Domestic Violence Management & Screening Procedure

1. Purpose Domestic Violence Management & This Procedure provides all West Coast District Health Board (WCDHB) clinical staff members with clear guidelines to enable them to implement the WCDHB Family Violence Policy. 2. Application This Procedure is to be followed by all WCDHB clinical staff members. 3. Definitions Refer to WCDHB Family Violence Management Policy. Responsibilities Refer to WCDHB Family Violence Management Policy 5. Resources Required Family Violence Guidelines 1-13 Partner Abuse: Assessment & Response flow chart Family Violence Resource Kit Cue Cards 6. Process Family Violence Risk Assessment Form Family Violence Fax Referral Form 1.00 Identification 1.01 All females aged 15 years and older should be screened routinely. This includes questioning about physical and sexual abuse, or if they are afraid of a current or past partner. 1.02 Males aged 15 years and older who present with signs and symptoms indicative of abuse should be questioned. 1.03 Physical and sexual abuse commonly co-exists, therefore assessment for both needs to occur. See Guideline 3 for Signs and Symptoms of Family Violence. See Guideline for Guidelines on Identifying Abuse. 2.00 Support and Empower Victims of Abuse 2.01 Disclosure of Family violence is a difficult step, and many victims feel shame and guilt. Victims of all ages need to be reassured that it is not their fault and that help is available. Hearing these messages from a health care provider is one of the most powerful interventions that health professionals can provide. It is not necessary to take a full history 1

of the abuse and it may be unhelpful. See Guideline 5 for Supporting and Empowering Victims of Abuse. 3.00 Risk Assessment 3.01 The purpose of the risk assessment is to establish the level of immediate risk for a patient leaving the health care facility. This includes the risk of homicide, the risk of suicide and any risk to children. Hospital Admission must be considered as an option. 3.02 The presence or absence of injuries or other evidence of abuse are not prerequisites for making a referral, particularly if there is a risk to children. Early referral to support agencies is the preferred intervention. 3.03 Health care professionals are responsible for conducting a preliminary risk assessment with victims about their abuse in order to identify appropriate referral options. A detailed risk assessment may be undertaken by agencies that specialise in responding to partner abuse, e.g. a social worker or community agency, such as Women s Refuge. A multidisciplinary team approach is the preferred option for assessment. 3.0 When domestic violence is identified a history of child abuse must be sought. For the assessment and management of children who may be at risk of abuse refer to the WCDHB Child Protection Procedure. See Guideline 6 for Guidelines for Risk Assessment and see Risk Assessment Form..00 Safety Planning and Referral.01 If family violence is identified or suspected a plan for safety needs to be made following the risk assessment. A multidisciplinary team approach is the preferred option. Hospital Admission should be considered as an option..02 Information regarding family violence and safety planning are held in each department in the Family Violence Resource kit..03 Except in rare cases where victims of partner abuse are in immediate danger, for most adult victims of partner abuse, affirmation may be the most powerful intervention you can offer..0 Women s refuge is available as a safe place for women who wish to leave, and consideration needs to be given to making the necessary arrangements to facilitate this. See Guideline 7 for Guidelines for Safety Interventions See Guideline 8 for Safety and Security Processes See also Family Violence Community Directory and fax referral form (intranet) 5.00 Documentation 5.01 Accurate documentation is fundamental regardless of the purpose, therefore if it is not documented, then it did not occur. Accurate and timely documentation is an important element of keeping victims safe. The clinical record may be used to refer or assist in 2

