Let's Talk Health Justice with Marika Manioudakis

Welcome to Health Justice Australia’s new series, Let's Talk Health Justice, a portrait of the people working in health justice partnership. It’s an honest series bringing detail and colour to the reality of working at the intersection of health and justice, where the aim is to assist people who experience inequity. If you’re new to this space, head to our website to find out more about who we are and what we, and health justice partnerships, do. 

In our first episode, recorded in June 2023, Health Justice Australia’s Partnerships Director, Lottie Turner sits down with Marika Manioudakis, Director of Family Violence Initiatives and Principal of Integrated Practice at Eastern Community Legal Centre.  

Marika shares insights gained from her wealth of experience working in health justice partnership, including what client-centred practice and trauma informed care mean for the team at ECLC, why working in partnership can achieve outcomes for clients that services can’t achieve alone, and what her one piece of advice is for those working in partnership.

Health Justice Australia acknowledges the Traditional Custodians of the lands and waters where we work, and pays respect to Elders past and present.   

This episode references sexual and family violence. For 24/7 support, contact Australia’s national domestic, family and sexual violence counselling, information and support service, 1800 RESPECT (1800 737 732). If you are Aboriginal or Torres Strait Islander, you can also reach out to 13 YARN (13 92 76) and talk with an Aboriginal or Torres Strait Islander crisis supporter. LGBTIQ+ people looking for peer support and affirming referral pathways can contact QLIFE on 1800 184 527, 3pm to midnight 7 days a week.   

• Read ECLC’s report, It couldn’t have come at a better time, early intervention family violence legal assistance. 
  
  
• You can also read Lottie and Marika’s conversation from back in 2020 on Health Justice Australia's website.   

For more from Health Justice Australia visit our website, at healthjustice.org.au. 

Credits 

Produced by Lizzie Marton, Content Coordinator at Health Justice Australia 

Transcript

Cath: Health Justice Australia acknowledges the Traditional Custodians of the lands on which we work and pays our respect to Elders past and present. We recognise the ongoing harm of colonisation and acknowledge the resilience, knowledge, wisdom and teachings of Aboriginal and Torres Strait Islander Peoples. 

This episode references sexual and family violence. For 24/7 support, contact Australia’s national domestic, family and sexual violence counselling, information and support service, 1800 RESPECT, on 1800 737 732. If you are Aboriginal or Torres Strait Islander, you can also reach out to 13 YARN, on 13 92 76, and talk with an Aboriginal or Torres Strait Islander crisis supporter. LGBTIQ+ people looking for peer support and affirming referral pathways can contact QLIFE on 1800 184 527, 3pm to midnight 7 days a week. You’ll also find this information at the top of the show notes. 

[theme music] 

Welcome to Let's Talk Health Justice, where we explore the intersections of health and justice. We’ll be discussing how these systems can work better together, and what that means for those who rely on health, social and legal services for help. 

For many people, the problems in their lives are not easily broken down into the narrow areas of expertise that our service systems are designed around.  

Think about women and children experiencing family violence, or people navigating mental health challenges. The problems they may face are multi-dimensional, and can require support from a range of people, including doctors, lawyers, social workers, midwives and financial counsellors. 

By working together, health, legal and social services can support people living with complex problems much better than they ever could as a single service. 

Stay tuned as we talk to people working at the intersections to transform the way people access help, including frontline practitioners in health and legal services, researchers who are trying to understand what works and why, and policy makers who shape our service systems. 

This podcast is produced by Health Justice Australia. Health Justice Australia supports the expansion and effectiveness of health justice partnership though research, capability building and strategic advocacy.  

Health justice partnership integrates legal help into services that support people’s health and wellbeing. 

To find out more about health justice partnership and the work of Health Justice Australia, visit our website at healthjustice.org.au 

Hello, I’m Cathy Bucolo, Partnerships Manager at Health Justice Australia.  

For our first episode of the podcast, recorded in June 2023, Health Justice Australia’s Partnerships Director, Lottie Turner, sat down with Marika Manioudakis, Director of Family Violence Initiatives and Principal of Integrated Practice at Eastern Community Legal Centre. 

Marika started her career working in the disability and homelessness sectors, before becoming a family violence advocate in the legal sector. Marika’s a fierce advocate for systemic reform, and is on a mission to fill the service system gaps community members experiencing family violence can face.  

