Sue Gedeon - on Wurundjeri Country:
Hello everyone.
Welcome to this evening's dating violence and technology abuse management in general practice webinar. My name is Sue Gedeon and I'll be your host for the evening.
Before we get started, I would like to make an acknowledgement of country. We recognise and acknowledge the traditional custodians of the land and sea, on which we live and work and pay our respects to elder's past, present and future.
Just a few housekeeping notes, this webinar is being recorded and will be uploaded on the RACGP website.
We have put everyone on mute to ensure that the learning will not be disrupted by any background noise. If you have questions during the webinar, please add these using the Q&A box at the bottom of the screen. You can also interact with the panellist’s and attendees using the chat function.
We will try and address questions throughout the presentation. If we don't get to your questions, we will review these and provide a response offline.
If you're not comfortable asking a question during this webinar, please don't hesitate to email your question through to me and we'll answer it offline.
I'll put my email in the chat box in a second. So I'd like to introduce Dr Deepthi Iyer and Dr Cynthia Brown. Deepthi is a general practitioner and lecturer at the Safer Families Centre at the University of Melbourne. She completed her PhD in 2019 exploring Australian young woman's perceptions of dating and dating violence. Deepthi was an author and an expert advisory group member of the latest edition of the RACGP White Book.
Cynthia is a research officer at the Safer Families Centre at the University of Melbourne.
In 2021 she completed a PhD investigating technology facilitated abuse, with a focus on the measurement of technology facilitated abuse and its impact among the youth.
Cynthia developed a new and innovative measure of technology facilitated abusive relationships which has gained both national and international interest.
Independent of her academic work, Cynthia holds chair and independent director roles across profit and not for profit sectors, thank you Deepthi and Cynthia.
Dr Deepthi Iyer - Safer Families Centre, University of Melbourne:
Thanks for introducing us Sue.
Welcome everyone and I'm going to start screen sharing my presentation.
Can everyone see that? Okay, Cynthia does that look all right. Great, thank you. So another welcome, and thank you so much for having us today
to talk about dating violence and technology facilitated abuse.
I'd also like to acknowledge the traditional owners of the land from where we present to you today, and also the traditional owners of the lands from where each of you join today on zoom.
I pay my respects to the elder’s past, present and emerging and any aboriginal elders of other communities who may be here with us today.
I'd also like to acknowledge any survivors of family violence in this zoom gathering, we hope that this session is presented in a way that is compassionate and empathic to your experiences.
So this will be an interactive session. It starts off a little bit didactic and we'll be talking to you about dating violence and technology facilitated abuse.
While we acknowledge that dating violence and tech facilitated abuse does occur in older women's relationships we will focus today
on intimate partner violence within young people's relationships and particularly young women aged about 16 years to 25 years.
I'll first talk to you a little bit about dating violence and then Cynthia will take us through a little bit more detail regarding the technology facilitated abuse. We did our PhDs together a few years ago and finished at different times.
Towards the end we will wrap up with tips on how to manage dating violence and tech facilitated abuse in general practice and I'll present a case as well, for us to have a bit of a brainstorm with.
So our learning outcomes for today so number one to identify dating violence amongst young people's relationships and how they present to general practice.
And we will talk a little bit about identifying different forms of tech facilitated abuse, including how they differ across gender and Cynthia will be taking us through more of that in detail.
And we will wrap up with going through how we safely, assess and support survivors of dating violence.
So, a little overview of what dating violence is, if you see young people in your practice, it is likely that you're seeing victims survivors of dating violence.
Dating violence is a type of intimate partner violence and it's not a term that is commonly used in the Australian context it's very popular in the United States but there isn't really a term that better defines this aspect in young people's relationship. In Australia it tends to be included within the definitions of intimate partner violence in adult women.
Contextual factors are important, so dating violence encompasses any type of violence, including physical, sexual, emotional violence, verbal, financial, stalking.
It is contextual in the fact that those behaviours are usually occurring simultaneously. There’re usually multiple types of abuse occurring, and the common theme is that the person who is perpetrating this violence wants power and control so they might, for example, control the young person's friends, who they see, their outfits, what time they are leaving the house, what time they are coming back and things like that.
And the same types of abuse can be perpetrated via technology as well, especially with our booming use of technology in high income countries such as Australia. Dating violence is gendered. There is international evidence that young women are at higher risk of victimisation compared to young men and this has been confirmed by systematic reviews as well.
The individual's perception of the abusive experience is also important, so often these sorts of behaviours when perpetrated make the individual feel afraid or intimidated or insecure and can cause various effects of trauma for them.
So in terms of the contextual factors, the perpetrator essentially intends to cause harm and there's often frequency of these sorts of behaviours, there's often coercion, control over the victim and there are several consequences of the abuse that aren't always obvious to anyone, including the person's family, friends or doctor or psychologist and there is a need to conform to patriarchal social structure, so it isn't always very clear to the person when they are being abused.
So what are the steps here in Australia. So approximately one in four young women in Australia have experienced some form of dating violence. Now this number is likely to be an underestimate because first of all it's very difficult to actually measure dating violence, there isn't a single set scale to measure it, and dating violence is also under recognised and under reported, so the number might well be one in three or even higher.
Now about approximately one in three Australian women aged over 15 years have experienced physical or sexual violence and or emotional abuse by an intimate partner, and we know that intimate partner violence rates are highest amongst young women aged 18 to 24 according to the ABS, now the ABS conducts a personal safety survey every four years that's funded by the Australian Federal Government.
The other interesting thing with our Community here in Australia is that there is poor public appraisal of dating violence, the latest and national community attitudes towards violence against women survey, which surveyed 1761 young Australians age 16 to 24 years has shown that Australian young people are actually very knowledgeable about key issues concerning men's violence against women and they're very supportive of gender equality in theory.
However, the young people when surveyed were actually unaware that violence against women is usually gendered and perpetrated by men towards women.
They were incredulous when they found out that there was a gendered aspect to it.
And the young people who were surveyed were also less likely to hold attitude supportive of gender based violence or gender equality within relationships and households, whereas gender equality was very important in workplace and public contexts.
Worryingly, a significant percentage of the young people also believed that women exaggerated claims of violence to gain advantage in custody battles and demonstrated a very limited knowledge of consent and believed that controlling behaviours were normal within relationships and a private matter. So, despite most young people, acknowledging that violence against women is a greater issue.
