White Book

Recommendations

White Book - Chapter recommendations

Recommendations from each chapter can be found below.

Recommendation
Safety is a concept that should be foremost when working with patients experiencing abuse and violence

Recommendation
Health practitioners should have a system in place that includes the whole of practice and referral pathways to safety and healing

Recommendation
It is important to receive training that includes our own attitudes and assumptions about abuse and violence as they can affect the way we respond to patients experiencing abuse and violence

Explanation
Body of evidence can be trusted to guide practice in most situations

Recommendation
Health practitioners should ask patients who are showing clinical indicators of the mental and physical effects of intimate partner abuse about their experiences of abuse

Recommendation
Health practitioners should provide first line support – listening, inquiring about needs, validating women’s disclosure, enhancing safety and providing support – to women who disclose abuse

Recommendation
Health practitioners should work closely with specialist services including police, to enhance safety for women and children

Recommendation
Safety assessments need to be undertaken by health practitioners when seeing any patient experiencing abuse and violence

Recommendation
Documenting carefully what a patient has said about the abuse and violence in the record is important for communication with others and potentially for legal processes

Explanation
Body of evidence can be trusted to guide practice in most situations

Recommendation
A range of counselling approaches, including motivational interviewing strategies, provide support and are effective in assisting women to discuss safety and reduce depressive symptoms in general practice

Explanation
Body of evidence can be trusted to guide practice in most situations

Recommendation 
Health practitioners should offer to refer women who have post-traumatic stress disorder (PTSD) and who are no longer experiencing violence for trauma-informed cognitive behavioural therapy (CBT)

Explanation
Body of evidence can be trusted to guide practice in most situations

Recommendation 
Pregnant women who disclose intimate partner abuse should be offered empowerment counselling and advocacy support by trained health practitioners

Explanation
Body of evidence can be trusted to guide practice in most situations

Recommendation 
Health practitioners should offer children who have been exposed to intimate partner abuse a referral for psychotherapeutic counselling or small group therapy

Recommendation 
Health practitioners need to have an index of suspicion of the possibility of men using violence when they are also experiencing substance abuse issues

Recommendation 
Men’s behaviour change programs are the referral options of choice for men who perpetrate domestic violence

Explanation
Body of evidence can be trusted to guide practice
 

Recommendation
Health practitioners have a role in prevention of child abuse by identifying families at risk (eg where domestic violence is co-occurring) and referring to parent training programs and nurse home visitation programs

Recommendation
Harmful alcohol and drug use has a strong link with child abuse. Alcohol screening and brief interventions in health settings have proved effective in reducing alcohol use. The WHO recommends working to reduce alcohol consumption in adults with children in their care

Explanation
Body of evidence provides some support for recommendation(s) but care should be taken in its application

Recommendation
Health practitioners should ask young patients with chronic physical, social or mental health indicators about their experience of bullying

Explanation
Body of evidence can be trusted to guide practice

Recommendation
Health practitioners should understand that school programs can be very effective to deter and deal with bullying if supported across the whole school

Explanation
Body of evidence can be trusted to guide practice

Recommendation
Health practitioners need to recognise that child abuse is associated with a higher incidence of comorbidity: mental health issues, suicidality, drug and alcohol problems and chronic disease in adults

Recommendation
A trauma-informed approach to care across all human and health sectors services, as well as trauma specific services, may assist patients who have experienced abuse as children

Recommendation
Offer first-line support to women and men who are survivors of sexual assault by any perpetrator

Recommendation
Consider and ask about post trauma responses by assessing for mental health problems – acute stress, PTSD depression, alcohol and drug use problems, suicidality or self-harm and offering appropriate support and treatment

Recommendation
Offer emergency contraception if within 72 hours of assault and offer all women sexually transmitted infection investigation, prophylaxis and treatment as appropriate

Recommendation
Elder abuse needs to be considered by any health practitioner seeing elderly patients, as they have a pivotal role in the recognition, assessment, understanding and management of elder abuse and neglect

If confronted with elder abuse, establish the patient’s capacity to make decisions. Help may need to be sought from the person legally responsible for giving consent for their healthcare. If this person is the abuser, then seek help from the appropriate advocacy source in your state or territory

Explanation
Body of evidence provides some support for recommendation(s) but care should be taken in its application

Recommendation
Health practitioners should be aware that people with disabilities, particularly those with a mental illness, are at a much greater risk of violence – physical, sexual, or intimate partner – than those without a disability

Explanation
Body of evidence can be trusted to guide practice

Recommedation
Health practitioners should raise the issue with any Aboriginal or Torres Strait Islander patient, no matter where they live, who is presenting with indications of being a victim of violence

Recommendation
At a community level, health practitioners need to show leadership through local organisations by advocating for provision of services that meet the needs of Aboriginal and Torres Strait Islander peoples experiencing family violence

Recommendation
In working with patients from migrant and refugee backgrounds, remember that they are likely to have similar symptoms to other victims of family violence. However consider that this may be in addition to trauma experienced in their country of origin, refugee camps and in transit 

Recommendation
Practices need to put systems in place to ensure care is delivered in a culturally sensitive manner

Recommendation
Assistance and support offered in a culturally sensitive manner to migrant and refugee women helps to empower women to make positive changes in their lives. Ideally these services should be language concordant

Recommendation
Health practitioners can assist their patients experiencing abuse and violence by providing information on legal options and access to legal services

Recommendation
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

Recommendation
Health practitioners cannot give to others if they are experiencing compassion fatigue, so it is advised that self-care and a whole of practice approach be addressed so that patients receive the best care

Recommendation
Working as a team within the practice by using a system that provides peer support and the ability to discuss distressing cases may help protect against stress