Environmental Scan – Part 3

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Part three: Environmental scan of community service provision

5    Characteristics of community services

5.1    Victim/survivors’ service needs
5.2    Types of services provided
5.3    Access to services
5.4    Survey respondents’ views on how service delivery could be improved
5.5    Summary

6    Views on community capacity

6.1    Perceived gaps in service provision for victim/survivors
6.2    Meeting emotional and medical needs
6.3    What works – effective interventions
6.4    Summary

Endnotes
Glossary of Maori terms
References

5    Characteristics of community services

This chapter describes the community service providers that participated in the survey. This is based on self-reported information provided by representatives from agencies or individual service providers (i.e. counsellors) and looks at the characteristics of the clients they see, the services they provide, and their views on what could assist them to improve service delivery.²⁵ A broader look at community capacity, including survey respondents’ views on how well their community as a whole is able to deliver effective interventions, is presented in chapter 6.

As illustrated in chapter 3, a broad range of services in the community respond to victim/survivors of sexual violence, including specialist sexual violence agencies (SSVAs), women’s refuges, Victim Support, mental health counselling services, medical services, and other community agencies. These providers vary considerably in the types of services they offer, and the nature and extent of their interactions with victim/survivors. Their level of specialisation also varies, and SSVAs are the only group that specialises solely in responding to victim/survivors of sexual violence.

This chapter aims to clarify which agencies provide what services and their views on their ability to meet the needs of victim/survivors who come to them.
Information is presented about:

• the service needs of victim/survivors (section 5.1)
• the types of services provided (section 5.2)
• the factors that influence access to services, including to people from diverse backgrounds (section 5.3)
• service providers’ views on ways to improve service delivery (section 5.4).

Note: Findings presented in this chapter are not a stocktake of services, because the characteristics of those who did not respond to the survey are unknown.

5.1    Victim/survivors’ service needs

Survey respondents were asked questions about the needs and characteristics of the victim/survivors that came to them. This is a useful starting point before moving on to consider how well service providers feel they respond to such needs.

5.1.1    Client characteristics (recent compared with historical sexual violence)
The length of the period between when an assault occurred and treatment-seeking has implications for the needs and types of services required (e.g. crisis intervention or longer-term support and counselling). Some victim/survivors seek assistance from services soon after an assault, others do not. Some will only ever seek help from family/whānau or friends, and some may never tell anyone. Multiple factors influence an individual’s decision to disclose, including the fear of not being believed, a lack of trust in the criminal justice system, or not recognising what happened as sexual violation. Delays in reporting can also be because of a change in the a victim/survivor’s life circumstances, such as leaving a violent relationship and wanting to break the cycle of violence or being no longer able to cope with the affects of the assault and/or previous victimisations, including childhood sexual abuse.

The majority of service providers reported that they worked mostly with clients who were victims of historical sexual violence (i.e. violence occurring over 12 months ago).²⁶ Nearly two-thirds of the service providers reported that ‘most’ or ‘all’ of their clients were seeking help in relation to historical sexual violence. This was particularly true with mental health agencies (91 percent) and SSVAs (76 percent). Victim Support and women’s refuges were the only type of service providers where recent sexual violence cases were more frequent – half or more of their caseloads (82 percent and 70 percent, respectively).

5.1.2    Information requests
Access to information is one of the key requirements of victim/survivors (and/or their family/whānau). The type of information they are seeking indicates the type of needs they are seeking help with.

Survey respondents were asked to indicate which of the seven information requests listed in Table 8 were commonly made by victim/survivors who came to their agency/service. Responses in Table 8 are presented in order of frequency (from most to least frequent).

The most frequent requests from victim/survivors were for information on counselling (made by 84 percent of respondents), followed by a related request on ‘how to feel better’ (67 percent). Information on court processes, reporting to the police and victims’ rights were also frequently requested. 

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Table 8: Frequency of information requests by (n=166)

Some information requests were higher for certain types of service providers. Victim Support agencies reported receiving a particularly high level of requests for information on victims’ rights (90 percent of Victim Support respondents). Information on pregnancy, sexually transmitted infections or injuries were far more commonly made of medical services (82 percent of medical services survey respondents).

Other common information requests respondents mentioned related to:

• accessing financial support if unable to work because of trauma
• understanding why the sexual violence occurred
• managing day-to-day relationships.

A semi-rural Māori service provider commented that victim/survivors need information about the services available and the definition of sexual violation/rape.

Because it’s amazing really the number of clients who still say ‘I’m not sure if it is rape’  … They know something was wrong but they don’t want to go so strong as to say it was rape; especially when it’s a partner, ‘I love somebody who raped me’. It’s easier to say, ‘I love someone who likes rough sex’.

Other SSVAs also described how it is relatively common for clients who have been sexually abused as children to not realise that what is happening to them in their marriage is sexual violation.

A few suggestions were offered on what would assist in providing information to victim/survivors. These included:

• written information on victims’ rights, reporting to police, and court processes
• a directory of procedures and relevant service providers.

5.1.3    Additional services required by victim/survivors
In addition to coping with the direct consequences of the sexual violence, victim/survivors can often have other needs they require assistance with. Survey respondents were asked to indicate whether victim/survivors who contacted their agency/service had any of the 11 additional needs listed in Table 9.

Service providers identified a high number of additional needs, suggesting victim/survivors have high and complex needs. Over three-quarters of the service providers identified mental health issues, family/domestic violence, alcohol and other drug counselling, and suicide and self-harm as additional needs.

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Table 9: Identifying additional needs

Some survey respondents noted other types of needs that victim/survivors had presented with: financial support (n=8), childcare (n=2), transport (n=2), assistance around personal safety issues when working as a sex-worker (n=2), managing
work-related issues (n=1), relationship issues (n=1), sexuality issues (n=1), and historical abuse (n=1).

Survey respondents were also asked to indicate, in their area, where they feel increased service capacity is required to ensure victim/survivors can get appropriate responses to their needs. The three areas most frequently noted as needing more services were in relation to:

• immigration issues
• language translation
• accommodation.

Immigration issues and language translation, while less common among those victim/survivors who sought assistance from service providers, appeared to have the highest levels of perceived unmet need.

5.2    Types of services provided

To better understand which type of agencies provides what types of services, survey respondents were asked to indicate which of the services listed in Table 10 they provided to victim/survivors. Note they were not asked whether they had adequate funding to deliver these services or to comment on how well they felt they were able to deliver them.

The data presented provide some indication of where victim/survivors are likely to be able to access the different types of assistance they require. However this is not a stocktake of services and is representative of only those service providers that participated in the research.

As illustrated in Table 10, some agencies provide a wide range of services (e.g. SSVAs), whereas other agencies have particular areas of focus (e.g. medical services and mental health counselling services).

The SSVAs, women’s refuges and Victim Support are most likely to provide crisis intervention, advice and advocacy. Education and prevention work was also identified as part of most (93 percent) SSVAs, and almost two-thirds (64 percent) of refuges. SSVAs and Māori agencies were the most frequent providers of family/whānau support.²⁷

Pregnancy, sexually transmitted infection and other tests were most frequently provided by medical services, although a small number of integrated community health centres (in the other community agencies group) reported they offered these services. Surprisingly, not all medical services reported that they assessed and treated injuries (most health centres did, some sexual health clinics, but few family planning centres). However, the findings may well reflect differences in how an injury is defined. Interestingly, 36 percent of mental health counselling services also indicated they assessed and treated injuries, which for this group presumably was interpreted to include emotional, psychological and other mental health effects. This would most likely be applicable to all counsellors.

