1. STRENGTHENING HOSPITAL RESPONSES TO FAMILY VIOLENCE Module 1: A Shared Understanding

2. SESSION SUMMARY Demystifying Family Violence o Prevalence o Risk Factors o Gender Analysis o Myths Health Impacts Professional Responsibility

3. LEARNING OBJECTIVES A sound and practical understanding of family violence as a health issue, its prevalence and impact Identification of the key determinants underpin family violence Awareness of the health impacts of family violence

4. SETTING THE SCENE World report on violence and health: summary. Geneva, World Health Organization, 2002. Typology of Interpersonal Violence

5. WHAT CAN WE DO

6. DEFINING FAMILY VIOLENCE BEHAVIOUR Family violence is behaviour by a person towards a family member of that person that: o is physically or sexually abusive o is emotionally or psychologically abusive o is economically abusive o is threatening o is coercive o in any other way controls or dominates the family member and causes that family member to feel fear for the safety or wellbeing of that family member or another person. Family Violence Protection Act 2008 (Vic)

7. CHILDREN EXPOSED TO FAMILY VIOLENCE Immediate and long term impacts on the unborn, infants, children and adolescents even if they do not witness it¹. o Psychological / Behavioural o Physical Since the age of 15, over 400,000 women had experienced intimate partner violence during pregnancy and over half a million women reported that their children had seen or heard it². 30-60% co- occurrence of intimate partner violence and child abuse³. 1Grealy, C., Humphreys, C., Milward, K., and Power, J. (2008) Urbis, Practice guidelines: women and children's family violence counselling and support program, Department of Human Services, Victoria. 2 Violence against women: Additional analysis of the Australian Bureau of Statistics' Personal Safety Survey, 2012 / Peta Cox. Sydney : ANROWS, c2015 3 Edleson, J. L. 1999, 'The overlap between child maltreatment and woman battering', Violence Against Women, vol. 5, no. 2, pp. 134-154.

8. ABOUT CHILDREN Family Violence Protection Act 2008 “…a child is exposed to family violence if the child sees or hears family violence or otherwise experiences the effects of family violence.” Mandatory Reporting Legislative requirement to report suspected cases of children at risk of physical harm

9. DEFINING ‘FAMILY’ A person –who is, or has been, the relevant person’s spouse or domestic partner –who has, or has had, an intimate personal relationship with the relevant person –who is, or has been, a relative of the relevant person A child –who normally or regularly resides with the relevant person or has previously resided with the relevant person on a normal or regular basis –of a person who has, or has had, an intimate personal relationship with the relevant person Any other person –whom the relevant person regards or regarded as being like a family member (a carer or flatmate for example) Aboriginal Australian, Torres Strait Islanders and CALD definitions –of family may also extend to relationships within extended families, kinship networks and communities.

10. WHO IS LIKELY TO EXPERIENCE FAMILY VIOLENCE? Australian women are most likely to experience physical and sexual violence in their home, at the hands of a male current or ex-partner*. *ANROWS (2015) Compass, Issue 2 Violence against women in Australia: Additional analysis of the Australian Bureau of Statistics’ Personal Safety Survey, 2012: Key findings and future directions

11. PREVALENCE 36% of Australian women have experienced physical or sexual violence from someone they knew, since the age of 15. Of all Australian women, 15% have been sexually assaulted by a person they knew, since the age of 15. 89 women were killed by their current or former partner between 2008-10. http://www.anrows.org.au/publications/fast-facts/key-statistics-violence-against-women - drawn from Personal Safety Survey 2012

12. COMMON MYTHS It’s not a widespread problem She wasn’t wearing much It only happens in poor, uneducated families She provoked him There are as many male victims as female victims

13. CAUSES OF FAMILY VIOLENCE The key determinants of family violence o the unequal distribution of power and resources between men and women o an adherence to rigidly defined gender roles Family Violence is Preventable o promoting equal and respectful relationships between men and women o fostering non-violent social norms and reducing the effects of prior exposure to violence (especially on children) o improving access to resources and systems of support 1.Vic Health. (2007). Preventing violence before it occurs: A framework and background paper to guide the primary prevention of violence against women in Victoria. Melbourne. VicHealth.

14. WHOSE ROOM IS WHOSE? Suggestion: add an image of two different bedrooms here and ask participants to say whose room might belong to a boy or girl

15. ATTITUDES

16. RISK FACTORS Key determinants for family violence result in women being most at risk of experiencing violence¹ ² Family violence occurs in a diverse range of households across the entire Victorian community and remains largely undetected and unreported³ 1. Morgan, A. & Chadwick, H. (2009). Key Issues in Domestic Violence. Australian Institute of Criminology. Australian Government. 2. Better Health Channel. (2015). Domestic Violence – why it happens. Retrieved from https://www.betterhealth.vic.gov.au/health/healthyliving/domestic-violence-why-it-happens 3. Department of Human Services (DHS). (2012). Family Violence Risk Assessment and Risk Management Framework and Practice Guides 1-3. Victoria. Department of Human Services. https://www.betterhealth.vic.gov.au/health/healthyliving/domestic-violence-why-it-happens

17. LIKELIHOOD AND SEVERITY pregnancy, mental health, drug or alcohol misuse, suicidality, isolation, drug and alcohol misuse, suicidality, use of weapons, access to weapons, threats or actual harm, strangulation, threats or actual to harm children, threats or harm to animals and pets, stalking, sexual assault, breach of intervention order, jealous behaviour, controlling behaviour, unemployment, history of violence, separation or plans for separation, financial hardship, escalation

18. DIVERSITY AND FAMILY VIOLENCE Aboriginal communities Culturally and Linguistically Diverse (CALD) communities, Refugee, Asylum Seeker Women with disabilities Women with mental health issues Homelessness Incarcerated Women Older women Lesbian, Bisexual, Transgender and intersex people Pregnancy

19. HEALTH IMPACTS Source: VicHealth (2004) The health costs of violence: Measuring the burden of disease caused by intimate partner violence

20. HEALTH IMPACTS Source: VicHealth (2004) The health costs of violence: Measuring the burden of disease caused by intimate partner violence

21. PROFESSIONAL RESPONSIBILITY ……THIS IS HEALTH’S BUSINESS Be aware o the issue and its prevalence o Its impact on health o Its causes o your own biases, world view, self-care needs etc. Consult o the patient - what steps would they like to take now? o with colleagues, senior staff, social workers, CASA, Mental Health, After Hours Coordinators, external agencies are also an option for 24 hour consultation – you can just ring them too – they are the experts! Refer o To hospitals policies, procedures o Offer referrals to the patient and where necessary seek their consent