Strengthening Hospital Responses to Family Violence
-
Upload
marsha-reeves -
Category
Documents
-
view
225 -
download
2
description
Transcript of Strengthening Hospital Responses to Family Violence
Strengthening Hospital Responses to Family Violence
Module 2: Identifying and Responding 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 Learning Objectives
Identification of patients experiencing or at risk ofexperiencing
family violence Introduction to the six step Sensitive Inquiry
modelof responding to patients experiencing or at risk
ofexperiencing family violence. Recap Family Violence is a serious
health issue
Family Violence is a fundamental humanrights issue and a crime in
Australia We are in a position of opportunity toidentify, respond
and prevent 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 experiencingany form of violence? ? 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 AgainstWomen: WHO Clinical and Policy Guidelines 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, Transgenderand intersex people Pregnancy
Individual Disability Sexual Orientation Language/Culture Community
Attitudes Access Systemic Legislative Control Access to resources
Health Impacts Source: VicHealth (2004) The health costs of
violence: Measuring the burden of disease caused by intimate
partner violence Health Impacts Source: VicHealth (2004) The health
costs of violence: Measuring the burden of disease caused by
intimate partner violence Sensitive Practice . is an approach to
engage with patients andclients in a way that increases or elicits
their feelingsof safety, respect and control The primary goal of
sensitive practice.is to facilitatefeelings of safety, choice and
control for thevictim/survivor during their interaction with
healthprofessionals It does not rely on victim/survivors disclosing
in orderto receive appropriate health care The Royal Womens
Hospital (2014). Preventing Violence Against Women Strategy ,
adapted fromSchachter, C.L., et al (2008). Handbook on Sensitive
Practice for HealthCare Practitioners: Lessons fromadult survivors
of childhood sexual abuse. Ottawa: Public Health Agency of Canada.
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 adultsurvivors of
childhood sexual abuse. Ottawa: Public Health Agency of Canada. 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 theWorld 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). 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 Framing Statements Family
violence is a health issue, so I ask about itroutinely. Because we
know family violence affects your health weare routinely asking
patients about it. The Royal Australian College of General
Practitioners. (2014). Abuse and violence: Working with our
patients in general practice (4thEd). Melbourne. The Royal
Australian College of General Practitioners. Retrieved from .
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 yourfamily
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 Step 2 Supportive
Response
Acknowledge what they have told you. Beempathic, 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 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 Step 4 Action Planning & Steps Toward Safety
Evidence Base Professional Judgment Patients Assessment + + What is
the victims own level of fear? What risk factors have I identified?
Is there an acute need for safety? = Action Plan
PartnershipRespectfulAppropriate 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). Step 6 Documentation
When documenting sensitive informationremember to: Be factual Be
succinct Ensure the safety of patient records (your hospitals)
Documentation Form (your hospitals) Internal Alert Systems(where
applicable) 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