litigation, protect actions taken by staff and also for example securing a Domestic Protection Order. An objective, systematic history and risk assessment is therefore essential and standard professional requirements apply (e.g. a legible signature and designation). (See WCDHB Clinical Documentation Procedure) 5.02 Confidentiality is paramount. Family Violence disclosures must be documented and the patient/client made aware that information is being documented: the purpose, the use of information, and their rights to access/correct inaccurate information and statutory requirements which may require the information to be disclosed to certain agencies (e.g. Police). 5.03 The WCDHB Family Violence Risk Assessment/Documentation Form is to be completed and filed in an accessory file and NOT the patient s Clinical Record. The HPS (Hospital Patient System) will be updated to reflect an alert exists and for staff to check the physical record. This alert appears on Ward, Theatre, OPD, ED and patient census screens. The accessory file is to be stored in the Medical Records Department and is only to be accessed with authority from a senior staff member. See Guideline 9 for Guidelines On Documentation of Family Violence. 6.00 Referral Agencies 6.01 Referral agencies are a vital service for the support of victims of abuse. WCDHB has established interagency processes with a range of organisations and agencies (refer to the Resource Kit in your Department). 7. Precautions And Considerations All females aged 15 years and older should be screened routinely for domestic violence Males aged 15 years and older who present with signs and symptoms indicative of abuse should be questioned. If family violence is identified or suspected a plan for safety needs to be made following the risk assessment. The WCDHB Family Violence Risk Assessment/Documentation Form is to be completed and filed in an accessory file and NOT the patient s Clinical Record. 8. References Ministry of Health. (1998). Family Violence. Guidelines for Health Sector Providers to Develop Practice Protocols. MOH: Wellington. Ministry of Health. (2002). Family Violence Intervention Guidelines. Child and Partner Abuse. MOH: Wellington 3

9. Related Documents WCDHB Family Violence Management Policy WCDHB Clinical Documentation Procedure WCDHB Guidelines on Family Violence WCDHB Tikanga Best Practice Guidelines WCDHB Child Protection Procedure Version: 3 Developed By: Family Violence Co-Ordinator Revision Authorised By: Executive Management Team History Date Authorised: September 2006 Date Last Reviewed: August 2012 Date Of Next Review: August 201 10. UIDELINE Guidelines 1 GUIDELINE 2 GUIDELINE 3 GUIDELINE GUIDELINE 5 GUIDELINE 6 GUIDELINE 7 GUIDELINE 8 GUIDELINE 9 GUIDELINE 10 GUIDELINE 11 GUIDELINE 12 GUIDELINE 13 Process for Achieving Outcome Cultural Considerations Signs and Symptoms Associated With Domestic Violence Guidelines for Identifying Victims Of Abuse Guidelines to Support And Empower Victims Of Abuse Guidelines for Risk Assessment Risk Assessment Form Guidelines for Safety Intervention Guidelines for Documentation of Family Violence Family Violence Community Directory Fax Referral Form Safety and Security Processes Relevant Legislation

GUIDELINE 1 PROCESS FOR ASSESSMENT & RESPONSE 5

GUIDELINE 2 - CULTURAL CONSIDERATIONS This section from the Family Violence Intervention Guidelines 1 was developed with consultation from the Ministry of Health Family Violence Maori Advisory Committee. This appendix offers some background and context for family violence in relation to Maori, and identifies key principles and actions for effective screening and intervention. The experience of family violence for Maori is complex. The historical context and process of colonisation have distanced Maori from their traditional roles and social supports. With the breakdown of traditional whanau structure, loss of beliefs and values, including te reo Maori, patterns of behaviour have emerged. For some Maori family violence is no longer viewed as prohibited and the traditional sanctions are no longer in place. Violence impacts negatively on whanau, hapu and iwi. The Family Violence Intervention Programme (FVIP) has developed this programme within the founding principles of the Treaty of Waitangi. Consultation with Maori has been a valued component of the programme from planning, through the implementation and evaluation phases. Principles of Action E tau hikoi I runga I oku whariki E tau noho I toku matapihi E hau kina ai toku tatau toku matapihi. Your steps on my whariki (mat), your respect for my home, Opens my doors and windows. Health care providers should ensure the service they provide is safe and respectful of Maori women s beliefs and practices. The delivery of culturally safe and competent intervention that responds to Maori victims is supported by the following principles: Victim safety and protection are paramount Maori-friendly environment Culturally safe and competent interactions Engagement of local iwi, hapu and whanau Knowledge of the community Intersectorial collaboration Monitoring and evaluation of family violence interventions with Maori women and children. Victim Safety Maintaining safety of women and children is paramount. This includes only questioning women about abuse when they are alone or accompanied by children under 2 years Affirm women s and children s right to a safe, non-violent home Have Maori staff available when possible, this may include Kaumatua or Kuia who can provide support. Routinely screen Maori women for violence Offer women options about possible plans of action they would like to take. The Provision Of A Maori-Friendly Environment Ensure there are Maori images within the environment of the health care service, such as posters, signage and Maori designs Having Maori on staff (liaison with Maori Advisor) Convey a genuine attitude that is gentle, welcoming, caring, non-judgemental and respectful 6

