White Book

Development of the White book

About the White Book

Abuse and violence: working with our patients in general practice, 4th edition, (the White book) was developed by general practitioners (GPs) and experts to ensure that the content is the most valuable and useful for health practitioners.

The manual provides an easy and practical resource and was based on the best available evidence in February 2014. This included 2014 Cochrane systematic reviews on advocacy;1 2013 Cochrane systematic reviews on screening2 for intimate partner violence; 2013 World Health Organization (WHO) guidelines for health professionals based on systematic reviews and international consensus on intimate partner and sexual violence;3 international consensus intimate partner violence guidelines;4 2013 randomised controlled trial evidence from general practice;5 a 2006 meta-synthesis of qualitative studies of what women experiencing intimate partner violence expect from health practitioners6 and a 2009 systematic review on child abuse interventions.7

For clinical interventions, the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology was used to assess the quality of the supporting evidence. For some recommendations, existing guidelines were relied on, in part, and the quality of the evidence in those guidelines was assessed. Recommendations on healthcare provision, and on mandatory reporting, were considered to be best practice by consensus or to address human rights.

How to use the White Book

The manual offers health practitioners evidence-based guidance on appropriate identification and response in clinical practice to patients experiencing abuse and violence. In particular, it focuses on intimate partner and sexual violence and children experiencing abuse, as these are often the main victims of abuse.
Although men are also survivors of intimate partner abuse and sexual violence, this manual focuses on women, because they experience more severe physical and sexual violence, and more coercive control from male partners.3 However, much of the advice given will be relevant in respect of violence by family members and others, and may be relevant for intimate partner abuse against men.

This edition of the White book adopts the most recent National Health and Medical Research Council (NHMRC) levels of evidence and grades of recommendations.8 Recommendations at the start of each chapter are graded according to levels of evidence and the strength of recommendation. The levels of evidence are coded by the Roman numerals I–IV, while the strength of recommendation is coded by the letters A–D. Practice points are employed where no good evidence is available (refer to Table 1).

Table 1

Table 1

Coding scheme used for levels of evidence and grades of recommendation 

What’s new in the 4th edition of the White book

Much of the content in this edition is similar to the 3rd edition, however it has been extensively updated and reformatted to align with other RACGP publications. Two new chapters have been added regarding Aboriginal and Torres Strait Islander peoples and migrant and refugee communities. Particular attention is paid to rural communities throughout the manual. Levels of evidence and recommendation grades are now provided alongside each recommendation at the start of each chapter.

Resources have now been combined into Appendix 7 to allow ease of reference. A link to Appendix 7 is included at the end of each chapter to allow you to select resources relevant to your state, territory or nationally.