Summary of recommendations

Emotional and physical safety are concepts that should be foremost when working with patients experiencing abuse and violence.³ 
(Practice point: Consensus of experts)

Health practitioners should have a system in place that includes the whole of practice and referral pathways to safety and healing.³
(Practice point: Consensus of experts)

It is important to receive training that includes reflecting on our own attitudes and assumptions about abuse and violence, as they can affect the way we respond to patients experiencing abuse and violence.³
(Practice point: Consensus of experts)

Ask all patients who present with clinical indicators (eg depression and anxiety) (refer to Table 2.2, particularly psychological symptoms) about possible experiences of IPAV.
(Strong recommendation; Moderate certainty of evidence)

Routinely screen for IPAV in all pregnant women attending a practice or clinic.
(Strong recommendation; Low certainty of evidence)

It is not recommended to routinely screen all patients for IPAV.
(Strong recommendation; Moderate certainty of evidence) ​

Provide first line support to women who disclose IPAV. This includes listening, inquiring about needs, validating women’s disclosure, enhancing safety and providing support/referrals – the LIVES approach (refer to Box 2.2)
(Practice point: Consensus of experts)

Refer patients to specialist services for advocacy to enhance safety and mental health.
(Strong recommendation: Very low certainty of evidence)

Conduct a safety/risk assessment and a brief safety plan for any patient who is experiencing IPAV and their children.
(Practice point: Consensus of experts)

Document carefully what a patient says about IPAV in their patient record, to ensure clear communication with others, and potentially for legal processes.
(Practice point: Consensus of experts)

Depending on individual needs, offer psychological therapies, including motivational interviewing, trauma-informed and mindfulness-based cognitive therapies, as these have been shown to provide support and improve women’s mental health in the short term (less than six months).
(Strong recommendation: Moderate certainty of evidence)

Offer to refer women who have post-traumatic stress disorder (PTSD) and who are no longer experiencing violence for trauma-informed therapy.
(Practice point: Consensus of experts)

Consider asking men who are experiencing substance misuse and mental health concerns about possible use of IPAV.
(Practice Point: Consensus of Experts)

Men’s behavioural change programs are the referral options of choice for men who use IPAV.
(Conditional Recommendation: Low Certainty of Evidence) ​

Any psychological therapies should be delivered by people who are experienced IPAV, and should have a trauma-informed focus.
(Practice point: Consensus of Experts)

Health practitioners have a role in prevention of child abuse and neglect by identifying families at risk where domestic violence is co-occurring. Refer to parent training programs and nurse home visitation programs.
(Strong recommendation: Moderate certainty of evidence)

Harmful alcohol and drug use has a strong link with child abuse and neglect. It is therefore recommended that practitioners work to reduce alcohol consumption in adults with children in their care, using evidence-based methods such as alcohol screening and brief interventions.
(Practice point: Consensus of experts)

Maintain an awareness about the possibility of both peer^12,20 and sibling1^9,21–23 bullying in children
(Practice point: Consensus of experts)

Develop a brief approach to asking about bullying when seeing children that may be at increased risk.^24–35
(Practice point: Consensus of experts)

Be aware of adolescent violence towards parents and how it might present to general practice.
(Practice point, consensus of experts)

Young people’s violence against their parents may be associated with other forms of family violence; therefore, family violence should be sensitively inquired about.
(Practice point, consensus of experts)

Offer young people with behavioural concerns, and other family members, referral for psychological therapy.
(Practice point, consensus of experts)

There is a strong link between past experiences of child abuse and neglect and conditions such as mental health issues, suicidality, drug and alcohol problems, and chronic disease.^4,6 Therefore, consider the need to address past experiences of child abuse and neglect in adult patients presenting with these conditions.
(Strong recommendation: Moderate level of evidence)

Offer patients with a history of past child abuse psychological therapy to reduce PTSD, depression and anxiety.
(Conditional recommendation: Moderate level of evidence)

Offer first-line support to people who have experienced sexual violence by any perpetrator. This may include assessing and managing physical and mental health concerns, and suicide, safety and risk assessments.
(Practice point: Consensus of experts)

Consider and sensitively inquire specifically about a history of sexual violence (in addition to other traumatic experiences) when seeing patients with otherwise unexplained mental or physical health problems, alcohol or substance abuse issues, suicidality or self-harm.
(Practice point: Consensus of experts)

Assess need for emergency contraception and offer as required. Offer sexually transmitted infection (STI) investigations, prophylaxis and treatment as appropriate.
(Practice point: Consensus of experts)

Abuse of older people needs to be considered by any health practitioner, family member or aged care staff member who is caring for older patients, as they have a pivotal role in the recognition, assessment, understanding and management of the abuse and neglect of older people.
(Practice point: Consensus of experts)

Consider working with carers and families to prevent ‘carer stress’, which can contribute to the abuse of older people.
(Practice point: Consensus of experts)

Healthcare professionals need to demonstrate cultural awareness and a commitment to understanding the historical context that influences family abuse and violence.
(Practice point: consensus of experts)

Practices should provide a safe environment that addresses the barriers faced by Aboriginal and Torres Strait Islander people who require support for family abuse and violence.
(Practice point: consensus of experts).

Be aware that people with disabilities, including those with a mental illness, are at a much greater risk of abuse and violence than those without a disability.
(Practice point, consensus of experts)

Health practitioners can assist their patients experiencing abuse and violence by providing information on legal options and referrals to legal services.^3,4
(Practice point: Consensus of experts)

In cases of recent sexual assault, if you are not trained in the collection of forensic evidence, your patient needs to be referred to a sexual assault service.¹
(Practice point: Consensus of experts)

All healthcare professionals should be offered IPAV training, as it improves provider knowledge, attitudes and perceived readiness to engage in IPAV inquiry and care with patients.¹
(Strong recommendation: low certainty of evidence)

IPAV training content should include routine inquiry about IPAV (for at-risk patients eg antenatal, mental health), including inquiries about children’s safety and wellbeing, along with basic first-line response (LIVES) to disclosures. Other content includes case documentation, legal requirements, and referral methods and options.^6,7
(Practice point, Consensus of experts)

IPAV curricula should be integrated into healthcare provider undergraduate and postgraduate education and delivered to existing, qualified providers as continuing professional development on an ongoing (eg annual) basis.²
(Practice point, Consensus of experts)

Interactive training methods may include practice of IPAV communication/clinical skills through simulated role-play, supported through clinical resources, supervision and mentorship ^{1,4, 5}
(Practice point, Consensus of experts)

Training content to enhance provider readiness should include methods to foster provider commitment, adopting an advocacy approach, developing trusting relationships and team collaboration.⁹
(Practice point, Consensus of experts)