Do not rush. Leave time to think about and respond to questions Ask open-ended questions Offer resources and support. The Provision Of Culturally Safe And Competent Interactions Engage the support of Maori to provide cultural guidance during the planning, implementation and evaluation of the Family Violence Intervention Programme. All WCDHB staff are encouraged to attend cultural training. A collaborative community approach to Family Violence should be taken. Staff should be aware of the referral agencies appropriate for Maori women and children who are victims of abuse. Do not assume that the whanau should be involved in supporting the women and child(ren) - ask the women what plan of action they want (it may or may not include the whanau). Pacific Peoples and Family Violence There are seven main Pacific communities represented in New Zealand, Samoa, Tuvalu, Tokelau, Fiji, Tonga, Niue, and the Cook Islands. Family violence among Pacific communities in New Zealand occurs in the context of social change brought about by the migration from the Pacific, alienation from traditional concepts of the village, family support, extended family relationships and in combination with the socio-economic stressors, for example scarce resources may be stretched between the demands of everyday living as well as customary obligations, such as those to the church and remittance to family members who have remained in the Pacific. Victim Safety Maintaining safety of women and children is paramount, this includes only questioning women about abuse when they are alone or accompanied by children under 2 years. Affirm women and children s right to a safe, non-violent home Routinely screen Pacific women for violence Offer women options about possible plans of action they would like to take. The Provision of a Pacific-Friendly Environment Convey a genuine attitude that is gentle, welcoming, caring, non-judgemental and respectful Do not rush, leave time to think about and respond to questions Ask open-ended questions Offer resources and support that meets the ethnic specific needs of the victim Have Pacific staff available. 7

The Provision of Culturally Safe And Competent Interactions Develop knowledge and understanding about the dynamics of family violence and victims who are from the Pacific culture. Identify and remove barriers for Pacific women and children accessing health care services All WCDHB staff are encouraged to attend cultural training. Pacific protocols are observed where possible A collaborative community approach to Family Violence should be taken Staff should be aware of the referral agencies appropriate for Pacific women and children who are victims of abuse Do not assume that the family or church should be involved in supporting the women and child(ren)- ask the women what plan of action they want (it may or may not include the family and the church). People of minority ethnicities and Family Violence Staff need to consider the increased isolation of patients/clients who represent minority ethnic groups ie. non-european, non-maori or non-pacific people. The majority of these patients/clients will have no support structures outside of the direct family. The potential for these patients/clients to identify as being abused or to seek help is extremely low. Their cultures will undoubtedly have values systems completely different to those well known in New Zealand which will strongly influence these families behaviours. Another consideration for the staff is the potential for women from these ethnicities to know people from the same region employed by West Coast District Health Board. Assumption cannot be made that people of the same ethnicity will be supportive to the woman. WCDHB staff are encouraged to make available the National services of Shakti Asian Womens support centre Lesbian, Gay, Bisexual, Transgender and Family Violence Patients/clients who are not heterosexual require particular consideration when identifying as being abused or presenting with injuries representative of abuse. Consideration must be given to the environment where bisexuals and transsexuals should be cared for. A single room in an inpatient area should be used. Referral or suggested contact should be sought from an appropriate agency of specific support group. Again the consideration must be made of the small numbers of this group of people in our community. 8

GUIDELINE 3 - SIGNS AND SYMPTOMS ASSOCIATED WITH DOMESTIC VIOLENCE Physical Injuries Injuries to the head, face, neck, chest, breast, abdomen or genitals. Bilateral distribution of injuries, or injuries to multiple sites. Contusions, lacerations, abrasions, ecchymosis, stab wounds, burns, human bites, fractures (particularly of the nose and orbits) and spiral wrist fractures. Complaints of acute or chronic pain, without evidence of tissue injury. Sexual assault (including unwanted sexual contact by a partner). Injuries of vaginal bleeding during pregnancy, spontaneous or threatened miscarriage. Multiple injuries, such as bruises, burns, scars, in different stages of healing. Substantial delay between time of injury and presentation for treatment. Tufts of hair pulled out. Patient s Manner Hesitant or evasive when describing injuries. Distress disproportionate to injuries (e.g. extreme distress over minor injury). Explanation does not account for injury (e.g. I walked into a door ). Illnesses Headaches, migraines Musculoskeletal complaints Gynaecological problems Chronic pain Malaise, fatigue Depression Insomnia Anxiety Chest pain, palpitations Gastrointestinal disorders Hyperventilation Eating disorders Serious Psychosocial Problems Alcohol abuse or addiction Severe depression. Drug abuse or addiction. Suicidal ideation or attempts. History Suspicion or record of previous abuse. Substantial delay between time of injury and presentation for treatment. Multiple presentations for unrelated injuries. The Oasis Protocol: Guidelines for identifying, treating and referring abused women. Auckland: Injury Prevention Research Centre, 1996. Cited in Fanslow, J. L. Family Violence Intervention Guidelines. Wellington: Ministry of health, 2002 9

