White Book

Chapter 9

Sexual assault

Key messages

  • Sexual assault is very common, with one in five women and one in twenty men having experienced an assault in their adult lives 231
  • Many victims do not report sexual assault; therefore the effects, both physical and psychological, may go untreated 231
  • Particular groups are at greater risk of sexual assault, including young people, those with a disability, and those who have previously experienced abuse 231
Table 1

Table 1

Coding scheme used for levels of evidence and grades of recommendation 

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

Sexual assault is any behaviour of a sexual nature that makes a person feel intimidated, threatened or frightened. It is behaviour that is unwanted and uninvited where another person uses physical, emotional or psychological forms of coercion. It is committed more frequently than many people realise and can include any activity from sexual harassment through to life-threatening rape. The latter is defined as the physically forced or otherwise coerced penetration of the vulva or anus with a penis, other body part, or object, and may also include oral penetration.3

Every person 16 years and over has the right to choose about participating in sexual activity and must be afforded the opportunity to form free agreement (consent). Free agreement may be negated by many factors, including age, intellectual ability, use of force, threats or fraud, and the effects of drugs and/or alcohol. In some states, including NSW, it is specifically recognised that a person who is substantially intoxicated cannot consent to sex. Sexual assault is always violence – never a legitimate expression of a person’s sexuality, love or affection.

Sexual assault is a distressing experience and people who have been sexually assaulted report higher rates of adverse health outcomes.232–234 It is important to make it clear that sexual assault is never the fault of the victim. Above all sexual assault takes away the person’s control over what happens to their body so an understanding of this and a non-judgemental approach is essential. Many survivors access specialist sexual assault counselling when they are ready to do so, and find this helpful. The provision of high quality forensic and medical care is critical to successful patient outcomes following a recent sexual assault. GPs not familiar with forensic care should consult an appropriate sexual assault centre (refer to Resources).

GPs may not see many acute sexual assault presentations and may more often be involved in follow-up or other health issues, such as patients asking for emergency contraception or STI checks. The most frequent presentation of sexual-assault-related health issues to GPs will be for physical and other health conditions that are the long-term impacts of child sexual abuse. Commonly, patients may also be experiencing sexual harassment and intimate partner sexual assault.

In 2011, there were 17,238 reports of sexual assault in Australia or 76 reports per 100,000 people.231 This is likely to be lower than the true prevalence, due to under-reporting.

The age patterns for reports of sexual assault victims in Australia are similar for both sexes, peaking in the 10–14 year age group and then declining, but with rates of assaults against females being consistently higher in all age groups than in males.231

For females aged 10–14 years, the rate of sexual assault was 494 per 100,000 population, compared with 96 per 100,000 for males.3

The Australian Bureau of Statistics 2012 Personal Safety Survey10 showed that 17% of women (1,494,000) aged 18 years and over and 4% of men (336,000) aged 18 years and over have experienced at least one episode of sexual assault since the age of 15.

Relationship to perpetrator

Both men and women who had experienced sexual assault since the age of 15 were more likely to have been sexually assaulted by someone they knew, for example a friend or family member, than by a stranger. Specifically, in 2011, almost half of all victims were sexually assaulted by a ‘known other’ and 31% by a family member. Strangers accounted for only 15% of sexual assaults in 2011.231

Using a broad and inclusive definition of sexual coercion, an Australian survey found that 2.8% of men and 10.3% of women reported sexual coercion under the age of 16 years.214 Only 31.5% of men and 37.9% of women had ever talked to someone about the assault, with the majority talking solely to a friend.214 A low 2.6% of men and 8.4% of women reported the incident to police. These data provide a small insight into how common sexual coercion is in our society, and how infrequently disclosure is made or legal action instigated.214

People who have an increased risk of sexual assault

Certain groups of people appear to experience sexual assault more frequently and sexual assault can be part of intimate partner or family violence:

  • Socio demographic risk
    • women214
    • young people, aged 10–14 years231
    • Aboriginal or Torres Strait Islander peoples.
  • Associated health issue
    • alcohol users (either consumed by choice or via spiked drinks)235
    • illicit drug users (taken by choice or consumed via spiked drinks), including those injecting236
    • mental health issues
    • a disability (including learning difficulties).237
  • Past history of abuse
    • previous experiences of sexual assault238
    • a history of childhood sexual assault (up to one in three women who were sexually assaulted as a child report sexual assault as an adult).239
  • Living or working in circumstances such as:
    • poverty239
    • homelessness or threat of homelessness240
    • the sex industry241
    • custody and incarceration242
    • travelling or being an international student
    • an area of war and civil crisis.243

The majority of victims who have been sexually assaulted do not report the incident to the police. They may fear that they will not be believed, or are reluctant to enter a system that they fear will treat them as being responsible for the assault. Reporting of sexual assault is also dependent on the person’s previous experience with authority figures. They may also not recognise the incident as an assault or may blame themselves – this may also be influenced by cultural issues.

GPs need to maintain a high level of awareness that a history of sexual assault can be part of a patient’s history. The GP’s role includes identification and response to acute assault as needed and management of long-term consequences of sexual assault.

The most prevalent forms of sexual violence are child sexual abuse, sexual harassment and intimate partner sexual assault. Gender attitudes towards women are thought to underlie both intimate partner abuse and sexual violence3 ( refer to Chapter 2 ).

Types of presentations in general practice

A patient may disclose a sexual assault immediately, or years after the event.

GPs working in casualties and within sexual assault services will be seeing patients presenting immediately or very soon after the sexual assault. They will be trained to provide forensic assessment and to arrange follow-up.

Other presentations to general practice following a recent sexual assault may be for emergency contraception or STI checks. The patient may report that her behaviour was atypical – ‘not like me’. If patients present for these reasons, it is important to consider asking gently whether this was consensual sex. Later presentations may be for mental health and other health problems.

Sexual assault is extremely damaging to the victim’s sense of safety and self-esteem. It can result in a range of physical, mental and emotional disturbances.

Medical consequences of sexual assault can include:

  • immediate effects
    • physical injuries
    • unintended pregnancy, terminations and STIs
    • psychological affects
  • long-term effects
    • recovering from sexual assault can take many years. There are many ways of dealing with the experience. Some of the more common presentations are listed in Table 11.

Table 11. Common presentations of sexual assault

Table 11

Common presentations of sexual assault

Any post-assault reactions such as those outlined are important to note – nearly one-third of victims will develop rape-related PTSD. Victims are also three times more likely to experience a major depressive disorder compared to those who have not been sexually assaulted.245

Disclosure of sexual assault will rarely be direct and most likely will be couched in vague stories, clues or terms. The disclosure may take the GP by surprise. However, there are a number of strategies that can be used in dealing with a disclosure. Taking victim concerns into account helps to set the scene for the consultation.

In 2013, the WHO released clinical and policy guidelines for GPs responding to intimate partner abuse and sexual violence.3

The guidelines recommend that GPs ask women about sexual violence as part of assessing conditions that may be caused or complicated by such violence. These include mental health symptoms, alcohol and other substance use, chronic pain or chronic digestive or reproductive symptoms.

Before asking about violence you need to ensure that it is safe to do so — for example that the abusive partner is not present — and that you have systems in place that promote safety and a referral network. GPs should provide immediate first-line support to women and men who disclose violence, including:

  • being non-judgemental and supportive, and validating what the woman/man is saying
  • providing practical care and support that responds to her/his concerns, but does not intrude
  • asking about their history of violence, listening carefully, but not pressuring the patient to talk
  • helping them access information about resources, including legal and other services that the patient might think helpful
  • assisting the patient to increase safety for themselves
  • providing or mobilising social support.

Survivors’ concerns can revolve around issues of confidentiality (especially relatives and friends finding out), issues of blame, shame and medical issues – for example, pregnancy and STIs. The issue of confidentiality can present ethical dilemmas. The GP cannot maintain confidentiality when the safety of the patient, especially a child, is at risk. GPs are mandated to report child sexual abuse ( refer to Chapter 6 ). Discussion with a colleague, sexual assault service and/or medical defence organisation may help clarify any dilemmas the GP may have in making such a report.

Management will vary depending on when the assault occurred. It is important to listen to the patient, believe their story, and be non-judgemental and supportive. Management includes:

  • being aware of treatment options
  • allowing the patient to accept or decline treatment options using shared decision making
  • being aware of local resources – for example, sexual assault counsellors, group support
  • contraception, STIs and what needs to be offered now
  • forensic examination if a recent assault – this needs to be performed by an appropriately trained doctor or nurse as soon as possible after the assault, preferably within 72 hours246
  • follow-up – patients may need to return for follow-up at 2, 6, and 12 weeks following STI checks
  • continuing your involvement as the patient’s GP.

