Domestic and family violence

• Can involve sexual, physical, emotional, psychological or economic abuse/ violence or behaviour that causes fear, eg threats of violence and/or stalking — can occur in person, online or by phone 
• Usually directed at intimate partner — spouse, girlfriend, ex-partner, child. Often by a man against a woman but consider violence in all relationships
• May not be obvious. Usually happens privately
• Part of continuing and growing pattern of behaviour that may escalate — could go from emotional to physical violence
• Certain population groups are at higher risk of violence — Aboriginal women and children, pregnant women, disabled people, refugees or new arrivals, gender and sexually diverse people, the elderly
• Children who witness violence can suffer long-term effects — consider counselling and support

Domestic/family violence is a crime 

• Safety is the first priority for person and practitioner
• Do not confront or accuse any likely offender. Avoid doing anything that might make them angry or violent with you, other staff, or person you are helping
• You must know your responsibilities under the laws in your state/territory relating to violence against adults and children and mandatory reporting
• If you suspect child abuse (which includes witnessing violence) —  after medical consult you must report to child protection service, mandatory reporting

Consider domestic/family violence when

• Injury doesn’t match story of how it happened
• Injuries to abdomen or genitals (private parts)
• Injuries are covered by clothing — breasts, abdomen, chest, unusual or hidden places on body
• Injuries when pregnant
• Treating women with gynaecological or anxiety problems
• Person often comes to clinic with injuries or vague symptoms or there are delays in seeking medical attention or doesn't want to talk about what happened
• If concerned about a child — see Child neglect, abuse and cumulative harm 

Person may

• Appear nervous or ashamed and unable to communicate
• Describe person who did it as a bully or getting angry easily (people rarely use term 'domestic violence')
• Seem uncomfortable or anxious when partner present
• Be accompanied by partner who won’t let them speak or stays too close
• Have symptoms of chronic stress, anxiety, depression

Always

• Before involving family or other people — ask person who it is or isn't OK to talk to and who they would like as a support person 
• Arrange interpreter if needed
• Believe what person tells you — listen to their story, be supportive and responsive, don’t judge or blame
• Make sure you talk to person where they feel safe, alone if they want, not when highly distressed. May mean seeing person again later

If you suspect violence but person denies it 

• Talk about what someone could do to be safer if it did happen
• Make it clear that violence is unacceptable. Do not criticise them or partner. Explain that this is a non-judgement space to talk
• Sometimes victim may not feel able to leave their violent home. Accept their choice

If you have serious concerns about safety of person who is refusing help

• Talk about the situation with your manager
• Report situation to the police

Ask

Questions to find out about undisclosed (not reported) domestic/family violence

Build rapport by general conversation (talking about other things) and ask about having another family member,  ATSIHP or other health staff in the consult room

• Can I help you with anything today, are you worried or upset about anything
• Are you feeling OK in your body
• Do you have any pain or are you sore anywhere
• Are you worried about anything or anyone in your family

Direct non-blaming questions that won’t cause shame or guilt — explain they are part of normal clinical care

• Can you tell me what happened
• How does your partner treat you. Are you having any problems 
• Are you afraid of your partner — for yourself or your children
• Does your partner ever threaten to hurt you or your family

Physical and sexual violence

• Has anyone at home hit you or your children or tried to injure you or your children in any way
• Have you ever been slapped, pushed or shoved by your partner
• Have you ever been touched in a way that made you feel uncomfortable
• Has anyone ever made you do something sexual when you did not want to
• Always ask about strangulation — especially in intimate relationship assaults

Housing situation

• Have you got somewhere safe to stay
• Where are you staying now. Do you always live there
• Is it your house or someone else’s
• Who is staying with you
• How many people live where you are staying
• Does everyone in your house get along OK 
• Do you feel happy staying in the house with the people who are there

Social or emotional concerns

• Self-harm or thoughts of self-harm
• Drug and/or alcohol misuse
• Sleeping or eating problems
• Loneliness or isolation from family and friends
• Sexual problems or STIs

Check

• U/A, pregnancy test

Do

• Explain and check that the person understands confidentiality and that you might have to share information for mandatory reporting

Treat person’s injuries (if any) 

• Measure and describe injuries. Use drawings  (eg Numbered body and hand charts may be needed in court
• Record in detail what person says happened and how they presented — but remember it is not your job to investigate the complaint

Call for support

• Doctor, women’s shelter, police, specialist support services can give person the right legal advice — ask person if you can refer them 
  
• The person can talk directly to the women’s shelter staff if preferred
• If they want to report what happened to police — offer telephone and privacy. If they are unsure — ask if you or support person can ring for them

Management plan — if person stays in community

• Check they have a safe place to stay
• Record who support people are
• Make sure they know who to contact and how to get help quickly

Talk about a safety plan to avoid possible violence

• Warning signs for when violence is likely to happen
• Ways to avoid violence — getting away, having excuse to leave, safe places to go and people to be with, not being alone with violent person
• Plan for children’s safety
• Talking with a relative who can discourage (help stop) attacker from violence
• Getting a restraining order or Apprehended Violence Order (AVO). Contact local police for more information

Follow-up

• Review person within 24 hours and often until crisis has passed
• Offer referrals for counselling and support
• Domestic/family violence impacts on immediate and long-term physical and emotional health. Make sure victims are offered routine health checks — Adult health check including STI check, Mental health assessment, School-aged health check, Child health check

Remember if you feel upset or distressed by what you have seen or had to do. Ask for help from your manager and/or telephone counselling service

• Bush Support Services — phone 1800 805 391
• National sexual assault, domestic family violence counselling service — 1800RESPECT (1800 737 732)

Supporting resources

• Mandatory reporting of child abuse and neglect information
• Family and community safety for Aboriginal and Torres Strait Islander peoples study report