Implementing Victorian information sharing schemes in primary care

If professionals believe a person could be experiencing or using family violence, or a patient discloses experiencing or using family violence, a key part of their professional response is to share information with relevant organisations and services to enhance the safety of adult and child victim survivors. Risk assessments are discussed in detail in Safety and risk assessment in Chapter 3 of The White Book. 

Figure 1. Structured Professional Judgement model for undertaking a risk assessment⁸
Reproduced with permission from Family Safety Victoria. MARAM practice guides: Chapter summaries. Melbourne: Victorian Government, 2020; p. 10.  [Accessed 4 March 2022].
 
There are four elements to using the Structured Professional Judgement model in a risk assessment (Figure 1).

1. Adult victim survivor’s own assessment of their current level of safety.
   A victim survivor is an expert in their own experience, and their assessment forms an important part of a risk assessment.
2. Evidence-based risk factors.
   These require an understanding of perpetrator behaviour. The brief risk assessment tool could be used to conduct a risk assessment using evidence-based risk factors to assist GPs when determinin the level of risk for their information-sharing obligations. There are some risk factors based on evidence related to higher risk for those who are victim survivors. These evidence-based risk factors are outlined in Figure 2.

Figure 2. Evidence-based risk factors⁹

These evidence-based risk factors are formed below as questions that can be asked by health practitioners (see brief risk assessment tool).

Appendix 1. Brief risk-assessment tool (Multi-Agency Risk Assessment and Management practice guides) based on evidence-based risk factors¹⁰

1. Information sharing.
   The third element of the Structured Professional Judgement model in risk assessment is considering any information received through information sharing. Information that is shared is done to increase the safety of the adult and/or child victim survivors and to keep the perpetrator in view. This information should be used to update and inform risk assessment and management. 
2. Professional judgement intersectional analysis.
   The final aspect of the Structured Professional Judgement model is applying an intersectional analysis when assessing the level of risk. This means understanding that a person might have experienced or is experiencing a range of structural inequalities, barriers and discrimination throughout their life. These experiences will impact on:
   • their experience of family violence
   • how they manage their risk and safety
   • their access to risk management services and responses. 

Professionals should consider any additional barriers for the person and make efforts to address these. 

Professionals should use each element and the application of their professional experience, skills and knowledge to make an analysis of the level of family violence risk. 

A victim survivor could be judged to be at risk, elevated risk or serious risk. If at serious risk, they might require an immediate response. This assessment then informs safety planning (see Safety and risk assessment in Chapter 3 of The White Book) and referrals.
 

The CISS allows sharing information to support collaborative service provision to children, and to respond to identified needs and risks, regardless of whether a professional considers the issue related to either wellbeing or safety.

Three-part threshold test for CISS

ISEs can share confidential information with other ISEs under the CISS if:

• the ISE is requesting or disclosing confidential information about any person for the purpose of promoting the wellbeing or safety of a child or group of children
• the disclosing ISE reasonably believes that sharing the confidential information might assist the receiving ISE to carry out one or more of the following activities:
  • making a decision, an assessment or a plan relating to a child or group of children
  • initiating or conducting an investigation relating to a child or group of children
  • providing a service relating to a child or group of children
  • managing any risk to a child or group of children

• the information being disclosed or requested is not known to be ‘excluded information’ under Part 6A of the Child Wellbeing and Safety Act 2005 (and is not restricted from sharing by another law).

Consent under FVISS

Consent from an adult victim survivor or third party is required, unless you believe sharing the information is necessary to lessen or prevent a serious threat to their life, health, safety or welfare, or a child is at risk. However, views of the victim survivor should be sought where appropriate, safe and reasonable to do so. 

Consent from a child victim survivor is not required, but their views or the view of their parent, who is not a perpetrator, should generally be sought, where appropriate, safe and reasonable. 

Information regarding an individual using violence can be shared on request, without their consent, provided this is relevant to the family violence. GPs and PNs should not share information if doing so would risk a person’s life or physical safety. 

Consent can be obtained verbally or in writing, and it might be expressly given or implied by the victim survivor. Where obtained verbally, ISEs must make a written record of the verbal consent and the information is shared (eg when providing a tele-based service). When consent is sought, it is important to have regard to their decision-making capacity, including whether the victim survivor is able to understand what they are consenting to, so that they can retain the information for long enough to be able to make a decision (this is especially important in culturally and linguistically diverse communities, and among older people, people with disabilities and Aboriginal and Torres Strait Islander peoples), use the information to make a decision themselves by weighing up the pros and cons, and to communicate their views.¹¹

Consent under the CISS

Under the CISS, if the threshold has been met, ISEs do not require consent from any person to share relevant information with other ISEs. However, ISEs should seek and consider the views of children and family members about information sharing if it is appropriate, safe and reasonable to do so.

What information can be shared?

ISEs, including GPs and PNs, might be requested to share information under the FVISS or CISS. For the requirements of the scheme to be met, the request must be from an ISE for family violence risk assessment and management, including about perpetrator behaviour, and/or to promote a child’s wellbeing or safety. 

Because GPs and PNs are ISEs under the FVISS and CISS, they can:

• make a request for information to other ISEs in the context of family violence risk and for the wellbeing or safety of children
• disclose information to other ISEs on request if the requirements of the scheme are met
• disclose information voluntarily and proactively to other ISEs if sharing meets requirements under the schemes, including:
  • an adult victim survivor is at serious imminent risk
  • an adult victim survivor gives permission to share information to assess and/or manage family violence risk
  • concern about the behaviour of the individual using family violence – no permission is needed from the individual using violence
  • concern about a child as a victim survivor of family violence or a child’s wellbeing or safety – no permission is needed.

