Module 7: Principles of interorganisational cooperation and risk assessment in cases of domestic violence in multi-professional teams

Work with other service providers to develop and implement integrated protocols and effective referral networks to:

• link victims with needed health and social services like shelters, medical and psychological care institutions,
• institutionalise coordinated efforts,
• develop standards for referral services,
• ensure all communications between service providers are non-judgmental, empathetic, and supportive,
• identify the need for standardised data sharing protocols.

Ensure effective information sharing amongst justice service providers, including:

• informed consent for disclosure of information is sought from the victim/survivor and/or parents/guardians and legal representative, wherever possible,
• information is shared within privacy and confidentiality requirements,
• disclosure of information is for the purpose for which it was obtained or compiled or for a use consistent with that purpose,
• develop protocols and referral mechanisms that promote timely and efficient flow of information amongst service providers.

Entities shall establish written procedures on risk assessment and risk management, in particular on objectives, responsibilities and roles of professionals, duration and methodologies of risk assessment and management, namely:

• the identification of relevant sources of information, such as the history of violence revealed by the victim/survivor;
• the definition of the instruments to be used;
• the design of situational safety plans.

The information obtained from the risk assessment should be contained in a clear and objective written report and should cover several areas: history of violence, psychosocial history, current psychosocial adjustment of the offender, context of the victim/survivor’s experience and a conclusive opinion on the risk of violence presented.

Multi-institutional cooperation is of paramount importance for increasing the safety of women and children and requires a process of information sharing. 

Sharing information between different organisations can contribute to this:

• finding new ideas and solutions in the area of prevention and intervention, making them more coherent and effective, 
• minimising new incidents of domestic violence.

The sharing of information may conflict with one of the basic principles of intervention: confidentiality and the right to privacy. Information collection and dissemination strategies must take into account accepted ethical standards, respecting human rights.

The sharing of information should comply with the following principles.

• Safety: information should be shared in a safe way and should not increase the level of risk to the victim/survivor and children by placing them in a more vulnerable situation.
• Objectivity: information should be transmitted in an objective way, without any value judgement.
• Need: only information relevant to the creation of an effective safety plan should be considered.

The National Crisis Telephone Information Service helps victims of domestic violence and human trafficking through a telephone line available free of charge, non-stop throughout the country. Trained domestic violence counsellors (working in pairs) provide primarily counselling and information about available victim support services. In addition, they refer victims leaving their homes and escaping the abusers to shelters that closely cooperate with OKIT. A risk assessment tool supports the counsellors in assessing crisis situations and making decisions about the adequate response. The professional staff at OKIT react even if evidence is not available; victims do not have to prove (by medical report, testimony of witnesses or video footage) that abuse has occurred. All in all, the organisation is able to offer a low-threshold service targeted to the complex needs of domestic violence victims and thereby decrease latency.

http://bantalmazas.hu/

Living FREE of violence is a campaign to prevent violence against women and children founded in 2014. “Living FREE of Violence” (GewaltFREI leben) is coordinated by the Federal Ministry for Education and Women’s Affairs and implemented by the association “Autonomous Austrian Women’s Shelters” (Verein Autonome Österreichische Frauenhäuser, AÖF) in cooperation with the Vienna Intervention Center against Violence in the Family (Wiener Interventionsstelle gegen Gewalt in der Familie) and the Austrian National Youth Council (Bundesjugendvertretung). In the years 2014 and 2015, numerous projects aiming at awareness-raising for the issue of violence against women and children and providing valuable prevention work will be implemented.“

http://www.gewaltfreileben.at/en

Their homepage provides a broad range of information on domestic violence as well as training material and guidelines for practitioners.

What is an Anchor team?

In Finland there are multi-agency teams (“Anchor teams”) working in several police departments. Anchor teams consist of police officers, social workers, and psychiatric nurses. Anchor teams vary in terms of composition in different locations.

The multi-agency cooperation and the exchange of information between the police, social services and health care, which is the core of the Anchor method, are based on an agreement between the police and the city (note: municipalities have a duty to provide social and health care services, also in situations of domestic violence).

The Anchor (“Ankkuri”) model supports the wellbeing of children and adolescents and is geared towards the prevention of juvenile delinquency and crime, violent radicalisation and extremism. In some places, like in case location 1, the Anchor model is also used to prevent domestic and intimate partner violence by intervening in incidents at the earliest possible stage and by referring the parties involved to relevant support services (see https://ankkuritoiminta.fi/en/frontpage).

