1. Strengthening Hospital Responses to Family Violence
Module 2:
Identifying and Responding

2. Session Summary Clinical Risk Indicators Sensitive Practice
Six step Brief Intervention
Identify through Sensitive Inquiry
Brief Supportive Response
Identify Risk Factors
Action Planning
Referral
Documentation
Staff Support

3. Learning Objectives
Identification of patients experiencing or at risk of experiencing family violence
Introduction to the six step Sensitive Inquiry model of responding to patients experiencing or at risk of experiencing family violence.

4. Recap Family Violence is a serious health issue
Family Violence is a fundamental human rights issue and a crime in Australia
We are in a position of opportunity to identify, respond and prevent

5. Case Study
A woman presents to Emergency with a Urinary Tract Infection (UTI)
You review her previous history and note several other similar presentations with a UTI.
What relevant health related questions
would she be asked?
What about asking if she is experiencing any form of violence? ?

6. Clinical Risk Indicators
Physical
Suicidality or self-harm
Alcohol and other substance use
Gastrointestinal symptoms
Pelvic pain, sexual dysfunction
Multiple unintended pregnancies and/or terminations
Frequent bladder or kidney infections
Vaginal bleeding and sexually transmitted infections
Chronic pain (unexplained)
Traumatic injury
CNS - headaches, cognitive problems, hearing loss
Adverse birth outcomes
Mental
Depression
anxiety
PTSD
sleep disorders
Social
Delayed pregnancy care
Frequent presentations (possibly for physical and psychological health reasons)
Intrusive partner in consultations
WHO (2013), Responding to Intimate Partner Violence and Sexual Violence Against Women: WHO Clinical and Policy Guidelines

7. Diversity and Family Violence
Aboriginal communities
Culturally and Linguistically Diverse (CALD) communities, Refugee, Asylum Seeker
Women with disabilities
Women with mental health issues
Homelessness
Incarcerated Women
Older women
Lesbian, Bisexual, Transgender and intersex people
Pregnancy
Individual
Disability
Sexual Orientation
Language/Culture
Community
Attitudes
Access
Systemic
Legislative Control
Access to resources

8. Health Impacts
Source: VicHealth (2004) The health costs of violence: Measuring the burden of disease caused by intimate partner violence

9. Health Impacts
Source: VicHealth (2004) The health costs of violence: Measuring the burden of disease caused by intimate partner violence

10. Sensitive Practice
……. is an approach to engage with patients and clients in a way that increases or elicits their feelings of safety, respect and control
The primary goal of sensitive practice….is to facilitate feelings of safety, choice and control for the victim/survivor during their interaction with health professionals
It does not rely on victim/survivors disclosing in order to receive appropriate health care
The Royal Women’s Hospital (2014). Preventing Violence Against Women Strategy , adapted from Schachter, C.L., et al (2008). Handbook on Sensitive Practice for HealthCare Practitioners: Lessons from adult survivors of childhood sexual abuse. Ottawa: Public Health Agency of Canada.

11. Principles of Sensitive Practice
Respect
Taking time
Rapport
Sharing information
Supportive
Respectful
Creates a sense of control
These principles are ‘universal’
Adapted from Schachter, C.L., Stalker, C.A., Teram, E., Lasiuk, G.C., Danilkewich, A. (2008). Handbook on Sensitive Practice for HealthCare Practitioners: Lessons from adult survivors of childhood sexual abuse. Ottawa: Public Health Agency of Canada.

12. Six Step – Sensitive Inquiry
Step 1 – Identification
Step 2 – Supportive Response
Step 3 – Identify Risk Factors
Step 4 – Action Planning & Steps Toward Safety
Step 5 – Offer Referral
Step 6 – Documentation  
An adapted model of practice piloted in the Strengthening Hospital Responses to Family Violence project and based on the World Health Organizations case finding or clinical enquiry approach (WHO, 2013), the principles of sensitive practice (Schachter et al., 2008) and the New Zealand Ministry of Health Family Violence Intervention Guidelines (Ministry of Health,2002).

13. Step 1 – Identify Where safe to do so:
Sensitively inquire about family violence
Minimum requirements for enquiry
Policy, procedure and guidelines
Training on how to identify and respond
Private setting (when the patient is on their own)
Confidentiality
Referral systems

14. Framing Statements
“Family violence is a health issue, so I ask about it routinely.”
“Because we know family violence affects your health we are routinely asking patients about it.”
The Royal Australian College of General Practitioners. (2014). Abuse and violence: Working with our patients in general practice (4th Ed). Melbourne. The Royal Australian College of General Practitioners. Retrieved from .

15. Prompting Questions Are you feeling safe at home?
Are you ever afraid of someone in your family or household?
Has someone in your household ever put you down, humiliated you or tried to control what you can or cannot do?
Has someone in your household ever threatened to hurt you?
Has someone in your household ever pushed, hit kicked, punched or otherwise hurt you?
Are you worried about your children or someone else in your family or your household?
Would you like any help with this now?
Department of Human Services (DHS). (2012). Family Violence Risk Assessment and Risk Management Framework and Practice Guides 1-3. Victoria. Department of Human Services

16. Step 2 –Supportive Response
Acknowledge what they have told you. Be empathic, non-judgmental and non-blaming.
“That must have been terrifying. You are a strong person to have survived that.”
Educational message
“You are not alone – others experience abuse in their homes.”
“You are not to blame for the abuse.”
Provide information/support that may help you.
“You have the right to live free of fear and abuse.”
Listen
Acknowledge
Inform
Believe

17. Step 3 – Identify Risk Factors
Risk Factors for Patients
Pregnancy
Post Natal
Mental Health
Substance Use
Isolation
Perpetrator Factors
Threats to kill
Strangulation
Access to/Use of weapons
Substance use
Stalking
Sexual violence
Threats or direct harm to children
Suicidality
Threats or harm to animals and pets
Breach of intervention order
Jealous , controlling behaviour
Unemployment
History of violence
Relationship Factors
Escalation – increase in severity and/or frequency of violence
Recent Separation
Plans to separate
Financial hardship

18. Step 4 – Action Planning & Steps Toward Safety
Evidence Base
Professional
Judgment
Patient’s Assessment + +
What is the victims own level of fear?
What risk factors have I identified?
Is there an acute need for safety?
= Action Plan
Partnership Respectful Appropriate

19. Step 5 – Referral Social Worker CASA House Aboriginal Liaison Officer
Internal
Social Worker
CASA House
Aboriginal Liaison Officer
Mental Health Worker
Counsellor/Advocate
A/H Coordinator
External
Safe Steps (State-wide FV response centre)
Local FV specialist [Insert here]
CASA [Insert here]
Community Mental Health [Insert here]
Legal [Insert here]
Police [Insert here]
Child FIRST
Child Protection
Insert a link or title of your hospitals PP&G here (which should house a site specific algorithm for referral pathways here – see Guide 1 Service Model and Tool-kit).

20. Step 6 – Documentation
When documenting sensitive information remember to:
Be factual
Be succinct
Ensure the safety of patient records
‘(your hospitals) Documentation Form’
‘(your hospitals) Internal Alert Systems (where applicable)

21. Staff Support Consult Senior staff
Expert Staff i.e. Social Workers, Clinical Champions
Self Care
1800 RESPECT
SW, CASA & SACL
Access EAP
Speak to a trusted colleague/friend/family member