White Book

Specific vulnerable populations: the elderly and disabled - Chapter 10.1

Elder abuse

Abuse and violence: Working with our patients in general practice
Download PDF
    1. Elder abuse

Last revised: 15 Jan 2020

Key messages

  • Abuse may be physical, emotional, sexual or financial and may include neglect. It can occur in an aged care facility or in the community 11
  • Risk factors for elder abuse can be related to the individual, the perpetrator, relationships and the wider environment 248, 249
Table 1

Table 1

Coding scheme used for levels of evidence and grades of recommendation 

Download View full size

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

Practice point
Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees

  1. Australian Medical Association. AMA Position Statement on Care of Older People 1998 – amended 2000 and 2011, 2011.

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

Practice point
Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees

  1. Glasgow K, Fanslow J. Family Violence Intervention Guidelines: Elder abuse and neglect. Wellington: Ministry of Health, 2006.

Elder abuse is defined as any type of abuse – physical, emotional, sexual, economic – or neglect of people aged 65 years or over, either in an residential aged care facility (RACF), in private care, or living independently. It can be a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.11 Elder abuse occurs in all cultural and socioeconomic strata whenever there is an imbalance of power252 and is linked to increased mortality and disability.253

Abuse may occur to an elderly person being cared for by family or other community carers, or in an RACF and hospital when the frailty of elderly residents renders them unable to defend themselves. An abuser may be a family member or carer, and in the case of older persons in residential care, the abuser may be another resident (sometimes with dementia), a staff member (including volunteers), visitors or family members.

Elder abuse may occur for many reasons, covering individual, relationship, community and sociocultural causative factors.252 For example, caring for a family member means there may be a change in role where the carer becomes the ‘parent’ and the ‘parent’ becomes the ’child’. This increasing dependency can be frustrating and act as a catalyst for abusive behaviour by the carer, particularly if the carer is insufficiently supported.

The ongoing safety of the patient is paramount. Safety may only be achieved by transferring the patient from home or from the RACF. For elderly people the fear of retribution is strong and may be contributing to their unwillingness to disclose.11

There are no recent national statistics in relation to elder abuse254 and few worldwide. A NSW study of clients referred to an Aged Care Assessment Service showed that 4.6% of older people living in the community and referred to the Aged Care Assessment Service had experienced elder abuse.255 A study of four Aged Care Assessment Teams in QLD, WA and NSW showed a prevalence rate of 2.3%256 and a study in a large regional aged care service in NSW found 5.4% of clients referred had also experienced elder abuse.257 In studies in the United States (where participants aged 60 and over are included), the prevalence of elder abuse ranged from 11.4% to 14.1%.248,258 Apart from the age of those participants included in the studies, discrepancies in prevalence rates may be due to issues of definition as some types of elder abuse were not included.254

In addition, there may be five unreported instances of abuse to every one reported.259 The real prevalence of elder abuse is obscured due to a number of factors, including fear of retribution when reporting a complaint. The ageing of Australia’s population and the increasing numbers of adults with dementia contribute to the anticipated growth in the prevalence of elder abuse.260

The Australian Medical Association (AMA) stipulates in its position statement on the care of older people that GPs have a ‘pivotal role in the recognition, assessment, understanding and management of elder abuse and neglect’.250

GPs are often the first independent professional to see an elderly victim of abuse. There are a number of reasons why medical practitioners may not have been more involved in managing cases of abuse. These include lack of awareness, insufficient knowledge regarding identification or follow-up of a potential case, ethical issues, time constraints, and the victim’s potential reluctance to report the abuse.11

Understanding the risk factors for people who abuse vulnerable elders can provide information for intervention and preventive strategies.260

Risk factors can include:248,249

  • individual
    • cognitive impairment
    • behavioural problems
    • psychiatric illness or psychological problems
    • functional dependency
    • poor physical health or frailty
    • low income or wealth
    • trauma or past abuse
    • ethnicity
  • perpetrator
    • caregiver burden or stress
    • psychiatric illness or psychological problems
  • relationship
    • problems within the family
    • relationship conflicts
  • environment
    • low social support
    • living with others (except for financial abuse).

A US study found that community-dwelling middle-aged and older women who reported physical abuse in the preceding year, verbal abuse or both types of abuse had significantly higher adjusted mortality risk than non-abused peers.261

A predisposing factor to elder abuse is dependency caused by physical impairment, dementia, mental illness, stroke, sensory impairment, or intellectual impairment.252 This risk factor occurs regardless of whether the older person is being cared for in the home or in an RACF. However, as the majority of RACF residents have some form of dependency, such as physical or cognitive impairment, the GP and RACF staff should be alert to the possible occurrence of elder abuse.248 Refer to Table 15 for a list of possible signs and symptoms of elder abuse.

Table 15. Possible signs and symptoms of elder abuse

Table 15

Possible signs and symptoms of elder abuse262

Download View full size


If the possibility of abuse is suspected or concern is raised, you can use the consultation time to observe the emotional reactions and body language of the older person and the suspected abuser. Also, you can observe face-to-face interactions between the two. If the patient is in an RACF, remember that an abuser may be another resident (sometimes with dementia), a staff member (including volunteers), visitors or family members.

