Presentation by Angie Perkins and Anna Scott of Zonta House Refuge Association. Recvery Support Program, presented at the Western Australian Mental Health Conference 2019.

1. www.zontahouse.org.au A Zonta House Refuge Association Inc Initiative
Recovery Support Program

2. Domestic and family violence is when someone intentionally uses
violence, threats, force or intimidation to control or manipulate a
family member, partner or former partner.
It is characterised by an imbalance of power whereby the perpetrator
uses abusive behaviours and tactics to obtain power and control over
the victim causing fear. The violence is intentional and systematic and
often increases in frequency and severity the longer the relationship
goes on.
Carrington & Phillips 2003, Tually, Faulkner, Culter & Slater, 2008

3. Zonta House Refuge Association is one of the largest refuge organisations in Western Australia
Zonta House has supported over 13 000 women since 1984 and is committed to continuous
improvement, innovation and delivering outcomes.
Service Arms
• Crisis Accommodation (2 x 24/7 refuges for 17 women without children in their care)
• Transitional Accommodation (17 properties with 34 beds for women without children in their care)
• Positive Pathways Program (Outreach program for all women including education programs,
coaching, community awareness and a Safety and Wellbeing APP)
• Safer Pathways Program (Specialist FDV Case Management to Housing Authority Tenants residing in
the catchment areas of the Cannington and Victoria Park offices)
• Recovery Support Program (Mental health and drug and alcohol support)
• Adult Justice Reintegration and Parenting Support ReSet
• Future Employment for Multicultural women in our community (tailored
employment and training pathways and support)

4. What makes Zonta House unique?
Experience: Extensive experience working with women in crisis with complex needs. In the past financial year
Zonta House provided direct services to over 500 women.
Partnerships: Regularly refer to over 50 organisations to provide the required support to women in our
services. Relationships with organisations is vital to successfully refer, support and transition women where
appropriate. Zonta House works in partnership with 10 external providers to co-facilitate workshops and activities
for women and children.
Data: Zonta House collect data and utilise a number of tools based on Program Logic Approach to measure the
effectiveness of our services to ensure quality, provide the opportunity for improvements and identify gaps in our
service and the wider sector for women.
Results: The assessments collected by Zonta House have showcased the severity of mental health of women who
have experienced family and domestic violence, the safety risk of women in an abusive relationship and the overall
high quality of services provided in both decreasing the mental health of women who access services, overall
quality of life impact and individual satisfaction of services accessed.

5. ‘Trauma shocks the brain, stuns the mind, and freezes the body’
Levine (2015, Trauma and Memory)
If the stress levels stay elevated far longer than what is necessary for your ‘immediate
survival’ and your stress response doesn’t stop ‘firing’,
Research shows that the trauma and stress response memory lives in your nervous
system; this includes exposures to a stressful or traumatic events, where you have felt
helpless, hopeless, and lacked control.

6. 2016
What we had observed but had previously been unable to necessary evidence was
the increase in women with comorbidity related issues of family and domestic
violence, mental health and alcohol and other drugs.
What we were able to evidence from the implementation of outcome
measurements was the severity of mental health distress the women were in at our
refuge and crisis centre, the increased use of emergency services required and the
women leaving the refuge to potentially unsafe accommodation due to the
comorbidity related issues was significant and alarming. In a residential setting this
also presented a risk to other women seeking refuge and our staff.

7. 2016
The National Comorbidity Guidelines state that a number of social groups require special consideration with regard
to the management and treatment of comorbidity, these groups include:
• Indigenous Australians;
• Culturally and linguistically diverse people;
• Homeless persons; and
• Women
Zonta House supports all of the above groups across each of our service arms. As an example, data collected from
July 2015 to June 2016, in the Zonta House Accommodation Services, demonstrate how women meet the
comorbidity guidelines for groups that need special consideration:
• 25% of women identified as Aboriginal and/or Torres Strait Islander.
• 22% of women referred were culturally and linguistically diverse.
• 50% of women had a diagnosed mental health issue.
• 11% had accessed a psychiatric unit in the past 12 months.
• 34% of women had accessed a hospital.
• 15% of women presented to the service due to homelessness associated issues.
• 77% of women were presented to the service due to currently experiencing or having previously experienced
domestic violence.

8. 2016
15% of women were referred directly from hospital and 4% from a Mental Health service during this time
period. From the 2013/14 year to 2015/16 there had been a 26% increase of women with a diagnosed
mental health condition accessing crisis accommodation (24% to 50%).
This DASS21 Psychometric Assessment was completed by 60 women from January to June 2016 upon
entry into our Crisis Accommodation. The scores showed that upon entry to the refuge clients were as a
group in the Severe category for Depression, in the Extremely Severe category for
Anxiety, and Moderate category for Stress.

9. Recovery Support Program
• Focus on recovery in a client centred approach.
• Provide support, advocacy, counselling and referral to women with mental health and substance use issues in
Zonta House crisis and transitional accommodation and women accessing Positive Pathways.
• Facilitate briefings and awareness sessions to internal and external refuge staff.
• Facilitate short workshops for women accessing services, these may include a tailored mental health support
group or mental health and substance use information sessions.
• Network and liaise with stakeholders to strengthen relationships between providers and foster collaboration for
the benefit of women.
• Deliver education to existing providers on capacity and roles of crisis accommodation services in the
community.
• Assess women with complex and co-morbidity issues moving through internal and external crisis
accommodation providers in their suitability for longer term accommodation with Zonta House.
Clients, who have identified as having a mental health and/or alcohol and other drugs concerns or support needs,
are referred to the Recovery Support Program (RSP).

