slower pace of the group has been helpful, including because it provides more time for people with language difficulties to formulate their answer.

5.7.2 Using prompts and visuals

Both providers of cohort trials for individuals who use violence with an intellectual disability used ‘prompts’ in their perpetrator interventions. The idea to create theses ‘prompts’ came from subject matter experts in disability. These ‘prompts’ were used to teach participants how to correctly interpret the emotions of others, in particularly their partners. This was done through visually demonstrating the different emotions. Feedback from one of the participant’s partners was that after the first session that utilised ‘prompts’ her partner recognised her emotion correctly as sadness. Previously he had been misinterpreted her emotion for smugness, which had previously escalated his anger.

Participants involved in the cognitive impairment trials reported an emphasis on using visual stimuli, such as pictures and videos, to promote discussions in groups, and that this assisted in their ability to interpret emotions and understand. These groups also appeared to adopt elements of cognitive therapy, such as exploring the links between thoughts, feelings, and behaviours.

They've usually got some pictures on laminated sheet of paper about what's violence, nonviolence, so it's visual. So yeah, we just usually take a card and talk about what we see on that picture… I'm more a visual person so yeah, that photo really helps. It makes sense to me a lot easier.

5.7.3 Workforce intensity and skill-set

An enabler of the program has been having specialists assist in the design and delivery of the program. For example, the Peninsula Health trial was led by psychologists, a neuro-psychologist, while Bethany engaged a disability specialist to design and implement their trial program. This means the programs adopt a more clinical approach. In addition, there is greater resource intensity compared to MBCPs. Facilitators use more visual aids and slow down the pace of the content.

5.7.4 Unintended consequence

One service provider reported that an unexpected consequence of the program has been that it has increased awareness and understanding among facilitators within the mainstream MBCPs around working with people with cognitive impairment. This includes facilitators being more aware of challenges within their group, and how and why participants may present with particular behaviours, all of which has contributed to them being more flexible when running the MBCP.

Additionally, one provider commented on the unanticipated complexity that has arisen in some cases whereby a client carer is seen to be contributing to the cycle of abuse. Case workers had been noticing controlling-type behaviours from some carers, which they assessed to be a factor in the dysfunctional relationship dynamic. This included examples where a carer enforced strict daily regimes on the client. The provider indicated they have been in contact with a disability peak body in order to determine how to address this issue.