A quarter of the women surveyed had attitudes that did excuse violence perpetrated by young men against young women.
And we'll talk a little bit about the physical and mental health impacts of dating violence on young women's health.
So now, there is the violence, but it doesn't end there, the control and power doesn't end there, there are impacts on the individual who's experiencing the violence and also impacts on our society. So for an individual who's experienced any kind of dating violence there are poor physical health impacts, and that might be things like chronic pain or reproductive health impacts, it certainly leads to poor mental health impact so young women might present with symptoms of depression, anxiety PTSD or other sort of things like complex PTSD and borderline personality disorder.
There are often increased risk taking behaviours such as increased use of substances, alcohol and risky driving.
They often hold a poor perception of overall health and they might present to you with unexplained multiple miscarriages or multiple STIs, and this does cause an economic burden on our society because we spend billions of dollars for people having to take sick leave, due to injuries and mental health aspects that result from partner violence.
And of course there's a risk of experiencing IPV or intimate partner violence in future relationships with any form of violence. So KPMG in 2016 conducted a study that showed that partner violence cost the Australian economy about $22 billion for the year 2015 to 16, so this is expensive.
And there are huge health impacts and again this might even be an underestimate, if you consider that we don't always know when someone's presenting to mental health services or to hospitals about their experience of violence, because we don't always know about it and we don't always ask.
And of course men's IPV against women has also been found to contribute more to the disease burden in Australian women aged 18 to 44 years than other risk factors, including hypercholesterolaemia and smoking and substance abuse, according to a study by Webster in 2016.
Just a quick question I guess, would anyone like to talk about their experiences in the clinic with dating violence, I might stop screen sharing for a little bit just to open up to the audience.
Anything anyone wants to share at this stage.
If not, I will screen share and I’ll keep going.
So how do young people actually present to general practice. So as we said in the previous slide, they'll often present with mental health concerns such as symptoms of depression, symptoms of anxiety, substance abuse, sometimes suicidal ideation, deliberate self harm and disordered eating as well.
Sometimes they'll present with physical symptoms, such as chronic migraines or chronic gastrointestinal symptoms, chronic pain, particularly pelvic pain or urinary tract symptoms, reproductive health issues, as we talked about before as well unwanted terminations and pregnancies and STIs and on some occasions unfortunately homicide as well, which of course doesn't present to general practice, but we do need to know about it.
So how do we ask, so if a young person does present with the above medical concerns, I guess the first thing is for us to have dating violence, just at the back of our heads as a possibility.
Because unless we consider it as a possibility, it's very hard to think about asking about it.
And we'll talk about in the next slide about how we can ask, but one idea is if you do see a lot of young people, you probably be conducting HEADS assessments with young people, which you might be familiar with.
So HEAD’s stands for things like home and exercise and eating and so on, just sort of gives us a bit of a global picture about the young person.
Now there isn't I guess any written evidence that encourages it necessarily but there's also no evidence to suggest harm if we ask a young person about dating violence as part of the HEADS screen.
So that's normally a good idea, and because dating violence is normalised and minimised by young women due to societal influences and lots of other reasons, it might be that we need to ask in different ways, or ask again and basically revisit the topic in different ways, if you are going to be seeing the young person over a long period of time, and you might find that you get a disclosure a little bit down the line, rather than the first time that you ask.
Now there's plenty of suggestions for questions to ask in the RACGP White Book chapter on dating violence and tech facilitated abuse, so do go there and have a read for a more detailed overview, but this will be a good start today.
I didn't finish with the previous slide so I guess the first tip is to try and ensure that the young person's alone, because the last thing you want to do is ask the young person, while they're with a perpetrator or with someone else who excuses, the violence or encourages the young person to put up with it. Explain to them, obviously about confidentiality and the exceptions like you might do for other young people that you see in your practice.
And here are a few different questions you can ask. Now you'd probably want to practice these with yourself in front of a mirror or with your colleagues but kind of break the ice, I mean a lot of us will be quite experienced with talking to young people anyway, but asking something along the lines of how are things at home?
Tell me a little bit about your friendships or tell me a little bit about any sexual romantic relationships you've had or about your boyfriend, girlfriend or partner. Now, we do have to be careful about the terminology that we're using with young people.
It's good to get to know the young person and build a rapport before we start asking some of these questions, because they can seem a little bit personal and invasive if we kind of jump in and ask them straight away, so these are just some suggestions to ask, but not necessarily.
You know, a suggestion on exactly when to ask.
You could ask Have you ever felt afraid of your boyfriend, girlfriend, partner, sexual partner, romantic partner. Sometimes the word afraid doesn't really work with them, so you might have to ask in different ways - do they ever make you feel scared,
Do you ever feel afraid, or do you sometimes feel a little bit nervous around them so just try and change the terminology around depending on what you think you're getting back from that young person.
Now I thought I’d share a couple of quotes from my PhD that I did a few years ago, exploring Australian young women's perceptions of dating violence.
So I interviewed 35 young women aged 16 to 25 from across Australia and here's a couple of quotes.
One person, Briony age 24 from Melbourne, and these are all fake names, said to me, 'when I was going through the process of having him (she's talking about her sexual partner) treat me unkindly and in sending all those photos, there was a part of me that kind of felt like well this is what I deserve because I broke up the relationship, and I was in a relationship with somebody else. ‘So this is sort of the theme of self blaming and not blaming the partner or not putting the responsibility of the violence on their partner who perpetrated it.
Elaine, age 22, said, 'That I put myself in a position where that had happened that I let it happen and that I didn't stop it when I could have.'
A lot of young women felt that the violence was their fault.
And this is obviously not the case, they haven't done anything at all to deserve it and part of our management as GPs is to validate them and tell them that this isn't their fault, the perpetrator has done this, and the woman never deserves it.
Sarah, age 20, said 'I feel bad that some people get beat up by their partners, and I feel like my issues are, definitely don't compare to some of the more serious things that some poor women go through.'
So this highlights the minimising of the dating violence that we often see with young people.
Now Briony also said, 'there was sometimes the relationship when he was quite violent, but I always thought it was really attractive, which probably didn't help. I would probably encourage it.'
The other day I had somebody ask well if you've got somebody who's encouraging it and finds the violence attractive than why do we even ask, why do we bother doing anything about it, and the answer is that if we're feeling some form of injustice or violence or abuse, we often feel it before we can name it and these women have felt it but they haven't been able to name it, and in my PhD it came up that the young women would often feel like something was definitely wrong but they push it under the carpet, because they don't want to make a big deal of things, or sometimes they try to talk to their friends and in response they're told well suck it up, this is what it's like, you've got to learn to like this sort of stuff.