10. Recovery Support Program
Crisis Support: Such as AoD withdrawal management, suicide prevention support,
immediate mental health crisis support, support around mental health assessments,
medication management plans, support around challenging behaviours etc.
Initial stage of support is to provide safety, containment and self-regulation;
identification of presenting symptoms discussed and assessed and strategies to manage
immediate presenting symptoms discussed including symptom management strategies,
support from GP i.e. medications etc. as well as immediate support referrals i.e. to Alma
Street, GP, Bridge House etc.
Suggestions to strategies to try out provided and practiced in sessions including
grounding, deep breathing, mindfulness etc. Symptom management can also include
sleep management support and strategies, self-care/self-compassion strategies etc.

11. Recovery Support Program
Support and Counselling: Work around client’s individual presenting support needs and
goals, which include:
Understanding of a person’s brief story/background (brief only to prevent re-
traumatisation), psycho-education on FDV, trauma (including on body, mind/brain,
beliefs etc.), mental health and/or AoD and identification of individual symptoms and
triggers and symptom management strategies + provision of information on support
services and assistance with referrals.
Information and support around stages of behaviour change model provided regularly
and used throughout supports. Some specific AoD counselling provided, including
around personalised relapse plans etc.

12. Recovery Support Program
Where assessed appropriate and needed, support around appointments and meetings
is provided i.e. GP appointments (i.e. related to AoD withdrawal management and
mental health assessments), specialised mental health support (i.e. Alma Street) or a
client’s first external counselling/psychology appointment.
Throughout the support there is strong focus on emotional and symptom management
strategies and linking clients to external support services as well as risk assessments
and safety planning.
A trauma recovery/healing focussed, strength based and holistic approach is used and
main therapy approaches used are: Person Centred Therapy, Response Based and
Strength Based Approach, Sensorimotor Psychotherapy, Emotional Freedom Technique,
Narrative Therapy, Motivational Interviewing and Solution Focussed Therapy.

16. The Approach
Trauma support, trigger management support and psycho-education; Emotional
Support; Loss and Grief and FDV Support and Counselling; Connection with self/Identity
work and counselling; Symptom Management; Linkage with external services.

17. The Approach
• If we have experienced stress or trauma, re-training the body can be beneficial for
our health and wellbeing. This can be done by engaging in any activities and ‘get
strategies/tools’ that help to:
• Activate the parasympathetic response and
• ‘Deactivate’ the opposing sympathetic response.
• The aim is: to feel safe, regulate breathing, slow the heartbeat, and circulate blood
back to the vital organs.
‘Trauma is not a disease….rather a human experience rooted in survival instincts’
Peter Levine (In an Unspoken Voice)

18. Providing Support in a Refuge
Complexities are often overlapping and due to the crisis and shorter term
support nature of the refuge, it can be a challenge to address and provide
support around all needs. Assessments around most urgent support needs to
provide some stabilisation is needed.
‘Any act of healing is an act of courage’
Bessel van der Kolk – November 2017

19. Challenges
• Shared Accommodation
• Boundaries
• Triggers
• Safety
• Perceived ‘Complexity’
• Referral Pathways, Waitlists and Catchment Areas
• Resources

20. Outcomes
‘These principles are important to all of us, and if we’re lucky, we take them for
granted. People who experience interpersonal trauma – whether single incident or
complex – do not take these principles for granted’.
Reference and Image from: Blue Knot Foundation ‘empowering recovery from childhood trauma’ blueknot.org.au

21. ‘Trauma survivors are special – they have a PhD in survival’
“The most helpful part of the program was that [Worker] was non-judgemental. She helped me to
identify my goals and my triggers; she helped me to become more self-aware in my life, towards my
triggers. She supplied me with a lot of information on the topics we discussed. I found this program
worked amazingly.”
“I definitely recommend anyone suffering to become part of this program, as it helps a lot, it’s a safe
place and a non-judgemental environment.”
“I particularly felt that staff generally were a supportive group who were willing to listen, were hands-
on, practical and good at their job. Thank you to everybody for your past and on-going support,
kindness and generosity. Thanks [Service Delivery Manager] and [Team Leader], you have been
excellent and a big hug to [Worker], she is the best.”
“A big help to myself, saved my life giving me opportunity to be the nurse I dream to be, with support
and confidence. Thank you all Zonta.”

22. As outlined in the outputs and outcomes this program results in women who have
experienced family and domestic violence accessing crisis accommodation:
• A significant decrease in mental health distress;
• Decrease in number of women discharged from crisis accommodation due to co-
morbidity related behaviours and issues.
• Increase in women accessing supported accommodation.
• Increase in women being supported by specialist providers; and
• Improved relationships between sectors.
This program has led to an improved capacity and capability for all staff and the
organisation to support women who have mental health and AoD related issues. This is
the majority of our client group across all programs.
Outcomes

23. Within the first two years of the Recovery Support Program has:
• Facilitated 11 workshops with 84 attendances.
• 165 women supported with 859 individual appointments.
• For women supported there has been a 68% decrease in the overall scores of depression, anxiety and
stress from intake to exit.
• A decrease in 27% of women not returning to violent partners across the accommodation service.
• Of the women engaged in the longitudinal study 48% were known to remain in recovery from AoD post
18 months.
• Increase in training opportunities for Zonta House employees through established relationships,
partnerships and MOU`s.
• Networking with other services and increased referral pathways.
• Of the partners and external services who participated in the pilot survey – 100% said the program
needed to continue, 100% saw an improvement in their relationship with Zonta House and rated the
program 4.5/5.
Outcomes

24. “The biggest reward in the role is the honour of being allowed to walk
alongside women on their recovery journeys and experience when a
woman regains a sense of self, purpose and hope for the future – and a
sense of safety which can help the woman on their journey going forward.”