Module 7: Training Materials (health sector)


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Case study
Case study: Domestic violence has a negative impact on children

Gabby married her husband Nick after a long relationship and shortly thereafter moved to her husband’s family farm. The couple was happy at the farm and soon had their first child. During the pregnancy Nick’s behaviour began to change and by the time their daughter was born the relationship did not ‘feel’ as it had before. Nick seemed withdrawn and spent long periods of time by himself. He began to remind Gabby of Nick’s father who had always been a stern presence in his life.

Nick’s behaviour became threatening and controlling, especially in relation to money and social contact. He was increasingly aggressive in arguments and would often shout and throw objects around the room. Gabby thought that, because he wasn’t physically hurting her, his behaviour did not qualify as abuse. Nick did not show much interest in their daughter, Jane, except when in public, where he would appear to be a doting and loving father.

Jane was generally a well-behaved child, however, Gabby found that she was unable to leave her with anyone else. Jane would cry and become visibly distressed when Gabby handed her to someone else to be nursed. This was stressful for Gabby, and also meant that her social activities were limited further.

Jane took a long time to crawl, walk and begin talking. Her sleeping patterns were interrupted, and Gabby often did not sleep through the night, even when Jane was over 12 months of age. When Jane did begin to talk, she developed a stutter, and this further impeded her speech development. Gabby worried about Jane a lot. Their family doctor told her that this was normal for some children and that, if the speech problems persisted, she could always send Jane to a specialist at a later date.

After a number of years, Nick’s behaviour became unacceptable to Gabby. During arguments he would now hold on to the rifle that he had for farming purposes, and Gabby found this very threatening. On a number of occasions, items that Nick threw hit Gabby and she was increasingly afraid for their daughter. Gabby decided to leave and consulted the local women’s service, who assisted her to get an intervention order against Nick.

Once Gabby had taken Jane away from Nick, her behaviour changed. Jane’s development seemed to speed up and Gabby couldn’t understand why. As part of her counselling at a local women’s service, she discussed this issue, and her counsellor recognised the developmental delay, stutter, irritation, and separation anxiety as effects of Jane’s previously abusive situation.

This can be seen as a missed opportunity for identifying family violence. If the family doctor would have asked Gabby or Nick (who had presented with chronic back pain) about their relationship, about what was happening to the family, and specifically to Jane, the situation could have been identified much earlier.

Task for reflection

a) What could have been done better by those involved?

b) Take a moment to consider which agencies and professionals should have been involved in supporting and/or providing services to Gabby from the beginning.

c) Make a list of different professionals who make up the multidisciplinary team in your organisation and who could be involved in the provision of services for those who have experienced domestic violence (this will vary depending upon where you are based).

The wide range of professionals, provider services and specialist agencies who may be involved in supporting victim-survivors of domestic violence can include—but are not limited to—primary and secondary health care services, mental health services, sexual violence services, social care, criminal justice agencies, the police, probation, youth justice, substance misuse, specialist domestic violence agencies, children’s services, housing services and education.

Adapted from a case study from RACGP (2014): Abuse and Violence: Working with our patients in general practice

Intercultural self-awareness exercise

Reflecting on your cultural affiliations and recognising the influences and behaviours that you have experienced as a result make you realise how these events determine your own perceptions and actions.

How we communicate with victims, assess risk in DV and work well in interprofessional teams depends also on biases and prejudices which are also shaped by culture. Self-reflection is closely linked to cultural responsiveness. Integrating exercises to assess one’s own cultural self-awareness is thus crucial.

Reflecting on experiences from childhood to adulthood can aid in considering personal struggles and privileges throughout life.

Look at this video and reflect on the questions being asked.

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Here are the questions:

1. Where were you born? What area are you from?

2. What countries/regions does your family come from?

3. How long have you lived here? What has brought you here and what has made you feel welcome?

4. What is important to know about how you grew up?

5. Have you ever felt different from others because of your beliefs/ethnicity/race, etc. In what contexts/settings?

6. What is your socio-economical status now, what was it before? How did this influence your experience of the society/culture you grew up in?

7. Did you have more friends with diverse cultural backgrounds when you were younger or nowadays and why is that so?

8. How do ethnicity, age, family, experience, education, socio-economic status, gender, sexual orientation, religion, etc. impact your interactions with your patients? Can you give an example?

9. Do you know how your patients want to be treated or do you assume they want to be treated by your cultural standards, i.e. are you acting more often according to the golden rule that is ‘to do unto others as you’d have them do unto you’ or to the platinum rule, that is ‘to do unto others as they’d want done unto them’.

10. Achieving cultural competence and cultural humility involves a commitment to learning over a lifetime. Can you give examples from your professional context to demonstrate your commitment to this process?

Further training materials

Good to read

In the provided resource, you will discover a series of vignettes illustrating how multiple agencies collaborate in various cases of domestic violence to produce positive outcomes for victims and survivors:

  • Hale, H., Bracewell, K., Bellussi, L. et al. The Child Protection Response to Domestic Violence and Abuse: a Scoping Review of Interagency Interventions, Models and Collaboration. J Fam Viol (2024).

Additionally, the following source offers insights into interagency cooperation in child protection responses to domestic violence:

  • Stewart SL. Enacting Entangled Practice: Interagency Collaboration in Domestic and Family Violence Work. Violence Against Women. 2020 Feb;26(2):191-212. doi: 10.1177/1077801219832125. Epub 2019 Mar 11. PMID: 30854943. 

Knowledge assessment