Universal risk screening in relationships counselling to enhance client engagement and promote safety and wellbeing

Abstract

Relationships bring love and contentment. But under strain, relationships can also bring risk of harm to self and others. When people want help for their relationships, relationship practitioners must identify if there are any such possible risks of harm when they are clarifying the presenting issue. This is essential because clients may identify the problem as simply being an inability to talk or communicate when in reality it may be dangerous for them to talk.

Relationships Australia SA (RASA) paves the way in facilitating safe conversations with all its clients using the Family DOORS framework. Based on the Family Law DOORS (McIntosh & Ralfs, 2012a), Family DOORS begins with DOOR 1 which is a fifteen-minute universal risk screen developed from the evidence-based and validated Family Law DOOR 1 (McIntosh, 2011a). Clients self-report their risks on DOOR 1 on paper or using the Family DOORS app which selects relevant domains and builds a screen for the client based on client characteristics (like relationships status or being a parent).

This paper presents and reviews the findings from the first 675 clients of family and relationship services (FARS) to complete DOOR 1 at RASA. We found high levels of gendered past abuse and current risks of violence. However, other less obvious risks were also revealed as a result of undertaking the screening process including risky alcohol or drug use; parenting stress; child protection notifications about their children; and current suicidal thoughts. We describe the risk screening experience from both the client and organisational perspectives, and for both low and high risk matters. We show how the early identification of risks informs early intervention requirements in response to family safety and wellbeing.

We conclude that for many early intervention relationship counselling clients, the risks are real, and that quick, efficient and respectful screening is just as essential as it is for post-separation services. We demonstrate the Family DOORS app and provide participants with the opportunity to access the app to try it themselves.

Full text

PEER REVIEWED PAPERS
FROM THE FRSA 2019 NATIONAL
CONFERENCE
NEW HORIZONS:
Building the future, Paving the way
FRSA CONFERENCE E-JOURNAL
EDITION 4–NOVEMBER 2019

PUBLISHED BY FRSA
FRSA 2019 CONFERENCE EJOURNAL, EDITION 4
Peer-reviewed papers from the FRSA National Conference 2019,
19–22 November 2019, Crowne Plaza Hunter Valley
New Horizons: Building the future, Paving the way.
The copyright for the papers in this e-Journal is retained by the
individual authors. Unauthorised use is not permitted. Content was
the responsibility of each author or group of authors. Views expressed
in this publication are those of individual authors and may not reflect
those of Family & Relationship Services Australia (FRSA).
FAMILY & RELATIONSHIP SERVICES AUSTRALIA FRSA
Providing Leadership, Linking Services, Supporting Relationships
3/2 TOWNSVILLE ST, FYSHWICK ACT 2609
PO BOX 1270 FYSHWICK, ACT 2609
P: 02 6162 1811
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52 Peer reviewed papers from the FRSA National Conference 2019 NEW HORIZONS: Building the future, Paving the way
Loving relationships bring happiness, meaning and
celebration. When those relationships become strained,
people do not suffer in silence or struggle on without
support or simply separate with seeking help. Over a
third of people in peaceful, respectful relationships will
try relationship counselling or Family Dispute Resolution
(FDR) services before finally separating (Kaspiew, Carson,
Dunstan, De Maio, et al., 2015, p. 64). People in violent
relationships are twice as likely to seek these services as
those in respectful relationships; they are also twice as
likely to use those generic services rather than specialist
domestic violence services (p. 64–65). In other words,
Family and Relationship Services Australia (FSRA) members
see more clients in risky relationships than they do clients
in respectful relationships in relation to separation. 2
Relationships bring love and contentment. But under strain, relationships can also bring risk of
harm to self and others. When people want help for their relationships, relationship practitioners
must identify if there are any such possible risks of harm when they are clarifying the presenting
issue. This is essential because clients may identify the problem as simply being an inability to talk
or communicate when in reality it may be dangerous for them to talk.
Relationships Australia SA (RASA) paves the way in facilitating safe conversations with all its clients
using the Family DOORS framework. Based on the Family Law DOORS (McIntosh & Ralfs, 2012a),
Family DOORS begins with DOOR 1 which is a fifteen-minute universal risk screen developed from the
evidence-based and validated Family Law DOOR 1 (McIntosh, 2011a). Clients self-report their risks on
DOOR 1 on paper or using the Family DOORS app1 which selects relevant domains and builds a screen
for the client based on client characteristics (like relationships status or being a parent).
This paper presents and reviews the findings from the first 675 clients of family and relationship services
(FARS) to complete DOOR 1 at RASA. We found high levels of gendered past abuse and current risks of
violence. However, other less obvious risks were also revealed as a result of undertaking the screening
process including risky alcohol or drug use; parenting stress; child protection notifications about their
children; and current suicidal thoughts. We describe the risk screening experience from both the client and
organisational perspectives, and for both low and high-risk matters. We show how the early identification
of risks informs early intervention requirements in response to family safety and wellbeing.
We conclude that for many early intervention relationship counselling clients the risks are real, and that quick,
efficient and respectful screening is just as essential as it is for post-separation services. We demonstrate
the Family DOORS app and provide participants with the opportunity to access the app to try it themselves.
UNIVERSAL RISK SCREENING IN RELATIONSHIP
COUNSELLING TO ENHANCE CLIENT
ENGAGEMENT AND PROMOTE SAFETY
AND WELLBEING
Jamie Lee (Relationships Australia SA)
Jennifer E. McIntosh (Deakin University)

