GAB/DST 17

Engender Equality

Submission to the Government Administration B Inquiry DISABILITY SERVICES IN TASMANIA

Engender Equality, April 2021

“So many surveys, so tired of saying the same thing over and over again. We need help. Not this snail pace, same old, same old. We all know the problem. We all know what to do, so do it!”

— Engender Equality, Advocate for Change

Background

Engender Equality works for the elimination of violence and abuse in Tasmania by providing a suite of integrated and specialist responses to family violence. Our key impacts are delivered via counselling, education and support to people affected by family violence, along with primary prevention initiatives that address violence against women and children.

We are pleased to see the Tasmanian Government inquiring into disability services in our state. We have recently lodged a submission with the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. We welcome the opportunity to make a further submission in Tasmania, drawing from the issues we raised with the Royal Commission.

In the context of our work, this submission focuses on the experience of people with disability in relation to violence, abuse, neglect and exploitation caused by family and relationship violence. This intersection is too often invisible in public debate.

Our submission is informed by a rapid evidence assessment conducted by Dr Morag MacSween, and by over three decades of experience as a service provider, advocacy organisation and strategic partner in the Tasmanian domestic and family violence sector.

Our views are further informed by insights from our counselling staff and members of our Advocates for Change Program. The Advocates are a group of individuals with lived experience of family and sexual violence who contribute their expertise to public discourse, policy design and services. In this submission we have particularly relied on the evidence from the lived experience of our Advocates with disability.

Our submission is relevant to Inquiry questions 2, 3 and 4:

1. The range of support services available to Tasmanians who are not on, or eligible for, the NDIS;
1. Funding for organisations that service those not eligible for the NDIS; and
1. Workforce development and training opportunities for the disability support sector, including allied health.

Submission

In our submission to the Royal Commission, we noted key messages from current research on the experience of family and relationship violence of people with disability and summarised critical areas of the evidence base. Key messages relevant to this Inquiry are as follows:

People with disability disproportionately experience violence of all kinds, including intimate partner violence and sexual violence.
Domestic and family violence is itself a leading cause of disability, particularly for women and children.
Some forms of abuse are unique to people with disability, including forced contraception and forced sterilisation of women and girls with disability.
Framing relationship and family violence as occurring in the home and from partners and relatives excludes the violence women with disability experience in institutions and from service providers within their own ‘domestic’ spheres.
People with disability who are members of other marginalised groups experience multiple disadvantage and complex experiences of violence.
Lack of progress in tackling barriers to physical access for women with disability and securing women’s basic safety from violence is a critical issue in Tasmania.
Sexual objectification, dehumanisation and the normalisation of violence against women is intensified for women with disability.
The literature notes significant social, physical, systemic, skills-related and attitudinal barriers for people with a disability in identifying and disclosing experiences of violence and in accessing services.
Many women who have experienced intimate partner violence do not seek help from specialist services but do talk to someone they know, and a positive social response is correlated with better outcomes.
Fear of having children removed if they disclose abuse is an issue for women with disability, particularly women with intellectual disability. The available research confirms that parents with intellectual disability are over-represented in child protection services.
There are excellent resources for increasing access for women with disability in family and relationship violence services, but no sources of funding to implement improvements which entail cost.

Excerpts from our submission to the Royal Commission which are relevant to this Inquiry are at Attachment A.

People with disability in Tasmania who are not on, or eligible for, the NDIS have access to funded psychological supports in relation to family and relationship violence through:

Medicare provisions, which are limited to 10 sessions per year;
Government-provided counselling, which has shifted to offer brief intervention in response to demand;

Psychosocial support provided through the Psychosocial Support Measure, which does not include counselling, and is generalist not specialist; and
Engender Equality.

Engender Equality is currently the only state-wide Tasmanian service funded to offer medium to long-term specialist counselling to victim/survivors of family and relationship violence. Demand for our services significantly outstrips supply, and new clients are currently waiting up to three months for an initial appointment in Hobart. We are likely to have to triage further in response to demand.

We have noted above that people with disability disproportionately experience family and relationship violence; that there are unique forms of abuse for people with disability; and that there are increased barriers to accessing services. In light of this evidence, we can predict, with a high degree of confidence, that:

A significant number of Tasmanians with disability are experiencing family and relationship violence with no access to specialised counselling;
Disability services, including allied health services, are unlikely to be fully equipped to recognise as family and relationship violence the forms of abuse uniquely experienced by Tasmanians with disability; and
Refuges and accommodation for women leaving family violence do not have sufficient funding to ensure physical accessibility or to take up service improvement opportunities which require funding.

