Module 2: Training materials (Social sector)

This case is about Daniel, a 4-year-old boy, and his mother Ms. Luscak, aged 27 years who had four different partners. She misuses alcohol and depicts occasional violence towards her partners. She speaks little English. Daniel had 2 siblings, a 7-year-old sister Anna by mum’s first partner and a 1-year-old brother Adam by mum’s fourth partner, Mr. A. On 27 different occasions, the police were called to domestic violence incidents often complicated by both parents being drunk. On 2 occasions Daniel’s mum took sleeping pill overdoses with the intention of committing suicide. The family moved house on numerous occasions due to an inability to pay rent. When pregnant with Adam, Mr. A. urged Ms. Luscak to have a termination. She missed 4 antenatal appointments. At one stage she was hospitalised and Mr. A took the drip out of her arm and she self-discharged.

Daniel had a spiral fracture to the left arm reported as due to jumping off the settee with his sister the previous when being seen at the emergency room. Bruises on his shoulder and lower tummy were explained by his mother to be due to falling off his bike regularly. Meetings of health care professionals took place but the long history of domestic violence was not considered. When Daniel started school, there were frequent absences as for his sister Anna. Teachers became concerned as Daniel was getting markedly thinner and always seemed hungry, taking food from lunchboxes of other children. Daniel had poor English and was a shy and reserved boy and did not talk to the teachers.

Task for reflection
(1) Reflect on the numerous signs and red flags presented in Daniel’s case. What were the early indicators of potential abuse, and how might they have been identified sooner?
(2) What were the missed opportunities for intervention and support of healthcare professionals? How could it have been done better?

Case from The Medical Women’s International Association’s Interactive Violence Manual

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 Nick seemed withdrawn and spent long periods of time by himself.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