53 Peer reviewed papers from the FRSA National Conference 2019 NEW HORIZONS: Building the future, Paving the way
FSRA members are encouraged, or required, to be
sensitive to domestic violence and other known areas
of risk beyond simple frequencies. The 2012 Family
Law Act amendments show the importance for services
to ask about key family safety risks and encourage
clients to speak out about those risks (Kaspiew,
Carson, Dunstan, et al., 2015). Competency standards
for psychologists, social workers and FDR practitioners
(FDRPs) require practitioners to be proficient in
assessing, identifying and responding to risks, including
violence, in everyday practice. Family Relationships
Centres (FRCs) have operational guidelines that set
out how Commonwealth-funded services should
incorporate screening for risk. Relationship counsellors
and family therapists should also screen for risk
including domestic violence, with O’Brien (2015) and
Weiss (2015) stating that psychologists in relationship
services should inquire about the risk of domestic
violence when working with couples. Finally, from
a sector wide perspective, FRSA has recognised and
advocated for the widespread adoption of intake,
screening for risk and assessment based on a public
health perspective (Toumbourou et al., 2017).
Given the top-down expectations in addition to
prevalence rates, practitioners should be purposefully
exploring key areas of risk as part of their daily practice.
However, there is much evidence showing this is not
the case. Practitioners often report that they ask about
key risks such as family violence or child abuse, though
it is often not clear how they do this (Kaspiew, Carson,
Coulson, Dunstan & Moore, 2015), meaning the general
requirement to screen is contested (Cleak & Bickerdike,
2016; McIntosh, Lee & Ralfs, 2016). Other surveys of
practice specific to relationships services indicate that
only one third to one half of US practitioners routinely
use structured screening tools and few follow best
practice processes such as individual screening of
couples (Schacht, Dimidjian, George & Berns, 2009;
Todahl & Walters, 2011; Tower, 2006). Todahl, Linville,
Chou & Maher-Cosenza (2008) suggest this practice of
‘screening to screen’ relies on the dubious belief that
the signs of domestic violence will be obvious to the
practitioner. In summary, we should be screening all
the time, but we don’t.
The opportunity to intervene in risks
By not formally inquiring about risks, practitioners
may be missing an opportunity for early intervention
or even prevention of harm. Clients may – quite rightly
– not tell a practitioner about risk because they don’t
recognise the behaviour as being a risk or risk indicator
or something that they should tell the practitioner.
For example, Kaspiew, Carson, Dunstan, De Maio, et
al. (2015) found clients provided credible reasons to
not disclose risks such as ‘It wasn’t really happening
at the time’, ‘It wasn’t serious enough at the time’,
‘It was happening but I wasn’t worried about it’, or ‘It
wasn’t affecting the kids’. Importantly, clients may not
report high violence risks unless practitioners proactively
ask about risk (Ballard, Holtzworth-Munroe, Applegate
& Beck, 2011; Rossi et al., 2015).
Though the focus so far has mostly been on domestic
violence, practitioners may also be missing opportunities
to intervene with other types of risks that co-occur
with domestic violence. Firstly, there is a risk of
developmental harm where children have witnessed
domestic violence, which happens according to
two-thirds of mothers and a half of fathers in families with
domestic violence (Kaspiew, Carson, Dunstan, De Maio, et
al., 2015). Research also indicates that both mental illness
and drug and alcohol misuse are linked to both family
violence and relationship separation (Ellis & Stuckless,
2006a; Kaspiew et al., 2009). Separation can also increase
the risk of mental health problems and drug and alcohol
misuse – particularly for men – that further elevates the
risk of violence and lethality in the post-separation context.
Indeed, mental health and separation have been shown to
share a bidirectional relationship, whereby mental health
problems are predictive of separation, and separation is
predictive of mental health problems (Gibb, Fergusson
& Horwood, 2011). Australian data confirm these wider
risks, with divorced/separated individuals in Australia
being nearly five times more likely to have a substance
use disorder than married individuals, and nearly twice
as likely to have an affective (emotional/mood) disorder
(Australian Bureau of Statistics, 2011b). In short, risks ‘run
in herds’ and so domestic violence is unlikely, for clients, to
exist in isolation while everything else is going well in their
lives and in their families. In other words, practitioners
should also be purposeful about wider risks.
To summarise, practitioners who are not purposeful in
their practice around risks may be missing significant
opportunities to intervene in a range of potential harms
which they might otherwise see on a daily basis. This is
significant given that parents may under-report harmful
and even potentially lethal dangers unless practitioners
ask about risk (Ballard, Holtzworth-Munroe, Applegate
& Beck, 2011; Rossi et al., 2015). More succinctly,
Cleak and Bickerdike (2016) emphasise that: “simply
being asked would have led to disclosure [of risks]”
(p. 18). While most effort on researching screening has
focussed on domestic violence in a post-separation
context, it is possible that similar trends of co-occurring
risks will also be found in FARS.
The Family DOORS framework
One way for relationship practitioners to be purposeful
in risk practices is through clients self-reporting risk with
holistic universal risk screens. In 2012, McIntosh and Ralfs
(2012a) developed the Family Law DOORS (‘Detection of
Overall Risk Screen’) framework in Australia.