Counselling was provided, as expected, by all mental health counselling services and most SSVAs (93 percent). It was also provided by 62 percent of Māori providers. Four medical providers (36 percent) also provided counselling. These were all university health centres that provided integrated health services. 

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Table 10: Types of services provided (n=167)

Notes: CA = other community agencies; Med = medical; MH = mental health counselling service; Ref = women’s refuges; SSVA = specialist sexual violence agency; VS = Victim Support. Percentages should be interpreted with caution as base numbers are low.

1.     One medical survey had missing data for this variable.

The principal service providers that offered support to victim/survivors when reporting to the police were SSVAs, Victim Support, and women’s refuges. Assistance in preparing for court and support during court was most likely to be provided by Victim Support or SSVAs.

Community service providers were also asked if they provided any additional services. Many of the responses given were examples of categories of assistance already indicated (e.g. types of counselling such as telephone counselling and family violence counselling). Other additional services were kaupapa Māori services, emergency housing, food, and youth education programmes. 

5.2.1    Perceived shortfalls in types of services
Survey respondents were asked to indicate the types of services they felt were not being delivered.

Among the most frequently cited shortfalls were insufficient specialist sexual violence services to deliver crisis interventions, sexual violence education and prevention, and specialist social work and counselling services (n=13).

Anyone who works with sexual violence survivors must have extensive and specialised training in the specifics of crisis intervention. A local specialised, integrated, professional, fully funded, sexual assault service is needed. (Mental health counsellor)

Survey respondents from three areas reported there being no SSVAs (Kapiti Coast in the Wellington region, Hastings in the Eastern region, and South Otago in the Southern region). Three service providers noted there were no SSVAs for Māori in their region (Christchurch, Canterbury; Rotorua, Bay of Plenty).²⁸ One service provider commented there were no SSVAs for men in their area (Waitakere City in Waitemata).

These areas should be seen as the minimum and not total number of areas requiring SSVAs, because survey responses were received only from areas where there was at least some level of service provision. Areas where there are no agencies/services are not represented.

One survey respondent elaborated on why it was important for victim/survivors to have access to specialised sexual violence services.

If sexual abuse is not dealt with properly and with specialised people, it can turn very quickly for the victim, including feelings of shame, disappointment, filth and anger. (Women’s refuge)

There were also shortfalls in forensic medical services (n=13). Concerns centred around the lack of doctors qualified to conduct examinations and the resulting delays when victim/survivors had to travel to where forensic medical examination services were available.

the lack of medical staff to do the forensic tests in the outlying areas, resulting in the need to travel sometimes more than 200 km. (Victim Support)

 A lack of restorative justice services for victim/survivors of sexual violence was also noted by several respondents (n=14).²⁹

Many survivors of sexual violence ask – 'why'. Restorative justice conferencing is one way to give survivors an opportunity to ask this and other questions and empowers them to begin the healing process by telling the offender the effects and what is needed. The offender may begin rehabilitation by hearing the effects, take responsibility and make amends. (Mental health counsellor)

Māori providers also requested availability of restorative justice conferencing, with the proviso that conference facilitators were Māori. One Māori provider requested that marae (Māori meeting place) justice be recognised. 

5.3    Access to services

Survey respondents were asked to describe how clients came to access their service or agency (i.e. what the referral mechanism was). They were also asked to give their views on how well they were able to deliver services to diverse groups of victim/survivors, providing some indication of particular groups that might experience difficulties in accessing services to fully meet their needs.

5.3.1    Referral mechanisms
Survey respondents were asked to indicate how common it was that clients came to them through the four referral mechanisms listed in Table 11. Data presented are the proportion of survey respondents who indicated the referral mechanism listed was how clients ‘mostly’ or ‘always’ came to them.

As can be seen in Table 5.4 self-referral by victim/survivor was the most common form of referral for all service providers except for Victim Support, where 85 percent came from police referrals. High levels of self-referral point to the importance of service providers and the services they offer being well publicised.

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Table 11: Most common methods of referral to service provider (n=166)1

Notes: CA = other community agencies; Med = medical; MH = mental health counselling service; Ref = women’s refuges; SSVA = specialist sexual violence agency; VS = Victim Support. More than one method of referral was possible. Percentages should be interpreted with caution because base numbers are low.

1. Survey respondents indicated if clients came to service provider ‘never’, ‘sometimes’, ‘mostly’ or ‘always’ via the different methods of referral. Data presented are the proportion of respondents who reported the method of referral was used ‘mostly’ or ‘always’.
2. One SSVA survey had missing data for this variable.
3. One medical survey had missing data for this variable.

Some of the differences in the method of referral across types of service reflect agency policies and agreements; for example, Victim Support is located in police stations, so the high level of referral from police reflects this proximity and agreed referral protocols between the police and Victim Support. Survey respondents from women’s refuges indicated they only ‘sometimes’ accepted referrals from other service providers, which may reflect their policy of working directly with clients, even if initial information comes from another source. Community agencies and Māori providers have comparatively higher rates of referral from the victim/survivor’s family/whānau or friends (38 percent), perhaps reflecting their close links to their communities.

Referral from another agency was generally less common, and where this had occurred the most common referral routes were through a victim/survivor’s doctor (n=10). Other referral agencies mentioned included Plunket,³⁰ a midwife, the Community Probation Service, social workers, counsellors, and a church.

For rural Māori, referrals were more likely to be made by victim/survivors and whānau or from a variety of services including Child, Youth and Family³¹ and Barnardos. Mental health counsellors also pointed out referrals often came through the ACC list of registered counsellors
 

5.3.2    How well service providers perceived they could provide services to diverse groups
Service providers were asked to rate how well they felt their agency (or themselves in the case of counsellors) provides services to victim/survivors from a range of diverse groups (responses were given on a five-point scale from 1 (not very well) to 5 (very well)). Groups with lower ratings (services perceived to be delivered less well) are indicative of those groups more likely to experience difficulties in accessing services to fully meet their needs.

The groups of clients that service providers felt least able to deliver services well to were victim/survivors who were:

• ethnic, migrant, refugee peoples (65 percent of service providers rated their service delivery as average or worse)
• Pacific peoples (49 percent of service providers rated their service delivery as average or worse)
• people with disabilities (47 percent of service providers rated their service delivery as average or worse).

Just under a third of service providers had concerns over their ability to deliver services to Māori victim/survivors (30 percent) and male victim/survivors (29 percent), and around a quarter in relation to victim/survivors who were sex-workers (24 percent). Some service providers commented on factors they felt limited their ability to deliver effective services to these groups. These are reviewed below.

Factors limiting service providers’ ability to meet the needs of specific groups of victim/survivors
An open-ended question invited survey respondents to describe the factors they felt limited their ability to meet the needs of specific groups of victim/survivors (Māori, Pacific peoples, youth, and other specific groups). Identifying such factors points to ways access to effective service delivery might be improved for these groups. Responses were analysed and the findings are presented below.

Māori victim/survivors
Factors perceived to be limiting service providers’ ability to deliver effective services to Māori victim/survivors have been separated out, according to whether the providers were Māori or non-Māori.

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Māori service providers: Of the 16 Māori service providers that completed the survey, six agencies commented on factors that limited their ability to meet the needs of Māori. Two Māori mental health counselling services stated that their workers had to cover large geographical distances, which meant it was difficult to get to some clients. A lack of ongoing specialist support for Māori victim/survivors and their whānau and a lack of resources were also issues for them.