Marika shares her experiences of working in health justice partnership, how partnership is an opportunity for early intervention, what trauma-informed practice means for ECLC, and her one piece of advice for people working in HJP. 

 Lottie: Our first guest is Marika Manioudakis, Director of Family Violence Initiatives and Principal of Integrated Practice at Eastern Community Legal Centre in Melbourne. Welcome Marika. 

Marika: Thanks Lottie. It's great to be chatting to you today. 

Lottie: Marika, for listeners who aren't super familiar with Eastern Community Legal Centre and the history and legacy of health justice partnership at the centre, can you tell us a little bit more about your key programs in that area. So Mabels, WELS and ELSA. 

Marika: Eastern Community Legal Centre does have a number of health justice partnerships that we're really quite proud of. The Mabels program, which is a health justice partnership with maternal & child health services in our local region, which we choose to keep anonymous for the safety of women accessing the program,.As well as Boorndawan Willam Aboriginal Healing Service. It's a program where our team is embedded within maternal child health centres as part of the broader maternal child health teams in those regions to really increase the capacity of each of our services responding to the needs of women and children attending those services, and it's also partnered with Boorndawan Willam Aboriginal Healing Service to provide Aboriginal women or mothers of Aboriginal children with a service that's culturally informed, if that is the woman's preference. But the partnership with Boorndawan Willam Aboriginal Healing Service also extends to build a trusted referral pathway. Sometimes the maternal child health pathway isn't necessarily one that seems safest by our Aboriginal communities, so that partnership really does challenge us to think in a more culturally safe way and make the program accessible to our Aboriginal communities. 

The WELS program is a bit of an offshoot from the Mabels program and it was really developed through our advocacy for responding even earlier to women experiencing family violence and responding through their pregnancy and their experience through maternity services. So one of the challenges that did show up in Mabel's was that often the disclosure that women make within their maternity services when they're pregnant doesn't necessarily flow through to their maternal child health experiences, so to provide just that extended support Eastern Health actually funded for one of our team to be embedded within their maternity services.  

The ELSA program is really down the other spectrum but it did build on that partnership that we started with Eastern Health and it is to respond to the needs of older people experiencing elder abuse, and again it's a health justice partnership and a multidisciplinary team that really seeks to respond to... hopefully early intervention but sometimes not, where elder abuse has been identified by health practitioners within that health setting. So yeah, a range of programs, some really strong partnerships that form that basis. But also multidisciplinary teams from ECLC's perspective that seek to deliver that type of work. 

Lottie: Marika, they're a handful of really diverse partnerships and I can imagine someone new to health justice partnership or just interested in picking your brains about health justice partnership would be sitting there going ‘Wow.’ That's a tertiary health setting. That's a community controlled setting. And that's a maternal and child health setting, which is generally a community-type setting. Did you have to take different approaches to building and fostering those partnerships? What did what did some of the initial steps to building those partnerships look like? 

Marika: So the initial steps, and I don't know if this is cheating, but it was to build on relationships that had already been formed to some degree where we were a little bit sure or as sure as we can be that there would be shared goals and a shared understanding and a shared partnership approach. I don't often think that we see partnership skills as skills that need to be identified as separate skills to some of the other skills that are sometimes needed for our services. So it was kind of capitalising on some relationships we already had where, perhaps provided some fertile grounds for partnership conversations. Um, and that was with two local government areas in the east and both were really different with where they were at in their responses to family violence and how they were supporting their teams to respond. The relationship was very much around working together to develop and to... that going into those relationships with an openness to learn ourselves as well. There had been a long relationship with Boorndawan Willam Aboriginal Healing Service that really did support that relationship and that partnership. And I guess the tertiary relationship in the same way but that developed over a period of time until it really did develop into the broader ELSA program where we were able to tender for a program together. But I guess one of the elements that we really do take is building a strong governance model around the way we set up those partnerships. I think we often talk about champions within health services and although champions can be really useful, it can really take a toll on individual people to be responsible to really making programs work. So it means we have lots of program meetings and it means we have lots of meetings at different levels of leadership. So most of our programs have a steering group at the really senior executive level to make sure that we have buy-in and, um, that we're able to make strong advocacy decisions about the way programs function and how they roll out. Also really important for that middle management level, where services are really able to problem-solve or identify challenges or come up with creative solutions or enhance practice – the real kind of collaboration, shared practice, professional development space. But then also supporting the practitioners to spend time together and sometimes that happens through co-location but it's especially facilitated by attending team meetings and really being part of the broader health justice team. So it's really supporting all of those elements and spending the time that we need to to do that. I can't say there hasn't been times where, there hasn't been glitches in our partnerships where we've had to have difficult conversations or perhaps have had to be patient while some people have come into roles without the same level of motivation or, yeah motivation, for the health justice partnership and from our perspective remaining consistent to those goals and really making sure that we're promoting a shared space of quality that drives the work that we do. I think it does end up paying off in those partnerships in the end. But um, I'll let you know if it ever fails and if we ever give up [laughs]. 