54 Peer reviewed papers from the FRSA National Conference 2019 NEW HORIZONS: Building the future, Paving the way
Funded by the Australian Government Attorney-
General’s Department, the framework and handbook
(McIntosh & Ralfs, 2012b) provided an approach
and a practical set of tools to assist a wide range of
practitioners working on post-separation parenting and
property disputes (McIntosh, 2011a; 2011b). In 2015, the
framework was expanded outside of the family law
context as the Family DOORS framework which covered
areas such as gambling and current relationships; it also
covered individual clients not in intimate relationships
or in disputes. This extension was piloted as MyDOORS
(McIntosh & Lee, 2016) in non-family law services
across RASA and Relationships Australia Tasmania. In
2017, all the resources and paper-based tools in the
Family DOORS framework were integrated into a single
online platform called the Family DOORS app (Flint,
Lee & McIntosh, 2017). The app creates a personalised
risk screen for each client built by asking a few basic
questions about the client’s current situation.3 Though
hidden to clients and practitioners, the app is selecting
from the best of 16 different possible permutations
for the client.
The three parts to the framework have remained
constant throughout the development and refinement
of Family DOORS; namely it enables practitioners to
identify, elaborate and assess risks in order to minimise
and manage those risks in everyday practice. The three
parts begin with DOOR 1, a simple self-report form
for adults to complete before their initial appointment
with their practitioner. At DOOR 2, the practitioner
elaborates any possible risk areas that the client has
indicated on the self-reporting tool, meaning that
the practitioner gently explores what the client has
meant by reporting the risk.4 If any risk appears to
be significant, the practitioner would undertake
a detailed risk assessment with the client at DOOR
3, before planning a suitable response or onwards
referral. Importantly, the framework makes a clear
distinction in the steps between risk screening and
risk assessment: everyone is screened but only those
clients with possibly significant risks are assessed.
By using the three-part framework, practitioners
distinguish between clients presenting with
normative stresses and those presenting with high
risk indicators (McIntosh & Ralfs, 2012b). In practical
terms, practitioners do this by having the opportunity
to explore their clients’ answers to up to 100
evidence-based risk questions, which clients have
typically completed immediately before meeting their
practitioner, potentially in consultation with DOOR 3
resources. Doing this allows practitioners to explore
any patterns of risk that might need further assessment
before they meet with the client(s). Using client self-
report rather than practitioner interview is highly
efficient because clients can typically do this in fifteen
minutes, whereas answering the questions through
practitioner interview would typically take 90 minutes.
Rationale and research question
Several presentations and publications have described
organisational, practitioner and client experiences of
‘doing DOORS’ at Relationships Australia Tasmania and
RASA (Kelly, French & Lee, 2017; Kelly & Lee, 2018; Lee
& Ralfs, 2015; 2016; 2017), with numbers of DOORS
completed across the world now reaching over 30,000.
However, published analyses of clients’ responses have
so far focused on large samples of family law clients
(McIntosh, Wells & Lee, 2016; Wells, Lee, Li, Tan &
McIntosh, 2018). Importantly, over 10,000 clients have
completed a Family DOORS tool for services other than
post-separation services (namely outside mediation,
children’s contact services and family law services
which would have used FL-DOORS tools). This provides
the rationale for exploring a non-family law population,
namely, all clients who presented for Family and
Relationship Services (FARS) at RASA.
The research question for the present study builds on
several premises. Firstly, it’s likely that clients may have
significant risks in addition to their presenting issues
when they come to FARS appointments provided by
FRSA members. Secondly, it’s likely that they are not
being pro-actively screened for risks despite the high
prevalence and the numerous top-down requirements
to screen. Thirdly, the sector has a freely available risk
management framework tool that has already been
applied many thousands of times with counselling
clients. Lastly, this will be the first published and
presented study analysing DOORS in everyday practice
in non-family law services. Therefore, our research
questions are: what risks are reported by clients in
everyday practice who are screened with DOORS
as part of relationship counselling compared to the
equivalent family law service? Will we see significant
levels of risk that would otherwise be unreported or
undetected, had practitioners not purposefully asked
key risk questions?
Method
Participants
The participants in this analysis were the full population
of adult RASA counselling clients who commenced as
new adult clients between February 2017 to November
2018. The Family and Relationships Service (FARS) at
RASA is a generic Commonwealth Department of Social
Services (DSS) funded relationship counselling service
for individuals, intimate partners and families to work
on problems related to relationships. Clients received a
face-to-face service at one of ten organisational outlets
or as part of outreach at a smaller host venue. All
clients completed the pilot paper version of MyDOORS
which was later used in the electronic version of
the Family DOORS (namely the Family DOORS app).