Responding to information-sharing requests

If a request is received, GPs and PNs must first verify that the request is being received from an ISE or RAE. If the request is by phone, this might involve calling the direct number of the service or organisation that is making the request, and then asking to speak to the practitioner or worker making the request. Alternatively, asking for an email from the requester’s verified work email account will assist in confirming their identity. You should not use a person’s personal email to share information. Requests should be recorded in the patient’s chart, along with what information has been shared. Please note that care needs to be taken with recording information in the perpetrator’s file, to ensure there is no inadvertent alerting to the perpetrator that you are sharing information if there is a request for access to files. 

The process that should be followed if a request for information sharing is received is outlined in the flow chart (Figure 3). 

This flow chart should be followed if an information request is received under the FVISS.

Figure 3. Process if a request for information is made under the Family Violence Information Sharing Scheme

Excluded information includes information that could endanger a person’s life or physical safety, or contravene a court order or law that prohibits the disclosure of the information. You must not share information where, to your knowledge, the information is excluded under the schemes. 

Remember, information can still be shared with services that are not ISEs under privacy law with consent or where necessary to lessen or prevent a serious threat.

Proactive sharing information under the FVISS

ISEs might voluntarily share information without a request to an RAE to assist them with establishing and assessing family violence risk. They might also voluntarily share information with another ISE for ongoing risk assessment and management. In both cases, the information must not be information that is excluded under the schemes, and the consent requirements are the same as for information requests (see ‘Responding to information-sharing requests’). 

If a victim survivor is deemed to be at serious and/or immediate risk of harm during an assessment with a GP or PN (see Safety and risk assessment in Chapter 3 of The White Book), then consent should be sought to discuss the case with a family violence specialist service or organisation and/or police. 

If the victim survivor is at serious risk and requires immediate protection, but does not consent, information can be shared with a specialist family violence organisation or the police to keep the victim survivor safe. It is advisable to let the victim survivor know that this information is being shared so they can organise safety planning for themselves and their children, if relevant. 

All information shared should be clearly documented in the patient file, along with who the information has been shared with. Again, care needs to be taken with documentation in perpetrator files if the perpetrator is not the source of the information. 

Proactive sharing information under the CISS

Under the CISS, information can be shared proactively if it is believed that the information could assist the service to undertake one of the activities in Part 2 of the CISS threshold test for sharing.

Requesting information from an ISE

Under the FVISS, GPs and PNs are permitted to request information from other ISEs for family violence protection purposes to assist with assessing or managing the risks within their practice expectations, and under the CISS for child wellbeing and safety purposes. Requests can be made verbally or in writing, and the purpose of your request to the ISE should be made clear. 

Requests for information from other ISEs should also include:

• name, title of the person making the request, occupation and organisation
• the level of risk (at risk, elevated risk, serous risk/and requires immediate protection)
• purpose of the request
• identifying details of the person/s subject of the request (eg name, date of birth, address)
• whether the request pertains to adult or child victim survivors or the individual using violence. 

It is important to confirm you are speaking to someone who is authorised to provide information under the FVISS or CISS, and clearly document the name of the person providing the information and the service for which they work. All information gained through this conversation should also be documented. Be careful to ensure that all information discussed relates to reducing the risk of victim survivors, and do not overshare information.

Pivoting to the perpetrator

One of the key aims of the MARAM Framework is to keep family violence risk of perpetrators in view and to support the service system to work together to hold perpetrators to account for their use of violence. When working with a victim survivor, GPs and PNs can request information about an individual using family violence to better understand their behaviour and to inform the risk assessment and assist with managing that risk for their patients. Information about the person using violence can also be shared with other ISEs, which could include specialist family violence services or the police. Their consent is not required, although you might require consent, as previously specified, if sharing information about the victim survivor. 

As a treating GP, managing both the perpetrator and the victim survivor it is not recommended, where possible. When working with an individual who has used violence, it is vital that you never disclose anything about the victim survivor that could increase their risk. You should also not directly discuss the person’s use of violence with the perpetrator (if the victim survivor has disclosed), as this is a complex practice that requires specialist skills, and if done incorrectly, could increase risk to the victim survivor.

If you are working with a person who discloses they are using violence, you should:

• ask the patient if they think they need any help with the issues in their life or their relationship issues they have disclosed to you (if safe to do so)
• inquire about their mental health, alcohol intake, drug use and employment status
• seek secondary consultation with other professionals in your service who have a role in working with people who have used violence or specialist services, and share information with other services working with the person using violence or an adult or child victim survivor
• proactively share information, particularly if there is immediate risk

If you deem there is an immediate risk to any person, call 000. 

When working with an individual who has used family violence, a GP might receive a request for information from an ISE or might decide to voluntarily share information with an ISE. Consent from the person using the violence is not required; however, if the GP believes that sharing the information will put the victim survivor at risk, they could refuse to do so. 

For further information, see Chapter 5 in The White Book – Working with men who use intimate partner abuse and violence.

How can I be sure I am not breaking the law?

It is important to record the following in the notes (Figure 4). Detailed information about this and other resources can be found here. 

Figure 4: Record-keeping requirements⁷