So, as you can imagine society will often tell these young women that what they're feeling is wrong and that they shouldn't be feeling it.
And that's where we come in to say that no actually what you've gone through is very wrong and what you're feeling is a very natural consequence of what you've gone through.
I’m stopping again for any reflections in your practice that you might want to share with us, please yell out if there's anything.
I'm not going to stop screen sharing at this point, unless someone wants to talk.
Dr Cynthia Brown:
Yeah, I just noticed in the chat
Somebody commenting that it is difficult for people to engage.
Dr Deepthi Iyer - Safer Families Centre, University of Melbourne:
Okay.
Sorry I’ll just have a quick look at the chat.
Sorry guys hard for me to keep up with the chat
When I've got the screen share on.
Okay, just emotional setting, so attendees can't speak with videos on, might take longer to engage with questions over chat. Okay got it.
Ah I see, can only contribute via chat function, got it thanks.
Any questions at this stage or okay, if there's anything, Sue if you could just let us know that would be great because it's hard to keep contact with the chat while I've got screen share on.
So I’ve got a comment here from someone who says, I had a client today, who was blaming herself for the violence that happened to her, because she didn't get out of the relationship.
Yeah, there's a lot of reasons why women, including young women don't actually leave their violent relationships.
For older women, adult women, who are living with their partners and might have children there's a lot of reasons they are unable to leave. First of all, the time that a woman, particularly an adult woman in a domestic violence situation, that time when she's leaving that relationship, is the most dangerous time for her.
That time is the highest risk for homicide so she knows that that's high risk that's why it can be very, very difficult for her to leave.
The other reasons, of course, are sometimes the women, including the young women genuinely love their partners, and when you love someone and they treat you unkindly, it's like a beauty and the beast story, and this is the theme that came up in my PhD as well.
The young women, particularly were married to a concept, where they were taming the beast, and so they had this expectation that if they were good enough, then this beast of a boyfriend would one day turn into a handsome wonderful lovely Prince, and that the abuse would disappear, so there was a lot of hope involved with staying in these dating violence relationships.
Obviously not always correct and with the adult women of course there's children there's financial abuse and control which keeps them in the relationship, sometimes there's visas, dowry in certain cultures.
There's lots of other things, sometimes there's complicated social arrangements including shared family and friends, which is another reason people find it very hard to leave.
Leaving a violent relationship can mean that you're left with nothing and you're completely socially isolated.
So they are just some of the reasons why women would stay but absolutely women will blame themselves for the violence and blame themselves for not leaving but it's very complicated it's not easy, and it can be frustrating as a health practitioner when a woman doesn't leave because you just want to help her, you just want to take her out of the toxic situation and fix her life forever, but that's not always possible.
Yes, thanks for that feedback. Often women don't want the relationship to end they want the violence to stop, absolutely right that's spot on, they just want to stay with the partner and with the kids or with the friends circle and they just want the violence to go away, absolutely right, and Cynthia saying, Cynthia feel free to unmute and pitch in, Cynthia is saying, also often the coercive control and threats to a woman, leaving abusive relationship yeah it's really, really hard it's so complicated.
Alright, so I guess we'll move on to the next, but so now technology facilitated abuse or digital dating and there's a lot of different terms for that but we're going to stick with the term technology facilitated abuse, which includes the use of digital media to monitor, control threaten, harass, pressure or coerce a dating partner, and although definitions and measurement of this type of abuse are not clear or consistent, we know that this is a real problem. Now Australians are amongst the highest users of technology in the world and we know, like even now we're using technology to do this webinar, but technology is so deeply embedded in our day to day lives and in young people, sexual and romantic relationships, it’s used to find romantic partners, it's used to get to know each other, to break the ice.
In my PhD young women said that they'd often check out the person's Facebook account or their Instagram or snapchat and look at their profile to suss them out and figure out the kind of personality they are before they start talking to them a little bit more.
They use it to initiate relationships and to end them as well. So now I'd like to hand you over to my wonderful colleague and fellow PhD graduate Dr Cynthia Brown.
Dr Cynthia Brown:
Thank you and welcome everybody, thank you for joining us this evening.
I'm going to share with you this evening, several of the findings from my PhD completed last year in really the measurement of technology facilitated abuse and its impact.
So I used a slightly different definition of technology facilitated abuse, and that is that it's a patterned or single use of abusive or controlling behaviours in digital mediums, and I found that these types of behaviours grouped together really into four different dimensions of behaviours. So next I'll provide you with some examples of those behaviours and of each of the dimensions, next slide please.
So the first dimension that are defined was humiliation behaviours and that included behaviours like threatened to hurt yourself or to her family or friends.
Threatening to hurt to distributor partners nude images and telling a partner to harm themselves and editing a photo or video and offensive manner of a partner or sharing a hurtful meme about the partner, so they just some of the examples.
The next thing I looked at was sexually coercive behaviours and these are some of the behaviours that may be a little more familiar and given a bit more media coverage, we tend to hear about revenge for one and terminal non-consensual sharing of some nude images so sharing a new photo without permission pressuring a partner to send nude images, pressuring a partner have phone or video sex or some type of some form of engaging sexually using technology or sending them welcome images which we described as a vindictive but can involve other things as well, other nude images.
A third category of behaviours, monitoring and controlling behaviours, and these are the most common behaviours and are highly normalised among young people, so this is where a partner might monitor where their partner is by tracking software, and I say that this behaviour is really normalized because then, you may have come across this in your practice or even through people, young people in your lives were young people actually are tracking their friends group online, so that they always know where their friends are so it's a really normalized behaviour among young people, and it can be quite harmless but it can also be quite harmful.
Other monitoring controlling behaviours are where a partner logs onto the partners device without permission where they've made the part of disclosed conversations, they’ve had with someone else.
And when I made the partner stop interacting with somebody or pressure their partner to share their passwords so there’s quite a range of different types of behaviours in that category, and then the final category is what I term threatening behaviours where a partner would threaten to hurt themselves if the partner didn't do what they wanted, so this will be using technology so sending a text message, or some kind of a meme or something that the partner will understand that forms a threat and that lets them know that they will hurt themselves if the Partner doesn’t do as they're wanting them to.