55 Peer reviewed papers from the FRSA National Conference 2019 NEW HORIZONS: Building the future, Paving the way
RASA’s privacy policy allows for use of de-identified
client information for service evaluation purposes. All
participants were made aware of this policy and agreed
to the use of data.
Procedure
Clients undertook DOOR 1 as part of their intake
appointment at RASA FARS. Typically, clients were
asked to arrive at their appointment 30 minutes early
‘to complete registration forms’ before their scheduled
face-to-face appointment with their FARS practitioner.
If the clients were a couple or intimate partners, they
were asked to sit separately and to complete their
DOOR 1 in private. Once DOOR 1 was completed, the
practitioner was notified that the client(s) were ready
to begin their face-to-face session with the practitioner.
The practitioner reviewed the client’s DOOR 1 responses
before meeting him/her/them or read the DOOR 2,
which contains guidance on potentially risky responses
and suggested strategies. The practitioner then took
the DOOR 1 results into the room to begin engagement,
elaboration and risk assessment if necessary.
Population demographics
Data from a total of 675 unique and individual clients
were used in the research exercise, with 460 of these
clients having dependent children and 211 not having
any dependent children. Those clients with dependent
children completed additional questions. The
relationship(s) between parents/carers and dependent
children were: 58.8% were mothers (only); 31.4% were
fathers (only); 2.9% both fathers and stepfathers;
2.7% both mothers and stepmothers; and 4.2% were
in another type of relationship(s). Genders of clients
were 38.5% male, 61.3% female and 0.3% neither male
nor female. In terms of culture, 3.8% of clients said
they were Aboriginal or Torres Strait Islander or both.
Exactly half (50.0%) of clients were married or in de
facto relationships; 29.0% were separated or divorced;
and 17.9% were single or not in a relationship. The three
most common presenting issues named by clients
were: relationships assistance (61.9%); mental health
(28.9%); and child’s coping (26.1%).
Results
In family law matters, attention is often directed first
at the potentially high-risk indicators of the ‘big five’
safety risks: familicide, suicide, family violence, child
abuse or neglect, and child abduction (McIntosh &
Ralfs, 2012b, p.4). Therefore, examining these for FARS
relationships counselling clients, Table 1 shows DOOR
1 items which need elaboration by the practitioner to
explore possible indicators of these ‘big five’ risks.
Table 1. Items to elaborate for possible ‘Big five’ risks
in relationship counselling
DOOR 1 items N Yes
(%)
Familicide:
¡Currently afraid for own safety
because of partner, ex-partner or
someone else
¡Partner, ex-partner or other parent
thought of suicide
575
571
10.3%
19.4%
Suicide:
¡Ever thought of suicide
¡Currently thinking of suicide
604
567
34.1%
9.5%
Family violence:
¡Police called, criminal charge laid
or criminal justice involvement
due to behavior of partner, ex-
partner or other parent
¡Police called, criminal charge laid
or criminal justice involvement
due to own behaviour
¡Intervention order currently
protecting from partner, ex-
partner or other parent
¡Intervention order currently
protecting someone else from self
577
604
568
598
18.0%
11.4%
4.6%
2.8%
Child abuse or neglect:
¡Child protection report made
about child/ren
¡Current child protection
investigation into child/ren
401
398
11.7%
2.8%
Child abduction (separated
parents only):
¡Other parent threatened or
actually withheld child far beyond
agreed time
¡Parent him/herself threatened or
actually withheld child far beyond
agreed time
283
281
22.3%
4.6%
Note: No single screening item alone can predict risk with
certainty but endorsement of an item along with many others
indicate a need for elaboration and possible risk assessment
with professional to decide if the risk is a high risk indicator.
FARS population is 675 clients depending on question asked.
The figures in Table 1 show significant levels of risk
across many indicators in addition to domestic violence.
The figures also confirm the gendered nature of
domestic violence, with women 4.0 times more likely
to be protected by an intervention order than men; and
men were 5.7 times more likely than women to be the
defendant in an intervention order.
Table 2 compares the levels of risk and potential harm
with those in FDR at RASA on several key items.