If the patient has the capacity to give a history, it should be taken without others present. If this history differs from that given by carers or other family members, suspicions should be raised.251 Ask the patient direct questions (refer to Tool 6. Elder Abuse Suspicion Index), and if suspicion of abuse is confirmed, you can request permission from the patient to report the information to the appropriate parties (Table 16). However, although there is no legal compulsion requiring GPs to report elder abuse, any abuse affects the health and wellbeing of the patient and therefore the GP needs to have a response that ensures safety for the patient ( refer to Chapter 13 ).

Management of sexual or physical assault

If you are given permission by the patient, or you are satisfied that there are grounds to believe that the patient has been abused sexually or physically (eg the patient’s guardian has told you of the abuse) you may want to notify the police. Once it is established by the police that abuse has occurred, they will conduct any further notification or questioning.

In criminal cases you should document all injuries and consider photographing injuries before initiating treatment. You will need to gain consent from the patient to photograph injuries. In the case of sexual assault, evidence may need to be collected by forensic examination. Refer to Chapter 9 and resources for details about consulting forensic specialists or referring patients to them.

Table 16. Reporting and documenting

Table 16

Reporting and documenting

Download View full size

Rural and remote communities present another set of challenges associated with the lack of RACFs and access to other services.263 In some rural communities people living in an RACF will be some distance from their families and will be more isolated. There is also the understated issue of maintaining confidentiality within small community groups. Below is a case study from a rural area that illustrates some of the issues.

Case study: Winnie

Winnie, aged 69 years, is fiercely independent and lives by herself in a small country town. She has been a patient of yours for a number of years. She has severe arthritis and requires more and more help with the activities of daily living. Even with regular visits from community services, she finds it difficult to cope, but she is adamant that she doesn’t want to go to the regional hospital.

Eventually she moves in with her daughter and husband and their young sons. The neighbours begin to complain about the noise. Since Winnie has moved in, there is not much space in the house and the children are fighting more often, shouting and generally playing up. Winnie’s daughter receives no help from her other sisters and is expected to cope with the increased washing, cooking and other duties without complaint.

When you make house calls to Winnie you notice that she has marks and bruises on her arms and upper torso. These are explained away by her daughter, who says that she is becoming clumsier and keeps knocking into things. Winnie just shakes her head and says nothing, even when you speak to her in private. You are worried about pressing the issue because your clinic is the only one in town and you do not want to upset anybody.

Diagnosis

GPs need to acknowledge that abuse may be happening in this situation. The Elder Abuse Suspicion Index can help with an assessment.

Management

You may involve the home nursing service, home help, day centre, carer support groups or other local services to relieve the pressure on this family. Another alternative is to seek the help of an aged care assessment team if available. Respite care or admission to an RACF are other options, depending on what is available.

Outcome

Winnie remains in her daughter’s house with some extra aids – for example, a toilet raise, home help for bathing, respite care – which allows her daughter time out of the house; and Winnie attends the day centre once a week. It is unclear that this will alleviate the situation, so it is important to maintain a close watch on Winnie with weekly house calls.

  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. [Accessed 18 October 2013].
  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. [Accessed 18 October 2013].
  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. [Accessed 18 October 2013].
  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. [Accessed 18 October 2013].
  307. Raj A, Silverman JG. Intimate partner violence against South Asian women in greater Boston. J Am Med Womens Assoc 2002;57:111–4. [Accessed 18 October 2013].
  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. [Accessed 18 October 2013].
  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. [Accessed 18 October 2013].
  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. [Accessed 18 October 2013].
  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. [Accessed 18 October 2013].
  312. Hegarty K, Taft A, Feder G. Violence between intimate partners: working with the whole family. BMJ 2008;337. [Accessed 18 October 2013].
  313. Mezey G, King M, MacClintock T. Victims of violence and the general practitioner. Br J Gen Pract 1998;48:906–8. [Accessed 18 October 2013].
  314. NSW Health Department. NSW Health – Domestic Violence Policy Discussion Paper. Gladesville: NSW Dept Health, 1999. [Accessed 18 October 2013].
  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. [Accessed 18 October 2013].
  316. Rowe L, Kidd M. First do no harm: being a resilient doctor in the 21st century. North Ryde: McGraw-Hill Australia, 2009. [Accessed 18 October 2013].
  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. [Accessed 18 October 2013].
  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. [Accessed 18 October 2013].
  319. Hudnall-Stamm B. Secondary traumatic stress: self-care issues for clinicians, researchers and educators. Lutherville: Sidran Press, 1995. [Accessed 18 October 2013].
  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. [Accessed May 2014].
  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. [Accessed May 2014].
  323. Benson J, Thistlethwaite J. Mental Health Across Cultures. A practical guide for health professionals. Abingdon: Radcliffe Publishing Ltd, 2009. [Accessed May 2014].
  324. Snowdon T, Benson J, Proudfoot J. Capacity and the quality framework. Aust Fam Physician 2007;36:12–4. [Accessed May 2014].
  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. [Accessed May 2014].
  326. Edwards N, Kornacki M, Silversin J. Unhappy doctors: what are the causes and what can be done? BMJ 2002;324:835–38. [Accessed May 2014].
  327. Freeborn D. Satisfaction, commitment, and psychological well-being among HMO physicians. West J Med 2001;174:13–28. [Accessed May 2014].
  328. Figley C. Coping with traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel, 1995. [Accessed May 2014].
  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.