Getting access to clients who live out of [the] city centre and can’t travel. Finding resources to meet their practical and social support needs before they can be stable enough to make good use of counselling. Lack of people to work with in teams to work with whānau and social needs. (Māori mental health counsellor)

Three of the ten Māori community agencies stated that they did not have enough Māori counsellors. One Māori community agency commented on difficulties experienced working with other agencies.

Non-Māori services thinking of referring to Māori services too late. Protocols not being followed. Ignorance, and non-Māori assumptions about Māori behaviour. (Māori community agency)

Non-Māori service providers: Forty-eight (30 percent) of the non-Māori service providers commented on some of the limitations they felt they had in meeting the needs of Māori clients. Twenty-four (15 percent) service providers identified a lack of Māori counsellors and/or staff as a limitation.

We do not have Māori workers. We have been unable to employ any as they either don't apply or do not have enough skills (we would be prepared to train but we need basic skills). Most Māori workers with skills are in demand with Māori services. (Women’s refuge)

There is a real shortage of Māori counsellors in the [Tasman] areas, let alone those also trained to work with effects of rape/sexual abuse. (Mental health counsellor)

Three respondents specifically commented on the need for Māori men to work with Māori male victim/survivors of sexual violence.

Twenty (13 percent) service providers identified their lack of tikanga Māori (customs, rules, principles) and te reo Māori (language) as limitations for working with Māori clients.

Although I have high levels of awareness of Māori culture and the effects of colonisation I am not Māori so am limited in connecting on a deeper cultural level. (Mental health counsellor)

Interestingly, comments from one-third (n=54) of non-Māori service providers indicated they did not perceive themselves to have any problems delivering services to Māori clients. Explanations for this were that:

• agencies refer Māori clients to Māori service providers (n=11)
• the agency provides staff and counsellors with cultural supervision (n=11)
• the agency has Māori staff (n=7).

Six providers said that this was not an issue for them because they did not get referrals for Māori clients.

We generally don't get Māori clients. It's because we don't have any Māori counsellors working here. (Mental health counsellor)

Pacific clients
Almost half of the survey respondents rated their service delivery to Pacific peoples as being average or less. Sixty-one (34 percent) service providers, including 63 percent of SSVAs (17 out of 27), commented on the factors they felt limited their ability to meet the needs of Pacific clients who came to them.

Fifty-five (31 percent) service providers identified their lack of knowledge of Pacific languages and cultures as limiting their ability to provide effective services to this group. This is particularly challenging because Pacific people are not a homogenous group, coming from different islands with their own languages and cultures.

We are a very Pākehā organisation that cannot provide fully culturally appropriate services for Pacific women. Also Pacific and migrant women aren't accessing our service. We are working on what the barriers are for both parties – agency and potential client. (SSVA)

A further 13 (7 percent) service providers identified the lack of Pacific services as a problem.

A difficulty is that there is no local Pacifica service to collaborate with regards sexual abuse. We do collaborate with generic Pacifica services, however this has limitations. (SSVA)

Three mental health counsellors identified an additional issue for Pacific victim/survivors – ACC does not cover abuse that occurred in the Pacific Islands, so counselling is too expensive for many Pacific victim/survivors.

Young clients
Comments from the majority of service providers indicated they believed they were able to deliver effective services to youth (aged 16–25), with only 28 (15 percent) commenting on perceived limitations.

Seven service providers identified issues with working relationships with other organisations in their communities. Two stated they were unable to work with young survivors in schools, and others talked of poor inter-agency links and clumsy referral processes.

Sometimes there is interference from other agencies e.g. child, family and mental health services that refuse to work alongside ACC sensitive claims or private practitioners. (Mental health counsellor)

Five mental health counsellors commented on the difficulty of meeting the level of need of some young clients who had been sexually assaulted.

I have concerns regarding young people who have no adult supervision in their lives and who are not connected to other services. With such clients, mobility, poverty, drug abuse, not showing for appointments and suicidality are big issues. (Mental health counsellor)

Other issues specific to counsellors were that they were not trained to work with young clients (n=7) and had difficulty establishing rapport ‘across the generation gap’ (n=3).

Other groups of clients
Fifty-eight (32 percent) service providers commented on difficulties they experienced in delivering effective services to other groups of clients, including ethnic minority, refugee and new migrant victim/survivors; male victim/survivors; and victim/survivors with disabilities.

Ethnic minority, refugee and new migrant victim/survivors: Ethnic minority, refugee and new migrant victim/survivors were the group that survey respondents felt most challenged to deliver effective services to, with 65 percent rating their service delivery to this group as average or worse). Twenty-one survey respondents commented on the limitations they had experienced in meeting the needs of this group because of their lack of knowledge about the cultures and languages of these clients. They also identified a lack of networks or links into these communities, along with the lack of culturally appropriate services to refer clients to.

Ten service providers stated that a major concern for refugee and new migrant clients was that no ACC funding for counselling is available if the sexual violation occurred outside New Zealand.

ACC regulations state that if the historical abuse of an immigrant occurred outside of NZ, they are not eligible for funding for counselling. This does not make sense if we are wanting them to become fully functioning, healthy members of our society. (Mental health counsellor)

Male victim/survivors: Just under a third (29 percent) of the survey respondents identified their service delivery to male victim/survivors as being average or worse. The main factor identified as limiting this group’s ability to have its needs met was lack of services, raised by ten service providers. Four of these services were SSVAs that had been set up specifically to support women, so did not provide services to male victim/survivors.

Our … constitution papers [state we don't deal with men]. (SSVA)

We are a feminist organisation, with a women-centred empowerment philosophy of valuing the need to have a ‘woman and child only space’. This limits men being able to come to the centre, however we have begun to offer info and support to men over the phone. We are not experts on the impact sexual violence has on men, and we are all women. We are not altering the ‘women only’ aspect of our service, but would love to see a specialist service for male survivors run by men. (SSVA)

Victim/survivors with disabilities: Just under half of the survey respondents identified their service delivery to victim/survivors with disabilities as being average or worse (47 percent). Eleven (6 percent) service providers identified factors that limited their ability to meet the needs of victim/survivors with disabilities. Limitations centred on access difficulties for this group such as:

• no wheelchair access to the building (n=6)
• no access to Deaf interpreters (n=2)
• no professional development for working with people with intellectual disabilities (n=2)
• no information in Braille (n=1).

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5.4    Survey respondents’ views on how service delivery could be improved

Survey respondents were asked to identify which of the factors listed in Table 12 would assist their agencies (or themselves) to deliver better services to the victim/survivors that come to them. The top priorities were more funding for agencies and more appropriately skilled and experienced practitioners in the field, and ensuring existing practitioners had access to professional development.

Increased funding was identified as the top need for the majority of respondents from SSVAs, women’s refuges and mental health counselling services. The first two of these three service providers are those most likely to deliver crisis intervention and the third is most likely to be responding to the impacts of sexual violence.

Funding appeared to be a particular issue for SSVAs with all but one identifying a need for increased funding (96 percent).

Current service delivery levels are not indicative of resource levels. Our agency has repeatedly been on the verge of financial collapse and required government assistance every time. The way we have managed money has been closely scrutinised and the conclusion every time has been that actually we run the services on the equivalent of 'the smell of an oily rag’. (SSVA)

Table 12: Survey respondents’ views on how they can be assisted to provide better services

Notes: CA = other community agencies; Med = medical; MH = mental health counselling service; Ref = women’s refuges; SSVA = specialist sexual violence agency; VS = Victim Support. Percentages should be interpreted with caution because base numbers are low.
    1    One SSVA survey had missing data for this variable.
    2    One medical survey had missing data for this variable.

