Family Violence


  • Statewide logo

    This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network

  • See also

    Poor Growth
    Unsettled or crying babies (Colic)
    Child abuse
    Engaging with and assessing the adolescent patient

    Key Points

    1. Family violence (FV) is a major health issue in Australia: it affects one in four Australian women and half of these women have children in their care at the time. Medical and nursing staff are mandated by law to report suspected child abuse.
    2. Recognising the risk factors for FV followed by sensitive enquiry are the first steps in assisting families.
    3. Trust your instincts: if you notice the signs, act on them.
    4. FV does not discriminate: it crosses all social strata, cultural groups and identity groups.

    Background

    Living with FV places children at risk of developing lifelong health issues.
    FV is not just physical; it includes emotional, psychological, sexual and financial abuse which tends to escalate over time.

    Perpetrators of family violence make a choice to use their power to control and dominate family members.

    FV is challenging to detect and requires active and sensitive enquiry.

    Health professionals are well placed to enquire because those affected by FV are most likely to disclose to us. It is important to remember that most people do not disclose FV the first time they are asked. However, enquiry alone is considered a therapeutic intervention and with each time a person is asked (appropriately), validated and supported, the possibility of help seeking and change increases.

    Assessment

    History

    Caregiver

    • Identify risk factors and vulnerabilities: 
    • Pregnant/recent birth child
    • Aboriginal or Torres Strait Islander
    • Non English speaker and/ or different cultural background
    • Disability

    Consider intersectionality – in what other or multiple ways might the person be experiencing marginalisation or discrimination (e.g. LGBTQI) and how might that impact their safety or support.

    • Difficulty obtaining a clear history from caregiver, ask yourself why.

    Consider

    • Is the caregiver affected by mental illness or substance use?  
    • Is the caregiver subject to historical or ongoing trauma (psychological/emotional/generational)?
    • Known history of intimate partner violence – this may be difficult to know unless volunteered, or in the medical record.
    • Repeat presentations to health care provider – this may not be recognised unless presenting to the same provider or service.
    • Failure to attend multiple medical appointments.

    Child

    • Identify risk factors
      • age 0-6 years age
      • disability  
      • past history of abuse
    • Identify red flags
    • Real or perceived feeding difficulties/poor growth
    • poor control of a chronic medical condition
    • poor school attendance or school refusal
    • regressive behaviour such as bed wetting and separation anxiety
    • self-harm
    • symptoms of anxiety and depression such as agitation, changes in sleep and appetite
    • social withdrawal

    Examination

    Behaviour

    Are the child/siblings/caregiver:

    • Withdrawn or highly anxious
    • Overly familiar
    • Reluctant or fearful to speak
    • Hypervigilant
    • Is the child taking on the parent role

    Is the caregiver intrusive, controlling or intimidating toward child, partner or staff member?

    Physical

    • Unexplained injuries: burns/bruises/fractures (see Child abuse)
    • Unexplained pain:  abdominal pain and headache are common complaints that could be a symptom of a child’s stress or fear of going home.  
    • Symptoms incongruent with level of distress
    • Signs of neglect
    • Signs of traumatic brain injury

    Management

    diagram family violence

    Do

    • Trust your instincts – a feeling of “something is not right” may be the only trigger to prompt enquiry about FV.
    • Ask for senior clinician help.
    • Know that it takes time to feel comfortable asking about FV – practice makes it easier.
    • Remember how common FV is – one in four Australian women experience FV.
    • Listen, validate and empower

    Don’t

    • Ask about FV when a caregiver’s partner is present. Or assume it is safe to talk in the presence of a family member or child over two years of age.
    • Encourage the caregiver to leave their partner.
    • Blame FV behaviour or impacts on non-offending family members (e.g. impact on parenting)
    • Feel you have failed if you suspect FV and a disclosure is not made.

    Lethality risk factors 

    Victims who are experiencing any of the following are at increased risk of being killed or almost killed: 

    • Escalation of violence (severity or frequency)
    • Recent separation
    • Stalking (including cyber stalking)
    • Access or use of weapons
    • Perpetrator threatens/attempts to commit suicide
    • Threats to harm/kill children and pets
    • Perpetrator unemployment
    • Sexual assault
    • Strangulation

     Consider consultation with local paediatric team or FV services when:

    1. You have reason to believe this child or caregiver is not safe and requires escalation of care (see flowchart).
    2. At any time you feel uncomfortable managing the situation and need advice on how to proceed.

    Consider transfer when:

    Advice re escalation of care beyond local centre.

    Consider discharge when:

    1. After thorough clinical assessment, you are confident the child is safe at home.
    2. Appropriate referrals have been made.
    3. There is a follow up plan in place.

    Health professionals are susceptible to FV like any member of the community. If you are experiencing FV please utilise the resources listed below.

    FV specialist Services (24 hours a day):

    1800 RESPECT or 1800 737 732
    Safe Steps (Vic)
    DHHS - Child protection (Vic)
    Kids Help Line 1800 55 1800
    Parentline Victoria 13 22 89
    The Daisy App
    The White book

    Information specific to RCH

    Family Violence: Responding to patients and families 
    Social work: 56111 / A52853 
    WADJA: 56111 
    VFPMS: 1300 66 11 42 
    Gatehouse: 56391 
    Mental Health: 1800 44 55 11

    Any staff who would like further training in Family Violence are encouraged to contact their department for information regarding the available training sessions.

    Information specific to Monash Children’s Hospital

    For assistance page Social Work 
    SECASA 95942289

     

    Last updated June, 2018