Relationships Australia 2016 - 2017 Annual Report 1 - Page 85

UNIVERSAL SCREENING AT RELATIONSHIPS AUSTRALIA SA The why and the how behind Relationships Australia SA’s journey in implementing the Family Law DOORS universal screening tool was presented on an international stage. The Family Law DOORS is a three part framework that assists separating parents and family law professionals to detect and respond to both wellbeing and safety risks. The Family Law DOORS screening tool was created by Professor Jennifer McIntosh, Director of Family Transitions, in conjunction with Relationships Australia SA. In order to ensure that effective and consistent data systems and analysis underpin measurement of client outcomes, universal screening using the Family Law DOORS has been rolled out across Relationships Australia SA services over the past decade. An audience at the World Congress on Family Law and Children’s Rights in Dublin in June 2017 heard CEO Dr Claire Ralfs present the story behind these major organisation-wide changes at Relationships Australia SA. The emergence of the Family Relationship Centres in Australia and the tragic murder of a client by her husband triggered the investigation into universal screening. “As most family law practitioners know, you only need such a tragedy to happen once in your career to be motivated to build greater safety,” said Dr Ralfs. The presentation, with standing room only, detailed how Relationships Australia SA worked with Professor Jennifer McIntosh to implement the Family Law DOORS. Principal Researcher Jamie Lee went on to explain the steps taken to overcome barriers to making universal screening a standard practice. Complemented by a poster summarising analysis of over 5,000 clients, the presentation has already generated significant interest from practitioners in the UK, Barbados, Canada and India. Editor’s note: From October 2017 Family Law DOORS changed its name to Family DOORS A large scale validation of the Family Law DOORS: a universal screening framework for identifying and responding to family-wide risks after parental separation. Jennifer McIntosh, Deakin University, Australia Yvonne Wells, LaTrobe University, Australia Jamie Lee, Relationships Australia SA, Australia (presenter) Issues Results • Separation brings risks for families (1), with risks greater still for families using post-separation relationships and family law services (2) • But clients using services may not tell practitioners about the risks unless they are asked; and service providers can miss two thirds of family and domestic violence unless they use validated tools (3) • There are other risks too after separation, not just FDV – eg risk to children, parenting stress, mental health, perpetration risks • Can we use universal risk screening (asking all clients briefly about all these risks) to identify which families need further assessment and support? • Is there a validated universal risk screening tool that covers all key risks after separation and is suitable for all clients? Study Rationale • FL-DOORS is a framework to screen, elaborate and assess risk, so it helps us ask about risks (4) • DOORS is already validated as a universal screening tool based on an audit of n=660 (5) • Can DOORS screening now be validated in a large scale validation with the next n=5,772? Your take home messages Meaningful risk domains • DOORS provides a robust framework to screen, elaborate and assess for risk • DOORS had 11 meaningful risk domains, showing good overall internal reliability with .68 -.85 (average .76) Client disclosure makes a difference Self safety concerns 1.59*** 1.30*** 1.23*** 1.20*** .79*** Child safety concerns 1.40*** 1.01 1.34*** 1.40*** .71*** • Screening is different to risk assessment • DOOR 1 is now validated as a universal screening tool on a large scale (n=5,772) • These findings confirm the smaller scale validation (n=660) and have been submitted for peer review and publication (7) • Clients won’t mind if you ask them screening questions with DOORS • It’s very efficient to do universal screening with paper self report ! Prior Safety plan intervention Needed order • DOORS is available at • Collaborations are welcome to use universal risk screening with DOORS in your setting! Serious client matter Any child protection report Mediation occured and many others • What clients say on DOOR 1 links strongly to many important case and safety decisions, showing good external criterion validity Parents corroborate their stories Dad, ‘My behaviour is unsafe.’ The Study Setting Dad, ‘I’m worried about our child’ Dad, ‘I’m worried about our infant’ Mum, ‘His behaviour is unsafe.’ r = .54 *** Dad, ‘She’s not coping.’ • DOORS is routinely used at Relationships Australia SA, a government- subsidised health and family relationships service in South Australia r = .47 *** r = .41 *** Mum, ‘I’m not coping.’ Mum, ‘I’m worried about our child.’ Mum, ‘I’m worried about our infant’ r = .27 *** and many others and many others AUSTRALIA South Australia Adelaide • Analysing matched pairs of shows parties/parents broadly corroborate each other’s story on DOORS risks domains • Strong links found between perpetrator and victim stories of violence risks • What ‘He says’ and what ‘She says’ are closely linked • We audited 5,772 DOORS completed by 5,559 post-separation clients in 2014-16 Confirmed by other measures • Clients were mostly in mediation (80.4%), with 50.5% separated less than two years, and included 1,685 matched pairs of parties or parents 2. Ballard, R. H., Holtzworth-Munroe, A., Applegate, A. G., & Beck, C. J. A. (2011). Detecting intimate partner violence in family and divorce mediation: A Randomized Trial of Intimate Partner Violence Screening. Psychology, Public Policy, and Law, 17(2), 241-263. Family Law DOORS • Screening was done by clients completing paper forms (79.5%) Child Mental Health SDQ Parental Responsiveness Adult not coping r = .21 3. De Maio, J., Kaspiew, R., Smart, D., Dunstan, J., & Moore, S. (2015). Survey of Recently Separated Parents: a study of parents who separated prior to the implementation of the Family Law Amendment (Family Violence and Other Matters) Act 2011. Research report. Melbourne: Australian Institute of Family Studies. Infant Distress Child Distress r=.44 Drug Use r=.41 4. McIntosh, J. E., & Ralfs, C. (2012). The DOORS Detection of Overall Risk Screen Framework. Canberra, Australia: Australian Government Attorney-General’s Department. r=.47 Negative emotions r=.58 r=.21 Toddler Mental Health BITSEA Adult Mental Health K10 • Screening by paper form takes about 15 minutes. Clients complete it the waiting room before meeting with their practitioner for elaboration (DOOR 2) • Clients overwhelming see DOORS as ‘just part of paperwork’ and many can see the benefits to ‘being screened’ (6) References 1. McIntosh, J. E., & Ralfs, C. (2012). The Family Law DOORS Handbook. Canberra, Australia: Australian Government Attorney General’s Department. 5. McIntosh, J. E., Wells, Y., & Lee, J. (2016). Development and validation of the Family Law DOORS. Psychological Assessment, 28(11), 1516-1522. 6. Lee, J., & Ralfs, C. (2015). Truthful, beneficial and respectful: A survey of client attitudes to universal screening for safety risks in families. Poster presented at the Inaugural Stop Domestic Violence, Canberra, Australia 7. Wells, Y., Lee, J., &McIntosh, J.E., (2017). Confirmatory Re-Validation of the Family Law DOORS: Brief Report. Manuscript submitted for publication. • Brief DOORS risk domains link strongly to longer, detailed ‘gold standard’ mental health measures, showing good concurrent validity • Other DOORS risk domains also link to adult mental health For more information the authors can be contacted via Success Indicator: Service outcomes are researched and results are published. Contribute to a Better World | Relationships Australia SA Annual Report 2016 -2017 77