Any investigations performed depend on the nature of the assault and prevalence of the STI in the geographic area. Screening recommendations following a recent sexual assault, suggested prophylaxis, and a review program are outlined in Tables 12–14.

Information is also available from the National Management Guidelines for Sexually Transmissible Infections.

Also check with your local health department or centre for disease control, as there are some variations in treatments in different parts of Australia.

Table 12. Baseline screening recommendations to be considered for STIs

Table 12

Baseline screening recommendations to be considered for STIs 


Source: Mein JK, Palmer CM, et al. Management of acute adult sexual assault.  Med J Aust 2003; 178(5):226-230© Copyright 2003 The Medical Journal of Australia - adapted with permission. The MJA accepts no responsibility for any error in the adaptation.

Table 13. Suggested prophylaxis to be considered for STIs

Table 13

Suggested prophylaxis to be considered for STIs 


Source: Mein JK, Palmer CM, et al. Management of acute adult sexual assault.  Med J Aust 2003; 178(5):226-230© Copyright 2003 The Medical Journal of Australia - adapted with permission. The MJA accepts no responsibility for any error in the adaptation.

Table 14. Review program

Table 14

Review program


Source: Mein JK, Palmer CM, et al. Management of acute adult sexual assault. Med J Aust 2003; 178(5):226-230© Copyright 2003 The Medical Journal of Australia - adapted with permission. The MJA accepts no responsibility for any error in the adaptation.

Apart from the specific gynecological and reproductive health issues for women, men experience many similar emotional and psychological impacts of sexual assault. The principles outlined above are equally appropriate for men.

A common issue for men who have been sexually assaulted is concern about their sexuality. Sexual acts that they may have been forced to perform (or have performed on them) may challenge their perception of their sexuality. For example, getting an erection or ejaculating during the assault are physiological processes, but may be interpreted by the victim as an emotional response. It is good to take the time with your patient to ensure that they understand the difference.

Male sexual assault may involve more force and violence, and physical injuries may be more severe. Societal and other values may prevent men from disclosing sexual assault; again the strategies discussed earlier can be applied – for example, involvement of police and sexual assault teams.

The decision whether to report an assault to the police is ultimately the victim’s. They may want to access help in making their decision through rape crisis and sexual assault centres. A nationwide list can be found at Forensic and Medical Sexual Assault Clinicians Australia (refer to Resources). The most important exception to this rule is mandatory reporting for children, in which case GPs are mandated to report child sexual abuse ( refer to Chapter 6 and Chapter 13 ).

There may be other circumstances where a GP may consider reporting. In cases where the person has an intellectual disability or dementia you may involve the legal guardian, provided they are not the abuser. This may also be a consideration where an ongoing risk is present for the victim. In these circumstances, discussion with a medical defence association and colleagues may be of use before deciding whether to disclose to the police.

Sexual assault requires a multidimensional team of providers to assist survivors on a pathway of healing and recovery. A GP who is trained in gender-sensitive sexual assault care and examination should be available at all times of the day or night at a district level.

Clinical care of survivors of sexual assault,3 in addition to first line support – listening, practical care and support, offering comfort – includes using shared decision making by:

  • offering emergency contraception – levonorgestrel within 72 hours or IUD within 5 days
  • considering offering HIV post-exposure prophylaxis within 3 days for sexual exposure – get advice from an on-call immunologist about the level of risk as soon as possible
  • exploring legal and other community services referral
  • documentation
  • encouraging support within the victim’s community.

Watchful waiting in the first 3 months, using regular follow-up and offers of ongoing support, allows the GP to identify the women who become incapacitated during this time by post-rape symptoms. In this case psychological therapies specific to women who have been traumatised may be helpful. GPs should also treat any mental health issues in accordance with best evidence guidelines for depression, alcohol or drug use problems. For women after 3 months, GPs need to assess for a diagnosis of PTSD.

Case study: Sarah

Sarah, 26 years of age, presents to the GP with worries about ‘the possibility of vaginal infection’. On careful history taking the story begins to take shape. Sarah worked part time in a club while studying. She reveals that she had gone home with one of the local patrons for a cup of coffee and he had sexually assaulted her. She has been unable to tell anyone since it happened 2 weeks ago.

Diagnosis

Sarah has been sexually assaulted and now has concerns about pregnancy and STI. She appears to have continued to function for the last 2 weeks and wishes to address her feelings and seek help now.

Management

You need to acknowledge that Sarah has been sexually assaulted and then help her deal with the consequences. Is she pregnant? Does she have an STI? All these issues need to be addressed in this and subsequent consultations.

Emotionally, Sarah needs to talk about what has happened to her so that she can perhaps understand and be aware of how this may be affecting her. You should explore the options with Sarah of reporting the incident to the police, being referred to a sexual assault service for counselling, and considering if she could share this with a member of her family or with a friend. Sarah is also given the option of seeing the GP once a week for 4–5 sessions to begin to work through these issues. Consider using a mental health plan and using a mental health referral to someone with appropriate training in this area if this is needed.

Outcome

Sarah is not pregnant nor has she contracted any STIs. She opted to see you for four sessions and was able to discuss this with her family who were very supportive. She may need further help. Other victims may feel more comfortable talking with a counsellor or attending a sexual assault centre.

Resources

Please refer to Appendix 7 for resources nationally and in your area.

Further information

Adult sexual assault – this article discusses forensic care for those who have experienced adult sexual abuse.

Better Access Initiative – the MBS item relating to GP Mental Health Care Plans may be useful for survivors wanting to initiate ongoing mental healthcare.

RACGP information relating to GP Mental Health Care Plans.