And also using technology to make department feel threatened if they're if they're having ignores the calls and messages.
That's also a really normalized behaviour among young people, that there is an expectation that you're on pretty much 24 seven.
So in young people there's an expectation that they will respond to people's messages almost immediately, and this can be used as a form of creating a threat in a relationship if a partner doesn't respond to calls and messages.
And then there's a more explicit form of threatening behaviour where someone's actually sending apart from threatening messages or threatening voicemails using technology and a couple of quotes from some young focus for participants are part of my PhD I took some focus groups with some 36, 16 to 24 year old’s and just a couple of quotes for you here, guys will try and get girls to send nudes of themselves via snapchat and then sometimes they screenshot it and then use it like prizes to see how many nudes they could get so it's interesting how this element of technology and how it's being used interacts with the sort of the masculinity conditioning of young men and how what young men used to give themselves status amongst their peers.
And then the one on the right-hand side a partner can install a GPS on someone without them knowing, so they can just track it with the APP on the phone.
So this young woman's just describing how easy it is for partner to just some install some kind of tracking software or tracking APP on to their partners phone without them, knowing so that they can keep track of where they are.
You may have noticed that the definition that I presented earlier identified by single and patterned behaviours of technology facilitated abuse, with the emphasis on patterns of behaviour and we've defined it that way, or I defined it that way.
Because the vast majority of the time, as with dating violence described by the early take a facilitated abuse occurs as a part of a pattern of behaviour is very unusual.
It does occur, but it's unusual, for there just to be single behaviours that are occurring so on the next slide I’ll explain these patents and share my findings that suggest strongly that the patents agenda.
So I’ll speak, through this is a bit on this slide here the humiliation person included.
Included participants in the study, who had experienced at least one behaviour from the humiliation dimension but mostly in combination with other behaviours the sexual coercion pattern included participants that had experienced at least one behaviour from sexual coercion dimension but mostly in combination with other behaviours and then the monitoring controlling them threats patent included participants have experienced at least one behaviour of our monitoring and control behaviours or threatening behaviours but not humiliation.
And so I find it really showed that patents have checked facilitator news or really gendered on the left hand side, then men actually experienced this multi-dimensional sort of humiliation pattern more than women doing and significantly more, you can see their the difference.
Sexual coercion patent there in the middle women experiencing the Sexual coercion patent more than men.
And men and women experienced equivalent frequency of monitoring, control and threats patterns.
So it's really interesting to notice that there are actually there's lots of debates the tech facilitator literature is still reasonably good.
There is merging conflicting debate around the gendered nature, of the behaviours and we don't really fully understand it yet, but the way that I threw these patterns together shine some light on how the gender the gender as may be impacted and also perpetrating in different ways.
So really why does any of this matter It matters because of how these behaviours impact the lives of young people when they experienced this.
Examining the literature and asking young people themselves again that focus groups, I found 92 percent impacts of Technology -facilitated abuse.
This slide shows out actual words that people use when they were asked to describe the impact of facilitated abusive relationships with such as isolated, violated, suicidal devastated, scared, worthless, powerless.
When I asked young people to narrow these descriptions down to just two words, they told me that the stress and fear, were the two words that best captured together, collectively, the impact of tech facilitated abuse among young people's relationships, so what we can see here is that that these behaviours.
Although we still in the early phases of understanding them and understand the impact, we can see that the impact is significant because some of those words are very, very indicators very, very big impact on young people.
When we explore the impacts, a little bit further I found that men and women reported similar levels of stress on the patterns of tech facilitated abuse now I didn't expect this when I did this piece of analysis, but that is what I found.
So what I needed to do, then, was to drill down into the different types of behaviours and that's where I started to find the gendered impacts all the tech facilitated abuse just to the next page there on some individual behaviours and I’ll say for this slide because it is quite busy.
And some individual behaviour and it's from the humiliation and threats dimensions, there was substantial differences between the portion of men and the portion of women who rated the behaviours as very or extremely fear and distressing inducing.
So on the left hand side in yellow more women than men rated some specific behaviours as very or extremely fear and distressing inducing these included threatening on a digital device to physically hurt themselves if they're partner didn't do what they wanted threatening to distribute nude images, posting something negative through a part of the account without permission and sending threatening messages.
So these are the behaviours that women reported as very or extremely fear or stress inducing.
More men than women rated some behaviours as very or extremely fear and distress inducing, for example men more so than women rated threatening on a digital device to physically hurt family or friends as very or extremely fear or distress inducing.
Also editing a photo or a video of a partner and offensive manner and sending it to them and pressuring a partner to share their passwords with them.
So, in summary.
Not only a tech facilitated abusive behaviours really common among young people, for some people, that can have really serious impacts, hence why we really came to share things learnings with you this evening.
And so that brings me to the to the end of the material that I’ve present I will hand you over to Deepthi and I will be really interested to answer any of your questions.
Dr Deepthi Iyer - Safer Families Centre, University of Melbourne:
Cynthia there were just a couple of comments for you in the chat as well if you're interested to have a look at those Before I continue, one
Dr Cynthia Brown:
Thankfully, for the next slide we both missed that it is a very, very obvious in the pattern and it is very interesting, and I think there's a lot more research to be done for us to actually understand those patterns more thoroughly.
So I’m looking forward to doing some more work in that space and Allison. Yes, so if I’m reading your comment Allison.
It appears to me from those columns that moment, was suffering this and women, but I don't I didn't think that was the case So yes, I.
I was really surprised when I found some of the research of young men's experiences and certainly the high frequency and the high impact of some men's experiences, because this is not our perception of relationship abuse and how it functions, and I actually spent, believe it or not, about three months doing different analysis of the data to try and understand fully understand what was actually influencing the field anything any particular factors that are influencing.
The results that we're showing means experiences to be so impactful and so highly frequent and I was unable to find something in the data that I had so that that's a really big question for us to understand and the most.
The vast majority of research in the abuse and violence is really into female victims’ survivors, and I think that there is a big opportunity for us to learn a lot about males young and particularly young men's experiences in the tech facilitated abuse space.
Thank you.
Sue Gedeon - on Wurundjeri Country:
Cynthia there's also a question that's come through from Sarah.
When you suspect technology facilitated abuse may be occurring with a patient visiting in the clinic. Would you also suggest implementing some tech safety practices, before asking those personal questions?
For example, to air on the side of caution, for both parties, when speaking with the technology facilitated abuse victim.