The Anchor model is based on multi-agency cooperation, which involves different public authorities working together at police stations. An Anchor team may consist of a police officer, two social workers, a social advisor, a psychiatric nurse, and a youth worker. The social workers, the social advisor, the youth worker, and the nurse are municipal employees. The staff cooperates closely as a team, each bringing their own professional competence and the support and expertise of their own background organisation to the team.

Multidisciplinary cooperation makes it possible for professionals to serve the customer in a holistic manner based on a ‘one-stop shop’ principle. While the police officer from the investigation unit investigates the crime, the Anchor team’s health care and social work professionals look into the overall circumstances of the customer and his/her family. The Anchor team’s social workers and nurse assess the needs of the customer and refer him/her to further services such as victim support services, shelter services, NGOs working against domestic violence, mental health services etc. The benefits of this holistic approach and multi-agency cooperation are evident in challenging situations where the customer suffers from multiple problems like domestic violence, substance addiction and mental disorder.

Effective victim identification and detection

The involvement of handling domestic violence depends on the particular police station. Some of the anchor teams are very active in identification of domestic violence victims. The following case example describes the outreach work of an Anchor team.

The police officer of the Anchor team goes over all the local emergency reports two times per week and searches for expressions that indicate conflicts between couples, disturbing behaviour, mischief, or disorder. For example, an emergency report may be categorised as “disturbing behaviour” in the situation where there has been a noisy person in the corridor, but in reality, this person can be a person who has escaped to the corridor from her violent spouse. The police officer selects all the reports that refer to conflicts or arguments and collects these reports to generate an observation that is more precise.

After selection, the police officer tries to identify the persons from the emergency reports. The aim is to identify persons who associate with the reports by using different registers. After identification, the police officer collects data about the person’s living conditions, for example information about children and people living at the same address.

The Anchor team meets regularly. In the meeting, all of the selected, identified cases are presented to the social worker, the social advisor, and the psychiatric nurse. The police officer examines if the person has previously been in contact with the police. The social worker examines, among other things, if the family is a client of the child welfare service. The psychiatric nurse examines, for instance, if the medical reports give any information about mental disorders of the family’s children. This way, the Anchor team pieces together a huge amount of information about the family even before the family is contacted. The information exchange is easiest when the customer has children because the cooperation can be justified by the child’s interests without asking the customers to give her or his assent.

The family is contacted by the psychiatric nurse. The team has noticed that people are keener to speak about their life circumstances and potential domestic violence they experience, when they are contacted by the nurse of the multi-agency team. Similarly, people are not very responsive if they get a phone call from a police officer or a social worker who is associated to work for the child protection service.

After the psychiatric nurse has contacted a family or a couple, it often becomes clear that there actually have been violent conflicts in the family. In some cases, the police patrol has been on the spot solving the conflict but concluded that no violence has occurred, even though the family has actually suffered from domestic violence for a longer period of time.

Cooperation with other police units

Detective senior constables and detective sergeants of a Crime Investigation Unit consult the Anchor team members at the police department. The investigator can convince the victim or the perpetrator to meet the social worker or the psychiatric nurse of the Anchor team. Sometimes, with the permission of the person being questioned, the investigator asks the nurse or the social worker to attend the hearing as a role of a hearing witness. In the first place, the task of a hearing witness is to follow the hearing and make sure that no unappropriate methods are being used. When the hearing witness is the psychiatric nurse or the social worker of the Anchor team, they can hear the victim’s or perpetrator’s story as such. After the hearing is finished, they can start assisting the client without asking him/her to explain the circumstances all over again. In addition, the Anchor team may guide the victim to the Unit of Violence Work, shelters for victims of domestic violence, MARAC group or pass the information to the victim’s own social worker.

Cooperation with other professionals

The Anchor team will inform customers about the relevant services and tries to create bridges to other services and professionals. The Anchor team’s social worker cooperates with the municipality’s child welfare services and the psychiatric nurse has contacts to health sector professionals in addition to MARAC group professionals. In an individual process with the customer, it is decided which services are needed and would support the clients. Mainly meetings are organised in the police department but, for example if the customer is accommodated in a shelter, the psychiatric nurse and social worker can visit there.

