Domestic&FamilyViolence:TheChallengesofScreening

Dr Kathleen Baird, School of Nursing and Midwifery, Menzie’s Health Institute Queensland, Griffith University

& Gold Coast University Hospital

Obstetric Malpractice Conference9th August 2016

Objectives

Examinethecurrentdiscourseandevidencearoundscreeningfordomestic&familyviolence

Exploretheroleofhealthinrespondingeffectivelytodomestic&familyviolence

Recommendationsforfuturepractice

Background§ 1- 2womanaweekaremurderedbyacurrentorexpartner.§ WithinAustralia,theprevalenceofDomesticandFamilyViolence

(DFV)is1:4women.§ Formsthehighestcontributiontomorbidityandmortalityin

womenaged15- 44years(AustralianBureauofStatistics[ABS],2012).

§ FinancialcostofDFVinAustraliaisestimatedtobe$13.8billion,withthecoststoheathestimatedat$863millionalone (AustralianGovernmentDepartmentofSocialServices[AGDSS],2012).

Healthconsequencesofdomesticandfamilyviolence

Interpersonalviolenceisthetenthleadingcauseofdeathforwomen15– 44yearsofage(WHO,2010)

Theroleofhealth

§ ThehealthsectorisakeyentrypointforbothvictimsandsurvivorsofDFV.

§ Womenwhohaveexperiencedviolencearemorelikelythannon-victimstoutilisehealthcareservices.

§ Healthcareprovidersareinauniquepositiontoidentifyvictimsandsurvivorsandofferthemappropriatesupportandreferrals.

§ Womenidentifyhealthcareprovidersastheprofessionaltheywouldmosttrustwithadisclosureofabuse.

Theprevalenceofdomestic&familyviolenceinpregnancy

§ InAustralia36%ofwomenwhohaveexperiencedviolencebyapartner,reportthatthisoccurredwhentheywerepregnant,with17%experiencingviolence forthefirsttimeduringpregnancy(ABS2006).

§ Betweenonequarterandonehalfofallwomenphysicallyabusedduringpregnancywerekickedorpunchedintheabdomen,withbetween8%and34%reportingthattheviolenceincreasedduringthepregnancy(WHO,2010).

Effectsofdomestic&familyviolenceduringpregnancyComplicationsinpregnancyandbirthinclude:§ Lowbirthweight(Gentry&Baily,2014)§ Prematurebirthandmiscarriage (GarciaMorenoetal.,2005;

Sharps,Laughon,&Giangrande,2007)

§ Fetaldistress,traumaanddeath(Howardetal.,2013;Mercedes,

2015)§ Maternalsubstanceabuseandsmoking(Brownridgeetal.,

2011).

§ Maternaldepression/anxiety/postnataldepression(Howardetal.,2013;Taft,2002).

§ Sexuallytransmittedinfections (Mercedes,2015;Taft,2002).

Screening:whatdowealreadyknow?

§ Therecontinuestobeadebatearoundtheeffectivenessofscreeningtoolsinrelationtodomesticandfamilyviolence.

§ Theuseofscreeningtoolsincertainhealthsettingse.g.pregnancybyhealthcareprovidersincreasesdomesticviolencereportingrates.

§ Womenvaluecontactwithdomesticviolenceadvocatesandwantadvocacytobemorevisibleandaccessibleinallhospitalandprimarycaresettings.

Doesscreeningfordomestic&familyviolenceincreaseidentification?

§ Asystematicreviewby0’Dochertyetal.,(2015)foundmoderateevidencethatscreeninginhighincomecountrieswithdevelopedreferralservicesincreasedidentification.

§ Areviewof36studiesonDVandscreeninginhealthcaresettingsconcludedthatthereareeffectivescreeningtoolsthatdonotcauseanyharmandthatsomeinterventionhavehadpositiveresults(Nelsonetal.,2012).

§ Clinicalidentificationwasalsoincreasedinallmaternalhealthservicesandemergencydepartments.

§ InantenatalservicesdisclosureofahistoryofDFVwerefourtimeshigherinscreenedwomencomparedtothosewhoreceivedusualcare(O’Dohertyetal.,2015).

Benefitsandeffectivenessofscreening§ Increasesdetection– withoutwhichaninterventioncouldnot

takeplace.§ Noevidencethatcurrentscreeningprogramscauseharm.§ MostwomendonotobjecttobeingaskedaboutDFVandare

stronglyinfavourofbeingaskedaboutviolenceinhealthcaresettings.