The majority of SSVAs identified a range of funding-related needs that could also improve their service delivery: workforce issues such as increased level of staffing (73 percent of SSVAs), more qualified and experienced staff (62 percent), and improved access to training (54 percent), and improved facilities and equipment (58 percent).

Another major issue for SSVAs related to improved access to services. Over
two-thirds of SSVAs indicated this as a way to provide better services compared with around one-third or fewer respondents from other services. This reflected a concern about communities’ relatively low level of awareness of SSVAs and communities’ lack of awareness about the meaning of sexual violation/rape and barriers associated with the stigma of rape.

The services are there but there is an accessibility thing – they will hesitate to come to Rape Crisis, it's that ‘R’ word. Also, misinformation in [the] community about rape is hard to combat. (SSVA)

Several pathways are needed for survivors to get to services that are easily accessible and transparent to all i.e. through [doctors], Police, CAB [Citizen’s Advice Bureau], Health, Education etc. (SSVA)

Workforce issues (access to more training, more qualified and experienced staff, or increased levels of staffing) were identified as a top priority by six types of service providers (SSVAs, women’s refuges, Victim Support, medical providers, other community agencies and Māori providers). This appeared particularly pressing for Māori service providers, with 10 out of 13 Māori providers indicating they needed more qualified and experienced staff and 8 needing more staff.

Rural areas also needed additional staff to compensate for the travel time required to cover wide geographical areas to see clients, and to assist clients to undertake forensic examinations in town. As one Māori counsellor pointed out, they are at risk of feeling overwhelmed by the volume, and complexity, of work.

In [name of rural area] I’m the only Māori one. And if I knew that before I went there I wouldn’t have probably gone there … Well there were times when I thought  …  ‘Geez, I’m “it” and I’m “it”, and I’m “it”’. And there’s times that I thought, ‘Well, I’m not going to be “it” forever’.

The same counsellor also noted that specialist counsellors were needed to cover the specific needs of different age groups (i.e. rangatahi (youth), koro (elderly men) and kuia (elderly women)). In particular, counselling elderly people may invoke tuakana–teina (in this context, meaning roughly ‘inter-generational’; see explanation in glossary) dynamics that can require specialist cultural knowledge.

Well the difficulty was … I felt that I needed more training … I need exposure to that. Like I’ve only had one [kuia] up the [name of rural place] and … most of our kuias say they’ve sorted out [effects of abuse]. You know, they cope well with it or they’ve just lived like that for so long that this is what it is now … But this one that did [talk] … I sat and listened to her and she could talk about it to me and the story you know – that was all I could do.

Additional comments from service providers on how to improve services highlighted the three following themes.

• Responsiveness of ACC services and systems: ACC-registered counsellors identified issues with inadequate subsidies, delays in processing claims, poor information flows, and high compliance costs (i.e. paperwork).

There is a gap when working for ACC between assessment sessions and waiting for approval to continue treatment that is potentially distressing for those clients in need of continuous and immediate treatment. (Mental health counsellor)

Difficulty with ACC red tape and ongoing assessments of the client and the work means I significantly limit the number of ACC clients I am willing to see at any one time. These difficulties mean most experienced psychotherapists either do not work with ACC clients at all or limit the number. (Mental health counsellor)

• Childcare and transport: Service providers reported that childcare and transport are a problem for some clients in terms of accessing services.

Serious poverty and/or lack of social support is an ongoing problem for many of my clients – for example they may not have alternative child-care and, if their car breaks down, cell phone has no funds etc … they cannot get to sessions or, in some [cases], even advise that they are unable to attend [at all]. Poor health is also an issue and sometimes clients do not attend because they are sick. (Mental health counsellor)

• More services or better access to other services: Some service providers commented that they could provide better services to their clients if additional services were available in their community for referral (e.g. SSVAs, services for men, specialist Māori services, specialist counselling for refugees, and alternative treatments, such as massage, to assist with body integration). One medical provider commented that access to medical services was limited because of short, fixed appointment times.

More time available to see client in consultation [and to potentially] discover if client has been a victim of abuse. Currently we have very strict 10 and 20 min appointments. (Medical provider)

5.4.1    Inter-agency collaboration
Inter-agency collaboration is recognised as an important aspect in the delivery of effective services. Cross-agency referrals and the sharing of information are crucial to a well-functioning support system. This appeared to be recognised by service providers with 42–62 percent indicating that improved inter-agency collaboration would assist them to deliver better services to victim/survivors (see Table 12). This need was particularly evident among more generalist service providers (community agencies, 62 percent; Māori providers, 62 percent; and Victim Support agencies, 56 percent).

To explore this issue further, survey respondents were asked to rate on a scale from 1 (very poor) to 5 (very good), the level of inter-agency co-operation they experienced with each of the agencies listed in Table 13. Table 13 presents the proportion of agencies that felt there was ‘good’ or ‘very good’ inter-agency collaboration with those agencies listed.

SSVAs were rated most frequently by survey respondents as good collaborators (rated by 61 percent). Other types of agencies received similar recognition as being good collaborators: DSAC-trained and -accredited doctors (57 percent); community agencies (54 percent); police (53 percent); health services (52 percent); and Māori providers (49 percent). While inter-agency collaboration was perceived to be good among many agencies, there appears to be plenty of opportunity for greater numbers of agencies to participate.

One way to increase inter-agency co-ordination and collaboration is to have written protocols or agreements in place for service providers working with any other agency that responds to victim/survivors. Just 49 of the service providers (30 percent) stated that they had such written agreements in place.

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Table 13: Types of service providers perceived as being good at inter-agency collaboration

Notes: DSAC = Doctors for Sexual Abuse Care. Percentages should be interpreted with caution because base numbers are low.

1. The number of survey respondents that rated having ‘good’ or ‘very good’ inter-agency collaboration with these service providers.

2. The total number of survey respondents varied because some agencies decided not to comment or felt unable to comment (i.e. they had no experience of working with particular agencies).

5.5    Summary

5.5.1    Characteristics of services and their clients
Community service providers who participated in the survey offered different types of services, which meant the nature and extent of their interactions with victim/survivors varied. Levels of specialisation also varied, with SSVAs being the only group responded solely to victim/survivors.

The majority of clients seen by community service providers were seeking assistance in relation to historical sexual violence.

Information on counselling and how to feel better were the most common requests victim/survivors made to service providers. However, only those who recognised and were able to name their experience as ‘rape’ were likely to seek assistance.

Service providers identified the high and complex needs for some victim/survivors, which required enhanced service capacity. Issues included assistance with immigration matters, language and accommodation.

Some agencies provided a wide range of services (e.g. SSVAs), whereas other service providers had particular areas of focus (e.g. medical services and mental health counselling services).

Gaps were identified in the availability of specialist sexual violence services, doctors able to perform forensic medical examinations, and access to forms of restorative justice for victim/survivors.

5.5.2    Access to services
Most clients were self-referrals, although Victim Support received most of its clients through referrals from police. High levels of self-referral point to the importance of service providers and their services being well publicised.