Lottie: [laughs] You spoke about some of those really integral activities of health justice partnership learning and development, professional development – joining multidisciplinary team meetings, and presumably the relationship building that was required to even engage in some of that joint activity. That was the stuff that took time, right? 

Marika: Yes. 

Lottie:  I think it's helpful for people to hear sometimes like there's no set period of time over which that happens but even just for you to share what that looked like. Generally speaking, how much time did it take to get you to the point where you were ready to engage in some kind of shared activity in each of those partnerships? 

Marika: So, the Mabels program – we designed for the first six months of the program of the funding to be spent solely on building the partnership, on understanding what coming together meant for all of us. Having shared goals, objectives, having some of the difficult practice conversations of legal professional privilege which always comes up… 

Lottie: We'll talk about that in another episode [laughs].  

Marika: No, if we can avoid it I'd much prefer it [laughs]. It is a necessary conversation. But um, yeah, really having some of those tough practice conversations to understand what our roles are what our responsibilities were, what our approach was going to be. The maternal child health space can really be quite appealing to outside services and it does seem like a really convenient time to be able to come in and deliver services on the range of matters with a huge part of our population that does attend to that service. From the maternal child health nurses’ point of view that really is a special relationship to some degree, of where they try to build relationships that do last for the first five years of a young child's life, but where they're also required to do a lot of work in a really short amount of time to make sure that mum's health and the child's health and development are assessed and supported. And so to come in and wanting a piece of that time there really does need to be a respect for what that partnership looks like, how you work together, how you build trust for that nurse to spend time in that appointment talking about the program that you're developing. But also, so that the program becomes one where it's a shared program that it's not Eastern Community Legal Centre delivering this program within the maternal child health setting space, it's a program that's been developed by all of us together and continues to be developed by all of us together. So I guess Mabels is all of us, and it takes time to build that. The other comment that I would make there is that there hasn't been an end date to where that effort has needed to decrease and especially probably at the moment where there's been a real change of staff within our partnerships. We had a partnership meeting about a month ago now where it's almost completely different people in the room and it's how do we continue to share the history of how Mabels was developed so that we still continue to develop that really kind of shared approach to the continued development of the program. So I can't say it's ever finished. But it's like that constant negotiation that constant partnership conversations that keeps it in real time. And it is never ending, in a positive way, like we don't want it to end, but it does take consistent effort and time. 

Lottie: Yeah, yeah, absolutely. I really want to elevate a key thing you mentioned in there. I mean there are a number of things, but a really practical tip for people listening to this resource. And it's the same tip I heard from service leaders in Queensland when I was there recently, and that is, build that stakeholder engagement element into your funding applications and bolster that stakeholder engagement, sometimes by taking that time away from other things you might be bidding for within that funding arrangement. So just really encouraging people to factor that in and probably factoring in a little more than they think they need to as well. So really helpful to hear that at least 6-month reflection from you around Mabels, and that was factored into the funding agreement and negotiated in that particular partnership. 

Marika: We're also in a partnership agreement with the philanthropic organization that's supporting Mabels to extend into a regional area and we were able to build actually a twelve-month period into the start of that partnership. 

Lottie: Wow. 

Marika: Mostly because we're working with partners who are new to the type of program in a setting that's really different, who have the local regional needs of that community to take into consideration. Our experience so far from funders has been that they have been able to value or identify the importance of that partnership establishment time. 