With either request know tech be brought by them to the meeting, or at least Bluetooth and Wifi be turned off before the device was power down before any discussion took place.
Even a single air pod may be used maliciously as a listening device, and sadly anyone trying to help these women and girls might also find themselves targeted by a motivated abuser, if these conversations overhead.
Dr Cynthia Brown
Yes, I think that's a really important thing for consideration and definitely think that we have to be careful of and they comment exactly highlights the difficulty in supporting young people and the difficulty in addressing check facilitated abuse scenarios with individuals, because of the I guess the way that technology can be used so discreetly without people knowing.
Dr Deepthi Iyer - Safer Families Centre, University of Melbourne:
There's another question for you Cynthia from Pauline and the chat.
Dr Cynthia Brown:
Okay, so I can see a couple of comments there from Desiree and Pauline about the humiliation and young men, and this is an area that I’ve been doing a lot of thinking about and how to do some more exploration in.
My I guess I formed a very, very early hypothesis, we might say that that young women find that with technology they have a sense of agency, combined with perhaps a sense of sense of safety to be able to exercise or make attempts to gain some parallel controlling the relationship.
That they can do that by our technology in ways that they don't feel safe or able to you know face to face scenario.
And I think that some young women absolutely know the triggers all the vulnerabilities of young men and play that's around the masculinity conditioning and young men learning how to be men in the Australian context and what behaviours are valued or a young man to be seen as a man, and I think that there's certainly a piece there around young women, knowing that if they in some way threatened or attacking young men and masculinity that that will have a very direct impact on them in a significant impact for me.
Cynthia Brown: That is purely hypothesis that is not being researched but it's sort of way my thinking is going and trying to understand what's actually going on there and I actually an I am wondering in the back of my mind what relationship that might have two young men suicidal ideation and really serious mental health impacts, but of course that's just my ruminating in trying to make sense of what I found in my PhD.
Dr Deepthi Iyer - Safer Families Centre, University of Melbourne:
Thanks Cynthia and thanks everyone for the very engaging chat conversation that's really fantastic, and I believe we will have more time for questions at the end so Cynthia will be here util the very end, as well.
Okay, so we'll just move on to how we as GPS can support young people who present to us with suspected dating violence so with all young people, obviously first thing I’d suggest that we do that.
I think most of us know about is to is trying to establish a bit of a rapport with them and when the time's right to start conducting heads assessment for the young people.
And then, what we do is if they do disclose that they've experienced some form of dating violence, then we would approach them with their LIVES framework which I’ll go through later, some of you might already be familiar with, that if you've been to sessions to do with adult intimate partner violence.
So LIVES framework is about what we can do at the clinic and the care approaches, how to do it, trying to involve the parents with the young people's permission, if you can, if they feel that that would be a safe thing to do talk to them alone, of course, when you're first bringing up the topic, and if it's safe definitely try to get the school and the school involved.
And you might need to involve the police in some situations and the safety Commission a website is a great resource as well, we always encourage referring to psychology to of course, because of the high impact of dating violence on mental health.
I’ve just noticed a chat question so who was perpetrating the abuse in adults we know that most male victims’ survivors experienced family violence from other men.
Sorry if I missed this at the start of presentation yeah no that's all rights and I’m like I said at the start that dating violence in general is a little bit gendered of course there's a little bit of gender symmetry in certain forms of tech facilitated abuse and some studies have shown some level of gender symmetry in dating violence as well amongst young people's relationships, but generally in Australia what we found so far is that dating violence is usually perpetrated by young men against young women, of course, young men also experienced dating violence from male as well as from female partners we don't have exact statistics for this, but certainly you're right that in adult women in adult men most intermate violence is is perpetrated by other men so thanks for that question.
Dr Cynthia Brown:
If I can just respond to that, yeah sure.
Go ahead in relation to my research because she may well have also been
inquiring about that, but with the data when I presented to you today, it was young men reporting young women as perpetrating against them, so it was describing young women as the perpetrators and young men as the victims survivors.
And it was interesting that I did, one of the things that I explored in the data to try and understand the high frequency of men's reports of some behaviours was to see if they were in same sex relationships to see if that's where the reports are coming from an absolutely was not the case.
Dr Deepthi Iyer - Safer Families Centre, University of Melbourne:
Okay.
So, in terms of what we can do when we have a young person or an adult women presenting to us, having disclosed dating violence is to use the lives framework develop those a World Health Organization and this stands for listen inquire validate enhance safety and support them.
So I guess what most women, including young women, one is for us to listen to the patient closely with empathy and without judgment.
They want us to ask them what they need, and what their concerns and this bit is really important that we're taking a patient centred approach.
They might not necessarily want to leave the relationship so it's important that we're not sort of saying Okay, you need to leave you need to leave because that might not be responsive to what their needs are it might be like one of the audience Member said that they just want the answer stop and they want to manage their mental health and if that's what they want, we need to respond unless there's an issue with safety, in which case we need to intervene accordingly.
Validate them, I think the validation bit is really important, as we said earlier run young women, as well as adult women will blame themselves for the abuse.
This is Multifactorial, but we need to they've also they're part of a culture where, and in my PhD I found as well that the young women who experienced abuse were not always validated by friends and family so like I said before, friends and family would say look, this is normal you've got to learn to like this, sex or you've got to learn to like this kind of behaviour it's pretty cool or this is you've got to change yourself and so she's not used to having someone saying Look, we understand you we believe you and you are not to blame so it's our role, I guess, to validate them and enhance safety, where you can so I mean in terms of because lives was formed for adult women there's a lot there about how to keep themselves safe at home and keep their children safe at home.
With dating violence we don't have kids involved usually but it's important to discuss with the young people a plan to protect themselves whether that's changing their mobile phone or whether someone suggested earlier on to switch off their Wifi in certain places, or to switch off their Bluetooth or let someone else know.
That Esafety Commission websites got some tips for young people, but as Cynthia was saying this sort of thing is really difficult to navigate because technology can be a source of safety for young women as well that's where they're keeping in touch with the rest of this social circle.
And that's also where they're getting help from they might be chatting to lifeline or something of course they might be tapped, and this is why it is so complicated, the safety aspect in technology.
And then finally supporting them through connecting them to services and other social supports.
Now I’m just looking at a chat in my research did I look at any intersection of factors such as experiences young women with disability. I didn't Sharon because it was outside the scope of the PhD I would have loved to.