Survey respondents had concerns about their ability to deliver services to certain groups, particularly victim/survivors who were from an ethnic minority including Pacific peoples, migrants and refugees, and victim/survivors with disabilities. Of particular concern, was the ineligibility for ACC funding for those living in New Zealand who had experienced sexual violence outside New Zealand.

5.5.3    Effectiveness of service delivery
Increased funding was identified as the top need by three out of seven service providers (SSVAs, women’s refuges and mental health counselling services). SSVAs appeared to be the least well resourced with 96 percent calling for more funding to improve service delivery. Increased funding could be used to increase workforce capacity and improve facilities and equipment.

Workforce issues were identified as a top priority for six out of the seven service providers. Increasing the number of experienced and qualified staff was seen to be particularly pressing among Māori agencies.

Other ways identified to improve service delivery included improving the responsiveness of ACC services and systems, increasing access to funding for practical support (such as childcare and transport), and ensuring adequate coverage of services in all regions.

Ways to improve service delivery for certain groups of victim/survivors included making ACC funding available for people living in New Zealand but who had experienced sexual violence overseas (e.g. Pacific and other ethnic minority, migrant and refugee victim/survivors). Services to these groups were also felt to be limited with services providers having inadequate knowledge of relevant languages and cultures. Appropriate services for victim/survivors who were male or had disabilities were also needed.

Service providers recognised the importance of inter-agency collaboration for the effective delivery of services. Many service providers were considered to be good collaborators, particularly SSVAs, room for improvement existed. Only about 30 percent of survey respondents had any formal working agreements with other agencies.

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6    Views on community capacity

This chapter presents the views of a wide range of survey respondents on the capacity of their community to respond the needs of victim/survivors. This contrasts with the previous self-reported information about the nature and types of services agencies delivered, and resulted from respondents being asked to stand back and comment more broadly on the overall level of service provision in their community.

To gain a broader perspective on the overall level of service provision across New Zealand, the views of other key informants (e.g. Doctors for Sexual Abuse Care (DSAC) regional liaison doctors (RLDs), police, court victim advisers, and Crown prosecutors) have been included alongside those of community service providers.
This chapter presents survey findings on:

• gaps in service delivery – views on inadequate service provision nationally and regionally and the gaps in services for particular groups of victim/survivors (section 6.1)
• the factors influencing a victim/survivor’s ability to have their needs met – factors limiting and enabling victim/survivors emotional support and medical needs to be met (section 6.2)
• what works – interventions and ways of working that community service providers think are effective in their communities (section 6.3).

6.1    Perceived gaps in service provision for victim/survivors

This section begins with an overview of the perceived gaps in service provision across New Zealand, according to agencies that respond to victim/survivors of sexual violence and participated in this survey (Table 14). This is followed by a regional breakdown of these perceived gaps (Figures 4–6). Perceived gaps in service provision for specific groups are then presented.

Note: The findings in this chapter should be viewed only as a indication of the minimum gaps in services and not the total number. Survey responses were received from those who were providing at least some level of service provision. Hence, areas without agencies/services responding to victim/survivors could not be represented.

6.1.1    Perceived gaps in services nationally
Survey respondents were asked whether there was a sufficient range or level of services in their area to:

• enable victim/survivors to disclose to a formal agency
• meet victim/survivors’ emotional support needs
• meet victim/survivors’ medical (non-forensic) needs.

Most victim/survivors do not disclose to police, so only community service providers were asked about the adequacy of service provision to enable victim/survivors to disclose to a formal agency. However, both community service providers and criminal justice groups were asked about the adequacy of services to meet victim/survivors’ emotional and medical needs. The proportions of respondents who perceived the range or level of service provision to be inadequate are presented in Table 14.

Table 14: Proportion of respondents viewing the range or level of service provision to be inadequate

Notes: DSAC RLDs = Doctors for Sexual Abuse Care regional liaison doctors. Don’t knows and no comments were excluded when calculating percentages. Percentages should be interpreted with caution because some base numbers are low. Exact question asked to criminal justice groups varied from service providers, but results have been included in same table for purposes of comparison. 

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As can be seen in Table 14 four out of five groups of survey respondents perceived the provision of emotional support to be the greatest unmet need; the DSAC RLDs reported medical support as most lacking. This difference may reflect the particular needs of the vicitms/surivors that DSAC RLDs come into contact with (i.e. only those requiring medical treatment or a forensic medical examination) or perhaps indicate the pressure they feel because of the lack of experienced specialised seuxal abuse doctors.

Service providers and DSAC RLDs are likely to have a high familiarity with service responses in relation to emotional and medical needs and observed higher levels of inadequate service provision than the criminal justice groups (court victim advisers, Crown prosecutors and police). Again, these differences could reflect the differences in the types of interactions each group has. Criminal justice groups interact only with those victim/survivors who have reported to police, so are likely to be less familiar with others in the community who have not reported.

Community service providers were invited to elaborate on their responses in relation to the adequacy of service provision. Responses are presented below.

Ability to disclose – gaps in services
Disclosing sexual violence is traumatic for most victim/survivors, and the decision to disclose can be affected by the availability of services and whether these services provide an environment conducive to reporting (e.g. a safe and respectful environment). Only 27 percent of service providers felt there were insufficient services available in their area for those who wished to disclose sexual violence. Seventy-nine respondents provided additional comments. Many of those who had indicated there were sufficient services qualified their response, noting that while services might be available, they might have waiting lists or be under-funded to provide those services.

I am unsure of the capacity of the available agencies and waiting times for people wanting these services (Victim Support)

Yes but – very under-funded – much of this work is done on a voluntary basis, as an adjunct to provided services (SSVA)

Concerns were also raised about whether victim/survivors and providers were aware of the specialist services that existed.

Survivors who have contacted [a high-profile rape victim/survivor], who didn't know who else to go to. Not visible – communication breakdown. Don't know who to ring. … Fear of who it is safe to talk to. (SSVA)

Whether all GPs [general practitioners] know what agencies these are is another matter (Mental health counsellor).

Where services were seen to be insufficient to enable victim/survivors to disclose, the following issues were mentioned.

• The availability and high cost of counsellors in some areas (often referred to in relation to ACC-registered counsellors) (n=13).

    ACC must respond more quickly with approvals for counselling – survivors often need immediate support, and having disclosed (as the forms require) should not have to wait several weeks for funded help. As an ACC counsellor – a recognition that ACC fees are inadequate would be helpful – I do not surcharge although many of my colleagues do and because of the fragmentation and poverty in the lives of many of my clients the non-attendance rate is very high. I do not get paid for non-attendance and accountability costs are corrosive. Financial stress on top of the difficulties of this kind of work tends to reduce the duration of many counsellors’ working life. (Mental health counsellor)

• The availability of specialist services appropriate to special groups: Māori (n=7); men (n=5); ethnic minorities (n=3); gay, lesbian, transgender, bisexual, intersex people (n=2); people with disabilities (n=1).

• The existence or availability of an SSVA (n=7).

There is no specialised formal agency. Survivors can disclose to police, and many would not seek to do this. There is a local Victim Support agency, but they are associated with the police and this compromises their availability. Some disclose to Women's Refuge, their GP [general practitioner], or seek out a counsellor independently. This area is well resourced with sensitive claims counsellors, but their working brief may need to be expanded to include other family members who are in distress (Mental health counsellor).

Emotional support needs – gaps in services
Table 14 indicates the greatest gaps in services are those to meet victim/survivors’ emotional support needs. Eighty service providers elaborated on their response, with issues centred on the lack of counselling and crisis support options. In terms of counselling support, issues were raised around costs and delays in ACC approval. In terms of crisis support, there were concerns about SSVAs’ ability to respond because of resource constraints, and the pressures placed on service providers when they attempted to respond without sufficient resources.