GUIDELINE - IDENTIFYING VICTIMS OF ABUSE When assessing for family violence, in most circumstances, it is best to use simple, direct questions, asked in a non-threatening manner. Asking Adults about Possible Abuse Framing statements: Because violence is so common in many peoples lives, I routinely ask patients about it Many women I see as patients are dealing with family violence, therefore I ask all women this question. I notice I m worried statements, E.g. I notice you look sad/ have a bruise. I m worried someone might be hurting you/ have caused this. Validated partner violence screening questions: Have you been hit, kicked, punched, forced to have sex or otherwise hurt by someone within the past year? If so, by whom. A Yes response to this question is considered positive to family violence if the perpetrator was a current or former spouse or other intimate partner. Do you feel safe in your current relationship? Is there anyone making you feel unsafe now? NB: An alternative set of questions can be found in the MOH Family Violence Intervention Guidelines. Cue cards are available from the Family Violence Intervention Programme Coordinator. 10

GUIDELINE 5 SUPPORTING AND EMPOWERING VICTIMS OF ABUSE Identified Victims Listen to the person s story Encourage them to go on. Example, Tell me about that. Acknowledge what they have told you, be empathetic, non judgemental and non-blaming. Example That must have been terrifying. You are a strong person to have survived that. Validate You are not alone, others experience abuse in their homes too You are not to blame for abuse. You did nothing to deserve or provoke this, abuse is never justified. Inform You have a right to feel safe, and live free of abuse I can provide some information, which may help/support you. Do not pressure the person to leave. A person needs to feel well resourced and supported before they can leave safely. Suspected Victims If domestic violence is suspected, but the individual does not acknowledge that it is a problem. o Leave the door open for further contact and state that if abuse does become a concern, you are available to discuss it with them if they would like to. o Provide them with a means of contacting appropriate support agencies, e.g. community resource card. o Complete a risk assessment detailing your concerns. 11

GUIDELINE 6 RISK ASSESSMENT Danger Assessment A Risk assessment form is to be completed for disclosed or suspected abuse. This form will be filed in an accessory file to ensure victim safety and follow-up. Assessment of the following factors can assist in danger assessment, particularly if the woman is minimising or denying the extent of violence experienced. The greater the number of indicators, the greater the risk. Immediate Safety Risk Is the abuser present? Is the patient afraid of their partner? Is the patient afraid to go home? High Danger Risk Life threatening injuries, or several life threatening assaults, e.g. choking, strangling, beatings Children, elders or disabled at risk A threat to kill or a threat with a weapon has been made The person has recently separated from the abusive partner, or is considering separation Physical violence has increased in severity (upward trend) Perpetrator s access to weapons, particularly firearms. Other factors to consider Is alcohol or substance abuse involved? Other factors that increase risk of chaotic/ irrational behaviour, e.g. uncontrolled mental illness. Risk of Suicide or Self-Harm There is a strong association between victimisation from a partner and self-harm or suicide. Health care providers need to consider assessing possible suicide of identified victims. Signs associated with high risk of suicide include: Previous suicide attempts Stated intent to die/attempt to kill oneself A well developed concrete suicide plan, or access to a method to implement their plan Planning for suicide (for example, putting personal affairs in order) Other factors that are frequently associated with the risk of suicide or self-harm may themselves be symptoms of abuse. Factors include depression, extreme anxiety, agitation or enraged behaviour, excessive drug and/or alcohol use or abuse. Make direct inquires to assess if the abused person is thinking about committing suicide, or has attempted suicide in the past. If Domestic violence is Identified, Assess the Children s Safety Domestic violence and child abuse frequently occur together. If domestic violence is identified or suspected it is essential that an assessment of risk to children is conducted. For example you could ask, Are you ever worried about your children s safety? Are they ever hurt? See guideline 7 for risk assessment form 12