§ HCP’s mayonlyaskwomenwhotheyfeelareatriskofDFV.§ IfaskingaboutDFVisselective- manyHCPwillavoidaskingthe

question.

Whyshouldwecontinuetoaskthequestion?§ Healthcanoftenbethefirstpointof

contactformanywomen.§ Womenarelikelytodisclosetoacaring

andknowledgeableprofessional.§ Healthprofessionalsresistancecanbe

associatedwith:§ lackofknowledgeandtraining§ timeconstraints§ beliefthatDFVisaprivatematter§ fearofoffendingwomen

Summaryoftheevidence§ Screeningorassessmenttoolsincreasetheidentificationof

domesticviolenceespeciallywhenfocusedonpregnantpopulations(Ramseyetal,2006;O’Reillyetal.,2010;Bairdetal.,2011;Bairdetal.,2015).

§ Theuseofscreeningtoolsfordomesticviolencethroughoutpregnancybyhealthcareprovidersincreasesdomesticviolencereportingrates.

§ Womenvaluecontactwithdomesticviolenceadvocatesandwantadvocacytobemorevisibleandaccessibleinprimarycaresettings.

Principlesforsafeandeffectivescreening/routineenquiry

§ Clear protocols, policies and procedures.§ Adequate safety planning for women.§ Referral pathways and collaboration with other services.§ A screening program that is well developed and evaluated.§ Evidence-based training and a support program for all staff.

§ responding safely and effectively to DFV requires the knowledge of the risk factors, signs and symptoms as well as the consequences for a woman who may be trying to survive in a violent relationship.

InconclusionHealthcareprofessionalscanplayacentralrolein:

§ Routinelyaskingwomenaboutexperiencesofviolence.§ Providinginformationandsupport.§ Enhancingsupportnetworksandmakingappropriatereferrals.

§ However,currentlymanyHCP’scontinuetostrugglewiththisexpectationandexpansionoftheroleandfindthisworkchallenging.

References§ Baird, K. (2015). Women’s lived experience of domestic violence during pregnancy. Practising Midwife, March 2015.§ Brownridge, A., Taillieu, L. Tyler, A., Tiwari, A., Cham. K.L., Santos, S.C. (2011). Pregnancy and intimate partner violence: Risk

factors, severity, and health effects, Violence Against Women, 17(7), 858 -881.§ Campo, M. (2015). Domestic and family violence in pregnancy and early parenthood. Domestic and family violence in

pregnancy and early parenthood. Australian Institute of Family Studies, 3-9.§ Garcia-Moreno, C., Jansen, H., Ellsberg, M.Heise, L., Watts, C. (2005). WHO multi-country study on women’s health and domestic

violence against women. Geneva, WHO.§ Gentry, A., Bailey, B.A. (2014). Psychological intimate partner violence during pregnancy and birth outcomes: Threat of

violence versus other verbal and emotional abuse, Violence and victims, 29, (3), 383 – 392.§ Howard,L., Oram, S., Gallery, H,trevillion, K., Feder, G. (2013). Domestic violence and perinatal mental disorders: A systematic

review and meta-analysis. PLOS Med, 10(5), e1001452.§ O’Doherty, L., Hegarty, K., Ramsay, J. et al. (2015). Screening women for intimate partner violence in healthcare settings,

Cochrane Review, Wiley Publishers. § O’Reilly, R., Beale, B., Gillies, D. (2010). Screening and Intervention for Domestic Violence During Pregnancy Care: Systematic

Review. Trauma Violence and Abuse,11, 190: 190 – 201. § Renker, P., Rinard, RNC Tonkin, P. (2010). Women’s Views of Prenatal Violence Screening: Acceptability and Confidentiality

Issues, Obstetrics & Gynecology, 105, 2: 348-352.§ Salmon, D., Murphy, S., Baird, K. et al., (2006). An evaluation of the effectiveness of an educational programme promoting the

introduction of routine antenatal enquiry for domestic violence. Midwifery, 22, 1: 6 – 14. § Taft, A. (2002). Violence against women in pregnancy and after childbirth: Current knowledge and issues in health care responses.

(Issue paper 6). Australian Domestic and Family Violence Clearing House. § World Health Organisation (2012). Violence Against Women: Global Picture Health Response, Available at:

http://www.who.int/reproductivehealth/publications/violence/VAW_infographic.pdf Accessed 15th May 2014. § World Health Organsation (2014). Responding to intimate partner violence and sexual violence against women. WHO clinical and

policy guidelines, WHO, Geneva.

ThankyouContactdetails

k.baird@griffith.edu.au

DV Connect 24 hour/7 days Helpline 1800 811 811