Family Violence – What health professionals need to know

Front Line Health Professionals

As a Front Line Health Professional you have an ideal opportunity to assess for and intervene in family violence. There are several things you need to know and do.

Screening
Knowledge
Resources and Referral Pathways

1. Screening

Front Line Health Professionals have shared that they often do not conduct screening or ask questions related to FV because they are concerned about what to do if someone indicates they may be at risk of harm. What if they “open Pandoras box” or a “can of worms” the health professional cannot cope with. Others have also reported that time constraints can play a significant role in dealing with these topics. Research has identified that health professionals are often misguided in their understanding of prevalence and influenced by their own bias. It is therefore essential that family violence is included in routine screening, and that appropriate screening tools are implemented. Screening must be routine and appropriate. In Australia different jurisdictions mandate different tools to be used.

2. Knowledge

What is family violence?

Family violence is also referred to as domestic violence or intimate partner violence. Family violence occurs when a person uses aggression, threats, intimidation or force to control a partner or former partner, or other vulnerable family members, such as a child. It is mainly committed by men, aims to cause fear and can happen to anyone, regardless of socio-economic position, age, culture or religion. Abuse can be verbal or physical, including sexual abuse. It can include isolating someone from family and friends, withholding money or family resources, emotional abuse and intimidation, such as threats to harm you or others, damage to property, threats toward or actual harm of pets, and threats to commit suicide as a form of manipulation.

Family violence during pregnancy

Sadly, one in four women will experience domestic violence at some point in their lives. Pregnancy is a time when violence toward women is known to increase. For many, it is the first time that they will actually experience family violence. Women who are already in an abusive relationship may hope that pregnancy and/or having a baby will reform their partner and that they violence and/or manipulation will stop; however, it is more likely to have the opposite effect, as rates of violence actually increase. In pregnancy, emotional abuse may take several forms. It may, for example, take the form of threats to report the woman to child welfare authorities as an unfit mother. A partner may obstruct access to antenatal care. They may refuse to support a woman financially during pregnancy. Physical violence in pregnancy is more likely to target the woman’s abdomen, breasts or genitals. Many women who experience family violence in pregnancy are reluctant to leave because they are financially vulnerable or they fear what their partner may do.

Health consequences during pregnancy

Violence during pregnancy is harmful to both the woman and her unborn baby. Research has shown that women reporting abuse during pregnancy had higher rates of intrauterine growth retardation, preterm labour and lower birth weight, as well as a higher risk of miscarriage. The baby can also be damaged by physical assault. Family violence has significant mental health impacts for women and is linked to antenatal depression, anxiety, and decreased attachment to the baby. It is also associated with lower rates of breastfeeding.

How to recognise and interpret behaviour associated with family violence

Unexplained or multiple injuries: bruises, burns, lacerations, bites.
Injuries at different stages of healing
Injuries hidden by clothing or on central body areas
Delay between injury and care-seeking behaviour
Describes self as “accident prone”
Partner present at office visits and/or speaks for the patient
Appearance of low self esteem
History of alcohol or drug abuse
History of anxiety, depression, or suicide attempt
Frequent office visits for somatic complaints (e.g, pelvic pain, headaches, gastric upset)

3) Resources and Referral pathways;

Knowing the local community resources that exist for victims of violence will provide access for the health professionals and may facilitate referral, provide crisis intervention for the victim and support that may empower the affected families. As a Front Line health professional, it is important to consider the goal of primary intervention; to prevent a detrimental health event from occurring. Therefore screening and connecting to the appropriate support is paramount.

Information for therapists

What do therapists need to know?

Much of what we have covered for front line health professionals relates in the therapeutic space as well. However, as we are generally providing longer term support and more in-depth assessment and treatment there are further considerations. It is important to explore specialised training that builds skill and knowledge in working with families experiencing trauma to better understand the impacts and outcomes for people who experience family violence.

It is also important to consider the creation and promotion of linkages with your local and National health care providers. There are facilities, health care providers, local shelters, and other resources for families experiencing violence. Knowing about these and developing contacts allows for relationships with “the system” before a need arises. These contacts will help you to know what can be done and enhance your confidence to empower the family if family violence is identified. It is also crucial to consider vicarious trauma and your own self-care.

For additional clinical support and guidance the following sites may be helpful:

What should therapists provide?

Patient empowerment: Use your clients strengths to empower them in the development of their treatment and choices for support.
Choice: Inform your clients regarding their treatment and support options. Involve them in the choice of the treatment options they prefer and provide psycho-education that will support this process.
Collaboration: Maximizing collaboration both with your client, their families and any other healthcare providers (such as Midwives, Obstetricians and Maternal Child Health Nurses) will support their healing and wellbeing.
Safety: Developing health care settings and activities that ensure clients physical and emotional safety. This may also involve communicating with other services in the clients care, or empowering them to voice their own needs in spaces such as antenatal and birth settings; and
Trustworthiness: Creating clear expectations with clients about what proposed treatments entail and what options they have. As well as exploring who can provide services, and how care will be communicated and provided.