Yes – But only because the two crisis counselling agencies are extremely committed to their role. The agencies and their staff are very stretched, under-funded and staff underpaid (especially the after-hours support counsellors). This area of support requires major funding investment. (DSAC RLD)

Medical needs – gaps in services
Overall, most service providers were happy with the level of medical services available in their area, with just 22 percent reporting insufficient services in terms of pregnancy and sexually transmitted infection checks, and assessment and treatment of injuries incurred during the sexual violence. Those with concerns identified the lack of access to doctors, no 24-hour service, the costs of after-hours services, and a shortage of female doctors.

These concerns were echoed by DSAC RLDs who pointed out that most victim/survivors attend after-hours services or hospital emergency departments, which provide a variable level of care. They also stated that some doctors in general practice have poor knowledge or understanding of the needs of victim/survivors, so cannot provide good care. However, they said if victim/survivors attend sexual health clinics they receive good care.

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6.1.2    Regional breakdowns of perceived gaps in services
To explore whether certain locations around New Zealand were perceived to have more gaps in services than other areas, the data presented above were broken down by region. Data from criminal justice groups have been aggregated to enable an easier comparison with community service providers.

The percentage of respondents in each region who reported that in their view services were insufficient to enable victim/survivors to disclose to a formal agency is shown in Figure 4, to have their emotional support needs met is shown in Figure 5, and to have their medical (non-forensic) needs met is shown in Figure 6. In the figures, the regions with comparatively longer bars are the regions where more respondents from that region perceived there to be gaps in services.

Percentages in Figures 4–6 must be interpreted with caution because the number of responses per region varied and was often small. Responses for service providers ranged from 6 in the Bay of Plenty to 21 in Wellington. Similarly with criminal justice groups, responses ranged from 7 in Canterbury to 41 from the Southern Region.³² 

Figures 4–6 reveal the regions perceived to have the greatest need for increased service provision. Data presented also reinforce the pattern of findings observed in Table 14. Figures 5 and 6 clearly show that community service providers perceived greater gaps in services than criminal justice groups, although the regional breakdown reveals variations in the degree of this difference. For example, Tasman and Auckland showed large discrepancies, whilst there appeared to be greater agreement in Waitemata and Northland.

The provision of emotional support was perceived to have the greatest unmet need across regions by both service providers and criminal justice groups (see Table 14). Bay of Plenty was the region both groups identified as having the greatest unmet need.
 

Figure 4: Ability to disclose to a formal agency – gaps in services by region

Figure 5: Emotional support needs – gaps in services by region

Figure 6: Medical (non-forensic) needs – gaps in services by region

Ability to disclose
Bay of Plenty was identified by the greatest number of respondents as having insufficient services to enable victim/survivors who wished to disclose sexual violence to a formal agency to do so (five out of six respondents; 85 percent). Canterbury was perceived to be the best-resourced region, with no reports of insufficient services (n=17).

Emotional support needs
Bay of Plenty was identified by most respondents as the region having insufficient services to enable victim/survivors to have their emotional support needs met: all six community service providers and six out of ten criminal justice respondents (60 percent). Other areas community service providers identified as having particularly high ratings of gaps in emotional support services were Tasman (78 percent), Southern (69 percent), and Wellington, Eastern, and Auckland City (all about 50 percent). In contrast, criminal justice groups ranked Central as having the second greatest level of unmet need (38 percent,) followed by Waitemata (23 percent). Canterbury was again perceived to be the best resourced by both groups.

Medical (non-forensic) needs
The regions identified by most community service respondents as having insufficient services to enable victim/survivors to have their medical needs met were Auckland City (5 out of 12 respondents; 42 percent) followed by Central, Tasman and Southern (all 33 percent). Reports of insufficient services in Auckland City were unexpected. Closer examination of responses revealed concerns about existing services not being available 24 hours a day and also problems travelling to medical services in Auckland City.

Services offered in only a few sites across a large city. Public transport can be difficult to face following sexual violence (SSVA).

In contrast, criminal justice groups identified Northland, Waitemata and Bay of Plenty as having the greatest unmet medical needs.

6.1.3    Perceived gaps in services for particular groups of victim/survivors
Community service providers (but not criminal justice groups) were asked to rate the extent of service provision for specific groups of victim/survivors on a scale from 1 (very poor) to 5 (very good). Figure 7 shows the percentage of community service providers who reported that services in their community were ‘not available’ or ‘poor’ for specific groups.

Figure 7 shows that half the service providers identified gaps in services for new migrants and refugees, and over a third identified gaps for Pacific peoples.
Few services for sex-workers, people with disabilities, and men were also noted. These findings very much mirror service providers’ concerns about their ability to respond to these particular groups (see section 5.3.2).

Respondents were also invited to comment on the needs of specific groups of victim/survivors in their communities. Not many commented on gaps in relation to specific groups; more commented on gaps in core services in their areas that affected all groups. For example, three service providers from Northland commented that their region lacked services across the board.

There aren’t enough services in our community. Those that do have resources are often inundated and struggle to cope with the demand. (Victim Support)

The key issues service providers identified for Māori concerned gaps in crisis services, services that are inaccessible to Māori and services that can respond adequately to cope with the volume of Māori clientele. Māori social service providers do not necessarily have staff with specialist counselling skills (or ACC registration) and there is a shortage of Māori counsellors generally. For some, the issues are compounded by multiple barriers.

Very poor availability of follow-up counselling services. Waiting lists for ACC-registered counsellors between six months and two years. No crisis service. Non-specialist services often offering unhelpful advice/service. (Māori mental health counsellor)

Figure 7: Reports of poor or no service delivery for specific groups of victim/survivors

Note: EMR = ethnic, migrant, refugee peoples; GLTBI = gay, lesbian, transgender, bisexual, intersex people; NZE = New Zealand European.

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6.2    Meeting emotional and medical needs

Community service providers (but not criminal justice groups) were asked to comment on the factors that assisted or limited victim/survivors having their emotional and medical needs met. These were open-ended questions, and the comments were content analysed. The themes that emerged are presented in Table 15.

As can be seen from Table 15 there was considerable overlap in the factors seen as important for ensuring victim/survivors could have both their emotional and medical needs met. Some factors related to attitudes about sexual violence that society holds and the resulting misattributions these cause in victim/survivors themselves (e.g. shame and self-blame), which acted as barriers to accessing services. Other factors related to the characteristics and availability of services.

Table 15: Service providers’ views on factors affecting victim/survivors having their needs met

Note: The numbers of respondents represent those who thought to mention these factors. If survey respondents had been specifically asked about the impact of each factor identified, it is likely the percentage of survey respondents who agreed would have been higher.

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6.2.1    Service providers’ perceptions of barriers that prevent victim/survivors from having their emotional and medical needs met
Views on barriers that prevent victim/survivors having their emotional support needs met were provided by 169 service providers. There were also 125 suggestions on barriers preventing victim/survivors having their medical needs met. The factors identified are reviewed below.

Shame and self-blame
Seventy-four service providers (44 percent) identified shame and self-blame as barriers to victim/survivors accessing services to meet their emotional needs. They were also seen to be limiting factors in victim/survivors having their medical needs met, although fewer respondents noted this (n=24; 15 percent).