56 Peer reviewed papers from the FRSA National Conference 2019 NEW HORIZONS: Building the future, Paving the way
Table 2. Comparison of relationship counselling and
Family Dispute Resolution
DOOR 1 items FDR
(%) FARS
(%)
Familicide:
¡Currently afraid for own
safety because of partner,
ex-partner or someone else
¡Partner, ex-partner or other
parent thought of suicide
21.7%
24.8%
10.3%
19.4%
Suicide:
¡Ever thought of suicide
¡Currently thinking of suicide
21.5%
3.5%
34.1%
9.5%
Family violence:
¡Police called, criminal charge
laid or criminal justice
involvement due to behavior
of partner, ex-partner or other
parent
¡Police called, criminal charge
laid or criminal justice
involvement due to own
behaviour
¡Intervention order currently
protecting from partner, ex-
partner or other parent
¡Intervention order currently
protecting someone else
from self
33.9%
12.8%
6.9%
6.0%
18.0%
11.4%
4.6%
2.8%
Child abuse or neglect:
¡Child protection report made
about child/ren
¡Current child protection
investigation into child/ren
13.1%
2.2%
11.7%
2.8%
Note: FDR population is 2,977-3,818 clients and FARS is 675
clients depending on question asked
Broadly, Table 2 shows that risk levels for FARS are
comparable to FDR for the potential harm to children,
lower for family violence, but higher for suicide risk.
DOOR 1 also includes many items which act as if they are
‘intensifiers’.5 These items are indicators of heightened
risk. This means that other identified risks, which without
the presence of the intensifier may appear ‘risky,’ are
actually likely to be ‘very risky’. For example, a domestic
violence risk becomes very risky if a client also reports
their former partner is using alcohol or drugs in a worrying
way and these behaviours are becoming worse or more
frequent; or a suicide indicator risk becomes very risky if
a client also says he/she is humiliated by the separation
and has recently been behaving out of character. Further
examples of ‘intensifiers’ are shown in Table 3.
Table 3. Intensifiers in relationship counselling
DOOR 1 items NYes
(%)
Escalation:
¡Behaving out of character in
past six months (self)
¡Behaving out of character in
past six months (partner)
¡Behaving out of character in
past six months (ex-partner/
other parent)
¡Other person’s risky behaviours
getting worse
586
414
191
507
39.6%
38.6%
33.0%
9.7 %
Alcohol and drug use:
¡Drunk/used more than meant
(self)
¡Felt needed to cut down (self)
¡Someone else worried about
drinking/drug use (self)
¡Worried about drinking/use of
partner
¡Worried about drinking/use of
ex-partner/other parent
640
634
626
448
171
23.4%
21.3%
11.3%
17.2%
32.7%
Hostility and hatred in
relationships:
¡Often feel hostile/hatred
towards partner
¡Often feel hostile/hatred
towards ex-partner/other parent
¡Often feel hostile/hatred
towards family members
¡Often harsher towards children
than meant to be
439
225
562
383
13.7%
19.6%
7.8%
5.2%
Emotional flooding about problem:
¡Hopeless/powerless
¡Angry/furious
¡Scared/afraid
¡Embarrassed/humiliated
¡Shocked/devastated
¡Jealous/resentful
675
675
675
675
675
675
32.0%
19.1%
17.3%
17.2%
11.0%
6.5%
Note: FARS population is 675 clients depending on question
asked
There are a number of factors in Table 3 which show
many other risks that become more potent for the
client or someone close to the client. Specifically,
these intensifiers may mean people become more
impulsive, reckless or callous in their behaviour
towards themselves and others. Most obviously, a
client reporting an escalation in behaviour or acting
‘out of character’ may indicate a worrying trajectory.