Lottie: Yeah, absolutely. I think we're zooming the camera lens on Mabels a lot. So let's stay there. The vision of Mabels is to provide an early intervention response to family violence within the maternal and child health context. Can you say a little more about how you understand early intervention particularly in the context of legal help? And what do you think Health Justice provides? 

Marika: I could say so much about that. We've actually got a report on that. 

Lottie: Ah, we can link to that in the show notes. 

Marika: That would be great. So by delivering a program that is embedded in that universal health system, we've really had been able to learn a lot about what women are asking us for at that early intervention stage. And what we've learned is that there's a real service system gap for early intervention and often now the nurses know how to ask about family violence and understand what it means and the impacts on children sometimes better than many of us. But there's a real gap between where a woman's ready to disclose her experience of family violence and where she's actually ready to try and access the broader family violence service system and we know that our family violence service system is so overwhelmed at the moment that it's almost impossible to respond to somebody who isn't in a crisis or at imminent need. So it really is around developing a program that is tailored to respond to those early intervention needs and spending time with women to support disclosures. And sometimes that can be framed around education but a lot of time it's just um, spending enough time with her, with practitioners that she can trust to respond to family violence needs, where it is going at that pace that the woman needs. And I know that is a luxury for services and programs. But that is the luxury that Mabels is focused on, our focus is on accepting referrals as quickly as possible, so that there isn't a big gap between when a woman's decided she would like to access the program before we contact her to initiate that contact. We know that it often means spending and investing time in those first interactions to build trust and to support the disclosure and really identify what a person needs at those times. And I guess the other important element is that what we considered and what we really challenged just in writing that report was really exploring our program and understanding our multidisciplinary approach. So we provide women who access that program with the choice of having a lawyer-only service or one that's integrated with a family violence advocate. There's also the option of an aboriginal liaison worker from Boorndawan Willam Aboriginal Healing Service if that's appropriate for that family. But the woman gets to choose who's in the room to respond to her needs at any one time and she can make a choice for it to be lawyer only and then change her mind to include an advocate once perhaps she understands what the advocate's role could be. She can then ask the advocate to leave. They make it very easy for her to have choice and be empowered about who she's disclosing what information to, but it is that multidisciplinary approach sometimes that does really allow practitioners to work in a really different way to what they ordinarily would. What we know is that  women don't necessarily come with a very clear legal question at that point, where a lawyer can spend 45 minutes narrowing down through a series of questions to identify what legal advice might be. We do have family violence advocates that often social workers opening up the story of trauma and really seeing where she's at in her decision making, helping to make children visible in that experience so that we can have broader conversations around safety. Um, and we've really seen that multidisciplinary approach really integral to that early intervention where we might be talking to somebody at some point about intervention orders, often it's not in that first appointment, it's often not the information they want straight away. But it's how do you safety plan around that. How do you have really tough conversations about keeping people safe alongside choosing those legal options that make those legal options accessible. There's a real kind of development in the practice that happens by delivering services to women at that early stage and really learning what that looks like and what people might need to be able to take up their legal options and also just having practitioners work alongside each other to further develop their skills. Mabels at the moment, our recent evaluation indicated that 25% of the women that are accessing the program, it is their first disclosure of family violence and that's asked normally at the intake stage, and we know that about 85% of those women will attend their first appointment with Mabels. So we're really keen to make sure that not only are we identifying people at that early stage but that our processes and that referral pathway really does support women to engage with the program as well. So very much learning how to do that and how to do that well and continuously challenging ourselves. 

Lottie: Mmmmm. I mean we talk in jest about not wanting to talk about information sharing. But you did share a really incredible activity that can be enabled by health justice partnership. That requires some form of information sharing to occur between practitioners and certainly the person accessing that service. Those multidisciplinary meetings where you might have a couple of practitioners in a room with a client. Presumably that goes to some of the comments you were making earlier about setting really clear expectations, communicating what your obligations are, being clear about role scope and boundary and how those things then mesh together. Do you have any more that you would want to say to that and what that takes? 