The idea behind the Anchor teams is to prevent domestic violence by intervening at the violence’s earliest possible stage and guide customers to relevant services. Perpetrators are often informed about the local NGO’s services working against domestic violence (Unit of Violence Work). Victims are referred to MARAC groups, shelter services, psychiatrics, victim support services, and also to NGO services and other necessary services that are available in the area (some customers are ready to receive NGO services even from different cities, like from the capital area or other bigger cities).

Anchor team management

Secrecy of personal information is the main cause that limits the effective exchange of information between the authorities. The core of Anchor work – multi-professional cooperation and exchange of information between the police, social work, and health care – is based on an agreement between the police and the municipality. If the customer gives her/his consent, the Anchor team shares information with the police as well as social and health care authorities. Information sharing is easiest and most effective when the customer has a child. In such a situation, the cooperation can be justified by the interests of the child and the cooperation does not necessarily require the customer’s consent. Childless couples are losers in this system if they do not want to receive help from the multi-professional team.

Some limitations within the work of the Anchor team are related to turnover of personnel. The work of the Anchor team is highly independent and self-guided albeit the core is based on teamwork with other authorities. This kind of working environment demands the employees to be open-minded, committed, collaborative, dependable and communicative.

Istanbul Convention and multi-agency cooperation

The Istanbul Convention, article 18, orders the parties to take the necessary legislative or other measures in accordance with internal law, to ensure that there are appropriate mechanisms to provide for effective co‐operation between all relevant state agencies. This includes the judiciary, public prosecutors, law enforcement agencies, local and regional authorities as well as non‐governmental organisations and other relevant organisations and entities. They are supposed to protect and support victims and witnesses of all forms of violence as covered by the scope of this Convention, this includes referring victims to general and specialist support services as detailed in Articles 20 and 22 of the Istanbul Convention. Multi-agency methods like Anchor teams and MARAC groups are means that increase this kind of cooperation between different agencies. 

Domestic violence-specialised investigation team

An investigation team that is specialised on domestic violence has got several positive outcomes. Specialising in one particular type of crime has produced highly skilled personnel and offered a possibility for motivated and emphatic people to apply for a job in the domestic violence investigation team. Inversely, police officers who are not motivated to investigate domestic violence cases are not forced to do so which lowers the possibility of secondary victimisation – for example in a situation where the victim blamed for the violence or would be treated without respect.

Due to the nature of domestic violence, its investigation demands highly skilled personnel with empathy, motivation, and commitment. The goal of the specialised team is to investigate the crime but also to find special support for the victims who are in a constant dependent or subordinate relationship to the suspect. A preliminary investigation of a domestic violence case means sometimes several long questionings, but the investigator needs to understand things like psychological response to trauma and victimisation. After the questioning is finished, the investigator tries to motivate a victim or a perpetrator to receive assistance. The detective senior constables and detective sergeants have to know how to approach a victim and a suspect to build trust, to motivate the person to talk about his/her situation and to motivate them to get help. This all takes more time than an average hearing in police work. The daily routine where a police officer focuses on one type of crime, and is not distracted by “easier” cases like thefts and forgeries, helps to achieve an environment where domestic violence cases are not skipped as more demanding or onerous tasks.

Allowing the personnel to specialise in domestic violence and feeding their motivation also generates subspecialisation. The supervisors in the domestic violence investigation team are motivated to develop the work among vulnerable groups. Specialisation has also made an effective service counselling possible. The Domestic Violence Investigation Unit has good connections to different governmental and non-governmental services. The employees have personally visited many of the cooperation partners. Knowing stakeholders personally and to be able to talk about their work diversely is an effective tool in motivating clients to receive help.

Istanbul Convention and domestic violence-specialised investigation teams

The specialisation in the Domestic Violence Investigation Unit has created many qualities that fulfil the guidelines of the Istanbul Convention. The skilled and motivated personnel meet the victims in a sensitive way to prevent repeated victimisation. The victim is asked if she/he wants to be informed when the perpetrator is about to be released from custody. All the victims are informed of their rights and the services at their disposal and the follow-up given to their complaint, the charges, the general progress of the investigation and their role therein. The victim is always asked to give her/his consent to pass the contact information to the Victim Support Finland and all the victims and perpetrators are asked to give their consent to pass contact information to the local Assistance Service for Domestic Violence.

