Family violence can occur in a variety of contexts, the ...



ADDITIONAL FAMILY VIOLENCE CONSULTATIONPractice Note for Maternal and Child Health (MCH) nurses - March 2018Family violence can occur in a variety of contexts, the majority of which are intimate partner violence, with the violence being perpetrated by men against women. Violence against women can range from psychological, economic and emotional abuse through to physical and sexual violence. It is the biggest contributor to ill health and premature death in women aged 15–44.Since the age of 15:1 in 3 Australian women have experienced physical violence1 in 4 Australian women have experienced emotional violence1 in 5 Australian women have experienced sexual violence.Women are more likely to experience violence:by a known male (partner, ex-partner, friend, date, acquaintance)in the home or a private placein an ongoing way - over weeks, months, years or lifetimes.Men are more likely to experience violence:by an unknown male (stranger) or non-intimate acquaintancein a public placeas a once-off incidentfrom a non-intimate male family member.Children are present in 1 out of every 3 family violence cases reported to Police.Assessing the mother, child and family risks and needsThe transition to parenthood is a time of heightened family violence risk, with one in five women reporting intimate partner violence in the year after giving birth. Family violence can also often begin or intensify during pregnancy. Experiences of family violence and the trauma it causes can have significant health and developmental consequences for children. Due to its universal nature, the MCH Service is well placed to identify and offer initial support to a family at risk of, or experiencing family violence, in a location that best suits their needs, at any point in the family’s engagement with the MCH Service. The additional family violence consultation aims to increase capacity within the MCH Service to provide greater outreach support to families. This consultation does not replace the need to ask the family violence questions at the existing Key Ages and Stages (KAS) consultations. MCH nurses who are identifying and assessing the mother, child and family for family violence must have completed Family Violence Risk Assessment and Risk Management Framework (also known as the CRAF) training. Please follow the below link if you would like details of upcoming CRAF training: violence consultationDue to concerns from the MCH service regarding the title ’Family Violence Consultation’ and confidentiality for the client, this visit will be recorded as ‘Family Consultation’ in CDIS from 1 April 2018.POSSIBLE INDICATORS OF FAMILY VIOLENCE The following list presents possible indicators of family violence for an adult victim. If any of these indicators are present, or the MCH nurse suspect’s family violence may be an issue, MCH nurses should ask the prompting questions on the following page to guide a conversation with the mother about their current situation.A mother who is a victim of family violence might:appear nervous, ashamed or evasivedescribe their partner as controlling or prone to angerseem uncomfortable or anxious in the presence of their partnerbe accompanied by their partner often, who does most of the talkingsuffer anxiety, panic attacks, stress and/or depressionsuffer drug abuse, including dependency on tranquillisers and alcoholhave chronic headaches, asthma, vague aches and pains, abdominal pain and/or chronic diarrhoeasuffer sleeping and/or eating disordershave attempted suicide and/or psychiatric illness report sexual difficultiesreport gynaecological problems, and/or chronic pelvic pain or vaginal dischargeexperience miscarriagespresent with injuries or patterns of repeated injury or signs of neglect.Please refer to the CRAF Practice Guide for a more extensive list of other indicators.A child who is a victim of family violence might present with:bruises, burns, sprains, dislocations, bites, cutsfractured bones, especially in an infant where a fracture is unlikely to have occurred accidentallybehavior that might change in the presence of, or hearing the perpetrator – this may present as a baby becoming stiff, crying, being unsettled or refusing to feedinternal injuriesshowing delayed speechshowing wariness or distrust of adultsbeing fearful when other children cry or shout.Family violence is often a direct or indirect attack on the mother-child relationship, which can undermine the safety and wellbeing of the child/ren. There is further information in the children and family violence section below. The CRAF is being redeveloped in line with the findings from the Royal Commission into Family Violence and family violence risk assessment and information sharing legislation. More information on the new framework will be as it becomes available.WHEN TO PROVIDE A FAMILY VIOLENCE CONSULTATIONA specific family violence consultation may be provided to a family if the MCH nurse has completed a consultation where any one of the following occurs:the MCH nurse was unable to complete the family violence questions (e.g. at the four week KAS consultation) because the partner or other family members were present; orfamily violence has been disclosed or identified and more time is required for discussion or to complete a safety plan; orthe MCH nurse suspects the family is experiencing family violence and requires additional time for exploration and discussion; orthe MCH nurse or family member/s require a joint consultation with a specialist family violence practitioner. Family violence consultations are to be led by the MCH nurse. In some cases, the MCH nurse may choose to hold a joint consultation with a family support worker, bi-cultural or Aboriginal Health Worker, and/or specialist family violence practitioner.UNDERTAKING the CONSULTATIONThe consultation is to be conducted in a location that is most suitable and safe for the mother and child/ren; this may be in their home, at the MCH centre or at another location in the community.Prompting questionsThese example prompting questions should not be used one after another, but rather as prompts as part of your conversation. Each question should be explored in detail if the response is vague or ambiguous, for example ‘Can you tell me more about that?’ or ‘Could you explain that a little more for me?’ “Tell me about how things are at home / your relationship with…/ what is worrying you?” “Is there someone that you are afraid of?”“I am a little concerned about you because …..”“Are you ever afraid of someone in your family or household? If so, who?” “Has someone in your family or household ever put you down, humiliated you, or tried to control what you can or cannot do?”“Has someone in your family or household ever threatened to hurt you?”“How is this affecting the child/ren?”“Are you worried about the child/ren?”“Would you like help with any of this?”You do not need to restrict yourself to the questions here. Please refer to the CRAF Practice Guide for examples of more prompting questions.Children and family violenceChildren and young people are particularly vulnerable to the impacts of family violence. Their experiences of violence are different to those of their mother, due to their age and stage of development, their relationship to the perpetrator and their dependence on adult caregivers. Children do not have to be physically present during violence to be negatively impacted by it. It can take the form of witnessing violence, hearing violence, being aware of violence, being used/blamed for violence, or seeing the consequences of family violence. Children exposed to family violence are at risk of a range of developmental and adjustment problems. It is a key cause of stress which disrupts healthy brain development and personality development. It is important to keep the child in mind and ensure that the needs of the child are assessed independently, in conjunction with the family’s needs. MCH nurses should be:mindful of the cumulative harm caused by living with family violencebe aware of their stage of development and how the impacts of trauma may present now and at future pointsexplore their responses to the violence in an age-appropriate way. MCH nurses should follow the Four Critical Actions of PROTECT - as soon as they form a reasonable belief that a child has, or is at risk of abuse.The cumulative harm of family violence, whereby children live a life continually waiting for the violence cycle to come to an ‘explosion’, results in children developing maladaptive coping strategies. Please refer to the CRAF Practice Guide for more information on children and family violence.REFERrALs and ongoing SUPPORT Making referralsTo provide continued support to families, MCH nurses may determine a need to refer to other services. Referrals can include:Specialist family violence servicesChild FIRSTPolice Specialists in child trauma where the child needs a specialist therapeutic responseA legal centre/serviceGP or other medical professional/service. The family may require case coordination or links to an existing care team to support them to navigate the service and broader system.Police and the Department of Health and Human Services must be notified in circumstances where child abuse is suspected.Developing a safety planIt is important to help the mother or other family member plan ways to increase their safety should they need to leave quickly or feel unsafe or in danger. Safety plans can be either written or verbal dependent upon the needs and risk to the mother or other family member. It is important to consider the risk and safety of the mother or other family member should a safety plan be found by the perpetrator. The mother or other family member should take part in developing the safety plan with the MCH nurse. At a minimum, the safety plan should include:list the contact numbers for a family violence organisation (local and 24-hour)list emergency contact numbersidentify a safe place for the mother or other family member to go and how to get thereidentify a family member, friend or neighbour who can help in an emergency and how to get thereidentify a way for the mother or family member to get access to money in an emergencyidentify a place to store valuables, medical needs e.g. prescription medicines, inhalers etc., and important documents so they can be quickly and safely accessed in an emergencydiscuss the needs of child/ren discuss any issues that may hamper the mother or other family member from fulfilling the safety plan.Please refer to the CRAF Practice Guide (CRAF) for more details on developing a safety plan. Further information on safety planning can be found on Fact Sheet 3 – Safety Planning on The Lookout website: What if a family declines assistance?If a mother or other family member indicates that they do not want assistance, the MCH nurses should:provide them with the contact details for a specialist family violence service in a manner that does not present a safety risk to the mother or other family membercontinue to monitor and assess the risk and impact of family violence and provide support to meet their immediate and ongoing needs through KAS or additional family consultationsconsider discussing the idea of safety planningdetermine an appropriate course of action to address the safety and wellbeing of children who are also victims of the family violence.If the MCH nurse has assessed that there is no immediate family violence risk to the child or mother (or other family member) and the mother (or other family member) is unwilling to engage in a process of safety planning, the MCH nurse will continue to asses risk and safety; and offer support and referrals to specialist family violence services as required at future KAS consultations. In these cases, MCH nurses must continue to ensure that accurate documentation is maintained. ................
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