Part 1: 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 enquiry 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 assessment and intervention guidelines are clearly endorsed by family violence agencies’ support programmes.
    • Patients have identified that abuse enquiry 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.

Identifying 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 for further information and assistance.


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 Ministry of Health Family Violence Assessment and Intervention Guideline. This includes funding for a dedicated coordinator position to support programme establishment and implementation for child abuse and intimate partner violence assessment and intervention.

Knowledge of the acute and long-term consequences of trauma and violence continues to increase. 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; Edwards et al 2005) including not only injuries but also effecting sexual and reproductive health, mental health and increasing the risk of chronic disease.

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 FVIAG 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).

Working to foster safe, stable and nurturing relationships between adults and children and healthy and respectful relationships between intimate partners are fundamental aspects of supporting health (FVAIG 2016)

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 government sectors (excluding health)

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

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:

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).

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 receiving support and information, and assistance in help seeking (Koziol-McLain 2005, DSAC 2005). Women find being questioned in health care settings regarding their experience of IPV to be both acceptable and appropriate (Feder et al 2009; Koziol-McLain et al 2008; MacMillian et al 2009).

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). Doing nothing can reinforce a patients feelings of humiliation and can compound damage to their sense of self worth (Jecker 1993).

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, also considering the psychological, social and spiritual dimensions of health.
  • The ethical principle of non-malfeasance suggests that health professionals’ failure to recognise family violence has the potential to lead to further injury and/or inappropriate or harmful treatment. 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 enquiry practice within their usual health assessment increase opportunities to provide early intervention and education on family violence.

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