1. Family Violence: How to identify it… what to do when you do

2. Session broken down into two broad themes: Family Violence Training: 1.How to identify it… 2.…what to do when you do

3. Learning Objectives/Outcomes Family Violence: How to identify it…what to do when you do  To develop a common understanding and increase the knowledge and skills base of health professionals and allied health staff in respect of identifying and responding to family violence.  To increase community health professionals and allied health staff understanding of their role in identifying and assessing victims of family violence.  To instil a knowledge of local and regional services and referral pathways that may assist those experiencing family violence so that practitioner identified patient safety concerns may be addressed.  Increase staff confidence in being able to identify family violence (vulnerability) and make appropriate referrals for victims experiencing family violence and perpetrators who are using violence towards family members within the community.

4. Legislative Framework Family Violence Protection Act 2008, Victoria (the Act). (a)behaviour by a person towards a family member … that is physically or sexually abusive; or emotionally or psychologically abusive; or economically abusive, threatening, coercive or in any other ways controls or dominates the family member and causes that family member to feel fear for their safety or wellbeing or the safety and wellbeing of another person FAMILY VIOLENCE IS DEFINED under the Act as: Family Violence: How to identify it… (b) Behaviour that causes a child to hear or witness, or otherwise be exposed to the effects of the behaviours referred to above

5. Legislative Framework Family Violence Protection Act 2008 (Victoria) (a) that non-violence is a fundamental social value that must be promoted; (b) that family violence is a fundamental violation of human rights and is unacceptable in any form; (c) that family violence is not acceptable in any community or culture; (d) that, in responding to family violence and promoting the safety of persons who have experienced family violence, the justice system should treat the views of victims of family violence with respect Preamble In enacting this Act, the Parliament recognises the following principles- Family Violence: How to identify it…

6. (a) that while anyone can be a victim or perpetrator of family violence, family violence is predominantly committed by men against women, children and other vulnerable persons; (b) that children who are exposed to the effects of family violence are particularly vulnerable and exposure to family violence may have a serious impact on children's current and future physical, psychological and emotional wellbeing; (c) that family violence— i.affects the entire community; and ii.occurs in all areas of society, regardless of location, socioeconomic and health status, age, culture, gender, sexual identity, ability, ethnicity or religion; In enacting this Act, the Parliament also recognises the following features of family violence: Family Violence Protection Act 2008 (Victoria) Family Violence: How to identify it…

7. (d) that family violence extends beyond physical and sexual violence and may involve emotional or psychological abuse and economic abuse; (e) that family violence may involve overt or subtle exploitation of power imbalances and may consist of isolated incidents or patterns of abuse over a period of time. Family Violence Protection Act 2008 (Victoria). …continued from previous slide ACCORDINGLY, FAMILY VIOLENCE IS DEFINED under the Act as…… (next slide) Family Violence: How to identify it…

8. Unsurprisingly Family Violence is a Contra-Indicator to Good Health MORBIDITY - Chronic physical and mental health problems are common sequelae of family violence (Ellsberg et al., Lancet 2008; 371(9619), 1165- 1172). It promotes a spectrum of pathologies including: Gynaecological disorders (Campbell JC, Lancet 2002; 359(9314):1331-1336). Chronic pain (Bronomi A E et al.,. Arch Intern Med 2009 169 (18):1692-1697). Neurological symptoms (Bronomi A E et al.,. Arch Intern Med 2009 169 (18):1692-1697). Gastrointestinal disorders (Bronomi A E et al.,. Arch Intern Med 2009 169 (18):1692-1697). Self-reported heart disease (Coker A L et al., J Prev Med 2002;23(4):260-268). Family Violence: WHY identify it…

9. MORTALITY – Family violence is the leading cause of preventable death for Victorian women under the age of 45.† Women are more likely to be killed by a male partner or ex-partner than any other person.‡ † The Victorian Health Promotion Foundation (VicHealth),The Health Costs of Violence: Measuring the Burden of Disease Caused by Intimate Partner Violence, Melbourne, 2004. ‡ Department of Victorian Communities (Vic), Changing Lives: A New Approach to Family Violence in Victoria, 2005, 13. Unsurprisingly Family Violence is a Contra-Indicator to Good Health TO REITERATE - Victoria Police dealt with more than 60,000 family violence incidents in 2012-13 including 29 murders, which account for a little less than half of all murders committed in the state’.† †John Elder, The Brutal Price of Domestic Violence, The Age 27 April 2014. Family Violence: WHY identify it…

10. Family Violence: How to identify it… What is Family Violence? What might it look like? Intimidation Verbal abuse Physical abuse Emotional abuse Social abuse Economic abuse Sexual abuse Controlling behaviours Spiritual abuse Stalking Spousal homicide

11. Family Violence: How to identify it… Power & Control

12. Are you afraid of anyone in your family or household? If so who? Has someone in your family or household ever put you down, humiliated you or tried to control what you can or can’t do? Has someone in your family or household ever threatened you? Have you ever been pushed, hit, kicked or hurt in another way by anyone in your household? Are you worried about your children or anyone else in your family? Would you like help with any of this now? Family Violence: How to identify it… Questions that may prompt disclosure from an adult patient:

13. If violence is detected, the victim needs to be asked questions about any children or other adults who may be involved. Questions that could be asked Are you worried about the children? How is this affecting the children? Is there anyone else in the family who is witnessing or experiencing what you are? Family Violence: How to identify it…

14. Case studies for discussion:

15. Flo (64 years) 64 years 64 years Recently retired/ medical related Recently retired/ medical related No pension No pension Homeless – recently moved in with daughter Homeless – recently moved in with daughter Increasingly ‘forgetful’ Increasingly ‘forgetful’ Several falls at home over past 6 months Several falls at home over past 6 months Chronic respiratory disease Chronic respiratory disease Flo (64 years) 64 years 64 years Recently retired/ medical related Recently retired/ medical related No pension No pension Homeless – recently moved in with daughter Homeless – recently moved in with daughter Increasingly ‘forgetful’ Increasingly ‘forgetful’ Several falls at home over past 6 months Several falls at home over past 6 months Chronic respiratory disease Chronic respiratory disease Family Violence: How to identify it… Case studies for discussion:

16. SAFETY PLAN Assess risks and safety Develop a safety plan and strategies for support Provide contact numbers for specialist and/or community based family violence response and support services Provide other emergency contact details and after hours contact numbers A SAFETY PLAN COULD ALSO INCLUDE: – A safe place where they can go if in danger – A friend, family or neighbor who can assist in an emergency – A way to contact that person, code and a plan to get to a safe place – A plan for leaving in emergency (small bag packed with important documents and essential items kept together) – The importance of having access to cash, documents and medication so they can be taken if leaving (passports, birth certificates, identification and prescriptions) Family Violence: …what to do when you do

17. Practical steps to address family violence Discuss with the patient the practical steps involved when addressing family violence- Refer patient to local services that can assist with said application: Application to Magistrates Court for a Family Violence Intervention Order (FVIO) (process discussed later) Centre for Non-Violence (CNV) Loddon Campaspe Community Legal Centre (LCCLC) Centre Against Sexual Assault (CASA) Bendigo & District Aboriginal Co-operative (BDAC) REMEMBER THAT ONCE FAMILY VIOLENCE IS IDENTIFIED - a general practice family violence training program then increases the referral rate of women to family violence advocacy organisations. Feder et al. Lancet 2011;378(9805),1788-1795. Holistic goal is to end the violence and remove the victims feeling of isolation – to that end: Family Violence: …what to do when you do

20. ACKNOWLEDGEMENTS