Part One: Why should health services respond to victims of family violence?

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Health consequences of violence

Rationale for a family violence intervention programme

  1. The magnitude of need: Family violence is common, the cost of family violence is high in terms of the victim’s health and financially to the health service (Snively 1994).
  2. Health harm from abuse is cumulative, routine abuse screening identifies at-risk individuals and increases opportunities for early intervention.
  3. Experts, patients and purchasers support family violence intervention programmes.
    • Ministry of Health family violence intervention guidelines are clearly endorsed by family violence agencies’ support programmes.
    • Patients have identified that abuse screening is acceptable and that the health professional is someone who can support victims who disclose abuse (Freidman et al 1992, Koziol-McLain et al 2005).
    • The Ministry of Health requires DHBs’ planning and funding teams to report on their responsiveness to family violence.
  4. The failure to implement a family violence intervention programme may lead to an unsatisfactory outcome. When a victim does not receive the level of support from the health service they expect, they may feel discouraged from further help-seeking. Without help, abused patients’ health deteriorates and the cost of their care rises (Campbell et al 1994).
  5. Additionally, as it becomes standard practice to respond to family violence, health organisations are likely to be criticised if they have failed to offer support to patients, especially following a homicide investigation
  6. Outlining the advantages and disadvantages of establishing or not establishing a programme may be beneficial when outlining rationale for the programme

Contact the National VIP Manager for DHBs vipmanager@ymail.com for any of the following documents:

  • Principles of a Business Case
  • Example of Business Case Proposal: Family Violence Intervention Programme

Also see the Family Violence Prevention Fund – Futures Without Violence website.

Advantages and disadvantages of adopting a family violence intervention programme

Advantages

Implementing the Ministry of Health family violence intervention guidelines offers staff clear directions for health professionals to intervene in abuse.

  • The DHB will have a chance to work with community agencies collaboratively, increasing its credibility with other agencies. The family violence intervention programme increases community networks and improves collaboration/integration between family violence agencies.
  • The DHB will be seen as taking an active role in addressing family violence in the community and thus being proactive in its approach to the health of the population it serves.
  • Customer satisfaction will increase with positive feedback from victims about the health professional offering family violence interventions.
  • Early intervention through implementing the programme could lead to reduced numbers of hospital admissions as a result of family violence. In future there may be less use of health services by victims of abuse.
  • The programme encourages the development of robust and safe systems and processes.
  • The DHB will be able to access funding available from the MoH FV Programme.

Family violence is a health issue, and a family violence intervention programme can help change health professionals’ perception of the issue by acknowledging it as such.

Disadvantages

  • The programme requires funding. Systems support, documentation and data capture systems need to be established.
  • More staff will be required to establish and maintain a family violence intervention programme.
  • It takes time to establish a family violence intervention programme before a cost-benefit is evident, it may take a 5- to 10-year plan to achieve and sustain change.
  • The programme has the potential to increase demand for services.

Advantages and disadvantages for not adopting a family violence intervention programme

Advantages

  • There are no financial demands.
  • No set-up process is required.

Disadvantages

  • The DHB will not be providing the best service possible for victims of abuse.
  • Adults and children who may be at risk will not be identified or treated and therefore will remain at risk of injury or death.
  • The DHB will not be complying with Ministry of Health reporting requirements and will achieve low scores against performance indicators in the Crown Funding Agreement.
  • There is the possibility of a sentinel event investigation in which the DHB’s practice standards/policies/processes will be identified as being deficient and not complying with Ministry of Health directives. A Sentinel event is “an undesired event that signals that something serious or ‘sentinel’ has occurred and warrants in-depth investigation (Ministry of Health, 2001b)
  • The DHB will score poorly in the Ministry of Health Audit of DHB responsiveness to family violence.
  • The DHB will miss the opportunity to collaborate with community agencies.
  • The DHB will be seen as failing to take a role in addressing family violence in the community.
  • The DHB will not be able to take a leadership role and address an issue with primary prevention.
  • The DHB will not be able to access funding available from the MoH FV Programme.

