New advice for health workers responding to family violence

A new evidence brief synthesising the latest global research into family and domestic violence outlines practical strategies to improve how health practitioners identify and respond to victim survivors and their children.

Professor Kelsey Hegarty, Joint Chair of Family Violence Prevention at the University of Melbourne and Co-Director of the Safer Families Centre of Research Excellence says the new evidence brief highlights that domestic violence is actually a major health problem not just a social or justice issue.

“We need a collaborative health sector response that supports health practitioners to carry out the work and provide pathways to safety for the victim survivors and their children,” Professor Hegarty says.

Researchers systematically reviewed 72 studies and found health practitioners encountered numerous personal and structural barriers when addressing domestic abuse and family violence.

Personal barriers

The top three personal barriers experienced by practitioners were:

'I can’t interfere': this highlights the belief that domestic abuse is a private matter and practitioners fear causing harm by intervening.

'I don’t have control': this illustrates that practitioners feel frustrated when their advice is not followed.

'It’s not my job': this illuminates the belief that addressing domestic abuse should be someone else’s responsibility.

“If somebody talks about something that you have no idea about, it makes you feel helpless because you feel like you can’t do anything to help them,” says Roland (not his real name), a health practitioner involved in a 2017 study that looked at primary care clinicians working with survivors of intimate partner violence.

Structural barriers

The top three structural barriers faced by practitioners were:

Working in suboptimal environments: practitioners are frustrated with the lack of privacy and limited time they have with patients.

Lack of system support: there is a lack of management support and inadequate training, resources, policies and response protocols.

Impact of societal beliefs: there can be a normalisation of victim blaming, including myths that women will lie about experiencing violence or that domestic abuse only happens to certain types of women.

According to Professor Hegarty, health practitioners need more support to undertake the work of responding to domestic abuse. This includes receiving guidance on how to provide immediate responses when patients disclose abuse, including: listening, inquiring about needs, validation and promoting safety, as well as better referral pathways and protocols. Access to ongoing training is also important, as is support from clinical champions, care navigators and other staff working in the sector.

“We need to build a trauma and violence informed, culturally safe health system that draws on the expertise of people with lived-experience and better equips healthcare workers across the sector,” Professor Hegarty says.

The Safer Families Centre evidence brief identified common survivor expectations on how practitioners should identify and respond to domestic abuse. The top three expectations shared among people with lived-experience of family and domestic violence were:

Universal education – provide information to all women about what constitutes a healthy relationship.

Safe and supportive environments – consultation approaches should demonstrate care and confidentiality.

How you ask – when enquiring about abuse, practitioners should demonstrate rapport and foster trust.

“Don’t just straight-out jump into it… At least get some type of relationship with them, make them comfortable,” says Layla (not her real name), a victim survivor who participated in a 2019 study of Aboriginal women’s perceptions of the impact of routine enquiry for intimate partner violence.

According to Professor Hegarty, the health sector is well placed for early engagement with survivors and their children, and needs to be a key part of the system response.

“Historically, domestic and family violence has been viewed as a social justice problem that needs policing and punishment. Government needs to recognise that this abuse and violence is also a national public health issue, and the solution needs to incorporate the voices of those with lived experience and the practitioners who see them.”

Top 10 Safer Families Centre Recommendations for Health Sector Reform

  • Clear domestic abuse protocols and referral pathways
  • Regular, mandatory on-site training for all staff
  • Education and training in cultural competency and awareness
  • Peer victim survivor workforce
  • Care navigators to assist more holistic and tailored pathways to care for victim survivors
  • Trauma and violence informed and culturally safe healing services
  • Victim survivor co-design of health system reform
  • Universal education for all women attending antenatal care
  • Sufficient consultation time
  • Continuity of care.

Read the evidence brief

First published on 9 August 2023.

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