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Abuse and violence - Working with our patients in general practice
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Useful tools from each chapter are available below.


Chapter 1 - What is interpersonal abuse and violence?

  • Be ready to identify and respond to intimate partner abuse
  • Recognise symptoms of abuse and violence, ask directly and sensitively
  • Respond to disclosures of violence with empathetic listening
  • Explore risk and safety issues
  • Review the patient for follow-up and support
  • Refer appropriately
  • Reflect on your own attitude, management and limitations to addressing abuse and violence
  • Respect your patients, your colleagues and yourself. This is an overarching principle of this sensitive work.


Chapter 4 - Intimate partner abuse and violence: Ongoing support and counselling
 

The health of an adult relationship encompasses a spectrum ranging from positive to negative.

Positive relationship health involves mutual trust, support, investment, commitment and honesty. It involves the exchange of words and actions in which there is shared power and open communication.

Negative relationship health involves unhealthy and abusive interactions with varying exchanges of emotional, physical and sexual violence. It involves words and actions that misuse power and authority, hurt people, and cause pain, fear or harm.

How healthy is your relationship with your current/ex partner?

Place an X on the point on the line that most closely reflects how you feel. (The X can slide along the scale)

 
Negative abuse
Positive healthy
  Unhealthy  


Chapter 4 - Intimate partner abuse and violence: Ongoing support and counselling

Women may be anywhere along a spectrum of how they feel about their partner or ex-partner. Some may have left the relationship, with or without recognising that their partner’s behaviour was abusive. Other women may continue in relationships that are unhealthy or abusive. It is most likely that fear of their partner will have affected their emotional health, although some will not see that connection.

Example of written tool for motivational interviewing

This is a tool you can use with your patient.
 

GP: Taking action is often challenging for people. Below is a set of steps for examining your current situation to decide on what action you might like to take and then how motivated and confident you feel at the moment about carrying out that action.
 
Step 1 What do you like about your relationship or current situation?
Step 2 What are the things you don’t like about your relationship or current situation?
Step 3 [Summarise – GPs understanding of the woman’s pros and cons]
Step 4 Where does this leave you now?

For women who are ready to change to some extent:
 
Step 5  

For Steps 1 and 2, you may like to ask your patient to use the box below to write down her responses.
 
 
Like
Dislike
Relationship    
Action (Specify)    

For step 5, women may choose a whole range of actions and we have listed some likely options below:
  • Feel better about themselves e.g. do more exercise, take up yoga
  • Manage finances better
  • Become less isolated e.g. go to social group activity
  • Have better parenting strategies with their children
  • Improve their physical health e.g. cut down on alcohol
  • Leave their partner
  • Get more understanding/affection from their partner
  • Get their partner to go to anger management classes
  • Get their partner to stop drinking/get a job/stop gambling.

These last three are obviously out of the woman’s control as it involves influencing their partner’s behaviour. Acknowledging this difficulty is important.
Next, you may ask your patient how motivated they are to carry out the actions they have suggested and what they feel they need in order to carry them out.
How motivated do you feel to carry out …………..?

​

You can ask your patient to place an X on the point on the line that most closely reflects how you feel. 

 
Not at all motivated
100% motivated


What would have to happen for your motivation score to increase?
How confident do you feel that you would succeed in carrying out…?

Place an X on the point on the line that most closely reflects how you feel. 

 
Not at all confident
100% confident


How can I help to increase your confidence?

Chapter 4 - Intimate partner abuse and violence: Ongoing support and counselling

 

Non-directive problem solving assists individuals to use their own skills and resources to function better. For women who have decided that the abuse is damaging to their health and wellbeing, but whose intentions are not translated into action due to perceived external barriers, then problem-solving techniques may be helpful.

Remembering of course that as GPs we should not problem-solve for the patient.

Goal setting occurs in the following stages:

  • clarification and definition of problems
  • choice of achievable goals
  • generation of solutions
  • implementation of preferred solutions
  • evaluation.
When used by GPs, this technique engages the patient as an active partner in their care. It creates a framework for individuals to re-focus on practical approaches to perceived problems and learn new cognitive skills.
Whether the solution chosen by the patient is successful is not as important as what the patient learns during the process to apply in other situations. A written example of how a structured approach to problem solving can be applied with an individual is detailed on the next page.

