Family violence

Interpersonal, domestic, and family violence is sadly a prevalent issue that affects many people across socioeconomic, cultural and community demographics. Chiropractors can play an important role in identifying and addressing domestic and family violence as they may treat patients who are hesitant or afraid to disclose incidents for fear of escalation, legal involvement or financial distress.

According to recent NSW Bureau of Crime Statistics and Research figures, approximately 1 in 6 women and 1 in 16 men experience interpersonal violence, with over 1 in 5 women making their first disclosure of domestic violence to their health practitioner.

Understanding the legal obligations and responsibilities of health practitioners can ensure the delivery of effective patient care as well as preventing further harm.

Understanding interpersonal abuse and violence

Interpersonal abuse and violence can include intimate partner abuse, sexual assault, child abuse, bullying, elder abuse and adult survivors of child abuse. Practitioners must recognise that violence extends beyond physical harm, encompassing emotional, sexual, economic and social abuse. Both men and women can be perpetrators - healthcare practitioners need to be aware of the prevalence and the complexity of these issues.

Prioritising safety and support:

Safety: The primary focus for health care practitioners is ensuring the safety of patients experiencing abuse and violence.

Comprehensive systems: Healthcare practitioners should establish systems that encompass the entire practice, providing referral pathways to guide patients toward recovery and safety.

Addressing attitudes and assumptions: Training programs should encompass healthcare practitioners' attitudes and assumptions about abuse and violence as these can significantly impact the response to patients.

Prevalence of interpersonal abuse and violence: Data from the Australian Bureau of Statistics reveal that young people aged 18-24 are most likely to have experienced some form of interpersonal violence. While both men and women can be victims, women are more likely to experience sexual violence.

Determining appropriate levels of involvement and intervention:

Identification and validation: Healthcare practitioners should proactively ask patients displaying clinical indicators of the mental and physical effects of abuse about their experiences. Patients who disclose abuse should be provided with first-line support, including active listening and validation of their experiences with a focus on ensuring their safety.

Safety and risk assessment: While expressing concern for a patient's safety and likelihood of risk is crucial, it’s equally important to respect their decisions around the most suitable pathway to safety.

Mandatory reporting: Healthcare practitioners are considered mandatory reporters who are required by law to report suspected child abuse and neglect to government authorities.

Mandatory reporters can make a child protection report by:

1. completing an eReport through the Childstory Reporter websiteopen_in_new
2. calling the Child Protection Helpline on 13 21 11.

In cases of intimate partner abuse where children are not directly affected, referral to a vulnerable children’s organisation or a report to Child Protection could be considered.

Counselling and support: Intimate partner abuse often coexists with mental health issues. Healthcare practitioners should ensure a comprehensive understanding of interpersonal violence and employ counselling approaches tailored to meet each patient's specific needs.

Collaborative intervention: Healthcare practitioners should view themselves as part of a wider support network, collaborating with domestic violence services, legal professionals, police and housing agencies to effectively assist survivors.

Understanding legal requirements: While healthcare practitioners are primarily responsible for medical care, it’s recommended practitioners have a basic understanding of the legal issues surrounding family violence and sexual assault.

It’s imperative to promptly document physical injuries as well as the specific descriptions of violence which then should be referred to qualified experts for interpretation. Healthcare practitioners can also offer information on legal options and facilitate access to legal services.

In cases of recent sexual assault, patients should be offered a referral to a specialist forensic service and counselling to help them make an informed decision about whether they wish to pursue a forensic examination.

The importance of self-care

Treating a patient who experienced domestic violence can be very distressing for practitioners, particularly when patients face barriers to reporting violence, or there is evidence the violence is causing persistent harm. Working with patients experiencing abuse and violence can result in vicarious trauma for healthcare practitioners. It’s important to prioritise self-care on both an individual and practice-wide level, creating an environment that safeguards against burnout and indirect trauma. Establishing peer support systems and fostering an environment conducive to discussing distressing cases can help mitigate stress encouraging psychological safety.

Key takeaways

• Healthcare practitioners must understand reporting and intervention obligations for treating patients presenting with domestic violence-related health concerns. Despite growing community awareness, interpersonal violence continues to affect many communities and healthcare practitioners play an important role in identifying and addressing incidents of violence.
• Prioritising safety, providing patient support, understanding the legal framework and ensuring self-care, can help practitioners effectively intervene in cases of intrapersonal violence, as well as mitigate further patient harm.

Further reading:

Joint Position on Family Violence by Regulators of Health Practitioners