The specialisation of Domestic Violence Investigation Units grants better protection of the victims, better information sharing, trust and knowledge of one another between partners, better problem solving capacity and better ability to take account of the particularities of each individual victim. The sub-specialisation within the team enables broader understanding of different phenomena like forced marriage and honour-related violence. Once, these sub-specialisation skills are acknowledged and seen as part of the organisation’s structure, they become part of the organisational memory and they are not bound to individuals anymore.

The ‘Berlin Initiative against violence towards women’ (in the following: BIG), founded in 1993, commits itself to improving the living conditions of women affected by domestic violence, including their children. BIG works to create social and professional conditions in the field of frontline response to domestic violence that reduce the incidences of domestic violence and provide better protection and appropriate support to those affected by domestic violence. This includes strengthening the rights of the victims and ensuring that abusive men are held responsible for their actions. Only if practices are improved in all relevant areas, this deems possible and sustainable. Thus, in order to carry out this work, a multi-professional, well-connected and active network and collaborative approach as the one of BIG is needed.

BIG involves three work units: BIG Coordination, BIG Hotline and BIG Prevention.

BIG Coordination establishes inter-organisational collaboration by involving all relevant professional groups and societal forces involved in domestic violence and by creating efficient cooperation structures for them.

Focussing on the three groups involved in domestic violence (victims, children, and perpetrators), BIG Coordination analyses practices or gaps to then develop or improve practices, which enhance and increase the protection of victims. Its working methods aim to firstly identify weaknesses and gaps in practice through feedback from victims and the cooperation network. Identified problems relate, for example, to difficulties with authorities or in collaborations, tough procedures, lack of offers for certain target groups, gaps in the law, etc. BIG Coordination then invites the relevant experts for a problem to jointly develop solutions that hopefully can be implemented in practice.

The cooperation network of BIG Coordination

BIG Coordination has an extremely large and diversified cooperation network, in which all relevant stakeholders of different professions and institutions take part.

• Psycho-social sector: all counselling and intervention centres, projects, and initiatives in the context of domestic violence and related fields, all women’s houses and shelters in Berlin as well as numerous others in Germany, asylum accommodations, Job Centres and many more
• Sector of child and youth welfare: in particular youth welfare offices, the children’s emergency service, girls’ emergency service and, for example, a children’s theatre
• Health sector: hospitals, trauma clinics, the Berlin Outpatient Clinic for the Protection against Violence to document the injuries, and S.i.g.n.a.l., another coordination NGO in Berlin, specialised on interventions in the health sector in the case of sexualised and domestic violence
• Executive: officers of the Berlin Police on various levels from base to headquarters
• Sector of justice: lawyers, district and public prosecutors, family courts
• Educational sector: schools and other educational institutions, including universities
• Political sector: all relevant senate administrations and federal ministries, the State Commission against Violence, integration commissioners of the Berlin Senate, equal opportunities commissioners of the districts

Measures of work

• Work groups often only convene for a very specific question or dilemma. An example of such a practice is an expert group dealing with risk assessment and case conferences.
• In contrast to the work groups formed on a transitional basis only, there also exists a number of regular round tables. The aim is to exchange information on current developments, requirements and challenges related with police work.

Outputs of inter-organisational collaborations

The following small selection of outputs of this system of collaborative action coordinated by BIG Coordination illustrates achievements at the legislative and police level.

• The Protection Act against Violence (Gewaltschutzgesetz 2002) is based on an initiative of BIG Coordination.
• The Berlin definition of Domestic Violence (2001) has been valid for almost two decades. It is postulated that in the Berlin Police force, every police officer who works in this context is familiar with it. During a time, in which many uncertainties of action in police operations of domestic violence still existed, in which such incidents were treated simply as “family disputes”, this definition made it possible to clearly categorise this form of violence, to compile meaningful statistics and to be able to describe and approach the phenomenon as such. However, with the implementation of the Istanbul Convention (2012), the dilemma aroused that the Berlin definition of domestic violence does not correspond to the one of the EU. The EU definition refers to intra-family violence, which can contain all kinds of violent crimes and not just domestic violence. Nowadays, cases must be counted nationwide according to the EU definition. Nevertheless, the Berlin definition is considered, as the police statistics of Berlin and the Federal Government additionally count violence in partnership. However, the presentation of homicides or other more specific forms of violence has become more difficult.
• Police action in cases of domestic violence includes a proactive approach. This is also incorporated in the police quality standards. The intention is to make it easier for the victims to access suitable support services: with the consent of the victim, the Berlin Police pass on the contact details to the BIG Hotline and a counsellor contacts the woman by phone within a short period of time.
• Particularly in the field of education and training, a great deal has been achieved through BIG Coordination, which also offers training and information events. This is important – after all, continuing education is an effective measure to consolidate the achieved results in practice.

