International Domestic Violence and Health Conference 2018

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International Domestic Violence and Health Conference 2018

 

The Women’s Community Health Network recently attended the first international conference to headline early intervention for domestic violence in health settings. Notable were the presentations on Safer Futures (US) and VIP (New Zealand).

 

Safer Futures

Safer Futures is a practice and partnership model that benefits survivors of intimate partner violence. This model demonstrates how community-based, non-clinical domestic and sexual violence (D/SV) intervention advocates can better serve survivors of intimate partner violence (IPV) in partnership with health care providers and child welfare staff. Such partnerships strengthen services for survivors of IPV in various settings including, but not limited to, public health departments, Federally Qualified Health Centers, primary care clinics, hospitals, and child welfare offices.

Safer Futures is focused on four high level strategies:

  • Participant level – provide survivors greater access to advocacy services by locating advocates at public health      departments, local health care clinics and child welfare offices
  • Provider level – train health care providers and child welfare staff on how to identify, respond and effectively intervene on behalf of survivors affected by IPV
  • Program level – develop organizational capacity and advocate skill in delivering services and for providing training in health care and child welfare systems
  • Policy level – change how health care and child welfare systems understand and respond to IPV; develop strategic partnerships to support the vision and work of the project; establish a diverse and reliable funding base to sustain the project beyond the grant cycle

 Project staff at each Safer Futures project site had distinct responsibilities, including:

  1. Community-Based Advocate – provides on and off site intervention, accompaniment and supportive services; provides case consultation with health care providers or child welfare staff
  2. Training and Partnership Development Coordinator – provides training and technical assistance; develops organizational capacity for effective IPV services in partnership with health care and child welfare systems; helps create partnerships and promotes the services provided by the advocate

Family violence intervention programme

The New Zealand Government recognises family violence as a priority issue. There is also national recognition of the significance of family violence for the health sector. New Zealand’s 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.
  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.
    • The Ministry of Health requires DHBs’ (District Health Boards) 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.
  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.

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.

Health professionals who adopt an abuse enquiry practice within their usual health assessment increase opportunities to provide early intervention and education on family violence. The VIP (Violence Intervention Programme) supports health sector family violence programmes throughout New Zealand. The programme funds family violence intervention coordinator positions in all district health boards (DHBs), audit DHB performance, support related research and evaluation, and offer technical advice and training support to health services committed to the programme.