GUIDELINE 7: RISK ASSESSMENT FORM Family Violence Risk Assessment Form Name NHI No. Or Place Client Label Here FV Screen FV + (Positive) FV? (Suspected) Patient Pregnant? Yes No Assessment Of Patient Safety Name & relationship of alleged abuser Is the abuser here now? Yes No Is patient afraid to return home? Yes No Has violence increased?(frequency/severity) Yes No Specific types of violence: 1. Is there an immediate need for help? Yes No Threats of Homicide? Yes No By Whom: Threats of Suicide? Yes No By Whom: Is there a gun/weapons in the house? Yes No Is there a history of strangulation? Yes No 2. Is patient/client in danger? Yes No Do you have children in your care? Yes No Has anyone abused the children? Yes No Have these children witnessed violence in the home? Yes No Where are the Children now? 3. Are the children at high risk?(refer to: Child Protection Procedure) Yes No If YES answered to questions 1 or 2 please discuss safety concerns and referral to Women s Refuge or the Police. If YES answered to question 3 please discuss safety of children and referral to Women s Refuge, the Police or YFS Please document any drug/alcohol issues: Agencies/Support currently involved: REFERALS Women s Refuge Victims Support CYFS Police WCDHB Social Work WCDHB Mental Health Other Referral Information Given 13

Culturally appropriate referral Made? Yes To Whom? PLEASE CONTINUE RISK ASSESSMENT ON NEXT PAGE Measure, describe and show abrasions, lacerations, areas of pain and tenderness, sites of trace evidence, tattoos, scars and birthmarks Police photograph of injuries offered? Yes No Was a Safety Plan discussed? Yes No SAFETY PLAN (use additional pages if required) Form Originally Completed By Designation Signature Date Do not file in patients notes Please send to the Violence Intervention Programme Co-ordinator at Community Services 1

GUIDELINE 8 SAFETY INTERVENTIONS For a Small Percentage of Women there may be Immediate Safety Concerns Is the abuser here now? Does the abused person have a safe place to go to when leaving the consultation? Is emergency assistance required? (e.g. Police, Women s Refuge) Any decision regarding contacting the police should be made in consultation with the patient. This is to ensure their safety, as reporting the incident may enrage the perpetrator and increase the risk to the women. In the cases where reporting is a requirement e.g. Crimes Act 1961 inform the abused person of the requirement. See Guideline 10 for Relevant Legislation On the rare occasion that the healthcare provider believes a person s life is in immediate danger, or has good reason to believe that the person is unable to extricate themselves from a high level of ongoing, life-threatening danger, the Police may be notified without patient permission. The Privacy Act 1993 is not breached if the health care provider has acted in good faith to protect the patient from serious harm. The Health Information Privacy Code 199 is not breached when the disclosure of information is necessary to prevent or lessen a serious and imminent threat to: Public health or public safety; or The life or health of the individual concerned or another individual For any serious events involving staff or patients/clients, including any events where the Police are required to be notified the Clinical Leader or After Hours Co-Ordinator (if after hours) should be notified immediately. Admission to Hospital should be considered. For Patients with Ongoing Safety Concerns If possible, suggest the patient/ client makes contact with a specialist family violence service, such as Women s Refuge, during the consultation. Ask the woman if she will talk to them on the phone. Identify an ongoing support system, for example family/whanau, friend or community agency. Suggest the person considers legal options, e.g. Protection Orders. Provide a copy of the community agency support card, with phone numbers and the Women s Refuge safety plan resource. For all Abused Patients Provide a copy of the WCDHB Family Violence Survivors Guide that contains information on the likelihood of the abuse becoming more severe and more frequent without intervention. The impact on children of witnessing abuse may also be relevant. Getting safer is a process, not a single act. Unless there is a risk to a child or a clear and immediate risk to the adult victim, s/he has the right to choose a course of action. The role of the health professional is to support this decision. Supportive risk assessment and counselling can make it easier for that person to seek further assistance in the future when they are ready to act. Always leave the door open so they have a future point of contact. 15

Raising Public Awareness Routine questioning may be facilitated by creating an enabling environment with appropriate posters and pamphlets in waiting and clinical areas. From time to time WCDHB staff may also contribute to public campaigns aimed at reducing family violence. Co-occurrence of Child Abuse and Domestic Violence Joint safety planning and referral processes need to be implemented when both domestic violence and child abuse are identified. For the assessment and management of children who may be at risk of abuse refer to the WCDHB Child Protection Procedure. The emphasis should be on keeping the child(ren) safe and enabling the abused partner to get real and appropriate help. 16