We cannot be confident that Child Safety services in Tasmania are better equipped than those in other states and territories to work in a fully disability-informed way.

We can be confident that the issues around demand and service-sector awareness that we experience at Engender Equality are mirrored for the Tasmanian sexual assault support service.

Our Advocates for Change told us prevention of family and relationship violence against people with disability depends on:

More victim-survivors with disability feeling safe and supported in coming forward telling their story, to remove or lessen the shame and secrecy around this abuse;
More local support services in the actual town that the victim and abuser live;
More service workers actually going into the home where they can discretely talk to the victim and ask them what is going on;
More educational campaigns that inform the public what abuse looks like and what to notice in victims that may indicate they are experiencing abuse;
Teaching better ways to communicate with and support people with a disability;
Teaching how to resolve disagreements without resorting to violence or abuse;
Challenging the belief that people with disability do not have relationships or sex;
Requiring disability support organisations to use trauma-informed practice;
Educating in-home care workers to identify family and relationship violence and to support clients following a disclosure of violence or abuse;

More awareness in the media about the prevalence of family and relationship violence in the disability community;
More funding to disability organisations to support victims of violence and abuse, and more funding to the family violence sector to support people with disability.

They also told us that:

Perpetrators of violence and abuse against people with disability remove, harm or threaten harm to assistance dogs or emotional support animals as a form of psychological abuse;
Social abuse includes refusing to transport their partner to access social engagements, see friends etc.;
Due to anti-sex and sex-stigmatising values intersecting with discrimination against people with disabilities, people with disabilities may face additional barriers to negotiating safe working conditions when operating in the adult sex industry; and
38% of people who identify as LGBTQI also identify as people with disability. i

Conclusion

There is so much to do to create a Tasmania in which women with disability experiencing family and relationship violence share the same rights, voice, and access to support as women without disability. Already, there is so much to do to create a Tasmania in which women without disability have adequate access to specialist supports and can freely and fully exercise their human rights.

Adequate resourcing of both the disability and family violence service systems is essential to improve outcomes for people with disability who are experiencing violence and abuse.

Although it is beyond the scope of this current Inquiry, we note that addressing the cultural drivers of violence against women with disabilities, in particular misogyny and ableism, must sit alongside improved service provision if we are to see sustainable change.

Recommendations

Recommendation 1 In partnership with the Tasmanian specialist family violence sector, we recommend that the Tasmanian Government undertakes a public cost analysis of the provision of an adequate specialist service response for all Tasmanian victims/survivors of family and relationship violence. Such a response must be based on an expanded definition of family and relationship violence that includes the specific forms of violence and barriers to access experienced by people with disability in Tasmania. We recommend that the Tasmanian Government commits to publish this analysis.

We further recommend that consideration is given to scoping this review to include victim/survivors of sexual assault, in partnership with the Tasmanian sexual assault support sector.

Recommendation 2 We recommend that the Tasmanian Government funds family and relationship violence training and ongoing specialist consultancy support for all funded disability service providers and allied health services so that they are safe, trauma-informed and dignity-promoting for people with disability.

We further recommend that consideration is given to including training and consultancy around sexual violence, in partnership with the sexual assault support sector.

Recommendation 3 We recommend that Primary Health Tasmania reviews the capacity of services funded through the Psychosocial Support Measure to respond adequately to victim/survivors of family and relationship violence who have disability.

We further recommend that consideration is given to scoping this review to include victim/survivors of sexual assault, in partnership with the sexual assault support sector.

Recommendation 4 We recommend that Government organises a Roundtable on Child Safety and People with Disability, to bring together perspectives from policy, practice and lived experience.

Violence-induced disability

While research focuses in the main on disability as a risk factor for violence and abuse, domestic and family violence is, in addition, a leading cause of disability.

