This article was first published by Medical Republic on 22 June 2023.
Detecting and reporting family violence is a team effort, not just a task for GPs. One success story is to be extended.
When a distraught woman visited IPC Health Deer Park, a health clinic in Melbourne’s West, months of specialised training had prepared the staff to provide her with the support she needed.
“[The patient] came in clearly distressed, dishevelled, and asking for help”, said nurse and practice manager Shafina Ali.
“One of our client services staff promptly recognised the situation and referred the individual to one of our nurses. The nurse then escorted them to a private room for triage, during which the patient disclosed experiencing family violence.”
The patient’s flour-coated appearance was enough to tip off the staff that something was wrong, but it wasn’t until she was in the safety of the clinic that she admitted she hadn’t eaten in a few days and was really hungry. Later, when she had been treated and referred to a GP, she was grateful for the work of the staff that allowed her to escape her situation and take her children with her.
The collaborative involvement of administrative staff, nurses and GPs in the care of such family violence victims was the main goal for the Primary Care Pathways to Safety (PCPS) pilot initiative that aimed to equip doctors, nurses, and general practice personnel with the skills to recognise and assist patients who are facing family violence.
Now, the Melbourne-based pilot program is set to expand to 30 new GP clinics following its success in the initial pilot phase.
First implemented in 2019 by the North Western Melbourne Primary Health Network, the aim of the program was to respond to the challenges faced by primary care providers when responding to overwhelming rates of family violence, mainly by training a wide range of staff to respond to such scenarios.
In Victoria, family violence is the “leading contributor to death, disability and illness in women aged 15 to 44”.
To tackle these alarming rates, the pilot phase of the program kicked off with six practices in Melbourne’s northern and western suburbs and will continue running until mid-2026.
The program started out with goals including “improving primary care DFV awareness and capacity, enhancing relationships and collaboration between the primary care and DFV sectors, increasing primary care sector referrals to DFV support services and improving the support experience and outcomes for DFV victim-survivors”.
One of the unique approaches of this program was training both clinical and non-clinical staff to have relevant conversations with patients and educating them on how to go about asking questions about the patient’s experiences with family violence.
“The whole purpose was to come up with strategies to ask those questions, but also to document and to alert other clinicians that the questions already been asked”, Sofi Milenkovski, a former nurse and the senior manager of clinical services at IPC Health, told TMR.
As part of the program, systematic reminders were added to appointments that patients at risk were likely to attend by themselves, ensuring privacy and confidentiality as these were ideal times for the nurses and practitioners to ask about the patient’s experiences.
“These appointment types [could] be reviews or during mental health care plans, antenatal and postnatal checks, cervical screenings, contraception advice or even refugee health assessments”, said Ms Ali.
Ms Milenkovski said addressing family violence was a notable gap in the nursing curriculum. She identified the lack of confidence and apprehension among staff and nurses when it came to dealing with cases of family violence, which affected their ability to investigate potential cases of violence in patients. Providing the necessary training for practitioners and staff to effectively respond to such situations was then seen as essential.
“We’ve got nurses here that were trained many, many years ago. I can confidently say that…being a nurse myself, we didn’t get that training,” she told TMR. “I think it’s an illusion that all health clinicians are actually trained [in this]. Because we aren’t, we’re left on our own.”
The program comprised of six different activities, each established to address and improve a unique facet of responding to family violence:
- Establish multi-disciplinary networks to respond to family violence, involving local hospitals and perspectives from those with lived experience integrated to allow for the delivery of a first line safety assessment response.
- Improve referral pathways to ensure ease of access via awareness and coordination with the appropriate and relevant services.
- Intensive quality improvement workshops spanning five months that involved workshops delivered by specialist GPs and domestic violence support workers
- Secondary consults and supervision from family violence-specialist services
- Supporting practises to undertake “self-directed quality improvement” to “identify, respond and refer for family violence”.
- Delivery of an educational campaign for other services using insights form participating services and those with lived experience.
This is not the only program of its kind recognising the importance of detecting, information sharing and reporting family violence on all levels of patient care.
It is complemented by the likes of the Family Violence Multi-Agency Risk Assessment and Management Framework (MARAM) initially rolled out in Victoria after the 2016 Royal Commission recognised that systems were failing to identify and share information about risks effectively.
Since then, it has aimed to “establish a system-wide shared understanding of what family violence is, and how to respond to it” by “[setting] out the responsibilities of these workforces when they come into contact with individuals and families experiencing family violence”.
Ms Ali and Ms Milenkovski both agreed that the program had helped raise awareness and increased recognition of family violence as a social issue, not one that is just medical and confined to GP clinics.
“It should be everyone’s responsibility…this question [of family violence] should be asked by everyone and it shouldn’t just be a GP issue,” Ms Ali said.
Overall, an in-depth evaluation by the government recognised the great success of the pilot program in producing improved results regarding their capacity to take on family violence cases.
Despite the pressure added by the covid pandemic, the evaluation found that the participating primary health networks reported impressive stats based on their activities between July 2021 and November 2022. Among these are 225 training session, attended by over 1700 GPs, administrative and other staff.
The primary health sector also reported improved capacity to take on domestic and family violence cases, which they attributed to the pilot program’s trainings and the ability of the program’s integrators to provide “…patient-specific advice on over 900 occasions, referral pathway advice on almost 700 occasions, and supporting GPs to make over 250 [domestic and family violence] victim-survivor referrals.”
“It’s a teamwork approach…everyone needs to be asking this question,” said Ms Ali.
“Everyone needs to have the knowledge to be able to refer on one’s own, and to be able to know who the next person is to refer to.”