GUIDELINE 9 DOCUMENTING FAMILY VIOLENCE Record the disclosure on the WCDHB Family Violence Risk Assessment/Documentation Form. (If not available use a new sheet of clinical notepaper) Note the stated or suspected cause of the injuries and when they allegedly occurred. Assaulted by partner is not sufficient. A vague history is readily challenged in court and therefore would not help keep a victim safe. Be specific, e.g. Miss X alleges she was hit with a closed fist/ kicked by John Smith. Record history obtained. Specify aspects you saw and heard, and which were reported or suspected. Use the patient s words as much as possible. Use quotation marks for specific disclosures where appropriate, e.g. John punched me. State the identified perpetrator s name and relationship to the patient Mark site(s) of old and new injuries on the body injury map Describe estimated age of injuries, coloration and measure size For suspected cases of abuse, record your opinion as to whether the injury is consistent or inconsistent with the patient s explanation Note the action taken by the clinician, referral information offered and follow-up arranged Include the date, time, a legible signature and designation Indicate in notes discreetly that family violence has been disclosed. For example, ticking the coded box in the notes The documentation is then to be stored in an accessory file and transferred to medical records after an alert has been put on the computer by the family violence response coordinator in consultation with the senior department staff member. Collection of Physical Evidence In certain circumstances collection of evidence may be required (legal proceedings) Steps to take in the collection of evidence include: Place torn or blood stained clothing and/or weapons in individual bags, which are sealed. Mark bag with date, patients name and the name of the person who collected the items. Keep the bag(s) in a locked place until they are turned over to the police or the patient s lawyer. Photographs The use of photographs to document injuries may be appropriate in some circumstances. To ensure the photographs are appropriate, accurate and admissible as evidence it is recommended that the WCDHB contact the police photographer. See intranet for Fax referral form 17

GUIDELINE 10 Family Violence Community Directory Agency Phone Number Work Hours Type of Help given by Agency How to use Agency New Zealand Police Greymouth Central Emergency 111 Ph: 768 1600 Fax: 768 1609 2hr access line Statutory reporting agency for family violence victims who have sustained injury or require protection Phone the police operator and advise them of the situation. Contact will be made with the complainant whilst in hospital. Child Youth and Family 0508 FAMILY 0508 326 59 Fax: 768 563(GM) 2 hr access line Statutory reporting agency for the care and protection of children. Investigation of allegations of neglect and / or physical, emotional, and sexual abuse relating to children from 0 to 17 years Telephone Call Centre about suspected or actual abuse. (Fax referral form) Women s Refuge Westport 0800 208 339 Ph: 789 8025 Fax: 789 5501 2hr access line Women s Refuge provides urgent and on-going support for women and children experiencing family violence. Accommodation, referral, education, legal information, advocacy and support. Phone the refuge. Contact can be made in hospital. Victim Support Family Court Greymouth 768 1600 (GM) Fax: 768 1609 789 7339(W/ Port) Fax: 789 6390 Ph: 769 9062 Fax: 769 9131 2hr access line 9am to 5pm 2x7 emotional support, personal advocacy and information to all people effected by crime and trauma throughout New Zealand Support to Families with Counselling and Information Contact through the Police, will accept self -referral, referrals from other agencies Ring and make an appointment with the Family Court Coordinator Rata Te Awhina Trust Ph: 755 6572 Fax: 755 6578 9am to 5pm Court approved programme for perpetrators of family Violence. Home based support for families. Contact by phone. Focus Trust Ph: 768 0369 Fax: 768 9835 9am to 5pm Home based support for families. Contact by phone. Strengthening Families Ph: 768 9833 Fax: 768 9835 9am to 5pm A service for families working with multiple agencies. Provide co-ordination and facilitation for family meetings with agencies. Complete referral form available from the Co-ordinator or from agencies. The Hub-Nurturing the Future Ph: 768 9159 9am 5pm Parenting programme & ongoing support. Phone to make an appointment. Well Women s Centre Ph: 768 7192 Fax: 768 7198 9am 5pm Counselling ie. Depression, anger, anxieties, phobias, stress, grief, family violence Contact by phone, or in person. 18