The Getting Safe Against the Odds report cites data from a 2004 VicHealth study demonstrating that not only is domestic violence the biggest single health risk factor for women aged 25-44, it is also the leading cause of disability, including acquired brain injury, disability arising from violence-related substance misuse, and psychosocial disability.ii

Similarly, Violence-Induced Disability: the Consequences of Violence Against Women and Children argues that domestic violence both causes disability and increases the severity of existing disability, cerebral palsy, behavioural and learning disabilities in children, and acquired brain injury and the effects of depression and anxiety for adults.iii

Both papers argue that disability is usually understood as a risk factor for experiencing violence and that disability caused by violence is an almost un-navigated backwater in the literature.

The Australian Institute of Health and Welfare reconfirmed the data in 2018, finding that domestic and family violence continues to contribute to the burden of disease – illness, disability, and premature death – more than any other single risk factor for women in this age group.iv

More positively, in the intervening years, the links between domestic and family violence and acquired brain injury have been the subject of research and awareness raising.v

The unique experience of violence for women with disability

“Pain is pain no matter how you frame it, however there are many more avenues to abuse and use a person with disabilities, physically and psychologically.

All forms of disability make it easier for the abuser to offend (as they are often the carer as well as the partner) and the victim more vulnerable to abuse.”

— Engender Equality Advocate for Change

Current discourse around domestic and family violence, and the service response to the problem, often fails to recognise that some forms of abuse are unique to women with disabilities. Specifically:

Sexual abuse of a woman with a disability may include forced sterilisation or forced abortion.
Sexual objectification, dehumanisation and the normalisation of violence against women is heightened for women with disability, for whom the male ‘gaze’ is often replaced by the ‘stare’.

Physical abuse may include taking away a woman’s wheelchair, denying personal care, rough handling, withholding medical treatment, or rearranging the physical environment of a person who is visually impaired.
Psychological abuse may include:
- women with physical disabilities having essentials such as house keys or medication kept just out of reach;
- women who are reliant on communication aids having access to aids restricted;vi
- perpetrators explaining away disclosures of violence by women with psychosocial or intellectual disability as inaccurate memory, confusion, fantasy, misunderstanding or lies, and threatening institutionalisation;vii
- for people with high support needs, when the abuser is the main carer, individuals suffering neglect, isolation and intense vulnerability to abuse and insurmountable barriers to support.viii

Accepted definitions of domestic and family violence as occurring in the home and from partners and family excludes the violence women with disability experience in institutions and from service providers. These experiences of violence can be downplayed and detoxified as workplace issues rather than crimes and may be justified on the grounds of ‘managing behaviours’.ix

Further, Engender Equality is concerned that simply widening the definition to encompass the experience of women with disability is likely to be part of what we have identified as ‘the existing system response’ – broadening the scope of an already overloaded and underfunded specialist sector.

Like all women, women with disability living in residential care settings require access to specialist family violence supports, validation and advocacy. However, this can neither function as an ‘add on’ to the specialist sector’s existing role or as a substitute for DFV-informed and DFV-safe institutional environments.

In relation to seeking a criminal-justice response to their experiences of violence, a report from Australia’s National Research Organisation for Women’s Safety (ANROWS) argues that the legal capacity of women with disability “was routinely denied or inhibited; reproductive and sexual autonomy were compromised; women’s decisions about treatment and desired outcomes were not respected; appropriate communicative methods and approaches were not offered; and therefore, agency to act as full citizens before the law was not accorded them”.x

The Australian Supported Decision-Making Network have made representations to Government to develop a national framework to enable the replacement of substitute decision-making for people with disability to supported decision-making with people with disability.xi Engender Equality supports these representations.

We were struck by the capabilities approach outlined by Professor Shane Clifton in his paper for the Commission. Engender Equality supports the identification of a list of human capabilities as the minimum basis for human rights; noting that the list includes being able to “experience bodily integrity, such as security against violence, and the opportunity for sexual satisfaction and choice in matters of reproduction”.xii

The full range of barriers experienced by people with disability experiencing family and relationship violence

Our rapid evidence review identified three levels of barriers that too often prevent people with disability accessing appropriate domestic and family violence supports: barriers to accessing services, barriers to accessing informal or ‘natural’ supports, and ‘barriers before the barriers’ – limits to awareness and disincentives to disclosure. The below discussion examines these factors in relation to the service response; living in remote and rural Australia; the social response; awareness and disclosure; and intersections with child protection.

The service response

The literature notes significant barriers for people with a disability experiencing violence in accessing services. We were struck by the consistency of messages and findings across decades.