  1. Rivas C, Ramsay J, Sadowski L, et al. Advocacy interventions to reduce or eliminate violence and promote the physical and psychoso-cial well-being of women who experience intimate partner abuse. Cochrane Review. The Cochrane Library, 2014.
  2. Taft A, O’Doherty L, Hegarty K, et al. Screening women for intimate partner violence in healthcare settings. Cochrane Review. The Cochrane Library, 2013.
  3. World Health Organization. Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. Geneva: WHO, 2013.
  4. Taft AJ, Hegarty KL, Feder GS. Tackling partner violence in families. Med J Aust 2006;185:535–6.
  5. Hegarty KL, O’Doherty LJ, Taft AJ, et al. Effect of screening and brief counselling for abused women on quality of life, safety planning and mental health: A primary care cluster randomised controlled trial (weave). Lancet 2013;382:249–58.
  6. Feder GS, Hutson M, Ramsay J, et al. Women exposed to intimate partner violence: expectations and experiences when they encounter health care professionals: a meta-analysis of qualitative studies. Arch Intern Med 2006;166:22–37.
  7. MacMillan HL, Wathen CN, Barlow J, et al. Interventions to prevent child maltreatment and associated impairment. Lancet 2009;373:250–66.
  8. National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Canberra: NHMRC, 2009.
  9. Krug EG, Mercy JA, Dahlberg LL, et al. The world report on violence and health. Lancet 2002;360:1083–8.
  10. Australian Bureau of Statistics. Personal Safety. Canberra: ABS, 2012.
  11. World Health Organization. A global response to elder abuse and neglect: building primary health care capacity to deal with the problem worldwide: main report. Geneva: WHO, 2008.
  12. Taft A, Hegarty K, Flood M. Are men and women equally violent to intimate partners? Aust NZ J Public Health 2001;25:498–500.
  13. Krug EG, Dahlberg LL, Mercy JA, et al, editors. World report on violence and health. Geneva: WHO, 2002.
  14. Reilly JM, Gravdal JA. An ecological model for family violence prevention across the life cycle. Fam Med 2012;44:332–5.
  15. Heise LL. Violence against women: an integrated, ecological framework. Violence Against Women 1998;4:262–90.
  16. Victorian Health Promotion Foundation. National Survey on Community Attitudes to Violence Against Women 2009. Changing cultures, changing attitudes – preventing violence against women. A summary of findings. Carlton: Victorian Health Promotion Foundation, 2009.
  17. Mouzos J, Makkai T. Women’s experience of male violence: Findings from the Australian component of the International Violence Against Women survey. Canberra: Australian Institute of Criminology, 2004.
  18. O’Donnell C, Smith A, Madison J. Using demographic risk factors to explain variations in the incidence of violence against women. J Interpers Violence 2002;17:1239–62.
  19. Kitzmann KM, Gaylord NK, Holt AR, et al. Child witnesses to domestic violence: a meta-analytic review. J Consult Clin Psychol 2003;71:339–52.
  20. Newman L. The last frontier: Practice guidelines for the treatment of complex and trauma informed care and service delivery: ASCA, 2012.
  21. Felitti VJ, Anda RF. The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual be-haviour: Implications for healthcare. In: Lanius RA, Vermetten E, Pain C, editors. The Impact of Early Life Trauma on Health and Dis-ease. Cambridge: Cambridge University Press, 2010. p. 77–87.
  22. Hegarty K. What is intimate partner abuse and how common is it? In: Roberts G, Hegarty K, Feder G, editors. Intimate partner abuse and health professionals: new approaches to domestic violence. London: Elsevier, 2006. p. 19–40.
  23. Vos T, Astbury J, Piers L, et al. Measuring the impact of intimate partner violence on the health of women in Victoria, Australia. Bulletin of the World Health Organization 2006;84:739–44.
  24. Bedi G, Goddard C. Intimate partner violence: what are the impacts on children? Aust Psychol 2007;42:66–77.
  25. Feder G, Ramsay J, Dunne D, et al. How far does screening women for domestic (partner) violence in different healthcare settings meet criteria for a screening programme? Systematic reviews of nine UK National Screening Committee criteria. Health Technology As-sessment 2009;13:iii–iv, xi–xiii, 1–113, 37–347.
  26. Tan E, O’Doherty L, Hegarty K. GPs’ communication skills: a study into women’s comfort to disclose intimate partner violence. Aust Fam Physician 2012;41:513–7.
  27. Hegarty K, Taft A. Overcoming the barriers to disclosure and inquiry of partner abuse for women attending general practice. Aust NZ J Public Health 2001;25:433–7.
  28. Hegarty K, Gunn J, Chondros P, et al. Physical and social predictors of partner abuse in women attending general practice: a cross-sectional survey. Br J Gen Pract 2008;58:484–7.
  29. VicHealth. Preventing violence before it occurs: A framework and background paper to guide the primary prevention of violence against women in Victoria. Melbourne: VicHealth, 2007.
  30. World Health Organisation. Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: WHO, 2013.
  31. Upston B, Durey R. Everyone’s business: a guide to developing workplace programs for the primary prevention of violence against women. Melbourne: Women’s Health Victoria, 2012.
  32. Powell A. Review of bystander approaches in support of preventing violence against women. Melbourne: Victorian Health Promotion Foundation/VicHealth, 2011.
  33. Bonds DE, Ellis SD, Weeks E, et al. A practice-centered intervention to increase screening for domestic violence in primary care practic-es. BMC Fam Pract 2006;7:63.
  34. Campbell JC. Health consequences of intimate partner violence. Lancet 2002;359:1331–36.
  35. Black MC. Intimate partner violence and adverse health consequences: Implications for clinicians. Am J Lifestyle Med 2011;5:428.
  36. Hegarty K, Gunn J, Chondros P, et al. Association between depression and abuse by partners of women attending general practice: de-scriptive, cross sectional survey. BMJ 2004;328:621–4.
  37. Waalen J, Goodwin MM, Spitz AM, et al. Screening for intimate partner violence by health care providers: barriers and interventions. Am J Prev Med 2000;19:230–7.
  38. Parkinson D. Partner rape and rurality. Australian Centre for the Study of Sexual Assault, 2008.
  39. Relf MV, Glass N. Gay and lesbian relationships and intimate partner abuse. In: Roberts G, Hegarty K, Feder G, editors. Intimate partner abuse and health professionals: New approaches to domestic violence. London: Churchill Livingstone Elsevier; 2006. p. 213–28.
  40. Mouzos J. Femicide: The killing of women in Australia 1989–1998. Research and Public Policy Series. Canberra: Australian Institute of Criminology, 1999.
  41. Wallace A. Homicide: The social reality. Sydney: New South Wales Bureau of Crime Statistics and Research, 1986.
  42. Australian Bureau of Statistics. Average Weekly Earnings, Australia, Nov 2013 – 6302.0. Canberra: ABS, 2013.
  43. Feder GS, Hutson M, Ramsay J, et al. Women exposed to intimate partner violence: expectations and experiences when they encounter health care professionals: a meta-analysis of qualitative studies. Arch Intern Med 2006;166:22–37.
  44. Gazmararian J, Lazorick S, Spitz A. Prevalence of violence against pregnant women. JAMA 1996;275:1915–20.
  45. Gazmararian J. Violence and reproductive health: current knowledge and future research directions. Matern Child Health 2000;4:79–84.
  46. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Social Survey 2008. Canberra: AGPS, 2010.
  47. Weatherburn D, Snowball L. Is there a cultural explanation for Indigenous violence? A second look at the NATSISS. In: Hunter B, Biddle N, editors. Survey Analysis for Indigenous Policy in Australia: Social Science Perspectives. Canberra: ANU E Press, 2012.
  48. McNair RP. Lesbian health inequalities: a cultural minority issue for health professionals. Med J Aust 2003;178:643–5.
  49. McNair RP, Kavanagh A, Agius P, Tong B. The mental health status of young adult and mid-life non-heterosexual Australian women. Aust N Z J Public Health 2005;29:265–71.
  50. Blosnich JR, Bossarte RM. Comparisons of intimate partner violence among partners in same-sex and opposite-sex relationships in the United States. Am J Public Health 2009;99:2182–4.
  51. Irwin J. (Dis)counted Stories: Domestic Violence and Lesbians. Qualitative Social Work 2008;7:199–215.
  52. McNair R. A guide to sensitive care for lesbian, gay and bisexual people attending General Practice. Melbourne: The University of Mel-bourne, 2012.
  53. McNair RP, Hegarty K. Guidelines for the primary care of lesbian, gay, and bisexual people: a systematic review. Ann Fam Med 2010;8:533–41.
  54. Laing L. Risk Assessment in Domestic Violence: Australian Domestic and Family Violence Clearninghouse, 2004.
  55. Campbell JC. Helping women understand their risk in situations of intimate partner violence. J Interpers Viol 2004;19:1464–77.
  56. Coker AL, Bethea L, Smith PH, et al. Missed opportunities: intimate partner violence in family practice settings. Prev Med 2002;34:445–54.