57 Peer reviewed papers from the FRSA National Conference 2019 NEW HORIZONS: Building the future, Paving the way
Alternatively, the emotional state of a client may
intensify his/her feelings towards him/herself and
anyone close to them or more generally to the likely
reactivity or resolution of the problem.
Discussion
Our research question aimed to explore the levels of
risk indicators reported in FARS at a mainstream agency
where DOOR 1 is used universally with clients as the
first step in a risk management process. Clients use
FARS to work on intimate partner relationships and
family relationship issues; yet many clients report
highly significant levels of risk on items in Tables 1 and
3. To recap, we found one in six had police called to
domestic disputes; one in seven had child protection
notifications made about their children; over one in ten
had highly risky AOD use; and one in ten were currently
feeling suicidal. FARS clients are disclosing risks at similar
levels – or even more often than FDR clients (where risk
screening practice is more established typically).
Combining high prevalence with high throughput of
clients means a typical relationship practitioner with a
typical caseload will see at least one client per day with
very worrying use of alcohol or other drugs; and every
other day will see at least one currently suicidal client
and at least another who is currently scared for his/her
safety. Given ‘risks run in herds’, it’s likely that there
are many other co-occurring risks in addition to these.
Anonymous feedback from relationship counsellors
at Relationships Australia Tasmania has showed that
learning about these risks with clients in daily practice
is very helpful without becoming overwhelming (Kelly,
French & Lee, 2017; Kelly & Lee, 2018). This answers our
research questions about the levels of risk reported by
clients and the utility for practitioners in knowing these
risks in advance of meeting their client.
Another aspect of clinical utility for practitioners
is about seeing clusters of risk behaviours within
a client or between clients (where a practitioner is
working with a couple or more than one client from
the same family or case). A single response of ‘yes’ to
any single DOOR 1 item can never definitively confirm
high risk of a lethal outcome, yet clusters of many
‘yes’ responses may raise suspicions for practitioners
that they need to explore and possibly assess for
high risk outcomes family violence, harm to children,
suicidality, and possibly even familicide. In particular,
FARS clients often present as couples which means
DOORS enables discovery where one person discloses
a risky set of behaviours and their partner doesn’t.
Where two or more clients in the family have answered
the same questions using DOOR 1 then a practitioner
can compare, contrast and make sense of a client
who is dismissing, denying or simply unaware of their
partner’s distress or safety risk.
In this analysis, there were combinations of ‘yes’
responses that showed FARS clients may have
potentially dangerous combinations of content
domains, risk intensifiers and troubling emotional
states, which would not be known to the practitioner
without DOORS. For example, one non-parent client’s
profile was: resentful about doing counselling; feels
hostile towards a current partner; has had risky alcohol
use; and has had the police called to disturbances at
home because of their own behaviour. Another client
profile was a parent who is scared of a previous
partner with whom she shares children; is aware of
or has made child protection notifications; has been
kept from seeing the children by their father; thinks
the father is acting out of character and it’s getting
worse; however she feels powerless to do anything
about the situation. These profiles are possible for a
practitioner to ascertain by spending a few minutes
reviewing what the client has said ‘on paper’, enabling
the relationship practitioner to much more quickly
tune into any possible essential elaborations for risk
before getting to the heart of the matter. This further
demonstrates the utility of ‘doing DOORS’ for the FARS
practitioner and answers the research question about
value in risk discovery before meeting the client.
From the client perspective, the Family DOORS process
of finding out about these potentially risky clusters is
efficient and respectful. This typically happens through
a client’s self-report of risk (while they are in reception)
using either a paper form or – more usually – an app
on a tablet. It may include at times sitting separately
from a current partner while completing the self-
report. Nonetheless, client feedback on the process
and experience of ‘being screened’ is nearly entirely
positive. An anonymous survey of 97 ‘just screened’
FARS clients confirmed this when it found that 99.0%
thought the process was helpful; 89.8% said they
were honest in their answers; only 5.1% felt suspicious
about the process; and, importantly, 59.8% preferred
to disclose sensitive or personal risks on a form rather
than tell the practitioner face-to-face. In other words,
the process is acceptable to an overwhelming majority
of FARS clients and possibly even preferable if clients
have high risks. In short, clients are active participants
who ‘do DOORS’ rather than passive subjects who are
‘done by DOORS’.
Conclusion
According to large Australian surveys of people who
have used services of FRSA member agencies (Kaspiew,
Carson, Dunstan, De Maio, et al., 2015), clients using
relationship counselling face significant levels of risk to
family safety and wellbeing. Those at greater risk are
more likely to seek help when attending relationship
counselling rather than in isolation through specialist
services such as domestic violence services. We also