A family violence intervention programme can be developed as and when resources become available.


Ministry of Health requirements

Why does the health service need to offer family violence intervention?

Funding for DHBs is provided to support the implementation of the MoH Family Violence Intervention Guidelines. This includes funding for a dedicated coordinator position to support programme establishment and implementation for child and partner abuse intervention.

Violence and abuse cause significant and cumulative health harm – the longer violence and abuse continues, the worse the mental and physical health harm. Victims of violence use services at approximately three times the rate of people who are not victimised (Fanslow 2004, Krug 2002; Koss, Koss & Woodruff 1991). The Adverse Childhood Experiences (ACE) study suggests that being a victim of child abuse and/or witnessing partner abuse is linked to serious health problems in adulthood (Felitti et al 1998).

Early intervention provided by health professionals’ identification and support of child and adult victims is important to reduce health harm, social harm and health service utilisation. The FVIG intervention is highly acceptable to patients, increases help-seeking behaviour, and reduces medium term incidence of violence (Koziol-McLain et al 2005, McFarlane et al, 1998 and 2000, Muellman et al 1999).

International recognition of the significance of family violence

The seriousness of family violence is recognised by international organisations, conventions and documents, including:

National recognition of the significance of family violence for the health sector

The New Zealand Government recognises family violence as a priority issue, as shown in:

  • the Ministry of Health’s Statement of Intent 1 July 2013 to 30 June 2016 (Ministry of Health 2013)
  • The New Zealand Health Strategy (Minister of Health)
  • the Better Public Services: Results for New Zealanders
  • The Primary Health Care Strategy (Minister of Health 2001)
  • He Korowai Oranga: Māori Health Strategy (Minister of Health and Associate Minister of Health 2002)
  • The Crown Funding Agreement with DHBs.

Health professionals

Health professionals have more access to families than almost any other service provider. Health professionals have the opportunity to identify abuse early, provide immediate support and offer referrals, which could prevent serious harm or death.

Health professionals have a professional responsibility to act as an advocate for victims of abuse (Nursing Council of New Zealand 2001).

Health professionals have an ethical responsibility to diagnose appropriately suggest:

  • The ethical principle of beneficence suggests that health professionals have a professional responsibility to diagnose and treat abuse rather than to merely address physical symptoms.
  • The health professional should address the cause because failure to do so is likely to lead to further injury. For example, if abuse is the underlying reason for a health issue and it is not identified, then any treatment may be ineffective and even detrimental (McLeer and Anwar 1997; Spinola et al 1998)

Health professionals who adopt an abuse screening practice within their usual health assessment increase opportunities to provide early intervention and education on family violence.

Victims

Victims feel that health professionals should be able to provide support and offer intervention options (Campbell et al 1994, Koziol-McLain et al, 2005).

New Zealand victims of violence who have experienced the health service intervention are strongly positive about the impact of in providing support and information, and assisting in help seeking (Koziol-McLain 2005, DSAC 2005). Early intervention reduces longer term health service utilisation.

Victims have identified that when a health professional does not ask about their safety or screen for violence, they can feel helpless, discouraged, (Campbell et al 1994) and less likely to seek help in the future (Head and Taft 1995).

Victims will usually disclose violence if asked in a safe, non-judgmental way within the context of a health assessment (Freidman et al 1992, Koziol-McLain et al, 2005).


Ethical considerations

Health professionals have an ethical responsibility to diagnose appropriately.

  • The ethical principle of beneficence suggests that health professionals have a professional responsibility to diagnose and treat abuse rather than to merely address physical symptoms.
  • The health professional should address the cause because failure to do so is likely to lead to further injury. For example, if abuse is the underlying reason for a health issue and it is not identified, then any treatment may be ineffective and even detrimental (McLeer and Anwar 1997; Spinola et al 1998)

Health professionals who adopt an abuse screening practice within their usual health assessment increase opportunities to provide early intervention and education on family violence.