It was commented that many victim/survivors believe common rape myths, for example, that their actions contributed to the sexual violation.

They experience shame, guilt, denial (that it’s rape), or that it was serious enough. Guilt because the victim was drunk or drugged or it was ‘date rape’, and the victim blames herself or himself. (SSVA)

Although service providers identified that shame and self-blame are a major hindrance to all victim/survivors accessing assistance to meet their emotional needs, they noted that they are a particular difficulty for male victim/survivors.

For male survivors it is difficult. Males are indoctrinated from a young age to believe that males cannot be victims, expressions of anger and aggression are acceptable but other emotions (sadness, grief etc) must be suppressed. Shame and homophobia limit males seeking help. (SSVA)

One service provider acknowledged the courage it takes for victim/survivors to overcome their shame and seek help.

Lack of information about available services
Sixty-nine service providers (41 percent) noted a lack of information for service providers and victim/survivors about the availability of services to meet emotional needs.

Victim/survivors of historical sexual violence who did not make police reports often found it more difficult to know what services were available for them than those who had reported.

In our area there is no single point of contact e.g. crisis centre – so nobody knows where to go. (Medical provider)

There is a lack of information, no adequate referral system, and no direct accessibility for help. (Victim Support)

Information about ACC entitlements and access to and the availability of counsellors were also identified as factors that limited victim/survivors accessing the emotional support services they needed. This was also a significant limiting factor noted in relation to medical needs (n=49; 39 percent).

There is insufficient information regarding which counsellors will accept ACC clients at any specific time. Some who start with the ‘list’ are also desperate by the time they get to me. (Mental health counsellor)

Respondents commented that victim/survivors were often not aware of services other than the hospital emergency department or their family doctor.

Lack of information of services available unless contact is made through the police and this is not always an option for some victims. (Victim Support)

Costs
Sixty-eight service providers (40 percent) identified the costs of services as a factor preventing victim/survivors from accessing emotional support services. A slightly higher proportion noted this was a barrier to their getting medical needs met (n=63, 50 percent).

The cost of counselling was often referred to, with many ACC counsellors noted to be charging a surcharge because their services were not fully covered by ACC funding. As mentioned previously, there is no provision for ACC-funded counselling for victim/survivors who were sexually assaulted outside New Zealand.

The use of after-hours medical centres was also noted as expensive. If victim/survivors prefer to have ongoing medical treatment from a doctor other than the one with whom they are registered, they incur considerable costs for each visit.

Some family doctors may also be treating the perpetrators. (SSVA)

Other costs that limited access to services were the costs of transport and childcare.

Lack of services
A lack of services for victim/survivors was commented on by 42 service providers as negatively affecting victim/survivors’ ability to have their emotional support needs met (25 percent). This mirrors the data presented in Table 14. Gaps in services were particularly problematic for specific groups of people, for example, young people and Pacific people (see section 5.3.2). Inadequate services in rural areas were also noted.

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Geographical isolation
Geographical isolation was identified as limiting access to emotional support services (n=24; 14 percent) and medical services (n=10; 8 percent).

Victim/survivors in isolated places were less likely to have services in their area, so would need to travel to other areas. Geographical isolation was also identified as contributing to confidentiality difficulties.

Being a small town everyone knows everyone. Survivors don't want family/friends to know. Survivors have to travel up to two hours to receive help at the various agencies/counsellors. (Victim Support).

The perceived lack of confidentiality in rural and small communities was also viewed as a barrier to accessing medical care.

Confidentiality – they tend to go out of town for diagnosis and medical treatment. (Women’s refuge)

Ten service providers identified that some rural areas had no general practitioner services or only very limited access, for example, a monthly visit by a general practitioner to the area. Transport to medical services was a related issue six service providers identified. One service provider summed up the difficulties faced in accessing medical services in an isolated community.

Local people have to travel to Gisborne to have checks, whānau take them and their children, but there are lots of issues – money for petrol, reliable car, child minding, mental health issues and whakamā [embarrassment or loss of mana]. There are differences in culture … people don't want to go to town and be examined by someone different. (Mental health counsellor)

6.2.2    Service providers’ perceptions of factors that help victim/survivors to have their needs met
Suggestions about what factors help victim/survivors to having have emotional support needs met were given by 156 service providers. There were also 118 service providers who had suggestions about factors that help victim/survivors’ medical needs to be met. Factors included the availability of good quality services, good inter-agency collaboration and referral systems, and practical support for victim/survivors.

Availability of good quality services
The availability of good quality services was identified by 98 service providers (63 percent) as a key to ensuring victim/survivors have their emotional support needs met. Good quality services were seen to be those that:

• had immediate access (n=18)
• were affordable or free (n=14)
• offered a choice of counselling services (n=10)
• were visible or widely advertised (n=13).

Excellent services that are free of charge to users, with ease of referral/access, and out of office appointments for workers. Diverse service provision/choice for users and access to transport assistance. (SSVA)

Forty-seven service providers (40 percent) stated that the availability of quality medical services was important for ensuring victim/survivors can access services to meet their medical needs. A quality medical service was identified as one with approachable, knowledgeable, non-judgemental doctors and nurses who were supportive of victim/survivors of sexual violence.

GPs [general practitioners] being approachable and knowledgeable enough to ask the right questions and pick up on the non-verbal language being displayed. (Mental health counsellor)

Accessibility is a criterion for a quality service and was identified by 30 service providers (25 percent) as a key factor in enabling victim/survivors to have their medical needs met. Accessibility included not only geographical access to services, but also affordable or free and culturally appropriate services.

Other aspects of quality medical services included having female doctors available (n=3), guaranteed confidentiality (n=3), and doctors able to offer extended consultations with victim/survivors (n=2).

Good agency collaboration and referral systems
Good inter-agency collaboration and referral systems were seen as crucial for services to be able to meet victim/survivors emotional support needs (n=60; 38 percent) and medical needs (n=50; 42 percent).

Good liaison between services really helps. This includes good education of health professionals about available services. (Medical provider)

The need to have general practitioners ‘in the loop’ was specifically noted by 16 service providers.

Practical support
Nine service providers also noted that victim/survivors need practical support, such as childcare and transport, to enable them to access the services they require.

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6.3    What works – effective interventions

Service providers were asked to identify interventions or other aspects of service delivery that they felt were working well in their communities to promote the recovery and well-being of victim/survivors. Sixty service providers offered their views, with many of their responses overlapping with those reviewed above.

Unfortunately, one limitation of a self-complete survey is that the depth of information sought is not always forthcoming. For example, although service providers identified services they believe offer effective interventions, typically they did not describe what these services did or what made them effective. This is an area that warrants future research, so we can better understand why these interventions were viewed as effective. In the following sections, we refer to the agencies named and, where details have been given, provide examples of effective practice.

6.3.1    Effective counselling
The most frequently cited intervention that was seen to working to promote recovery and well-being in victim/survivors was effective counselling (n=39; 65 percent). Initiatives that were seen to be enhancing access to effective counselling included counsellor co-ordination across the region, counselling models that include whānau, group counselling, free counselling after ACC funding expires, and culturally matched counselling.

6.3.2    Effective crisis support
The second most frequently cited effective intervention was effective crisis support (n35; 58 percent). Examples of service providers that were perceived as providing effective crisis support were HELP centres, sexual abuse centres, Rape Crisis centres, Māori agencies, women’s refuges, women’s centres, and abuse prevention agencies. In one region, an online service for victim/survivors was seen to be showing promise.