The intersectionality aspect that I had in there was having more than 20 different cultural backgrounds represented in amongst the 35 young women that I spoke with.
And we also had a range of occupational backgrounds, that the young women came from as well, so we had people who were doing PhDs from universities, we had bachelor's, we also had young women going to we Tafe.
I had a young woman who dropped out of school, a young woman who's working as a prostitute, I had a wide range of young women, contribute to the PhD but not anyone with a disability so but that'll be really, really interesting to explore, because there is obviously evidence that.
The rate of abuse, would be much higher for somebody who had a disability, as well, so thanks for bringing that up and that will be a fantastic thing to explore in future research.
So the LIVES tells us what we should be doing, and the CARE model tells us how to do it.
So it's really about making sure that the young person has choice and control over what they what sort of help that they want.
That we're taking some action and advocating for them if that's what's required that we're recognizing what they're going through an understanding, so this is sort of like the process of validation so sort of being there for them to bounce off ideas and of how to keep safe and finally emotional connection that rapport is just so so important, as many of you would know who work with young people often.
Just coming into your office and having a safe space, just to talk about things and feeling heard and understood is a big big part of the therapy.
just some additional tips, so there are some tips on adopting youth friendly developmentally appropriate practice and approach.
In the RACGP White Book when the section on dating violence again make sure you're establishing a good rapport and you do go through explaining confidentiality and the exceptions.
Adopted trauma and violence informed approach to care wherever you can now there is a chapter on this in the RACGP White Book and as part of the University of Melbourne readiness program which I’ll briefly talk about at the end. We've got several E-learning modules that go through each type of violence and various and there's a module on trauma informed approach as well they're.
Trying to be nonjudgmental whenever you can it's very easy for us as GPS to judge because we're in a we're in a profession, where we're constantly trying to make judgments about diagnoses and we're trying to make those diagnoses, so that we can appropriately managed but the common question as we had earlier was you know why don't they leave or you know they've been so hurt by this relationship, and why can't they see what's happening, why are they normalizing it why they minimizing it.
But I guess it's not our job to judge them and adopting that nonjudgmental approach helps them to feel heard thanks for sharing the link Cynthia and Sue.
Ask open ended questions I think most of us would probably be pretty good with that and the GP sitting.
Allow adequate time for consultations, this is one of the biggest barriers that GP say that they find difficult to do these sorts of consultations, because time is, of course, always a problem we were always sitting in a pressure cooker of an office and you know not we're often falling behind I know I’m often falling 30 minutes behind in my practice but trying to book in longer concerts when you can, particularly for follow up is a good idea I’d often make 30 to 45 minute appointments for my young people if I know that they've got a lot that they need to talk about.
Encourage the young person to involve a trusted adult if you can for support, particularly if you're concerned that this violence is really impacting on their mental health and things.
And of course now with Telehealth, you can use Telehealth to compliment your face to face, but, of course, ensuring that this is safe for the young person to do.
It's incredibly tricky but, again, there are there is a really good Lancet article on Telehealth during Covid because as we know, during Covid lockdowns the rate of the prevalence of domestic violence and other sorts of intimate partner violence really went up through the roof it skyrocketed.
And it was very difficult for women to talk about violence over the phone obviously and The Lancet article and there's another one I think in the Australian general practices well that talks about forming codes and things with your with the women who you're talking to on the phone so that you're talking to them about the appropriate things at the right time, and you can form codes with them to make sure that they're safe I’m not going to go into that in any detail today.
Pauline's comment here is what happens when you try to end the relationship.
This give space to understand and empathize wash partly that's a really nice suggestion Pauline I really like that so that's a question that we could ask of the young person and help them to understand what they're going through and what their what the complications are.
So I’m just going to introduce a case study based on one of my own patients in my practice. So we've now, because it's all on chat feel free to type your questions into the into the Q & A, Cynthia feel free to be you know, on your video and contribute way we can.
So a 19 year old girl presents with fatigue and headaches she's recently moved to Melbourne from Sydney and lives at one of the local university colleges she came in to see us to organize a regular GPS suggested by her parents and she was brought in by her Dad who was visiting Melbourne.
History revealed that she was drinking alcohol almost every night and had some restricted eating. So with this presentation I guess what would you like to do and what would you like to know?
I’m just going to mute myself and I’ll wait for some comments in the chat and Q & A.
So was her father in the room, during the consultation and why was the father there, yeah that's a really good question so yes her father came in with her that the start of the consultation her father was there because this young woman was really is really close with her Dad and she told him that she was having some trouble with alcohol that she was drinking every night and she wasn't eating very well, so he was very concerned said, you need to see your GP and I’ll come with you, and it was he came in with her as a form of moral support.
Interview her alone yeah absolutely, So yes, I did her Dad was actually really lovely and said, you know I’m only here to support a morally I’ll step out when you tell me to, and I just want to share my side of story.
So yes, that, luckily happened very easily.
Assure her that what she tells you is confidential yep thanks Susie that's great.
So get the Dad out speak with her alone assure her that what she tells you is confidential and of course explaining the exceptions that if we think that there's a high degree of risk to herself or someone else, then we will need to break the confidentiality.
Jacqueline says to ask what she thinks the trigger was sorry you mean the trigger to come in, or the trigger to drink alcohol and restrict our yep for her eating diet yep thanks Jackie I think that's a great idea.
Find out her perspective for the alcohol and food restriction yep, Thank you.
Yeah, so um so we did ask her and she said that she was feeling really stressed.
And she was she was by herself in Melbourne socially isolated from her family and her friends.
The history was that you know well, I did a bit of a heads assessment with her by herself explaining confidentiality and the exceptions and she told me that she's with a boyfriend who's been putting her down who's been controlling her controlling who she sees and what she wears he's also been a little bit verbally abusive and there's been also some reproductive coercion.
For those who might be might not be familiar with the term reproductive coercion, in a nutshell that's controlling the young woman's reproductive I guess rights so some of them might not allow her to use contraception, including not allowing her to use the pill, some of them might try to get her pregnant on purpose those sorts of examples so for reproductive coercion.
The history was also that she the boyfriend was pressuring her to send nudes which she does not want to and has not done to date.
She's very anxious about sending the nudes because she's had friends who have sent them news around to others, and then had them shared without their consent so she's very anxious that this might happen to her.
And she was quite open about the fact that she started drinking to help deal with the daily anxiety of this.