Triple Disadvantage: Out of Sight, Out of Mind reports on a project run in Victoria between 1997 and 2003. The project piloted a local partnership to address the relative invisibility of disability in domestic violence services, and the relative invisibility of domestic violence in disability services. Among the project’s key messages and findings were:

If sexual assault and family violence services were to target the population facing the highest risk of violence, that group would be women with disabilities;
The definition of domestic and family violence needs to change; for women with disability the perpetrators are not just intimate partners, but may also include those who provide personal care;
Interventions that work for women without disability cannot be assumed to work for women with disability;
Partnerships between the disability and family violence sectors, including training, ongoing networking and shared advocacy are needed.xiii

Fifteen years on, the ANROWS research report Women, disability and violence: barriers to accessing justice made similar points in its key findings:

Common sense, inaccurate and untested assumptions about the experience of violence for women with disability are common in the specialist disability, specialist DFV and legal sectors, including assumptions about what they need, what they want, how they understand violence, safety and security, their legal capacity and rights, the barriers they experience, the types of violence they experience and what responses they need;
Partial knowledge, insight and skills are held in different sectors, creating a key risk for women with disability affected by DFV – there has been limited progress towards integrated knowledge and skills;
Not only has there been inadequate progress towards effective access to justice for women with disabilities experiencing violence, there has been inadequate progress towards securing their basic safety from violence.xiv

Disappointingly, major disability system reform in Australia has not improved the situation. In fact, the National Disability Insurance Scheme, intended to bring choice and control to people with disability, is experienced by many as confusing, intimidating and distressing.

Engender Equality is aware of the submission to the Royal Commission by Vanimali Hermans which describes her mother’s experience with the NDIS as “nothing short of hell… a constant source of anxiety and dehumanisation”. Her mother June “felt small and at the mercy of a bureaucracy that at its best did not care for her, and at its worse actively sought to make her life worse”.xv

We are struck by the similarities between this description and descriptions of the experience of coercive control at the heart of family and intimate partner violence. We are concerned that the NDIA may not be delivering trauma-informed responses, and that in some cases, its response may be trauma-inducing.

Against this depressing background, the literature includes targeted guidance on tackling barriers to access – physical, systemic, skills-based and attitudinal:

Triple Disadvantage: Out of Sight, Out of Mind includes a detailed description of cross-sector training between the women’s and disability sectors;xvi
Women with Disability and Domestic and Family Violence: A Guide for Policy and Practice sets out steps domestic and family violence agencies can take to increase access to their services for women with disability;xvii
Getting Safe Against the Odds outlines strategies that domestic and family violence agencies have used to better respond to women with disabilities, including adapting interventions to better fit their needs;xviii
The National Symposium on Violence against Women and Girls with Disabilities identified eight key areas for enhancing good policy and practice from the Stop the Violence project evidence base, including training for service providers and sector development and reform.xix

Living in rural and remote Australia

“[In rural and remote Tasmania] there are nil or less support services for both disabled and abused, let alone a disabled person who’s also being abused. Victims have to travel far to find support and too often don’t disclose the abuse at all because they live in rural, small communities where everyone knows each other’s business and knows the abuser and too often thinks he/she is a ‘great guy/person’.

It is harder to access support services and there may be long travel distances to do so. We need more outreach to our rural areas.

More pain! Isolation, no way out and to where? No service providers, town gossip, judgements, shame, shall I go on?”

— Engender Equality Advocate for Change

Lack of progress in tackling barriers to physical access and securing women’s basic safety from violence is a critical issue in Tasmania, further exacerbated by the state’s heavily dispersed and rural population. Like many of the barriers to safety, these factors affect women with disability ten-fold. Engender Equality CEO Alina Thomas notes:

Appropriate crisis accommodation for women with disabilities is extremely limited in Tasmania, and, in many places, non-existent. Long-term accommodation that is tailored to people with

disabilities is also an issue for Tasmania. When women with disabilities experience abuse, they are extremely limited in their options to access safety and stability. This is even more difficult when women have pets.

