Why is family violence a health problem?
Family violence is common.
For information and articles pertaining to family violence including prevalence and health effects see New Zealand Family Violence Clearinghouse.
Why should child and partner abuse intervention be linked?
Studies show a high co-occurrence of child and partner abuse – (Murphy et al 2013).
The Family Violence Assessment and Intervention Guideline: Child abuse and intimate partner violence (Ministry of Health 2016) identifies that the frequent co-occurrence of child abuse and IPV within families means that the issues cannot be addressed in isolation.
It is therefore recommended that:
- if intimate partner violence is identified, a health and risk assessment be undertaken for child abuse
- if child abuse is identified, a health and risk assessment be undertaken for intimate partner violence.
This dual health and risk assessment increases the opportunities to identify abuse, and allows intervention to be offered for all victimised family members.
Witnessing partner violence causes distress and can have long term detrimental effect on health. The Adverse Childhood Experiences (ACE) study suggests that being a victim of child abuse and/or witnessing partner abuse is linked to serious health problems in adulthood (Felitti et al 1998; Edwards et al 2005).
The health effects include not only injuries but also sexual and reproductive health, mental health and increasing the risk of chronic disease. Witnessing partner violence can be considered an adverse event in its own right (Carroll-Lind et al 2011) and therefore it is important to assess the safety and well being of children.
Identifying partner abuse can be the first step in assisting access to support for both mothers and children through local referral agencies.
Should you routinely enquire for child abuse?
Routine enquiry about child abuse and neglect is not recommended (Bailhache et al 2013).
The Family Violence Assessment and Intervention Guideline: Child abuse and intimate partner violence (Ministry of Health 2016) recommends that health care providers need to be alert for signs and symptoms that require further assessment or that might be indicative of violence and abuse.
It identifies strategies for a thorough and careful approach to clinical assessment of all children and young people presenting for health care and for appropriate response to those situations where the health care provider becomes concerned that a child is either ‘at risk’ or actually coming to harm.
See: Family Violence Assessment and Intervention Guideline: Child abuse and intimate partner violence:
- Section 1: Child abuse and neglect
- Appendix A: Assessing for child neglect
- Appendix B: HEEADSSS
- Appendix M: Child abuse assessment and intervention guideline: summary
- Appendix O: Child abuse and neglect assessment and intervention flow chart
Why is there not routine enquiry for men regarding intimate partner violence?
The Family Violence Assessment and Intervention Guideline: Child abuse and intimate partner violence (Ministry of Health 2016) recommends that men aged 16 years and older be assessed if they present with signs and symptoms indicative of intimate partner violence.
Routine enquiry is not recommended because of the differences in prevalence and severity of violence against men. Available data shows violence by women against their male partners tends to be less prevalent and less severe (Lievore and Mayhew 2006).
A New Zealand study demonstrates that males who have been hit by females partners report needing no first aid, medical or hospital treatment compared with 9 percent of women who were hit by their male partners (Langley et al 1997).
Kimmel (2002) acknowledges that prevalence rates of males reporting violence from partners may compare those reported by females. He also notes that perpetrators of systematic, persistent and serious violence are predominantly men.
Is it mandatory to report abuse?
In New Zealand, it is not mandatory to report partner and child abuse.
Best practice recommends staff who identify or suspect child abuse report their concerns to a statutory agency, the police or Oranga Tamariki – Ministry for Children service (formerly Child Youth and Family). In some DHBs this is mandatory.
Health professionals should recognise the paramouncy principle for child care: ‘[the] welfare and best interests of the child or young person shall be the first and paramount consideration.’ (section 6 of the Oranga Tamariki Act 1989, Children’s and Young People’s Wellbeing Act 1989).
Whilst the legislation does not require mandatory reporting of child protection, District Health Boards have within their Child Protection policies the requirement to report child protection concerns to Police and/or Oranga Tamariki.
In addition, all DHB’s have signed a Memorandum of Understanding (MOU) with Oranga Tamariki and the New Zealand Police that requires that the parties to the MOU practice in accordance with their organisations policies/procedures.
The MoU has four associated schedules:
- Schedule 1: Children admitted to hospital with suspected or confirmed abuse or neglect
- Schedule 2: Child, Youth and Family/District Health Board Liaison Social Worker
- Schedule 3: Guideline for the Neglect of Medical Care
- Schedule 4: Joint Standard Operating Procedures for Children and Young Persons in Clandestine Laboratories.
In most circumstances concerning an adult victim of partner abuse, the victim should be empowered to take a variety of actions themselves.
This can be achieved by providing the victim with an active referral to contact community/hospital-based services at any time (for example offering support and privacy to enable a victim to call an agency at the initial assessment).
However it is important to recognise that in high risk situations, safety planning may need ‘to shift from the creation of a list of actions that victims take to empower themselves and keep themselves safe, to generating collective actions that agencies can take to contain, challenge and change the abusers behaviour’ (Family Violence Death Review Committee 2014).
See Appendix J, Excerpts from relevant legislation in the Family Violence Assessment and Intervention Guideline: Child abuse and intimate partner violence.
What intervention is offered for elder abuse?
Family Violence Intervention Guidelines: Elder abuse and neglect is available to download or you can order hard copies.
If elder abuse is suspected, the person should be assessed and referred to the appropriate services. For additional information contact your local Age Concern group.