Example of written plan for goal setting

Non-directive problem solving aims to help you:

  • recognise the difficulties that contribute to you feeling overwhelmed
  • become aware of the support you have, your personal strengths and how you coped with similar problems in the past
  • learn an approach to deal with current difficulties and feel more in control
  • deal more effectively with problems in the future.
You are asked to follow six steps:

Step 1

Identify the issues/problems that are worrying or distressing you.

Step 2

Work out what options are available to deal with the problem.

Step 3

List the advantages and disadvantages of each option, taking into account the resources available to you. 
 

Problem
Options
Advantages
Disadvantages
 

 		    
       
 

Step 4

Identify the best option(s) to deal with the problem.

Step 5

List the steps required for this option(s) to be carried out.

Step 6

Carry out the best option and check its effectiveness.
Best option = ----------------------------------------------------
What steps are required to do this?
1.-------------------------------------------------------------------
2.-------------------------------------------------------------------
3.-------------------------------------------------------------------
 

Chapter 4 - Intimate partner abuse and violence: Ongoing support and counselling

 

‘What kinds of power and privilege do I have? How do these shape my life and world view?’

‘Have I considered how experiencing trauma and violence may have contributed to the development of the presenting complaint or reason for referral?’

‘How do his coercive and controlling behaviours constrict her and her children’s lives and her ability to do what she wants to do, including ability to engage in any mental healthcare plans?’

‘What do I know about what safety strategies she previously tried, how these worked, if services were helpful, her partner’s reactions, and what, if any, access she has to financial, family, social and cultural supports?’

‘Are she and her family experiencing systemic barriers (eg lack of stable housing, limited access to money and transport, poverty, language barriers and dismissive racist responses from services)? How is this impacting her, her children and family’s safety and wellbeing?’

‘Who is working with her partner? What strategies are in place to support him and address his use of violence?’

‘Comprehending all of this, what actions can I take as a ‘safety ally’, as part of my treatment plan?’

‘How and with whom will I review whether what we are doing is supporting safety for her, the children and her family?’

Adapted from: Short J, Cram F, Roguski M, et al. Thinking differently: Re-framing family violence responsiveness in the mental health and addictions health care context. Int J Mental Health Nurs 2019;28:1209–19.
Chapter 10 - Sibling and peer bullying
 

A resource from the Royal Children’s Hospital

Home:

who, where, recent changes (moves or new people), relationships, stress or violence, smartphone or computer use (in home versus room)

Education and employment:

where, year, attendance, performance, relationships and bullying, supports, recent moves, disciplinary actions, future plans, work details

Eating and exercise:

weight and body shape (and relationship to these), recent changes, eating habits and dieting, exercise and menstrual history

Activities:

extra-curricular activities for fun: sport, organised groups, clubs, parties, TV/computer use (how much screen time and what for)

Drugs and alcohol:

cigarettes, alcohol and illicit drug use by friends, family and patient. Frequency, intensity, patterns of use, payment for, regrets and negative consequences

Sexuality and gender:

gender identity, romantic relationships, sexuality and sexual experiences, uncomfortable situations/sexual abuse, previous pregnancies and risk of pregnancy, contraception and STIs

Suicide, depression and self-harm:

presence and frequency of feeling stressed, sad, down, ‘bored’, trouble sleeping, online bullying, current feelings (eg on scale of 1 to 10), thoughts or actions of self-harm/ hurting others, suicide risk: thoughts, attempts, plans, means and hopes for future

Safety:

serious injuries, online safety (eg meeting people from online), riding with intoxicated driver, exposure to violence (school and community), if high risk – carrying weapons, criminal behaviours, justice system

Chapter 15 - Abuse of older people

 

Q.1-Q.5 asked patient; Q.6 answered by doctor within the last 12 months
1. Have you relied on people for any of the following: bathing, dressing, shopping, banking or meals? YES NO Did not answer
2. Has anyone prevented you from getting food, clothes, medication, glasses, hearing aids or medical care, or from being with people you want to be with? YES NO Did not answer
3. Have you been upset because someone talked to you in a way that made you feel shamed or threatened? YES NO Did not answer
4. Has anyone tried to force you to sign papers or to use your money against your will? YES NO Did not answer
5. Has anyone made you feel afraid, touched you in ways that you did not want, or hurt you physically? YES NO Did not answer
6. Doctor: Elder abuse may be associated with findings such as: poor eye contact, withdrawn nature, malnourishment, hygeine issues, cuts, brusies, inappropriate clothing, or medication compliance issues. Did you notice any of these today or in the last 12 months? YES NO Not sure
This event attracts CPD points and can be self recorded

Did you know you can now log your CPD with a click of a button?

Create Quick log

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