Agency Phone Number Work Hours Type of Help given by Agency How to use Agency Relationship Services Ph: 768 5702 Fax: 768-16 9am 5pm Court approved counselling for victims of Family violence Contact by phone/fax Homebuilders Ph: 788 8065 Fax: 788 8066 9am 5pm Home based support services ( Based in Westport) Contact by phone/fax Rape & Sexual Abuse Support Services Buller Reap Ph: 768 7700 Fax: 789 7716 Ph: 789 7659 Fax: 789 6335 Tues, Wed, Thurs 9am- pm. 9am 5pm A free & confidential support service Elder Abuse support services. Can assist with support options in the West Coast Community ( Based in Westport) Contact by phone/fax Contact by phone/fax Shakti Asian Women s Support centre 0800 72 58 2 hrs 7 days Asian Women s support centre & Refuge based in Auckland. Contact by phone Family Start Ph: 789 6561 Fax : 789 6735 9am 5pm Provide comprehensive support for families. Referrals accepted from second trimester 1 year after birth. Contact by phone/fax Relationship Services Ph: 768 5702 0800 RELATE 9am 5pm Family Court approved Counselling Nicola Searle Suzy Bergin Paul Hartesley Contact by phone Jennifer Hellyer Ph: (03) 789 7392 9am 5pm Sexual Abuse, ACC counselling. Contact by phone Family Works Ph: (03) 768 7158 9am 5pm Family Court approved Counselling Peter Clarke Annabel Gosett Contact by phone Margaret Adams 021 1 8805 Pam O Hara Ph: (03) 768 9619 Claire Pierson Ph: (03) 768 0227 9am 5pm ACC Accredited Counsellor Contact by phone 9am 5pm ACC Accredited Counsellor Contact by phone 9am 5pm ACC Accredited Counsellor Contact by phone/fax Kay Raffell Ph: (03) 736 9553 9am 5pm ACC Accredited Counsellor Contact by phone 19

Family Violence Fax Referral Form Name NHI Or Place Patient Label Here Date: Name of Referrer Referral To: Referral For: Name: Address: Alternative contact person: Relationship: Time: Department: Fax number: NHI number Phone number: Address or ph: Support Required: Urgent Non urgent (please tick) Comments: Time/Day it is safe to contact this person: Signed (health worker) Signed (person referred) ---------------------------------------------------------------------------------------------------------------------------------Please cut off along the line above and return: West Coast DHB Fax: (03) 768 2793) NHI no: Date of contact: Service provided: ongoing not ongoing (please tick) Comments: (Where possible please ask the person referred to your service to complete below) Did you feel the DHB response was appropriate? Yes No (please tick) Can we contact you to discuss this response? Yes No (please tick) Comments: Signed: Do not file in patients notes Please send to the Violence Intervention Programme Co-ordinator at Community Services 20

GUIDELINE 12 SAFETY AND SECURITY GUIDELINES This Guideline sets out the WCDHB process for staff when there is a need to access support to optimise the safety for victims of family violence when the risk to the victim s safety is assessed be a high risk. Procedures should be discussed with the patient/client who is the victim of abuse and their consent obtained. The safety of the patient is the paramount consideration. If a patient who is a victim of violence expresses fear of the perpetrator or others s/he is likely to be correct. It is defensible in this case for hospital staff to refuse public access to patient details and to facilitate the patient leaving the hospital for a place of safety PROCESS TO ESTABLISH NAME SUPPRESSION FOR VICTIMS OF ABUSE ENSURING PERSONS MAKING PUBLIC INQUIRIES ARE GIVEN NO DETAILS ABOUT THE VICTIM. i). ii). iii). iv). v). vi). The victim of abuse identifies that s/he is concerned that the perpetrator may trace them to the hospital. The staff member in consultation with the Clinical Leader/ After Hours Co-ordinator discusses with the victim the potential to place name suppression on the patient s details. The victim consents to this name suppression being actioned. The Clinical Leader/ After Hours Co-ordinator of the service concerned notifies the following staff of this name suppression being actioned: Clinical Leader/Service Leader/After Hours Co-ordinator Ward receptionist/front Office/Patient Enquiries/Privacy Officer All relevant staff within the department. This information transfers if the patient is admitted to a ward The patient s name is replaced with a OCCUPIED on all patient details boards in the Ward. This directive against the patient details is valid for the duration of the patient s hospital visit or until appropriate personnel remove the directive. The patient is to be advised that ALL enquirers will be given the same information. The Clinical Leader of the service concerned responsible for the patient s care and/or After Hours Coordinator will remove the name suppression at discharge or when the patient requests this. PROCESS FOR STAFF TO FOLLOW WHEN NAME SUPPRESSION HAS BEEN GRANTED. i). When any staff member (including switchboard, clinical staff and volunteers) receives an enquiry about a patient for whom name suppression has been granted s/he will: ii). iii). iv). v). Inform the caller s/he is unable to provide any information Ask for the caller s name and write this down (if provided) Notify the Clinical Leader / After Hours Co-ordinator responsible for the patient s care Notify Orderlies (e.g. if the caller is the suspected perpetrator of an assault and police charges are likely). 21

