Liz Wall, a Research Officer at ACSSA, interviews Jane Vanderstoel (Executive Officer) and Esen Uygun (Crisis Care Counsellor) of West CASA

Western Region Centre Against Sexual Assault (West CASA) is a Victorian service that aims to facilitate the healing of victim/survivors of sexual assault and work towards the elimination of sexual violence in our society. Their services are available to women, men and young people 12 years and over who are victim/survivors of sexual assault. and counselling services for individuals and families at risk of domestic and family violence.

Liz Wall, a Research Officer at ACSSA, interviews Jane Vanderstoel (Executive Officer) and Esen Uygun (Crisis Care Counsellor) of West CASA

What would you see as the main difference between crisis care response and other therapeutic responses to sexual assault?

Esen Uygun: Essentially, it is in the timing. For a crisis response, the sexual assault happened in the last 72 hours or 2 weeks and we have a coordinated response in that the Sexual Assault Crisis Line (Victoria) take the call and contact us and we are there to support the client and provide immediate counselling. Police may be there to deal with the legal side of it and forensics are there to pick up the evidence. So our response is pretty immediate. It is different to the long-term counselling, what we deal with at CASA is often historic sexual assault so that is more long term and people come quite regularly, but crisis care - we are there on that night and look after them and try to empower them. In crisis mode, the brain functions very differently, people sometimes get very confused. Our job is to make sure they understand everything so that they can give informed consent to all that is happening.

What do you do if someone doesn't speak English in a crisis situation. Is there access to interpreters at all times?

Esen Uygun: Usually we call the interpreter and if possible we want them there in person. It can be difficult to talk with a phone interpreter in a crisis situation. Police can also arrange an interpreter for us. Sometimes they have done all that and we can just arrive and talk to the client and say what is happening. We organise and we try to make sure the interpreter is female if possible. If the community is a brand new community in Australia, it can be harder to find interpreters.

Do the police always have to be involved in a crisis response?

Jane Vanderstoel: No, it sort of depends on the process around what has happened. If it is a recent sexual assault the person may have rung the police as a first reaction. So then they are the first organisation involved. We support the victim/survivor around informed consent and making sure their wishes are being taken care of in terms of the police response and the forensic response. Someone might have a recent assault and they don't want the police but they want some support and ring the sexual assault crisis line. We can meet them at the crisis care unit without the police. We might talk to them about their options with the police and what the procedures are. It is very much around doing what the victim/survivor wants to do. When their decision-making has been taken away through the assault, it is very important that our processes are supportive of them making decisions. Then they might decide in the next day or so that they do want to report to the police and we can organise for them to have the forensics taken. Forensic can only be involved within 72 hours of the assault. If the sexual assault occurred within two weeks some people might ring here direct and say they will come to the Footscray office and we will do a crisis response. It is the importance of helping normalise their reactions and just helping them understand some of what the impacts might be of what happened to them and just give them a lot of that immediate support. If we can have help at that early point, it often assists with their long-term recovery.

If they make that decision to pursue a criminal justice response and report the sexual assault are there some aspects of the formal process that may be confronting for victim/survivors?

Jane: It can be but I think the police are very good, the forensic doctors are very good in that circumstance, very victim focused, and very much want to ensure that the victim/survivor doesn't participate in something that they don't want to. They are given clear support around being able to stop the process at any time.

What sort of special skills and training are required to be a crisis response worker in the sexual assault field? Is it very challenging for staff and are there issues with turnover or trauma for staff in that role?

Esen Uygun: We train them. We have two teams a day team and an after-hours team. The after-hours team does the crisis care. We provide 3 days training for after-hours staff and most of them are working in the field anyway, social workers or welfare workers, they know the system and have a good understanding. Then once we train them, in the beginning of their shift we pair the new workers up with the more experienced after-hours team member so they can observe, learn and ask their questions. Later they go on after-hours shift by themselves and respond the call outs. We also have a back up system, if after-hours team member is not sure how to respond during the call out, they can call the back up person to consult or ask them to go to the unit at Sunshine Hospital to support them.

Jane: I think also some of the key skills are around being supportive and listening, not judging, believing and normalising. It is quite basic counselling techniques that actually set a frame around the victim not taking on the responsibility and blame for what happens.

I also think we are really aware here of vicarious trauma and as an organisation manage that quite well. We have a backup person on the roster - so if someone needs to debrief after a particularly difficult presentation, they can give the back up person or the sexual assault crisis line a call and say that they just had a difficult presentation and need to offload before going home to bed. People often debrief the next day with our intake workers. There are also monthly meetings for people to attend and that is an opportunity for the after-hours team to be able to talk about what has gone well, what hasn't, things we might need to fix or change.