6.3.3    Follow-up support
Several successful interventions for follow-up support were identified (n=29; 48 percent): a survivor’s support group initiated by a survivor, an empowerment group and course for victim/survivors, outpatients groups at Dunedin Hospital, and community mental health nurses providing support in the community.

6.3.4    Effective services for specific groups
The importance of providing for the needs for specific groups of victim/survivors has been reiterated throughout this report. Examples of effective interventions for specific groups was mentioned by 46 percent of respondents (n=28).

Pacific peoples
Pacific peoples’ church meetings were seen as an effective way of working with Pacific victim/survivors. The Pacific Health Trust in Canterbury was also identified as working well.

Young people (16–25 years)
Examples of interventions working well for young victim/survivors included the resilience model used in Waitakere; the Auckland HELP youth team working in schools; START in Christchurch; the Safer Centre and teen parent mentoring unit in the Central region; the Life Trust (youth) and Uri o Hau (Māori youth) in Northland; and Kapiti Youth Support, Evolve and VIBE youth centres in Wellington.

Māori
Culturally matched services and whānau-based programmes were seen to be effective for Māori victim/survivors. Specific services perceived by service providers as working well in their communities were Te Puna Oranga in Christchurch; Parakatia Te Piri for Māori women in Dunedin; Te Rata Awhina Trust in the Tasman region; and Horo te Pai, Orongomai Marae, Wānanga Marae, Māori Women’s Refuge, and Kōkiri Marae in Wellington.

It is interesting to note that non-Māori service providers often identified local iwi and marae services and hauora (local Māori health services) as providing effective interventions for Māori. However, Māori service providers generally identified their services lacked a specialised workforce to respond to the highly complex needs of adult victim/survivors. Rural services were particularly short of specialist counsellors, particularly when hauora aim to treat the whole whānau.

Only one Māori provider indicated their service provided long-term counselling beyond that provided by ACC and they provided whānau interventions. Clients were also referred to this provider’s Māori peer-based educational programmes to build ‘a sense of whanaungatanga [relationships and connection] and resilience’.

6.3.4    Good inter-agency collaboration
Inter-agency co-operation, inter-agency collaboration, and cross-agency
co-ordination were mentioned by 38 percent of respondents (n=23) as a key to effective services and has been highlighted throughout this report (see section 5.4.1).

Effective networks that met regularly, shared information and looked for solutions to problems, were identified by service providers in Canterbury, the Central region, the Eastern region, Northland, the Southern region, Waitemata and Wellington. The Tairawhiti Abuse Intervention Network in Gisborne (Eastern region) was also cited as an effective model of inter-agency collaboration.

6.3.5    Police services
Good police liaison was mentioned positively by eight community service providers. Police specialisation in adult sexual assault was also seen as an effective police intervention. One SSVA described the changes to its work that having a specialist Adult Sexual Assault Team in the area made.

It is not like the old days. When I am meeting with survivors I have confidence in saying to them, ‘If you are thinking about it and you are not sure what you want to do, how about we just go and meet the police’. With ASAT [the Adult Sexual Assault Team] I have the confidence that I’m going to get a good response. It is not like the crime squad, where you don’t know what you are going to get. I wouldn’t do it, and crime squad wouldn’t have the time or space or energy. (SSVA)

Sexual assault work is unpleasant work, it has a low resolution rate and an even lower conviction rate, so it is not feel-good work for the police. So when it is in the general pile, everything can and does take priority. It is hard to investigate and it takes a long time. Whereas when you have a team, and that is their work, they need to get satisfaction out of making it work. It is quite a shift. (SSVA)

6.3.6    Education
Rape prevention and date rape programmes in schools and the community were identified as effective education interventions, as was raising the issue of sexual violence with all clients to Family Planning (n=8).

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6.4    Summary

6.4.1    Community capacity – gaps in services
Nationally, the greatest concern was an insufficient level of services to ensure victim/survivors can have their emotional support needs met. Particular concerns were the costs, delays and eligibility criteria for accessing ACC-funded counselling and the inadequacy of resources for SSVAs to provide these services efficiently.

Regionally, Bay of Plenty was the area seen to be most lacking in services, and Canterbury was seen to be one of the better resourced regions.

Gaps in services for diverse groups mirrored service providers’ concerns about their ability to respond to particular groups (see section 5.3.2). Half the service providers identified shortfalls in services for migrants and refugees, and over a third identified gaps in services to Pacific peoples. Few services for sex-workers, people with disabilities and men were also noted.

6.4.2    Meeting emotional and medical needs
There was considerable overlap in factors seen as important for ensuring victim/survivors could have their emotional and medical needs met. These included addressing barriers caused by shame and blame experienced by victim/survivors, a lack of services and information about services that do exist, the cost of services, and problems caused by geographical isolation.

Factors seen to be helpful included the provision of quality services, practical support to enable victim/survivors’ to access these services (e.g. childcare and transport), and encouraging good inter-agency collaboration among providers.

6.4.3    What works
Examples of interventions or aspects of service delivery that were seen to be working in survey respondents’ communities included counselling, crisis support, follow-up support, effective services for diverse groups, good inter-agency collaboration, police liaison and specialisation, and rape prevention education.

Endnotes

25. Data in this chapter are based on 168 survey respondents who provided services to victim/survivors. Eleven of the 179 agencies who completed a survey (see chapter 3) indicated that they did not provide services to victim/survivors (e.g. those providing services to sexual violation offenders). However, these agencies had views on the capacity of their community to respond to victim/survivors, so completed the second part of the survey; the results of which are presented in chapter 6.

26. There is no accepted definition for what constitutes historical sexual violence. Violence occurring over 12 months ago was an operational definition decided on by the researchers in conjunction with the Ministry of Women’s Affairs. The aim was to differentiate the types of service needs of those at different stages of recovery. For example, the acute crisis needs of those seeking help more immediately, compared with those who delayed their help-seeking and had moved beyond the acute crisis stage (e.g. those who had experienced childhood sexual abuse).

27. Working with families/whānau is central to the holistic way Māori providers work. Only one Māori provider did not work with families/whānau and this was an ACC counsellor who provided individual counselling.

28. Māori services do not necessarily work on the premise that sexual violence requires specialist services. This is more characteristic of a Western approach to intervention.

29. The appropriateness of restorative justice in cases of sexual violence is an area in urgent need of research attention, particularly considering the difficulties faced by victim/survivors who seek justice through the current criminal justice system.

30. The Royal New Zealand Plunket Society is New Zealand’s leading provider of Well Child and family health services.

31.  Child, Youth and Family is the government agency that has legal powers to intervene to protect and help children who are being abused or neglected or who have behavioural problems

32. Not all survey respondents replied to this question, further reducing numbers in some regions. For an idea of the maximum number of total number of survey responses per region, see Table 5 in chapter 3, and Figure 2 in chapter 4.

Disclaimer

This report was commissioned by the Ministry of Women’s Affairs. The views, opinions and conclusions expressed in the report are intended to inform and stimulate wider debate. They do not represent government policy.
 

Published in September 2009
by the Ministry of Women’s Affairs | Minitatanga Mō Ngā Wāhine
PO Box 10 049, Wellington, 6143, New Zealand
Phone: 0064 4 915 7112
Fax: 0064 4 916 1604
Email: mwa@mwa.govt.nz
Website: www.mwa.govt.nz

ISBN 978-0-478252-45-3 (Print)
ISBN 978-0-478252-46-0 (Digital)