She also told me that she's not advised her parents about this particular relationship that she's in in Melbourne.
Because she had previously been in an abusive relationship similar to this in Sydney that our parents have helped her with, and she felt ashamed to share the same problem with them again.
She's managing to keep up with her university work just about.
She's just about passing things, but the grades are dropping she's late for assignments and she's losing marks and she's sometimes late to class if she's had a hangover.
So Susie says tell her she's an adult and has the right to make her own decisions yep so validating her sometimes I’ve even had to check that the young person's got their own Medicare card sometimes they'll still be on the Medicare card that their parents if it's their first year out of home so it’s important to absolutely tell her that you know you can have your own Medicare card from the time you're 15 and your parents don't need to know you know the item numbers that you claim that acclaimed against you. Absolutely that's good.
What else would you do next?
What happens if he says what happened to her in her past is not her fault, yet, so what Susie is doing is going through the LIVES framework.
So we've listened and we're acquiring and this is sort of the validation section where we're telling her, this is not your fault.
Allison says, I would want to determine if she wants to be in this relationship, yes, so that's part of the inquiry and lives as well that are fitting quite well so asking her what she exactly wants to do and yeah and congratulate her for not sharing photos and using her wisdom yeah can be really hard to do that, but absolutely congratulating her for taking that step, so far, it is so hard.
To learn from her bad experience yeah that's really hard I think that's why she's struggling so much and she so she's actually feeling ashamed that she's not able to learn from our past experiences and there is actually research evidence that.
One abusive relationship, unfortunately, does have is correlated with having future abusive relationships and including dating violence so it's it's very complicated.
Yes open ended questions exploring her thoughts and feelings and helping her to organize those thoughts absolutely.
Yes definitely using open ended questions asking what our strengths are and her support networks yep and tapping into those yep and Jackie says on some level encouraged her that she has recognized that something's not right that's so important Jacqueline.
Because women as Cynthia and I’ve said, women often normalize and minimize what's what they're experiencing and so to tell her that it's fantastic that you've actually recognized that there's something that's not quite right is really a great thing.
CBT and keep a diary yeah look I did do a mental health care plan.
And I believe she's seeing a well being counsellor at her College as well, so she's she is seeing a psychologist often on it's hard.
To keep a diary, yeah so do you suggest, what sort of a diary do you suggest.
Oh yeah she has shared so much with you reaffirm that you would like to help where you can that you appreciate her trust and will support her how she needs that's a lovely thing to say Pauline.
And that's part of that validation but also part of the support.
Yeah her feelings and how she deals with them enquire about her safety fantastic yep so that's sort of getting to the end of LIVES as well, so inquiring about her safety is really important.
So in in her case so according to her knowledge, she wasn't being tracked online or anything he didn't have passwords she wasn't aware of any GPS technology or anything on her phone her phone seemed like a very safe place for her.
We should stay in touch with their friends and let them know where she was going and what she was up to.
But they were all friends and Sydney the whole problem here was their social isolation and again it came up in my PhD that the young women a lot of the young women who are experiencing dating violence were quite socially isolated, so they’d
get into a romantic relationship which they were then stuck in and couldn't get out of because that was their only entry into a social circle and they might often share their partners friends, which kept them going socially.
Anything else that you do so everyone's covered LIVES pretty well.
I’ll just check the time yeah sometime would you consider referring to one 1800 respect I think that's it's definitely worth giving her that number, thanks Sharon.
And Pauline is she fearful of the new boyfriend what are her feelings about what might be happening it's normal to feel it before you can name it.
Yeah I did say that it was it's such a beautiful quote it's actually it's not my quote for it's someone else who wrote a book on feminist research and she said it and I quoted it in my thesis because I loved it so much and I’ve experienced it myself she says, I think it's his Bible, and she says might not be her, but she says with any injustice you usually feel it before you can name it so absolutely right.
Susie yep so practical strategies, such as sleep hygiene having hobbies and activities that make her feel happy socializing with the right kind of friends yeah.
I guess getting her to explore other social circles, where she can make maybe new friends and do other things with other people that might help her to get out of this relationship.
Jacqueline says she's made the first step thoughts about what she'd like to do and organizing follow up yep absolutely so we have follow up appointments every few weeks to discuss how she's going and how she's managing the relationship.
Yeah, I agree Pauline I love to steal that quote I just yeah I love it headspace yep yeah we can refer to headspace, as we all know, they're incredibly full at the moment, I mean with any psychologists they are incredibly for at the moment.
Cynthia did you have any input at this stage at all about what you'd suggest that we do.
Has GPS from a tech perspective.
Cynthia Brown:
No look I think you're really covered it, I think it is really important, as I mentioned earlier I’m just hoping the person to understand what the potential risks are with their phone as well, so some people are not so aware of that something that that's really that is really important.
Deepthi Iyer - Safer Families Centre, University of Melbourne
Yeah thanks Cynthia, I think come we can't underestimate our ability to be able to educate young people on tech facilitated abuse, so I think that's a really good point, because I think often where as GPS we're afraid of talking down to the young person or you know, telling them something they'll read no, but I think that they would actually appreciate if we did ask them how much they know about Tech facilitator abuse that's really good point Cynthia.
So the safety Commissioner website is actually really good it's got some great tips on staying safe with technology and it talks a lot about tech facilitator abuse, so I think as part of giving them some information about what this is and how it might be perpetrated I think it'll be great and Cynthia is very kindly shared link again for us.
I think it'll be great to give them this link to have a look at if they feel safe to look at it on their phones or their laptops.
Cynthia Brown:
Refer to origin is also a lot of other sections in the safety website just around young people but focus more generally and strategies and places people can go for help, and if they went into legal assistance and involve the police and all sorts of things, so a lot of information in it.
Deepthi Iyer - Safer Families Centre, University of Melbourne:
Yeah thanks for that Cynthia thanks, Origin what I think most of us know Origin is a great suggestion, but they just won't take young people unless it's you know they're having worse than a bed mental health crisis have been rejected, so many times by origin over the past year, but definitely worth keeping origin in mind for.
Those young people who are suffering from really bad mental health of violence couples counselling is not recommended for any kind of partner violence, because it does increase the risk for the person who's experiencing violence.
So that's a that's recommended by the World Health Organization, that we can refer them to psychology and but individually so you'd get the young woman to go and then you know she could encourage her partner to go somewhere else, and if there was no violence, of course, if it was a nonviolent relationship couples counselling would be very appropriate but not otherwise that's good.