  57. Campbell JC, Sharps P, Glass N. Risk assessment for intimate partner homicide. In: Pinard GF, Pagani L, editors. Clinical assessment of dangerousness: Empirical contributions. Cambridge: Cambridge University Press, 2001.
  58. Family violence risk assessment and risk management. Department for Victorian Communities, 2007.
  59. Campbell J. Nursing Assessment for Risk of Homicide with Battered Women. Adv Nurs Sci 1986;8:36–51.
  60. Renner LM, Slack KS. Intimate partner violence and child maltreatment: understanding intra- and intergenerational connections. Child Abuse Negl 2006;30:599–617.
  61. Ernst AA, Weiss SJ, Enright-Smith S, et al. Positive outcomes from an immediate and ongoing intervention for child witnesses of intimate partner violence. Am J Emerg Med 2008;26:389–94.
  62. Hardesty J, Campbell JC. Safety planning for abused women and their children. In: Jaffe PG, Baker LL, Cunningham AJ, editors. Protect-ing children from domestic violence: strategies for community intervention. New York: Guilford Press, 2004. p. 89–101.
  63. Ferris L, Norton P, Dunn E, et al. Guidelines for managing domestic abuse when male and female partners are patients of the same phy-sician. JAMA 1997;278:851–7.
  64. Women’s Legal Services NSW. When she talks to you about the violence: A toolkit for GPs in NSW. 2013.
  65. Campbell JC, Sharps P, et al. Medical lethality assessment and safety planning in domestic violence cases. Family and Community Vio-lence 2003;5:101–11.
  66. Neighbors C, Walker DD, Roffman RA et al. Self-determination theory and motivational interviewing: Complementary models to elicit voluntary engagement by partner-abusive men. Am J Fam Ther 2008;36:126–36.
  67. Rollnick S, Miller W, Butler C. Motivational interviewing in Health Care. New York: Guilford Press, 2008.
  68. Arkowitz H, Westra HA. Introduction to the special series on motivational interviewing and psychotherapy. J Clin Psychol 2009;65:1149–55.
  69. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol 2009;64:527–37.
  70. Burke JG, Denison JA, Gielen AC, et al. Ending intimate partner violence: an application of the transtheoretical model. Am J Health Behav 2004;28:122–33.
  71. Chang JC, Cluss PA, Ranieri L, et al. Health care interventions for intimate partner violence: what women want. Womens Health Issues 2005;15:21–30.
  72. Chang JC, Dado D, Ashton S, et al. Understanding behavior change for women experiencing intimate partner violence: mapping the ups and downs using the stages of change. Patient Educ Couns 2006;62:330–9.
  73. Frasier PY, Slatt L, Kowlowitz V, et al. Using the stages of change model to counsel victims of intimate partner violence. Patient Educ Couns 2001;43:211–7.
  74. Jewkes R. Intimate partner violence: the end of routine screening. Lancet 2013;382:190–1.
  75. Johnson NL, Johnson DM. Correlates of Readiness to Change in Victims of Intimate Partner Violence. J Aggress Maltreat Trauma 2013;22:127–44.
  76. Kistenmacher BR, Weiss RL. Motivational interviewing as a mechanism for change in men who batter: a randomized controlled trial. Vio-lence Vict 2008;23:558–70.
  77. Schrager JD, Smith LS, Heron SL, et al. Does stage of change predict improved intimate partner violence outcomes following an emer-gency department intervention? Acad Emerg Med. 2013;20:169–77.
  78. Sheehan KA, Thakor S, Stewart DE. Turning points for perpetrators of intimate partner violence. Trauma Violence Abuse 2012;13:30–40.
  79. Zalmanowitz SJ, Babins-Wagner R, Rodger S, et al. The association of readiness to change and motivational interviewing with treatment outcomes in males involved in domestic violence group therapy. J Interpers Violence 2013;28:956–74.
  80. Apodaca TR, Longabaugh R. Mechanisms of change in motivational interviewing: a review and preliminary evaluation of the evidence. Addiction 2009;104:705–15.
  81. Miller WR, Rollnick S. Ten things that motivational interviewing is not. Behav Cogn Psychother 2009;37:129–40.
  82. Burke JG, Mahoney P, Gielen A, et al. Defining appropriate stages of change for intimate partner violence survivors. Violence Vict 2009;24:36–51.
  83. Alexander PC, Tracy A, Radek M, et al. Predicting stages of change in battered women. J Interpers Violence 2009;24:1652–72.
  84. Burkitt KH, Larkin GL. The transtheoretical model in intimate partner violence victimization: stage changes over time. Violence Vict 2008;23:411–31.
  85. Chang JC, Dado D, Hawker L, et al. Understanding turning points in intimate partner violence: factors and circumstances leading women victims toward change. J Womens Health (Larchmt) 2010;19:251–9.
  86. West R. Time for a change: putting the Transtheoretical (Stages of Change) Model to rest. Addiction 2005;100:1036–9.
  87. Hegarty KL, O’Doherty LO, Astbury J, et al. Identifying intimate partner violence when screening for health and lifestyle issues among women attending general practice. Aust J Prim Health 2012;18:327–31.
  88. Ramsay J, Rutterford C, Gregory A, et al. Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians. Br J Gen Pract 2012;62:647–55.
  89. Mitchell L. Domestic violence in Australia – an overview of the issues. Canberra: Parliament of Australia, Department of Parliamentary Ser-vices, 2011.
  90. Alston M, Allan J, Dietsch E, et al. Brutal neglect: Australian rural women’s access to health services. Rural Remote Health 2006;6:475.
  91. Sprague S, Madden K, Simunovic N, et al. Barriers to screening for intimate partner violence. Women Health 2012;52:587–605.
  92. Tiwari A, Leung WC, Leung TW, et al. A randomised controlled trial of empowerment training for Chinese abused pregnant women in Hong Kong. BJOG 2005;112:1249–56.
  93. Kiely M, El-Mohandes AA, El-Khorazaty MN, et al. An integrated intervention to reduce intimate partner violence in pregnancy: a random-ized controlled trial. Obstet Gynecol 2010;115:273–83.
  94. Petersen R, Moracco KE, Goldstein KM, et al. Moving beyond disclosure: women’s perspectives on barriers and motivators to seeking assistance for intimate partner violence. Women Health 2004;40:63–76.
  95. Burge SK, Schneider FD, Ivy L. Patients’ advice to physicians about intervening in family conflict. Ann Fam Med 2005;3:248–54.
  96. Katerndahl DA, Burge SK, Ferrer RL, Becho J, Wood R. Complex dynamics in intimate partner violence: a time series study of 16 women. Prim Care Companion J Clin Psychiatry 2010;12.
  97. Klevens J, Kee R, Trick W, et al. Effect of screening for partner violence on women’s quality of life: a randomized controlled trial. JAMA 2012;308:681–9.
  98. Musser PH, Murphy CM. Motivational interviewing with perpetrators of intimate partner abuse. J Clin Psychol 2009;65:1218–31.
  99. Tetterton S, Farnsworth E. Older women and intimate partner violence: effective interventions. J Interpers Violence 2011;26:2929–42.
  100. Battaglia TA, Finley E, Liebschutz JM. Survivors of intimate partner violence speak out: trust in the patient-provider relationship. J Gen Intern Med 2003;18:617–23.
  101. Rees S, Silove D, Chey T, et al. Lifetime prevalence of gender-based violence in women and the relationship with mental disorders and psychosocial function. JAMA 2011;306:513–21.
  102. Aldridge ML, Browne KD. Perpetrators of spousal homicide: a review. Trauma Violence Abuse 2003;4:265–76.
  103. Laslett, A-M., Catalano, P., Chikritzhs, Y., Dale, C., Doran, C., Ferris, J., Jainullabudeen, T., Livingston, M, Matthews, S., Mugavin, J., Room, R., Schlotterlein, M. and Wilkinson, C. (2010) The Range and Magnitude of Alcohol’s Harm to Others. Fitzroy, Victoria: AER Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Eastern Health.
  104. Mintz H, Cornett F. When your patient is a batterer: what you need to know before treating perpetrators of domestic violence. Postgrad Med 1997;101:219–28.
  105. World Health Organization/London School of Hygiene and Tropical Medicine. Preventing intimate partner and sexual violence against women: taking action and generating evidence. Geneva: WHO, 2010.
  106. Danielson K, Moffitt T, Caspi A, et al. Comorbidity between abuse of an adult and DSM-III-R mental disorders: evidence from an epidemi-ological study. Am J Psychiatry 1998;155:131–3.
  107. Humphreys C, Regan L, River D, et al. Domestic violence and substance use: tackling complexity. Br J Soc Work 2005;35:1303–20.
  108. Sharps P, Campbell J, Campbell D, et al. The role of alcohol use in intimate partner femicide. Am J Addict 10:122–35.
  109. Thompson M, Kingree J. The roles of victim and perpetrator alcohol use in intimate partner violence outcomes. J Interpers Violence 2006;21:163–77.
  110. Taft A, Shakespeare J. Managing the whole family when women are abused by intimate partners: challenges for health professionals. In: Roberts G, Hegarty K, Feder G, editors. Intimate partner abuse and health professionals: New approaches to domestic violence. London: Churchill Livingstone Elsevier, 2006. p. 145–62.