In 1992, the round table against male violence in the family was launched. It developed the Hanoverian intervention project against male violence in the family: HAIP. In 1997, HAIP was officially implemented with a corresponding order from the police chief and has since then been working successfully as an interdisciplinary networked program.

In 1997, the HAIP network was developed by the “Round Table against male violence within a family” (founded in 1992) and it was established in 1997, even before the Protection Against Violence Act was established in Germany, as an attempt to structure the work against domestic violence.

Goals of HAIP

1. Provide extensive protection, assistance, and support to those affected by domestic violence.
2. Hold perpetrators accountable and achieve their accountability and behavioural change.
3. Reduce domestic violence through reasonably networked intervention of all those involved, and ensure sustainable long-term support, counselling, and intervention.
4. Prevention, information, and public relations work.
5. Take a public stand against domestic violence and on gender justice and work towards social developments and necessities.

Altogether to fight domestic violence, HAIP aims to provide a proactive, fast response towards victims and perpetrators of domestic violence.

Round Table

The largest body is the “Round Table” taking place twice a year. Members and HAIP committees inform each other about their work and activities, which are done according to the purpose of the Round Table. They make decisions about the work of HAIP including decisions that go into politics, develop opinions on current topics and accordingly distribute work orders to the HAIP committees. About 40 different institutions are part of this, including women protection shelters, the youth welfare office, the equal opportunities office, the medical network, different counselling centres, prosecutors, judges, the police, and representatives of all political factions in the city council.

Building Blocks

The center or heart of the HAIP is the committee that deals with actual cases, the eleven “Building Blocks” (Bausteine). They work independently and e. g., conduct case discussions especially on cases with high risk assessments. Additionally, orders and topics of the round table as well as own questions, case presentations etc. are processed there. Moreover, Building Blocks participate in HAIP’s public relations work and organise specialist courses, lectures, training, and seminars.

The eleven Building Blocks are:

• Coordination Unit “BISS”,
• Women and Children Protection Shelter,
• Prosecution Hanover,
• Police Hanover,
• Youth Welfare Office “Waage e.V.” (counselling for perpetrator-victim-agreements),
• Men’s Office Hanover e.V.,
• Empowerment Office (“Bestärkungsstelle”, counselling for female victims),
• “SUANA” (counselling for migrant women),
• Managerial Director of the HAIP office,
• Equal Opportunities Officer.

The coordination office, special working groups and the coordination unit “BISS” are further parts of the network.

https://www.hannover.de/Leben-in-der-Region-Hannover/Verwaltungen-Kommunen/Die-Verwaltung-der-Landeshauptstadt-Hannover/Gleichstellungsbeauf%C2%ADtragte-der-Landeshauptstadt-Hannover/Wir-f%C3%BCr-die-B%C3%BCrgerinnen-und-B%C3%BCrger/Hannoversches-Interventionsprogramm/%C3%9Cber-HAIP

PSP-Porto Victims’ Support and Information Cabinet (Gabinete de Atendimento e Informação a Vítimas da PSP-Porto; GAIV) operates in the city of Porto and has 17 police officers on an exclusive basis: they deal with cases of domestic violence, 24/7, in a confidential and specialised way. Between 2010 and 2014, 725 citizens were arrested for domestic violence in the city of Porto alone. About 3,000 victims were followed, 1,200 individual security plans and 1,600 risk assessments were carried out in the last year.

GAIV manages all the domestic violence-related calls in the city. GAIV has become the domestic violence pivotal frontline responder in the city. In the backstage, PSP creates the Crime Investigation Special Teams for domestic violence (Equipas Especiais de Violência Doméstica; EEIV) which are specialised in the criminal investigation of these crimes. This new arrangement allowed the PSP to obtain a high level of public awareness regarding domestic violence.

Aligning with the IMPRODOVA conceptual framework, the Porto experience merges an organisational arrangement from the part of PSP, involving intra-organisational cooperation (GAIV and other police units), with inter-organisational cooperation between the police, several NGOs, health services, and public prosecutor services. These arrangements aim to clarify the limits of the problem at hand, goals and stakes, resources and actors involved.