Most women who have experienced intimate partner violence do not seek help from specialist services (84-91%), however the vast majority will speak about it to someone they know (74-93%).xx

Against this background, the social response to domestic and family violence is of critical importance. The Centre for Response-Based Practice argues that:

Both victim-survivors and perpetrators of domestic and family violence are constantly mindful of the response they are likely to receive from their social networks;
A positive and helpful social response is strongly correlated with better immediate and long-term outcomes, including lower levels of distress and the confidence to disclose again;
The reverse is true for a negative social response.xxi

Community attitudes to domestic and family violence, and to disability, shape the social response people with disability experiencing violence will receive.

The available evidence on community attitudes about inclusion of people with disability suggests that they are positive, but paternalistic. Attitudes towards people with more severe disability and towards people with psychosocial disability, particularly schizophrenia, are more negative, and include stigmatising views, anxiety and discomfort. People with intellectual disability are often seen as less capable than they in fact are.xxii

However, community attitudes to violence against women are improving overall. ANROWS reports that most Australians have a good understanding of violence against women, support gender equality, support policies enabling violent partners to be removed from the home, understand that domestic violence is more than physical violence and reject violence-supporting attitudes.xxiii

Unfortunately, ANROWS also reports that:

Some Australians continue to believe that women cite violence to gain tactical advantage in their relationships with men;
40% of Australians believe that women make up false reports of sexual assault in order to punish men;
1 in 8 Australians believe that if a woman is raped while she is drunk or affected by drugs, she is at least partly responsible;
Many Australians are willing to excuse violence as part of a ‘normal’ gender dynamic in a relationship;
1 in 5 Australians believe domestic violence is a normal reaction to stress, and that sometimes a woman can make a man so angry he hits her without meaning to;
1 in 3 Australians believe that if a woman does not leave her abusive partner then she is responsible for the violence continuing.

Barriers before the barriers: awareness and disclosure

The literature notes a set of barriers which may prevent people with disability recognising that they are experiencing violence, abuse, neglect or exploitation. These factors further impede people with disability disclosing and seeking help for domestic and family violence. For example:

Inadequate or limited education may mean that women with disabilities have not been informed about the different forms of violence, abuse, neglect and exploitation they may encounter;xxiv
Information about services may not be available in formats that are accessible for people with some disabilities;xxv
Perpetrators may deliberately withhold information;xxvi
Care workers can be reluctant to raise violence as an issue with their clients, and this can operate as a form of gatekeeping, preventing them from making informed decisions and taking control of their lives;xxvii
Women with disabilities are frequently not believed when they disclose, have their experiences minimised, or are held responsible for the violence;xxviii
In common with women from other marginalised groups, women with disabilities disclosing family violence fear losing their children if they come to the attention of child protection;xxix
There is also fear that leaving violence may mean the available accommodation cannot support the required level of care and support;xxx
High dependence on support also reduces the opportunity to disclose or report violence;xxxi
Segregation or isolation in residential support, and social isolation because of discrimination, reduces access to networks of support that could provide support to seek help or leave;xxxii
The concepts of carer fatigue or carer sacrifice can obscure, minimise or excuse violence from carers.xxxiii

Intersections with child protection

Fear of child removal as a barrier to disclosing family violence is an issue for many Engender Equality clients with disability. As the Engender CEO notes:

Women with intellectual disabilities often tell their counsellor about the fear – and the reality – of having children removed. The literature talks about parents, but it is mothers with intellectual disabilities who are having their children removed, not fathers with intellectual disabilities.

The Royal Commission has learned about the removal of children from Indigenous women with intellectual disability who are victim-survivors of family violence. Evidence submitted by Thelma Schwartz, the principal legal officer at the Queensland Indigenous Family Violence Legal Service, has received media attention.

Ms Schwartz told Commissioners that the child protection system is broken, in crisis and stacked against First Nations women with disabilities. Women in violent relationships who reach out to police or services can then find themselves reported to child safety.

Ms Schwartz said:

She’s already on the back foot because of her disability. By coming forward and making the disclosure that you’ve been a victim, this is now used as a catch-22 for this mother and used against her to remove her kids.