  111. Gerbert B, Moe J, Caspers N. Physicians’ response to victims of domestic violence: Toward a model of care. Women Health 2002;35:1–22.
  112. Helfritz L, Stanford M, Conklin S, et al. Usefulness of self-report instruments in assessing men accused of domestic violence. Psychol Rec 2006;56:171–80.
  113. Adams D. Guidelines for doctors on identifying and helping their patients who batter. J Am Med Womens Assoc 1996;51:123–6.
  114. Taft A, Broom D, Legge D. General practitioner management of intimate partner abuse and the whole family: qualitative study. BMJ 2004;328:618.
  115. Miller D, Jaye C. GPs’ perception of their role in the identification and management of family violence. Fam Pract 2007;24:95–101.
  116. Featherstone B, Fraser C. Working with fathers around domestic violence: Contemporary debates. Child Abuse Review 2012;21:255–63.
  117. Smedslund G, Dalsbø T, Steiro A, et al. Cognitive behavioural therapy for men who physically abuse their female partner. Cochrane Re-view. The Cochrane Library, 2011.
  118. Urbis. Literature Review on Domestic Violence Perpetrators.
  119. Hanson RF, Kievit LW, Saunders BE, et al. Correlates of adolescent reports of sexual assault: Findings from the National Survey of Ado-lescents. Child Maltreatment 2003;8:261–72.
  120. Australian Institute of Health and Welfare. Child Protection Australia 2011–12. Canberra: Australian Government, 2013.
  121. World Health Organization, International Society for the Prevention of Child Abuse and Neglect. Preventing child maltreatment: a guide to taking action and generating evidence. Geneva: WHO, 2006.
  122. Barlow J, Johnston I, Kendrick D, et al. Individual and group-based parenting programmes for the treatment of physical child abuse and neglect. Cochrane Review. The Cochrane Library, 2008.
  123. Sanders M, Markie-Dadds C, Turner K. Theoretical, scientific and clinical foundations of the Triple P-Positive Parenting Program: A pop-ulation approach to parenting competency. The Parenting and Family Support Centre: University of Queensland, 2003.
  124. Mikton CA. Child maltreatment prevention: a systematic review of reviews. Bulletin of the World Health Organization 2009;87:353–61.
  125. World Health Organization. Child maltreatment and alcohol. Geneva: WHO, 2006.
  126. World Health Organization. Child maltreatment fact sheet 2010.
  127. Gilbert R, Widom CS, Browne K, et al. Burden and consequences of child maltreatment in high-income countries. Lancet 2009;373:68–81.
  128. Australian Institute of Family Studies. The economic costs of child abuse and neglect 2013.
  129. Taylor P, Moore P, Pezzullo L, et al. The cost of child abuse in Australia. Melbourne: Australian Childhood Foundation and Child Abuse Prevention Research Australia, 2008.
  130. Australian Institute of Family Studies. Child deaths from abuse and neglect 2014.
  131. Brown T, Tyson D, Fernandez P. Filicide in Australia. Addressing Filicide: The International Conference; Prato, Italy, 30–31 May 2013.
  132. Dawe S, Harnett P, Frye S. Improving outcomes for children living in families with parental substance misuse: What we know and what we should do. Canberra: Australian Institute of Family Studies, 2008.
  133. Perry BD. Examining child maltreatment through a neurodevelopmental lens: clinical applications of the Neurosequential Model of Therapeutics. J Loss Trauma 2009;14:240–55.
  134. Geeraert L, van den Noortgate W, Grietens H, et al. The effects of early prevention programs for families with young children at risk for physical child abuse and neglect: a meta-analysis. Child Maltreatment 2004;9:277–91.
  135. Zwi K, Woolfenden S, Wheeler D, et al. School-based education programmes for the prevention of child abuse. Cochrane Review. The Cochrane Library, 2009.
  136. Norman R, Munkhtsetseg B, Rumma D, et al. The long-term health consequences of child physical abuse, emotional abuse and neglect: A systematic review and meta-analysis. PLos Med 2012;9:e1001349.
  137. Meredith V, Price-Robertson R. Alcohol misuse and child maltreatment. Australian Government, Australian Institute of Family Studies; 2011.
  138. Jensen TK, Gulbrandsen W, Mossige S, et al. Reporting possible sexual abuse: A qualitative study on children’s perspectives and the context for disclosure. Child Abuse Negl 2005;29:1395–413.
  139. Fontes LA, Plummer C. Cultural issues in disclosures of child sexual sbuse. J Child Sex Abus 2010;19:491–518.
  140. Foynes MM, Freyd JJ, DePrince AP. Child abuse: Betrayal and disclosure. Child Abuse Negl 2009;33:209–17.
  141. Macdonald G, Higgins J, Ramchandani P, et al. Cognitive-behavioural interventions for children who have been sexually abused. Cochrane Review. The Cochrane Library, 2012.
  142. Australian Institute of Family Studies. Mandatory reporting of child abuse and neglect. Commonwealth of Australia, 2013.
  143. Gini G. Associations between bullying behaviour, psychosomatic complaints, emotional and behavioural problems. J Paediatr Child Health 2008;44:492–7.
  144. Jones L, Bellis MA, Wood S, et al. Prevalence and risk of violence against children with disabilities: a systematic review and me-ta-analysis of observational studies. Lancet 2012;380:899–907.
  145. Ttofi MM, Farrington DP. Effectiveness of school-based programs to reduce bullying: a systematic and meta-analytic review. J Exp Crim-inol 2011;7:27–56.
  146. Williams LC, Stelko-Pereira AC. Let’s prevent school violence, not just bullying and peer victimization: a commentary on Finkelhor, Turner, and Hamby (2012). Child Abuse Negl 2013;37:235–6.
  147. Finkelhor D, Turner HA, Hamby SL. Bullying vs. school violence: A response to Williams and Stelko-Pereira (2013). Child Abuse Negl 2013;37:608–9.
  148. Ybarra ML, Boyd D, Korchmaros JD, et al. Defining and measuring cyberbullying within the larger context of bullying victimization. J Ad-olesc Health 2012;51:53–8.
  149. Menesini E, Nocentini A, Palladino BE, et al. Cyberbullying definition among adolescents: a comparison across six European countries. Cyberpsychol Behav Soc Netw 2012;15:455–63.
  150. Slee PT, Spears B, Campbell M, et al. Addressing bullying and cyberbullying in schools: Translating theory into practice. Centre for Stra-tegic Education, 2011.
  151. Fisher S, Sauter A, Slobodniuk L, et al. Sexting in Australia: The Legal and Social Ramifications. Melbourne: Parliament of Victoria Law Reform Committee Sexting Inquiry, 2012.
  152. Walker S, Sanci L, Temple-Smith M. Sexting: Young women’s and men’s views on its nature and origins. J Adolesc Health 2013;52:697–701.
  153. Butler D, Kift S, Campbell M, et al. School policy responses to cyberbullying: An Australian legal perspective. Int J Law Educ 2011;16:7–28.
  154. Finkelhor D, Turner HA, Hamby S. Let’s prevent peer victimization, not just bullying. Child Abuse Negl 2012;36:271–4.
  155. Tucker CJ, Finkelhor D, Turner H, et al. Association of sibling aggression with child and adolescent mental health. Pediatrics 2013;132:79–84.
  156. Skinner JA, Kowalski RM. Profiles of sibling bullying. J Interpers Violence 2013;28:1726–36.
  157. Wolke D, Skew AJ. Bullying among siblings. Int J Adolesc Med Health 2012;24:17–25.
  158. Craig W, Harel-Fisch Y, Fogel-Grinvald H, et al. A cross-national profile of bullying and victimization among adolescents in 40 countries. Int J Public Health 2009;54 Suppl 2:216–24.
  159. Due P, Holstein BE, Soc MS. Bullying victimization among 13 to 15-year-old school children: results from two comparative studies in 66 countries and regions. Int J Adolesc Med Health 2008;20:209–21.
  160. Gan SS, Zhong C, Das S, et al. The prevalence of bullying and cyberbullying in high school: a 2011 survey. Int J Adolesc Med Health 2013 22:1–5.
  161. Hemphill SA, Kotevski A, Tollit M, et al. Longitudinal predictors of cyber and traditional bullying perpetration in Australian secondary school students. Journal Adolesc Health 2012;51:59–65.
  162. Cross D, Shaw T, Hearn L, et al. Australian Covert Bullying Prevalence Study. Child Health Promotion Research Centre, Edith Cowan University, May 2009.
  163. Waseem M, Ryan M, Foster CB, et al. Assessment and management of bullied children in the emergency department. Pediatr Emerg Care 2013 29:389–98.
  164. Undheim AM, Sund AM. Bullying – a hidden factor behind somatic symptoms? Acta Paediatr (Oslo, Norway: 1992) 2011;100:496–8.
  165. Carr-Gregg M, Manocha R. Bullying – effects, prevalence and strategies for detection. Aust Fam Physician 2011;40:98–102.
  166. Daigle L, Beaver K, Turner M. Resiliency against victimization: Results from the National Longitudinal Study of Adolescent Health. J Crim Justice 2010;38.
  167. Cappadocia MC, Weiss JA, Pepler D. Bullying experiences among children and youth with autism spectrum disorders. J Autism Dev Dis-ord 2012;42:266–77.
  168. Sentenac M, Gavin A, Gabhainn SN, et al. Peer victimization and subjective health among students reporting disability or chronic illness in 11 Western countries. Eur J Public Health 2013;23:421–6.