As mentioned, GAIV emerged as a focal service to attend domestic violence victims and follow-up their cases, control the use of the teleassistance devices (if triggered, police officers are deployed to attend to the victim), and react promptly in case of emergency. In principle, all domestic violence cases in Porto would be dealt with in GAIV. For that purpose, PSP choose a new police facility – Esquadra do Bom Pastor, Bom Pastor Police Station – which was built considering modern technical recommendations, such as friendly interior, among other physical and functional attributes supporting the specific work with victims (e.g., attendance rooms, learning and training rooms, spaces for children, separation between victims and offenders when inside the station). Also, GAIV had the chance to gather specialised personnel working exclusively with domestic violence matters.

Therefore, this new response was able to remove pressure from the system and to increase the quality of service regarding domestic violence victims.

https://www.facebook.com/policiasegurancapublica/photos/o-gabinete-de-atendimento-e-informa%C3%A7%C3%A3o-%C3%A0-v%C3%ADtima-gaiv-que-funciona-na-cidade-do-p/784141198308063/

25 September 2011: officer João Sousa Dias is on duty when he receives a call from a man reporting a death in a house located two minutes away from the police station. Without wasting time, he goes to the house targeted and is the first officer to witness the crime of domestic violence. Her husband, with whom she had been living for 30 years, murdered Julia, a 77-year-old woman, following a breakfast argument. He himself contacted the police and identified himself as a murderer.

João Sousa Dias says he never forgot the scenario he witnessed. A crime without any alert issued to the police before, but that the neighbourhood had some knowledge about: “I asked the neighbours about Júlia. They all told me she was an excellent lady. But when I asked them about the couple’s relationship, they shrugged their shoulders, manifesting that ‘between husband and wife, you don’t pick'”.

Júlia’s episode marked the whole population around her. And now, there is one before and after Júlia. RIAV was founded in 2015, thanks to the will and initiative of the Santo António Parish Council, with the Lisbon Metropolitan Command of the Public Security Police and the Central Lisbon Hospital Centre.

The Júlia Space, in honour of Júlia, is on the same street as the house where the elderly woman lived and was designed to provide an integrated response to victims of domestic violence. A response that is lacking in many police stations in the country is here: to support and accompany the victims of domestic violence: 365 days a year, 24 hours a day, with specialised technicians.

In the Espaço Júlia, 10 agents from the PSP work – 5 male agents and 5 female agents with training in the area of domestic violence and victim care. There is also the signatory (Head of the PSP and Trainer of the PSP in the area of domestic violence), and there are two technicians of Victim Support from the Santo António Parish Council (with TAV training from the Commission for Citizenship and Gender Equality), which includes the Technical Director of the Espaço Júlia, Inês Carrolo.

Since July 2015, the opening date of the Espaço Júlia, 1573 complaints have been received. In 2019 alone 285 complaints have been received – most of them (224) from women between the ages of 25 and 44, and there is still a certain percentage of those under 18 (10 complaints in 2019).

“The occurrences of the Espaço Júlia, as a rule, are complex and sensitive, since they involve especially vulnerable victims of various ages, from various social strata. The most complicated occurrences are those involving sexual abuse and rape of children, not only because of the nature of the crime, but also because of the technical procedures and police measures that need to be taken urgently”, the Space’s officials say.

All cases of domestic violence, rape, and sexual abuse are conducted at the Espaço Júlia, which is signalled by the health units of the Dona Estefânia Hospital’s Paediatric Emergency Department and the São José Hospital’s Emergency Department. “However, any person who goes to this space will be attended. If necessary, the victim will be taken to a safe place, managed by entities with which we have partnerships”, adds the Santo António Parish Council.

https://www.jfsantoantonio.pt/index.php/projectos/espaco-julia

You can also download one of the following documents to learn what good practice means and what the fundamental requirements are.

EIGE (2015). Preventing domestic violence Good practices. Vilnius: EIGE. ISBN: 978-92-9218-496-4. doi: 10.2839/7904

QLS (2016). Domestic and Family Violence Best Practice Guidelines. Brisbane: Queensland Law Society.

WHO (2013). Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. New York: WHO. ISBN 978 92 4 154859 5

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.

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