Why should our hospital be involved with this project?

Violence against women is a significant problem with serious social, economic and health consequences for women, their families and communities. There is a growing momentum across all levels of government to identify opportunities to intervene where family violence is occurring to prevent serious harm and death from family violence. As trusted health professionals, clinicians are uniquely placed to identify family violence and provide information and access to support.

Section 95 of the Royal Commission into family violence recommends that:

The Victorian Government resource public hospitals to implement a whole-of-hospital model for responding to family violence, drawing on evaluated approaches in Victoria and elsewhere [within three to five years]. 

There are currently 14 hospitals across Victoria formally participating in the SHRFV project, however any health setting can take up this initiative using the resources provided. The project team at the Women's and Bendigo health are happy to provide telephone advice and support to any hospital in Victoria based on our experiences of implementing the model.

How do I get our hospital board and executive to commit resources to this project?

Addressing family violence requires a whole of organisation approach that includes how we identify and respond to patients experiencing family violence as well as how we respond to any staff members that may be experiencing violence at home. A top-down commitment to this project is critical to success.

A senior management engagement presentation has been included in the Toolkit. This presentation provides a shared understanding and rational for committing to this important work. 

The Project Support team is also available to talk to through their experiences of implementing the project with any interested hospital.

How should we use the posters and other communications materials?

These materials have been developed for use by any hospital or health service within Victoria and allows services to add their corporate logo. 

These materials have been designed for use only after the model of sensitive practice has been implemented including training of staff. 

The materials include a poster for public areas to signify to patients that the hospital is a safe place to talk about family violence, and a poster for staff areas to prompt clinicians to ask patients about family violence. 

The buttons with the bird image are provided to staff once they have successfully completed their training.

The stickers with the bird image, are provided to alert staff that the patient has already disclosed family violence so that they are not re-asked the same questions, and to ensure that they are provided with an appropriate supportive response. This sticker may be placed on a patient's file or other appropriate location provided that file/sticker is not visable to family members of the patient.

A palm card is provided to write down any referral details and phone numbers - however training of hospital staff must include ensuring that this is done is a manner that will not put the patient at risk. For instance, the name of the a family violence service should not be written on the card.

The materials also include email banners for use.

Can the resources be adapted to different health settings?

The SHRFV service model implementation framework is applicable to any setting as is the model of sensitive inquiry. 

The original project focused upon health settings that were responding to women who are experiencing intimate partner violence. In 2016 - 2017 this project will be expanded to include health settings that work with children and older people that are experiencing family violence. As new tools and resources are developed that are more applicable to these settings we will add them to our resources library.

Who can deliver family violence training to our staff?

Family violence training should be delivered by a person who has experience working with victims/survivors of family violence, and who is a skilled facilitator. This might be a family violence project worker, a member of your social work team, or an external training provider. If the training is being delivered by a project worker without this experience, it is recommended that a family violence specialist worker from your local family violence outreach service co-facilitate the training.

External family violence training providers include:

The Domestic Violence Resource Centre Victoria (see www.dvrcv.org.au)

DV Alert Project by Lifeline  (see www.dvalert.org.au)

What is the model of sensitive practice?

Sensitive practice provides a framework for health professionals to respond to patients in a way that increases their sense of safety, respect and control. It involves a six step process. 

Step 1 – Notice the signs
Step 2 – Ask sensitively
Step 3 – Respond respectfully
Step 4 – Action plan
Step 5 – provide options and referral pathway
Step 6 – Document 

The SHRFV training materials are all based on the sensitive practice framework.

How do we document disclosures of family violence?

Each hospital will have different systems for recording information. Regardless of whether you use a paper based system or electronic software for recording patient data, it is important that each hospital implement a process for collating family violence data to assess the effectiveness of the program. 

Bendigo Health and the Women's has each developed a documentation form for identifying and responding to family violence. The form by Bendigo Health is provided in the Toolkit as an example.

In addition stickers or electronic alerts should be added to a patient's file to ensure that once a disclosure is made, all staff working with that patient are aware of the situation. The bird sticker located in the Toolkit is one means for doing this within a paper based system.

What if a patient discloses family violence and is unsafe to return home?

If a patient is unsafe to return home then a secondary consultation is required with a family violence crisis response service. 

Safe steps is the state-wide family violence crisis response service in Victoria and can be contacted on 1800 015 188. Their staff will conduct an assessment by telephone and develop a safety plan with the patient. If required and appropriate they may also provide access to safe accommodation and transport or alternatively work with the patient to identify other suitable options to ensure safety.

What if a patient is experiencing family violence but doesn't want to take any action?

Once family violence is identified, the role of the clinician is to sensitively provide that patient with appropriate information in a non-judgmental way so that the patient can make an informed decision regarding what to do next. It is not the role of the clinician to give the patient advice - but to instead recognize that there are many factors that need to be taken into account in responding to violence- and that the patient is the best person to make these decisions.

There are many reasons why a person may choose to not take immediate action - and often this is due to the escalated risk associated with leaving the relationship which may need to be managed very carefully. 

The sensitive practice model recognises that a patient should never feel rushed, pushed or judged to make a decision regarding their family violence situation. Instead the model aims to ensure that the patient feels supported, informed and identifies the hospital as a safe place they can return to if further family violence support is required. 

What if there are concerns regarding the safety of children?

All doctors, midwives, nurses and social workers are mandated to make a notification to child protection if they believe that a child is in need of immediate protection or at risk of significant harm from physical or sexual abuse. This is a legal requirement regardless of whether your hospital is participating in the SHRFV project or not.