  169. Mindmatters. Community matters-rural and remote issues. In: Bullying in rural settings. Canberra: Commonwealth Australia, 2010.
  170. Merrell K, Isava M. How effective are school bullying intervention programs? A meta-analysis of intervention research. Sch Psychol Q 2008;23:26–42.
  171. Vreeman RC, Carroll AE. A systematic review of school-based interventions to prevent bullying. Arch Pediatr Adolesc Med 2007;161:78–88.
  172. Karna A, Voeten M, Little TD, et al. A large-scale evaluation of the KiVa antibullying program: grades 4–6. Child Dev 2011;82:311–30.
  173. Salmivalli C, Poskiparta E. Making bullying prevention a priority in Finnish schools: the KiVa antibullying program. New Dir Youth Dev 2012:41–53.
  174. Williford A, Boulton A, Noland B, et al. Effects of the KiVa anti-bullying program on adolescents’ depression, anxiety, and perception of peers. J Abnorm Child Psychol 2012;40:289–300.
  175. Williford A, Elledge LC, Boulton AJ, et al. Effects of the KiVa Antibullying program on cyberbullying and cybervictimization frequency among Finnish youth. J Clin Child Adolesc Psychol 2013;42:820–33.
  176. Leff SS, Waasdorp TE. Effect of aggression and bullying on children and adolescents: implications for prevention and intervention. Curr Psychiatry Rep 2013;15:343.
  177. Hensley V. Childhood bullying: a review and implications for health care professionals. Nurs Clin North Am 2013;48:203–13.
  178. Copeland WE, Wolke D, Angold A, et al. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adoles-cence. JAMA psychiatry 2013;70:419–26.
  179. Ortega R, Elipe P, Mora-Merchan JA, et al. The emotional impact of bullying and cyberbullying on victims: a European cross-national study. Aggress Behav 2012;38:342–56.
  180. Ramya SG, Kulkarni ML. Bullying among school children: prevalence and association with common symptoms in childhood. Indian J Pediatr 2011;78:307–10.
  181. Gini G, Pozzoli T. Association between bullying and psychosomatic problems: a meta-analysis. Pediatrics 2009;123:1059–65.
  182. Sansone RA, Sansone LA. Bully victims: psychological and somatic aftermaths. Psychiatry 2008;5:62–4.
  183. Campbell M, Slee PT, Spears B. Do cyberbullies suffer too? Cyberbullies’ perceptions of the harm they cause to others and to their own mental health. International School Psychology 2012;1:1–27.
  184. Campbell M, Spears B, Slee PT, et al. Victims’ perceptions of traditional and cyberbullying, and the psychosocial correlates of their vic-timisation. J Emotional Behavioural Difficulties 2012;17.
  185. Perren S, Dooley J, Shaw T, et al. Bullying in school and cyberspace: Associations with depressive symptoms in Swiss and Australian adolescents. Child Adolesc Psychiatry Ment Health 2010;4.
  186. Shetgiri R, Lin H, Flores G. Trends in risk and protective factors for child bullying perpetration in the United States. Child Psychiatry Hum Dev 2013;44:89–104.
  187. Kowalski RM, Limber SP. Psychological, physical, and academic correlates of cyberbullying and traditional bullying. J Adolesc Health 2013;53:S13–20.
  188. Espelage DL, De La Rue L. School bullying: its nature and ecology. Int J Adolesc Med Health 2012;24:3–10.
  189. Hemphill SA, Kotevski A, Herrenkohl TI, et al. Longitudinal consequences of adolescent bullying perpetration and victimisation: a study of students in Victoria, Australia. Crim Behav Ment Health 2011;21:107–16.
  190. Boynton-Jarrett R, Ryan LM, Berkman LF, et al. Cumulative violence exposure and self-rated health: longitudinal study of adolescents in the United States. Pediatrics 2008;122:961–70.
  191. Fekkes M, Pijpers FI, Fredriks AM, et al. Do bullied children get ill, or do ill children get bullied? A prospective cohort study on the rela-tionship between bullying and health-related symptoms. Pediatrics 2006;117:1568–74.
  192. Allison S, Roeger L, Reinfeld-Kirkman N. Does school bullying affect adult health? Population survey of health-related quality of life and past victimization. Aust N Z J Psychiatry 2009;43:1163–70.
  193. Sourander A, Jensen P, Ronning JA, et al. What is the early adulthood outcome of boys who bully or are bullied in childhood? The Finn-ish ‘From a Boy to a Man’ study. Pediatrics 2007;120:397–404.
  194. Niemela S, Brunstein-Klomek A, Sillanmaki L, et al. Childhood bullying behaviors at age eight and substance use at age 18 among males. A nationwide prospective study. Addict Behav 2011;36:256–60.
  195. Schreier A, Wolke D, Thomas K, et al. Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Arch Gen Psychiatry 2009;66:527–36.
  196. Ttofi MM, Farrington DP, Losel F, et al. The predictive efficiency of school bullying versus later offending: a systematic/meta-analytic re-view of longitudinal studies. Crim Behav Ment Health 2011;21:80–9.
  197. Falb KL, McCauley HL, Decker MR, et al. School bullying perpetration and other childhood risk factors as predictors of adult intimate partner violence perpetration. Arch Pediatr Adolesc Med 2011;165:890–4.
  198. Turner HA, Finkelhor D, Hamby SL, et al. Specifying type and location of peer victimization in a national sample of children and youth. J Youth Adolesc 2011;40:1052–67.
  199. Sijtsema JJ, Veenstra R, Lindenberg S, et al. Empirical test of bullies’ status goals: assessing direct goals, aggression, and prestige. Ag-gress Behav 2009;35:57–67.
  200. Reijntjes A, Vermande M, Olthof T, et al. Costs and benefits of bullying in the context of the peer group: a three wave longitudinal analy-sis. J Abnorm Child Psychol 2013;41:1217–29.
  201. Kulig JC, Hall BL, Kalischuk RG. Bullying perspectives among rural youth: a mixed methods approach. Rural Remote Health 2008;8:923.
  202. Karna A, Voeten M, Little TD, et al. Going to scale: a nonrandomized nationwide trial of the KiVa antibullying program for grades 1-9. J Consult Clinical Psychol 2011;79:796–805.
  203. Pepler D, Jiang D, Craig W, et al. Developmental trajectories of bullying and associated factors. Child Dev 2008;79:325–38.
  204. Wolke D, Samara MM. Bullied by siblings: association with peer victimisation and behaviour problems in Israeli lower secondary school children. J Child Psychol Psychiatry 2004;45:1015–29.
  205. Holt KE, Kantor, Finkelhor D. Parent/child concordance about bullying involvement and family characteristics related to bullying and peer victimization. J School Violence 2008;8:42–63.
  206. Lamb J, Pepler DJ, Craig W. Approach to bullying and victimization. Can Family Physician 2009;55:356–60.
  207. Lyznicki JM, McCaffree MA, Robinowitz CB. Childhood bullying: implications for physicians. Am Fam Physician 2004;70:1723–8.
  208. Dawkins J. Bullying in schools: doctors’ responsibilities. BMJ 1995;310:274–5.
  209. Slee PT, Mohyla J. The PEACE Pack: an evaluation to reduce bullying in four Australian primary schools. Educational Research 2007;49:103–14.
  210. Committee on Injury V, and Poison Prevention. Policy statement – Role of the pediatrician in youth violence prevention. Pediatrics 2009;124:393–402.
  211. Usherwood T. Understanding the consultation. Open University Press, 999.
  212. Lee A, Coles J, Lee SJ, et al. Women survivors of child abuse – don’t ask, don’t tell. Aust Fam Physician 2012;41:903–6.
  213. Ogloff JR, Cutajar MC, Mann E, et al. Child sexual abuse and subsequent offending and victimisation: A 45 year follow-up study. Trends and issues in crime and criminal justice no.440. Canberra: Australian Institute of Criminology, June 2012.
  214. De Visser RO, Smith AMA, Rissel CE, et al. Experiences of sexual coercion among a representation sample of adults. Aust N Z J Public Health 2003;27:198–203.
  215. Hayatbakhsh MR, Najman JM, Jamrozik K, et al. Childhood sexual abuse and cannabis use in early adulthood: Findings from an Austral-ian birth cohort study. Arch Sex Behav 2009;38:135–42.
  216. Higgins DJ, McCabe MP. Multiple forms of child abuse and neglect: Adult retrospective reports. Aggress Violent Behav 2001;6:547–78.
  217. Indermaur D. Young Australians and domestic violence. Canberra: Australian Institute of Criminology, 2001.
  218. Mamun AA, Lawlor DA, O’Callaghan MJ, et al. Does childhood sexual abuse predict young adult’s BMI? A birth cohort study. Obesity 2007;15:2103–10.
  219. Mazza D, Dennerstein L, Garamszegi CV, et al. The physical, sexual and emotional violence history of middle-aged women: A communi-ty-based prevalence study. Med J Aust 2001;175:199–201.
  220. Moore E, Romaniuk H, Olsson C, et al. The prevalence of childhood sexual abuse and adolescent unwanted sexual contact among boys and girls living in Victoria, Australia. Child Abuse Negl 2010;23:379–85.
  221. Mouzos J, Makkai T. Women’s experiences of male violence: Findings from the Australian component of the International Violence Against Women Survey (IVAWS). Canberra: Australian Institute of Criminology, 2004.
  222. Najman JM, Dunne MP, Purdie DM, et al. Sexual abuse in childhood and sexual dysfunction in adulthood: An Australian population-based study. Arch Sex Behav 2005;34:517–26.