The available research confirms that parents with intellectual disability are over-represented in child protection services and court proceedings. The Australian Institute for Family Services argues that assumptions about people with intellectual disability, the erroneous reliance on IQ as a measure of parenting capacity, and the use of inadequate assessment tools combine to make it very likely that children are being removed from parents who can, or could with supports, care for them.xxxiv

The Victorian Public Advocate, commenting on this over-representation, notes that:

There is considerable knowledge available about how to work successfully with parents who have cognitive disabilities in order to reunify families or enable families to stay together; and
Women with disabilities are more likely to be the victims of domestic violence and are frequently perceived by child protection as likely to attract men who prey upon them and to be unable to keep their children safe. When this happens, parents are, in effect, being held personally responsible for the systemic social evil of domestic violence in our community.xxxv

References

i Hill, A. O., Bourne, A., McNair, R., Carman, M. & Lyons, A. (2020). Private Lives 3: The health and wellbeing of LGBTIQ people in Australia. ARCSHS Monograph Series No. 122. Melbourne, Australia: Australian Research Centre in Sex, Health and Society, La Trobe University

ii Domestic Violence Research Centre Victoria. Getting Safe Against the Odds.

iii Domestic Violence and Incest Resource Centre. Violence-Induced Disability: the Consequences of Violence Against Women and Children. 2006.

iv Australian Institute of Health and Welfare. Family, domestic and sexual violence in Australia: continuing the national story. 2019.

v Domestic Violence Service Management NSW. Reflections Paper 2.1 An exploration of the intersections between Domestic and Family Violence (DFV) and Acquired Brain Injury (ABI). 2018.

vi Domestic Violence Research Centre Victoria. Triple Disadvantage: Out of Sight, Out of Mind. 2003.

vii Ibid.

viii Ibid.

ix Clifton, S. Hierarchies of power: Disability theories and models and their implications for violence against, and abuse, neglect, and exploitation of, people with disability. Royal Commission, 2020.

x Maher, J et al. Women, disability and violence: Barriers to accessing justice. ANROWS, 2018.

xi The Australian Supported Decision-Making Network. Discussion Paper: Calling for development of a National Supported Decision-Making Framework. 2016.

xii Clifton, S. Hierarchies of power: Disability theories and models and their implications for violence against, and abuse, neglect, and exploitation of, people with disability. Royal Commission, 2020.

xiii Domestic Violence Research Centre Victoria. Triple Disadvantage: Out of Sight, Out of Mind. 2003.

xiv Maher, J et al. Women, disability and violence: Barriers to accessing justice. ANROWS, 2018.

xv Hermans, V. Submission to the Disability Royal Commission. Cited in Gibbs, E. What will it take for the NDIS to put disabled people first? 2020.

xvi Domestic Violence Research Centre Victoria. Triple Disadvantage: Out of Sight, Out of Mind. 2003.

xvii People with Disability and Domestic Violence New South Wales. Women with Disability and Domestic and Family Violence: A Guide for Policy and Practice. 2015.

xviii Domestic Violence Research Centre Victoria. Getting Safe Against the Odds.

xix Stop the Violence and Women with Disabilities Australia. Report of the Proceedings and Outcomes of the National Symposium on Violence Against Women and Girls with Disabilities. 2013.

xx Phillips, J & Vandenbroek, P. Domestic, family and sexual violence in Australia: an overview of the issues. Parliament of Australia, 2014.

xxi Wade A. Core Tenets of Response-Based Practice. Centre for Response-Based Practice, 2019.

xxii People with Disability and Domestic Violence New South Wales. Women with Disability and Domestic and Family Violence: A Guide for Policy and Practice. 2015.

xxiii ANROWS. Are we there yet? Australians’ attitudes towards violence against women & gender equality: Summary findings from the 2017 National Community Attitudes towards Violence against Women Survey. 2019.

xxiv People with Disability and Domestic Violence New South Wales. Women with Disability and Domestic and Family Violence: A Guide for Policy and Practice. 2015.

xxv People with Disability and Domestic Violence New South Wales. Women with Disability and Domestic and Family Violence: A Guide for Policy and Practice. 2015.

xxvi Ibid.

xxvii Maher, J et al. Women, disability and violence: Barriers to accessing justice. ANROWS, 2018

xxviii People with Disability and Domestic Violence New South Wales. Women with Disability and Domestic and Family Violence: A Guide for Policy and Practice. 2015.

xxix Ibid.

xxx Ibid.

xxxi Ibid.

xxxii Ibid.

xxxiii Ibid.

xxxiv Lamont, A & Bromfield, L. Parental intellectual disability and child protection: Key issues. Australian Institute for Family Studies, 2009.

xxxv Office of the Public Advocate. Rebuilding the village: Supporting families where a parent has a disability. 2015.