58 Peer reviewed papers from the FRSA National Conference 2019 NEW HORIZONS: Building the future, Paving the way
know that risks such as domestic violence are rarely
found in isolation and are likely to co-occur with
other risks including the potential to harm to a child’s
development by them having witnessed domestic
violence. Finally, a simple way to find out about these
risks early in the client’s engagement with a service
is for the service to use a thorough evidence-based
tool like DOORS, the universal risk screening tool that
includes the Family DOORS app.
The analyses presented here are taken from the
full population of clients presenting for relationship
counselling at RASA – a significant strength of this study
because it’s not a voluntary sample of clients opting
into a research project. These analyses have shown
that clients typically have a number of risky factors
currently affecting their lives. The holistic, whole-of-
family approach of Family DOORS shows that both
victimisation and perpetration risks are real factors
in the lives of clients and their families. Regardless
of what the presenting issue actually is that led to a
client seeking relationship counselling, knowing about
the presence of these other risks for large numbers
of clients is essential for relationships practitioners to
maximise the outcome of relationship counselling.
Practitioners are helped by knowing about the risks
in advance of meeting their clients. Practitioners also
benefit from clients being asked the risk questions in
a time efficient yet respectful manner now through
the Family DOORS app. Clients also benefit from being
able to disclose risks without having to do so directly to
their practitioner – something which can overcome the
embarrassment or even shame that may come from
looking someone in the eye and saying “I feel unsafe”.
Based on these results, we conclude that universal
screening should be seen as essential in counselling
services just as it is in post-separation FDR services.
Endnotes
1 Available at no charge via www.familydoors.com
2 As ratios, for every client who has no violence before separation
and uses a relationship service, there are 1.47 reporting physical
violence and 1.91 reporting emotional abuse also using services
(based on Table 4.2 in Kaspiew, Carson, Dunstan, De Maio, et
al., 2015).
3 Key branching questions include the service sought; the
presence and ages of dependent children; current intimate
relationship; recent separation from a partner; communication
with former partners or other parents; disputes with other
parties; and non-biological parenting relationships.
4 To illustrate an ‘elaboration’, one client self-reported on DOOR
1 that she had concerns for her children’s safety when they
were with their father. When the practitioner met her and
asked about this, doing a DOOR 2 elaboration, she said that
the children nearly drowned recently when they were with
their father. Further ‘elaboration’ revealed how their father
had taken them to a duck pond and spent time on his phone
rather than watching carefully. Given the children were nearly
teenagers and the pond was knee height, the practitioner’s
elaboration suggested no risk assessment was necessary
due to no risk of supervisory neglect, with no need for child
protection notification or referral.
5 This naming of ‘intensifier’ is used deliberately. It is analogous
to using ‘really’ to intensify an adjective or adverb to give it
more strength or force.
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