PROCESS USED TO DISCHARGE A VICTIM OF ABUSE IN A SAFE MANNER FROM A DEPARTMENT OR WARD SETTING WHEN THERE ARE HIGH-RISK SAFETY ISSUES. i). ii). iii). iv). v). Arrange the discharge plan in consultation with the patient and the discharge agency concerned, e.g. ensure the victim speaks to the agency concerned and that all parties are in agreement with the discharge plan. Complete the name suppression process as above if appropriate Ensure that the following people are informed of the discharge plan process: Clinical Leader / After Hours Co-ordinator Orderlies or The NZ Police (if risk is considered high by department staff and security) The discharge plan may include the use of the following plan: Leaving a ward or other department safely (e.g. via back route, transport arranged / taxi chit provision) Temporary shelter arranged (e.g. Accommodation Chit if community agency accommodation unavailable). Document the discharge plan on the Family Violence Risk assessment Form. vi). Advise the Clinical Leader / After Hours Co-ordinator of the discharge outcome. 22

GUIDELINE 13 RELEVANT LEGISLATION CHILDREN, YOUNG PERSONS AND THEIR FAMILIES ACT S15 Reporting of ill treatment or neglect of child or young person Any person who believes that any child or young person has been, or is likely to be, harmed (whether physically, emotionally, or sexually), ill-treated, abused, neglected, or deprived may report the matter to a social worker or a member of the police. S16 Protection of person reporting ill treatment or neglect of child or young person No civil, criminal, or disciplinary proceedings shall lie against any person in respect of the disclosure or supply, or the manner of the disclosure or supply, by that person pursuant to section 15 of this Act of information concerning a child or young person (whether or not that information also concerns any other person), unless the information was disclosed or supplied in bad faith. S66 Government Departments may be required to supply information (1) Every Government Department, agent, or instrument of the Crown and every statutory body shall, when required, supply to every Care and Protection Co-ordinator, social worker, or member of the police such information as it has in its possession relating to any child or young person where that information is required - (a) For the purposes of determining whether that child or young person is in need of care or protection (other than on the ground specified in section 1 (1)(e) of this Act): or (b) For the purposes of proceedings under this part of this Act. PRIVACY ACT Principle 11 (f) (ii) An agency may disclose information if that agency believes, on reasonable grounds that the disclosure of the information is necessary to prevent or lessen a serious and imminent threat to the life or health of the individual concerned or another individual HEALTH INFORMATION PRIVACY CODE Rule 11 subsection 2 (d) (ii) An agency that holds personal information must not disclose the information to a person or body or agency unless the disclosure of that information is necessary to prevent or lessen a serious and imminent threat to the life or health of the individual concerned or another individual HEALTH ACT 1956 Section 22 (2) (c) Disclosure of health Information Any person being an agency, that provides health services or disability services may disclose health information to a social worker or a Care and Protection Co-ordinator within the meaning of the Children Young Persons and their Families Act (1989), for the purposes of exercising or performing any of that person s powers under that Act. CRIMES ACT 1961 Inform the police if you have information relating to crimes such as the following: homicide, sexual abuse, any assault on a child under the age of 16 years, or any assault on any person where that person has sustained some serious wound, disfigurement, grievous bodily harm or serious injury or circumstances of the injury indicate that Police intervention is necessary for the further protections of the victim or any other offence included in Part 8 of the crimes Act (Sections 151-210) Failure to provide the necessities of life, abandonment, cruelty and abduction are offences in relation to children NOTE: Always seek advice prior to release of information (refer to WCDHB Management Of Personal Health Information Manual in the first instance and/or the Risk Manager). 23