I think you know I think the other thing will be nice as if she was willing to speak with a trusted adult whether that's her dad or mom or somebody. Just to get someone else on board so she's not so alone.
Probably be a good idea if she was happy to do that referral to psychiatrists for mental health assessment or know if there's any mental health diagnosis yeah so we're regularly reviewing her mental health, to make sure that she's safe and Okay, but absolutely I think she might need a psychiatry referral if she's struggling, particularly with the alcohol and the eating not getting any better, but I think that's definitely a fantastic suggestion.
Well, thanks Pauline I’m sure we're all doing our best to help our patients with whatever they're coming in with it's really hard work, though it's um it's it' good but it's hard work and sometimes it does get frustrating when you know they're not really moving or in our eyes when it feels like they're not making any progress.
But from their eyes it's a little bit different it's they do want us to just listen and be there is someone to bounce their ideas off and just be listened to, without judgment, so they do like that. She can find a GP that has done if fpst yeah that definitely a good idea, just taking the time so we're at 815.
So, Sue let us know how what, what do you think about time I’m happy for everyone to ask more general questions outside the case, if you like, before I wrap up with the last slide.
And they can be directed to myself or sincere, of course, so you you're going to say something.
Sue Gedeon - on Wurundjeri Country:
Oh yeah just letting you know we've got about 15 minutes left so definitely time for more questions.
Yeah lovely yeah all right I’ll be on mute for a minute.
Just to give people time to have a think. And type in any questions for myself or Cynthia.
Sue Gedeon - on Wurundjeri Country:
I think there's a question from Susie.
Sue Gedeon - on Wurundjeri Country:
Yeah where can we refer patients to a safe place when they have made up their mind to leave.
Deepthi Iyer - Safer Families Centre, University of Melbourne:
Yeah good question Susie um look, I think I think that's really tricky but domestic violence shelter usually so I can send you links for that if they're really unsafe, you can send them to there is a link that I can I can give you now, if you depending on it depends, where you are, because I know that this audience is national so it's a little bit tricky I’ll speak to you about the readiness program and the next slide where we're actually training general practices across Australia to identify and respond to domestic and family violence and in that it's usually presented by a GP such as myself or several other GPS across Australia, along with a family violence worker that's local to that State.
And they will be able to give you resources on where locally you've got domestic violence shelters and things and numbers so here in Victoria, where I work and in my sector we've got an organized you know, a Centre called Orange Doors, which is a one stop shop where you can send people who are experiencing any form of violence for support.
And there might be other things, similar to that in different states but it'll be good to get in touch with a local family violence organization and speak to the family violence worker but it'll be very specific to your region so if you let us know where you are.
We can try and put you through to something local for you.
So Allison says, if a person suffering this abuse and it's tracking on their phone can the police have been If so, do they need to reach out to specific department yeah look I don't know what exactly the police do, but I know that I was presenting with a family violence worker recently, who said that when the woman is taken to the family violence refuge from the police their family violence refuge will take out their old Sim card and put a new Sim card into their phone so that they're not tracked.
For location, so it is done by the family violence organization that organizes the refuge, but I don't know if the police, particularly help with that, but I imagine that they'd have some input with that Cynthia, are you aware of anything that the police stir.
Dr Cynthia Brown:
It really varies depending on an area where there's a lot of things occurring at the moment on turn the same exactly where it's up to him which locations, but that might be something that we can do a little bit of searching on and perhaps send out to people see if we can find anything useful.
Yeah we're supposed to that question because it's a really important question.
Yeah that's good question yeah thanks Cynthia and thanks Pauline for putting in those links as well that's good.
Deepthi Iyer - Safer Families Centre, University of Melbourne:
Okay, so I might just talk to the next slide and, of course, if you've got any other questions, please type away so today we're presenting as part of the safer family Centre readiness Program.
And, as I say, family central research excellence, we lead the readiness program where which is primary cares readiness to address domestic and family violence.
And we're doing this in partnership with the RACGP and the Blue Knot foundation and Phoenix Australia and this session is part of is as a result of this partnership.
Now we do practice cantered training, and this is called Pathways to Safety, where we do state based training for each State, so the training is delivered to general practices.
To each practice individually, we don't usually group practices together and will usually have a GP and a local family Vance worker because I won't know the resources in Queensland or the resources in certain part of region or Victoria so we'll get someone local and present together.
And we do face to face, as well as online workshops.
And we've got this RACGP webinar series where we're presenting on various types of violence.
And we've got a suite of E-learning modules that are available on our website as well on the safe for families.org.au website.
So there's a E learning module on an introduction to the messy and family wants that I highly recommend doing.
So really good overview, if you if you're not familiar with this with this space, so I can see that a lot of like some of you are already very knowledgeable in this area.
And there's also a module on child abuse and neglect on trauma informed violence and care, this one also on perpetrators, which is interesting one on Maram for those in Victoria.
And one on Aboriginal and Torres strait islander health as well.
And another one that I can't remember off the top of my head.
So please check them out there's the RACGP White Book as well, which covers a lot of these topics to and there's a section on trauma and violence informed care as well they're not see this.
Questions some links in the chat.
Police usually send Orange Door for intake assessment yep in Victoria they ward and thanks for the links Sue.
And also just want to say, I mean today was not an easy session for anyone, and if you do feel that today's session has triggered you please reach out to 1800 Respect or to Lifeline Beyond blue or otherwise a trusted friend or family member psychologist or GP.
It's not easy work, and it can impact us all, so please, please take care of yourselves and thanks for the link soon.
So just put in the links for Lifeline and 1800 Respect on there.
Sue Gedeon - on Wurundjeri Country:
Okay um does anyone have any last minute questions we've got a few minutes left before we end the session.
Deepthi Iyer - Safer Families Centre, University of Melbourne:
Thank you Pauline and thanks for your contribution Pauline and to everyone else, I think we've really enjoyed the active engagement that we've had tonight from all of you.
Sue Gedeon - on Wurundjeri Country:
Great so thank you to everyone for attending and we hope you enjoyed the webinar Thank you so much to our presenters deeply and Cynthia for sharing your knowledge and time this evening.
Please feel free to get in touch with us, if you have any questions, so I did put my email in the chat box or put it in now as well, again, if you have any anything else you want to ask about please do reach out Thank you.
Thanks everyone.
Thank you.