Esen Uygun: In that meeting we go through call-outs and talk about them and it gives a chance for everyone to learn from each other and ensure consistency of care. I just want to add that our after-hours team usually are longer term workers. We have had workers stay up to 10 years in the after-hours team.

Has the crisis care service seen an increase in complexity of cases - have you had to link in with more services and do they understand the needs of survivors of sexual assault?

Esen Uygun: We have a variety, some clients are straightforward and some are very complex, for example, people with mental health issues, and their mental health problems can be activated as a result of sexual assault. Usually when that happens we work with available resources in the hospital such as psychiatric unit. Clients need to be stabilised enough to proceed. Sometimes we see people who are homeless or have drug and alcohol issues. We can only do so much. The priority is that they are safe, whatever that might mean, we will try to maintain that first. We will try to follow up and we will link them with the agencies. If there is homelessness we may need to get them somewhere safe to sleep first. Everyone is different; it is difficult to say a particular number of a particular problem, as each person has their own issues.

How do you work in with these other services and organisations - is it mostly via informal links?

Jane Vanderstoel: Yes, it is sort of an individual response, depending on what each person needs. But we have do have formal relationships with VACP - Victims Assistance and Counselling Program at Western Region Health (Local Health Organisation) - and we can work with them for various practical assistance needs. For example, there was one instance where a woman had been assaulted in her bed and the forensics had taken the bed linen for testing so we could help her get some new bedding.

Esen Uygun: We also have formal protocols with the local Victoria Police Sexual Offences and Child Abuse Investigation (SOCIT) unit who are specially trained in dealing with sexual assault.

Jane Vanderstoel: The other service we use frequently is for people with an intellectual disability and we have a protocol with the Office of the Public Advocate so that we can get some support from them, particularly around communication.

Is that available in a crisis care situation?

Esen Uygun: Yes, they are on call 24 hours, 7 days. And they have a roster for their own regions.

Jane Vanderstoel: And sometimes what happens with those particularly vulnerable clients is that they can present a number of times. In the past, we've done a bit of case consultation with the police SOCIT unit and maybe the disability service that the person might be engaged with or the community housing service, just so that we can put in place some structures to help try and reduce that vulnerability.

What sort of crisis care response do you provide for men?

Esen Uygun: The same - what we provide for women, but they receive different information kits. People are often in a traumatised state at the time and may not retain all the information, so we give them a pack or kit to look at later. For men, this is a slightly different pack. We are still very keen to support them but the number of men assaulted is relatively small although it definitely happens. I think they appreciate the support and confirmation that it is normal, what they are going through and what the process is. It's about increasing their preparedness and safety.

Are there any male crisis response workers?

Esen Uygun: No - we just don't get presentations of men very often. We have only maybe two instances a year.

Jane Vanderstoel: I think the other thing we do for them is the connection through the crisis care and our counselling here. Through our intake system we will contact the victim/survivor the next day and check out how they are going and try and connect them in with some ongoing counselling - either here or locally if they are from another region. We try to connect them into a CASA. We try to make the connection between the crisis response and ongoing counselling.

How does the transition from crisis care work to long-term counselling operate?

Esen Uygun: When we are with our clients in the unit, we talk about the counselling service here at WestCASA and encourage them to receive longer term counselling. They are often confused so we just say "how about we check on you, see how you are going and whether would you like to come in and talk" and they say yes or no. It is their trauma response.

Jane Vanderstoel: If they say they do want counselling they go onto our priority waiting list.

Do people have to wait long for counselling?

Jane Vanderstoel: Unfortunately, yes - it can be 3 months, but usually for a crisis response it is a week or two.

Is there anything else that you would like to talk about the crisis response and sexual assault?

Jane Vanderstoel: I think crisis response is a great service because people feel more informed about their responses to sexual assault and the service can provide a good support.  The police are brilliant in their role, and the crisis response gives people an opportunity to recover faster and get help from other services. Often people need a bit of space with regards to sexual assault before they come to counselling, sometimes it's a year later when they ring and say can they come now. It is good that they can get a bit of help whether they use the crisis response or not.

Do you feel you provide an informal educative role in your dealings with other service providers?

Esen Uygun:Yes, we do. Sexual assault is an area where people often feel that they don't know what to do and struggle to provide appropriate response. As an agency we provide formal training to nurses and other professions and talk about how to appropriately respond sexual assault disclosure. I think it helps them to feel more confident.

Jane Vanderstoel: I think the emergency department staff are very supportive of our service and it is reciprocal because we are not really familiar with hospital settings, so they are supportive around some of the technical stuff that we need. That is a really positive thing for them. They are always happy to see us.