Marika: I think that there is a lot to learn about the decisions people make about sharing information and I think there's some really creative ways we can come together as practitioners that both protects a person's rights when accessing your legal service, both responds to safety needs and other needs, and, where we might sit in that I guess uncomfortable space about not always being able to control every element of that. But I guess what I've learned through experience is that there hasn't really been a problem that has arisen for us that hasn't been able to be problem-solved especially when taking a client-centred approach, so when clients or people choose who they want to give their information to and in what way and really trusting that people can be quite good at that if we're having very clear live conversations with them. It isn't that they attend their first meeting and you explain legal professional privilege to them and consent in that first appointment and then they sign a paper that says that they understand – it's how do you have an appointment that is constantly checking in for consent around sharing information and helping it become something that I guess we empower our clients to really take carriage of. The other thing that I would suggest, and this might be the controversial part, is that, I think there is a lot of scope where we might be able to understand the importance of legal professional privilege in a way that is especially different with a gendered lens and especially different in the family violence space. I think that sometimes the information that we need to provide appropriate and accurate legal advice needs to be the bigger experience of trauma and violence and disclosures of sexual assault in a way that sometimes one practitioner can't manage or support on their own. I know that when we do have that multidisciplinary trauma-informed client-centred approach with the skills of different practitioners we’re able to support people to tell us more of their stories in a way that informs the legal advice we're able to provide, the legal options that that person's able to choose, their ongoing engagement in legal processes and systems that can take years really, especially when we're talking that family law space, especially with people who are misidentified as perpetrators or experience sexual violence. I think we need to challenge what that looks like in terms of what information might need to be protected for a woman or other members of our community to really receive the type of legal support that they need that will hopefully lead to some sort of just outcomes in the end. 

Lottie: Yeah, well that's, let's stay with trauma-informed approaches then because really, that's what we're getting to here. We know and you've flagged with us already that a trauma-informed approach is really central to assisting many of the people who access programs offered through Eastern Community Legal Centre and your partners. So what does that mean for you and your team and the work you do? And I'm curious about how a trauma-informed approach extends to sustaining a workforce in the work they do in this particular space as well.  

Marika: Our approach to trauma-informed I must say is somewhere still on the really learning experience of where we're at. At the moment trauma-informed for us means making sure all of our staff provide trauma-informed training and just even by having a multidisciplinary team we're able to support people in ways that is more responsive to holistic needs. The way our teams really work is, and by providing a client-centred approach, really have a think about how we deliver, how we work as part of a legal system that can often create trauma for people or within legal processes that can also provide trauma to people – how we can kind of flip that around and make that as safe as possible. How, perhaps we as practitioners need to spend longer with people, provide support over a series of appointments, provide appointments that are focused on what clients need rather than what we need, and I don't say that simply – I know that sometimes when we have to complete documents ready for court, it’s not so easy to delay some of those processes. But it really is seeing how we can be flexible in our service delivery and client centred in our service delivery to provide people the most responsive service. There's a client that does come to mind when I think about trauma informed and she was one of the first people that we supported through one of our multidisciplinary teams. We were working with her for about 2 to 3 years through one of the hardest experiences with family violence that I've ever heard or come across. And during her time with us she completed her PhD which, with all the trauma she was experiencing... I think completing a PhD is phenomenal, no matter what you're going- 

Lottie: Full stop. 

Marika: Full stop. Um, and I guess that's often what I see when I think of trauma informed. Often people have to stop their lives when there's legal processes or when they're part of the legal system and it gets to continue when that's all over, and I guess the way I see trauma informed is how do we support people to start healing through their current experience of the legal system. And um obviously sometimes that is contributed into successful legal outcomes but also the connections that we can help them form along the way and how perhaps we can respond to their experiences respectfully and with real empathy that supports them to move through their experience in a healing way. I know you've mentioned the workforce and trauma-informed approaches and we tend to have... I know ECLC is quite consistent to other community legal centres where they really are built on a strong sense of social justice and really strong values and ECLC does strive to make sure that our everyday practice and conversations reflect those values. I wouldn't be able to work for an organization that didn't. When we provide safe spaces for our practitioners it really does start in the commitment to the values from the whole organization. We tend to have an approach where we don't see ourselves as others from our communities and I think one of the first lessons I learned as a practitioner is it could be anyone at any time. We try to... the same care and that approach that we would ask our practitioners to provide to clients is probably the same care of approach that we'd provide our team members and really try and have supportive open conversations. Um, where debriefing is easily accessible. We’re just finalizing our supervision policy that really tries to make that as transparent as possible. The team are able to... There’s opportunities to constantly share learning and collaborate and work as a team is a really important thing. But also structures like externally facilitated reflective practice regularly that supports the team to come together as a team rather than as a discipline. It's all disciplines together really exploring how to be trauma informed and client centred. Just that consistent support to support people to stay well through their work. It's not easy work but I think it does help when people can connect to their work through their values, especially when the work is hard. So it's ensuring that we as an organization support that connection. And having the integrity to the way our organization works to maintain this trust of the people working. 