  223. Price-Robertson R, Smart D, Bromfield L. Family is for life: How childhood experiences within the family help or hinder the lives of young adults. Fam Matters 2010;85:7–17.
  224. Rosenman S, Rodgers B. Childhood adversity in an Australian population. Soc Psychiatry Psychiatr Epidemiol 2004;39:695–702.
  225. Adults Surviving Child Abuse (ASCA). ASCA 1300 Professional Support Line Research, October 2013.
  226. Chartier MJ, Walker JR, Naimark B. Childhood abuse, adult health, and health care utilization: results from a representative community sample. Am J Epidemiol 2007;165:1031–8.
  227. Cutajar MC, Mullen PE, Ogloff JRP, et al. Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse Negl 2010;34:813–22.
  228. Scott JG, Cohen D, DiCicco-Bloom B, et al. Understanding healing relationships in primary care. Ann Fam Med 2008;6:315–22.
  229. Holden T. ‘It’s still not my shame’ Adult survivors of childhood sexual abuse report, May 2002.
  230. Kezelman C, Stavropoulos P. The Last Frontier: Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery. Sydney: Adults Surviving Child Abuse, 2012.
  231. Australian Institute of Criminology. Australian Crimes: Facts and figures. Canberra: Australian Institute of Criminology, 2013.
  232. Jozkowski KN, Sanders SA. Health and sexual outcomes of women who have experienced forced or coercive sex. Women Health 2012;52:101–18.
  233. Miller TR, Cohen MA, Wiersema B. Victim costs and consequences: A new look – National Institute of Justice Research Report. Maryland: US Department of Justice, Office of Justice Programs, 1996.
  234. Samuels JE, Thacker SB. Full Report of the Prevalence, Incidence, and Consequences of Violence Against Women. Findings From the National Violence Against Women Survey: National Institute of Justice, US Department of Justice. Centers for Disease Control and Prevention, 2000.
  235. Hurley M, Parker H, Wells DL. The epidemiology of drug facilitated sexual assault. J Clin Forensic Med 2006;13:181–5.
  236. Tucker JS, Wenzel SL, Straus JB, Ryan GW, Golinelli D. Experiencing interpersonal violence: perspectives of sexually active, sub-stance-using women living in shelters and low-income housing. Violence Against Women 2005;11:1319–40.
  237. Murray S, Powell A. Sexual assault and adults with a disability. Enabling recognition, disclosure and a just response. Melbourne: Austral-ian Centre for the Study of Sexual Assault, 2008.
  238. VanZile-Tamsen C, Testa M, Livingston JA. The impact of sexual assault history and relationship context on appraisal of and responses to acquaintance sexual assault risk. J Interpers Violence 2005;20:813–32.
  239. Loh C, Gidycz CA. A prospective analysis of the relationship between childhood sexual victimization and perpetration of dating violence and sexual assault in adulthood. J Interpers Violence 2006;21:732–49.
  240. Morrison Z. Homelessness and sexual assault. Melbourne: Australian Centre for the Study of Sexual Assault, 2009.
  241. Quadara A. Sex workers and sexual assault in Australia. Melbourne: Australian Centre for the Study of Sexual Assault, 2008.
  242. Tarczon C, Quadara A. The nature and extent of sexual assault and abuse in Australia. Melbourne: Australia Centre for the Study of Sexual Assault, 2012.
  243. Amowitz LL, Reis C, Lyons KH, et al. Prevalence of war-related sexual violence and other human rights abuses among internally dis-placed persons in Sierra Leone. JAMA 2002;287:513–21.
  244. Burgess AW, Holmstrom LL. Rape trauma syndrome. Am J Psychiatry 1974;131:981–6.
  245. Green AH. Child sexual abuse: immediate and long-term effects and intervention. J Am Acad Child Adolesc Psychiatry 1993;32:890–902.
  246. World Health Organization. Guidelines for medico-legal care of sexual violence survivors. Geneva: WHO, 2003.
  247. Mein JK, Palmer CM, Shand MC, et al. Management of acute adult sexual assault. Med J Aust 2003;178:226–30.
  248. Post L, Page C, Conner T, Prokhorov A, Fang Y, Biroscak BJ. Elder abuse in long-term care: types, patterns, and risk factors. Res Aging 2010;32:323–48.
  249. Johannesen M, LoGiudice D. Elder abuse: a systematic review of risk factors in community-dwelling elders. Age Ageing 2013;42:292–8.
  250. Australian Medical Association. AMA Position Statement on Care of Older People 1998 – amended 2000 and 2011, 2011.
  251. Glasgow K, Fanslow J. Family Violence Intervention Guidelines: Elder abuse and neglect. Wellington: Ministry of Health, 2006.
  252. World Health Organization. Elder maltreatment fact sheet. Geneva: WHO, 2011.
  253. Schofield MJ, Powers JR, Loxton D. Mortality and disability outcomes of self-reported elder abuse: a 12-year prospective investigation. J Am Geriatr Soc 2013;61:679–85.
  254. Kurrle S, Naughtin G. An overview of elder abuse and neglect in Australia. J Elder Abuse Negl 2008;20:108–25.
  255. Kurrle SE, Sadler PM, Cameron ID. Elder abuse – an Australian case series. Med J Aust 1991;155:150–3.
  256. Kurrle SE, Sadler PM, Lockwood K, Cameron I. Elder abuse: prevalence, intervention and outcomes in patients referred to four aged care assessment teams. Med J Aust 1997;166:119.
  257. Livermore P, Bunt R, Biscan K. Elder Abuse among Clients and Carers Referred to the Central Coast ACAT: a Descriptive Analysis. Aus-tralas J Ageing 2001;20:41–7.
  258. Acierno R, Hernandez MA, Amstadter AB, et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and poten-tial neglect in the United States: the National Elder Mistreatment Study. Am J Public Health 2010;100:292–7.
  259. National Centre on Elder Abuse. Fact Sheet: Elder Abuse Prevalence and Incidence. Washington: National Centre on Elder Abuse, 2005.
  260. Elder Abuse Prevention Project. Strengthening Victoria’s Response to Elder Abuse. Melbourne: State Government of Victoria, Department for Victorian Communities, 2005.
  261. The Senate Committee of Inquiry. Quality and equity in aged care report. Canberra: Commonwealth Government of Australia, 2005.
  262. Yaffe MJ, Tazkarji B. Understanding elder abuse in family practice. Can Fam Physician 2012;58:1336–40.
  263. Cupitt M. Identifying and addressing the issues of elder abuse: a rural perspective. J Elder Abuse Negl 1997;8:21–30.
  264. Eastgate G, van Deil M, Lennox N, Scheermeyer E. Women with intellectual disabilities – study of sexuality, sexual abuse and protection skills. Aust Fam Physician 2011;40:226–30.
  265. Eastgate G, Scheermeyer E, van Driel M, Lennox M. Intellectual disability, sexuality and sexual abuse prevention – a study of family mem-bers and support workers. Aust Fam Physician 2012;41:135–9.
  266. Hughes K, Bellis MA, Jones L, et al. Prevalence and risk of violence against adults with disabilities: a systematic review and me-ta-analysis of observational studies. Lancet 2012;379:1621–9.
  267. Australian Bureau of Statistics. Disability, ageing and carers. Australia: summary of findings 2009. Canberra: Commonwealth of Australia, 2011.
  268. Intellectual Disability Rights Service. Legal Advice, 2014.
  269. Jenkins R, Davies R. Neglect of people with intellectual disabilities. J Intellect Disabil 2006;10:35–45.
  270. Khemka I, Hickson L, Reynolds G. Evaluation of a decision-making curriculum to empower women with mental retardation to resist abuse. Am J Ment Retard 2005;105:193–204.
  271. Barger E, Wacker J, Macy R, Parish S. Sexual assault prevention for women with intellectual disabilities: a critical review of the evidence. Intellect Dev Disabil 2009;47:249–62.
  272. Johnson K, Frawley P, Hillier L, et al. Living Safer Sexual Lives: Research and Action. Tizard Learning Disability Review 2002;7.
  273. National Disability Insurance Scheme Launch Transition Agency (National Disability Insurance Agency). National Disability Insurance Scheme.
  274. Gordon S, Hallahan K, Henry D. Putting the picture together: Inquiry into response by government agencies to complaints of family vio-lence and child abuse in Aboriginal communities. Perth: State Law Publisher, 2002.
  275. Mow KE. Tjunparni: Family violence in Indigenous Australia. Canberra: ATSIC, 1992.
  276. Mullighan EP. Children on Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Commission of Inquiry. A report into sexual abuse. Adelaide: South Australian Government, 2008.
  277. NSW Aboriginal Child Sexual Assault Taskforce. Breaking the silence: Creating the future. Addressing child sexual assault in Aboriginal communities in NSW. Sydney: NSW Government, 2006.
  278. Robertson B. The Aboriginal and Torres Strait Islander Women’s Taskforce on Violence Report. Brisbane: Queensland Government, 1999.
  279. Victorian Indigenous Family Violence Task Force. Victorian Indigenous Family Violence Task Force Final Report. Melbourne: Depart-ment of Victorian Communities, 2003.
  280. Wild R, Anderson P. Ampe Akelyernemane Meke Mekarle: Little Children are Sacred. Report of the Northern Territory Government Inquiry into the Protection of Aboriginal Children from Sexual Abuse. Darwin: Department of the Chief Minister, 2007.