Lottie: Absolutely. Marika, jump in the time machine with me, back in 2020, and I know this is in the context of a global pandemic, and for me COVID years feel like leap years but stay with me, back in 2020 we spoke for a blog post, and we can link to that blog in the show notes, we were talking about how health justice partnership has helped you through crisis. Specifically how partnership helped you navigate covid and all of the disruption to services that happened as a result of the pandemic. You mentioned that the strength of the partnerships and programs you're a part of provided a bit of relief to the helplessness that you were feeling at that time that I think a lot of us were feeling. I'm interested in this idea that partnership might help strengthen our resilience. Can you say more about your experience of that? 

Marika: I can. I guess the helplessness that I really felt quite keenly was the inaccessibility of our service to people at a time when they might need it the most and I guess one of the things I'm most passionate about is making sure people have access to the support they need when they need it. The pandemic and the lockdowns really did highlight the inaccessibility that some people might have. The relief that our partnerships provided was that health services remained accessible during that time. So there was a really clear pathway into our service that continued through that pandemic where the maternal/child health nurses and the health staff could collaborate and problem solve with us about how we could provide responsive services to really small windows of opportunity that people might have had outside of their homes or where they might have been able to talk to other service professionals, and it was in that creative problem solving that it really felt like we were able to provide services to people that really needed us. But also the way we could pool our shared knowledge to support each other as a partnership at that time. So there was some really useful conversations of the nurses and ourselves problem-solving how they could have conversations with women over the phone where they could still explore an experience of family violence without knowing or with knowing whether a partner was at home or whether it was safe to ask or how to even provided a response to that person if they did disclose that they were experiencing family violence. So those conversations I think really not only helped the nurses with some extra strategies that they could implement but supported us in some extra strategies we could implement to be more responsive to people in a really timely way. Perhaps as a partnership it was that helplessness that we could all come together to try and find creative solutions. 

Lottie: Absolutely, what a response, thanks Marika. Working in partnership, whether it be Health Justice partnership or any other kind of partnership for that matter, isn't easy because there's no playbook or one way to go about it. I think you've been able to make that really clear across those 3 key partnerships you've invited us into today. What drives you to continue to do this work? And what keeps you really motivated and passionate given the journey we've been on today in this conversation? 

Marika: I'm really passionate about filling some of the gaps that our service system has created. We've built this service system and we often talk about working in silos and a range of other terms that we use, I think we really have the opportunity to continue developing it to one that is responsive to the needs of people. I think it's hard in the disciplines that we've developed and the different practitioners we have within this broad community service system. If we don't work out how to work together and to integrate our services and systems, we're really asking our communities and people who are at most at need to do that. What I am taking on myself, is how do we provide integrated servicesystem that really is responsive to people's needs and I think there's a lot of work that we can do to do that better and that's continually what motivates me. 

Lottie: Marika, it has been a delight. To wrap us up I know that you... Folks reach out to you a lot for your advice and tips about working in health justice partnership just because of the presence you have across this national landscape, a presence we're really grateful for. What is your one piece of advice for people working in health justice partnership? 

Marika: The advice I use myself especially is to stay open to learning and to challenge what you know. I think we often want to provide other people the solutions or the answers that we have and I think that where the gold is, is where we're open to changing how we do things ourselves and how we change practice, how we show up to our communities and to people that really need them. So spend more time listening to others and learning what they've got to tell us. Especially, I'm going to say clients, but I mean our community – people, especially people who ordinarily don't feel comfortable, accessing our service system, spend some time to work out why and then work out what we need to do differently to be able to create a safe space for them to access. 

Lottie: I love it. Marika Manioudakis, thanks for joining us. 

Marika: My privilege. 

Thanks for listening to this episode of the Let's talk health justice podcast. And a big thanks to Marika for sharing her insights and wisdom with us.   

For more from Health Justice Australia visit our website, at healthjustice.org.au.