  281. Victorian Government Department of Justice. Measuring Family Violence in Victoria – Victorian Family Violence Database: Seven Year Trend Analysis 1999–2006. Melbourne: Department of Justice, 2008.
  282. Berrios D, Grady D. Domestic violence: risk factors and outcomes. West J Med 1991;155:133–6.
  283. Campbell J, Lewandowski L. Mental and Physical Health Effects of Intimate Partner Violence on Women and Children. Psychiatr Clin North Am 1997;20:353–74.
  284. Langton M. The end of big men politics. Griffith Review 2008;22:13–38.
  285. Cripps K, Adams M. Family Violence: Pathways Forward. In: Dudgeon P, Milroy H, Walker R, editors. Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. Canberra: Commonwealth of Australia, 2014:399–416.
  286. Australian Human Rights Commission. Social Justice Report 2011. Sydney: Australian Human Rights Commission, 2011.
  287. Cripps K. Enough family fighting: Indigenous community responses to addressing family violence in Australia and the United States. Melbourne: Monash University, 2004.
  288. Dibble U, Straus M. Some social structure determinants of inconsistency between attitudes and behaviour: The case of family violence. J Marriage Fam 1980;42:71–80.
  289. Gill C, Theriault L. Connecting social determinants of health and woman abuse: A discussion paper. Charlottetown: University of Prince Edward Island, 2005.
  290. Malcoe L, Duran B. Intimate partner violence and injury in the lives of low-income Native American women. In: Fisher B, editor. Develop-ments in research practice and policy: Violence against women and family violence. Washington: US Department of Justice, 2004.
  291. Malcoe L, Duran B, Montgomery J. Socioeconomic disparities in intimate partner violence against Native American women: A cross-sectional study. BMC Medicine 2004;2.
  292. Oetzel JG, Duran B. Intimate partner violence in American Indian and/or Alaska Native communities: A social ecological framework of de-terminants and interventions. The American Indian and Alaska Native Mental Health Research: A Journal of the National Center. 2004;11:49–68.
  293. Raphael J, Tolman R. Trapped by poverty/trapped by abuse: New evidence documenting the relationship between domestic violence and welfare. Chicago: Taylor Institute and the University of Michigan Research Development Center on Poverty, Risk and Mental Health, 1997.
  294. Cripps K, Bennett C, Gurrin L, Studdert D. Victims of violence among Indigenous mothers with dependent children. Med J Aust 2009;191:481–5.
  295. Day A, Howells K, Nakata M, et al. The development of culturally appropriate anger management programs for Indigenous people in Aus-tralian prison settings. Int J Offender Rehab Comp Criminol 2006;50:520–39.
  296. White M. Pathways to a good life well lived: Community-owned recovery plan for overcoming suicidal despair in the Fitzroy Valley. Fitz-roy Crossing: Marninwarntikura Fitzroy Women’s Resource and Legal Centre, Marra Worra Worra Aboriginal Corporation, Nindilingarri Cultural Health and Kimberley Aboriginal Law and Cultural Centre, 2011.
  297. Raj A, Silverman JG, McCleary-Sills J, Liu R. Immigration policies increase south Asian immigrant women’s vulnerability to intimate part-ner violence. J Am Med Womens Assoc 2005;60:26–32.
  298. Baba Y, Murray SB. Spousal abuse: Vietnamese reports of parental violence. J Sociol Soc Welf 2003;30:97.
  299. Khosla AH, Dua D, Devi L, Sud SS. Domestic violence in pregnancy in North Indian women. Indian J Med Sci 2005;59:195–9.
  300. The Victorian Foundation for Survivors of Torture Inc. Caring for Refugee patients in General Practice: A Desktop Guide. 4th edn. The Victorian Foundation for Survivors of Torture Inc, 2012.
  301. Echevarria A, Johar A. Beyond bitter moments: Non-English speaking women’s access to support services for survivors of domestic vio-lence. Fairfield West: Ettinger House, 1987.
  302. Australian Bureau of Statistics. 2071.0 – Reflecting a Nation: Stories from the 2011 census, 2012–2013. Cultural Diversity in Australia. Can-berra: ABS, 2012. [Accessed 18 October 2013].
  303. Garcia-Moreno C, Jansen HAFM, Ellsberg M, et al. Prevalence of intimate partner violence: findings from the WHO multicountry study on women’s health and domestic violence. Lancet 2006;368:1260–9.
  304. Silverman JG, Decker MR, Saggurti N, Balaiah D, Raj A. Intimate partner violence and HIV infection among married Indian women. JAMA 2008;300:703–10.
  305. Vung ND, Ostergren PO, Krantz G. Intimate partner violence against women in rural Vietnam – different socio-demographic factors are associated with different forms of violence: Need for new intervention guidelines? BMC Public Health 2008;8.
  306. Raj A, Liu R, McCleary-Sills J, Silverman JG. South Asian victims of intimate partner violence more likely than non-victims to report sexual health concerns. J Immigr Health 2005;7:85–91.
  307. Raj A, Silverman JG. Intimate partner violence against South Asian women in greater Boston. J Am Med Womens Assoc 2002;57:111–4.
  308. Abramsky T, Watts CH, Garcia-Moreno C, et al. What factors are associated with recent intimate partner violence? Findings from the WHO multi-country study on women’s health and domestic violence. BMC Public Health 2011;11.
  309. Ellsberg M, Jansen HA, Heise L, et al. Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study. Lancet 2008;371:1165–72.
  310. Kumar S, Jeyaseelan L, Suresh S, et al. Domestic violence and its mental health correlates in Indian women. Br J Psychiatry 2005;187:62–7.
  311. Rodriguez M, Saba G. Cultural competence and intimate partner abuse: health care interventions. In: Roberts G, Hegarty K, Feder G, edi-tors. Intimate partner abuse and health professionals: New approaches to domestic violence. London: Churchill Livingstone Else-vier, 2006. p. 179–96.
  312. Hegarty K, Taft A, Feder G. Violence between intimate partners: working with the whole family. BMJ 2008;337.
  313. Mezey G, King M, MacClintock T. Victims of violence and the general practitioner. Br J Gen Pract 1998;48:906–8.
  314. NSW Health Department. NSW Health – Domestic Violence Policy Discussion Paper. Gladesville: NSW Dept Health, 1999.
  315. Coles J, Dartnall E, Astbury J. Preventing the pain when working with family and sexual violence in primary care. Int J Fam Med 2013;2013:7.
  316. Rowe L, Kidd M. First do no harm: being a resilient doctor in the 21st century. North Ryde: McGraw-Hill Australia, 2009.
  317. Weiner E, Swain G, Wolf B, Gottlieb M. A qualitative study of physicians’ own wellness-promotion practices. West J Med 2001;174:19–23.
  318. Clode D, Boldero J. Keeping the doctor alive – a self care guide book for medical practitioners. Melbourne: The Royal Australian College of General Practitioners, 2005.
  319. Hudnall-Stamm B. Secondary traumatic stress: self-care issues for clinicians, researchers and educators. Lutherville: Sidran Press, 1995.
  320. National Centre for Posttraumatic Stress Disorder. Working with trauma survivors: what workers need to know. National Centre for Post-traumatic Stress Disorder. Washington: Department for Veteran’s Affairs, 2007. [Accessed May 2014].
  321. Saakvitne K, Pearlman L. Transforming the pain: a workbook on vicarious traumatisation. London: Norton; 1996.
  322. Bloom S. Caring for the Caregiver: Avoiding and Treating Vicarious Traumatization. In: Giardino A, Datner E, Asher J, editors. Sexual As-sault, Victimization Across the Lifespan. Maryland Heights: GW Medical Publishing, 2003. p. 459–70.
  323. Benson J, Thistlethwaite J. Mental Health Across Cultures. A practical guide for health professionals. Abingdon: Radcliffe Publishing Ltd, 2009.
  324. Snowdon T, Benson J, Proudfoot J. Capacity and the quality framework. Aust Fam Physician 2007;36:12–4.
  325. Stevenson A, Phillips C, Anderson K. Resilience among doctors who work in challenging areas: a qualitative study. Brit J Gen Pract 2011:404–10.
  326. Edwards N, Kornacki M, Silversin J. Unhappy doctors: what are the causes and what can be done? BMJ 2002;324:835–38.
  327. Freeborn D. Satisfaction, commitment, and psychological well-being among HMO physicians. West J Med 2001;174:13–28.
  328. Figley C. Coping with traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel, 1995.
  329. Adults Surviving Child Abuse (ASCA). Best practice guidelines for working with adults surviving child abuse. (Accessed 2014).
  330. Taft A, Small R, Humphreys C, Hegarty K, Walter R, Adams C, Agius P. Enhanced maternal and child health nurse care for women experi-encing intimate partner/family violence: protocol for MOVE, a cluster randomised trial of screening and referral in primary health care. BMC Public Health 2012;12:811
  331. Gath DH, Mynors-Wallis LM. Problem-solving treatment in primary care. In: Clark DM, Fairburn CG, editors. Science and practice of cog-nitive behaviour therapy. Oxford: Oxford University Press, 1997.