Establishing a VIP Programme

Part Two: What can health services do to respond to victims of family violence?

In this section:

• Gaining management mandate
• Setting up a steering group to implement the FVIG
• Communicating with staff
• Passing clinical policy
• Collaborating with community agencies
• Supporting staff to implement the FVIG - Offering staff training
• Supporting staff to implement the FVIG - Providing resources pamphlets posters
• Supporting staff to implement the FVIG - Offering staff supervision and support

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Gaining management mandate

Example of management process for the introduction of FVIP

A trigger initiates the interest for developing a family violence intervention programme. Examples of such triggers may include the results from the Ministry of Health’s Audit of DHB responsiveness to family violence, a sentinel event or a staff member with an enthusiasm for implementing family violence intervention.

A person or persons may be charged with developing this programme. This may be an assumed or designated responsibility.

A senior management sponsor who has a direct link to the executive leadership team endorses the programme. This person may be responsible for reporting on family violence intervention performance indicators for the DHB.

A plan of action is developed to generate interest in family violence intervention within the DHB. This may include setting up a programme steering group.

The plan may include making a presentation to the executive leadership team, seeking their endorsement for developing a family violence intervention programme. The DHB should be encouraged to include family violence intervention within their district annual plan in response to family violence intervention performance indicators.

A business case is written for a formal family violence intervention programme with support from the senior management sponsor.

The example management process is also available to download in Word and PDF format:

• Example of management process for the introduction of FVIP (Word, 30 KB)
• Example of management process for the introduction of FVIP (PDF, 15 KB)

Setting up a steering group to implement the FVIG

Family Violence Intervention Programme Structure

1. Structure for a family violence intervention programme steering group

This is a suggested structure for a Steering Group (SG). The SG terms of reference including frequency of meetings may be influenced by resource availability. There may be smaller working groups established to progress specific operational tasks, including training or policy.

An example diagram of a steering group structure is available to download in Word and PDF format:

• Example diagram of a steering group structure (Word, 35 KB)
• Example diagram of a steering group structure (PDF, 16 KB)

The structure of the steering group will include members and associate members. Associate members may be called upon intermittently to provide consultation on issues relating to family violence intervention implementation. The steering group should have a direct reporting line via project sponsor to senior management team.

The members of the steering group will include the following; Senior project sponsor, Family Violence Intervention Coordinator, Child Protection Coordinator, Senior Clinician, Service Managers from each of the designated services, e.g. Maternity, Child and Youth, Emergency Department, Mental Health & Addiction, Community and Social Worker Department. Representatives will also be sought from Maori and Pacific Islands services and quality teams. Community agency staff that will receive referrals should also be invited to participate.

Associate members may include Information technology, security and health records representatives.

2. Terms of reference for a family violence intervention programme steering group

The steering group’s terms of reference may include:

• background information or information on the overall situation
• a list of objectives
• a list of key stakeholders and internal and external membership (see 1. Structure for a family violence intervention programme steering group above)
• operational guidelines (see Steering Group Terms of Reference)
• a list of milestones and objectives with timeframes
• quality assurance processes
• a risk analysis for the programme
• details on the steering group management structure and membership (link to community collaboration)
• a reporting framework
• programme authorisation.

An example of a Steering Group Terms of Reference is available to download in Word or PDF format:

• Example of a Steering Group Terms of Reference (Word, 249 KB)
• Example of a Steering Group Terms of Reference (PDF, 35 KB)

Communicating with staff

Communication Plan

Principles of a communication plan

• Consult

  Stakeholders need to be consulted during the planning, implementation and evaluation stages of a family violence intervention programme.

• Inform

  Stakeholders should be informed of the family violence intervention implementation plan, including updates and amendments.

• Encourage

  Stakeholders should be encouraged to give feedback in relation to service delivery, both internally and externally.

• Support

  Having a clear pathway for communication, including the communication method and who is responsible for communication, should support the implementation process.

An example of a Communication Plan is available to download in Word or PDF format:

• Example Communication Plan (Word, 255 KB)
• Example Communication Plan (PDF, 33 KB)

Passing clinical policy

Family Violence Intervention Policy Development

1. Principles of a policy or procedure

Policies are intended to support staff practice.

A policy should define the broad areas it covers, for example, generic family violence policy or separate policies for child abuse and partner abuse.

The policy must meet the needs of the services it relates to. The steering/reference group process must manage collaboration, consultation and completeness, including community agency collaboration and participation, which includes Māori and Pacific consultation.

The policy should cover:

• scope
• principles
• responsibilities (i.e. of the DHB, unit and employee)
• procedures for practice, including a clear intervention process with a referral pathway (this may include a flow chart delineating the process)
• relevant legislation
• review/audit processes.

A guide to establishing a family violence intervention policy is available to download in Word and PDF format:

• Guide to Establishing a Family Violence Intervention Policy (Word, 29 KB)
• Guide to Establishing a Family Violence Intervention Policy (PDF, 13 KB)

2. Example of policies

Partner Abuse Policy
This policy provides all District Health Board (DHB) staff with a framework to identify and manage family violence.

The policy also provides guidelines for the development of unit specific policies relating to identification and management of family violence.

• Partner Abuse Policy (Word, 246 KB)
• Partner Abuse Policy (PDF, 100 KB)

Child Abuse and Neglect Policy - Management of
This policy provides District Health Board (DHB) community and hospital -based staff with a framework to identify and manage actual and/or suspected child abuse and neglect. It recognises the important role and responsibility staff have in the accurate detection of suspected child abuse and/or neglect, and the early recognition of children at risk of abuse and adults at risk of abusing children.

• Child Abuse and Neglect Policy - Management of (Word, 244 KB)
• Child Abuse and Neglect Policy - Management of (PDF, 82 KB)

Collaborating with community agencies

Principles and outcomes of community collaboration

Family violence intervention for health professionals focuses on a partnership approach with community agencies based on

• recognising that community agencies are the family violence intervention experts
• engaging community agencies early in the programme development
• establishing the programme in collaboration with community agencies and recognising their knowledge and expertise, which enables development of trust and partnerships between services
• teaching together with an evaluation process, supports the mutual trust and respect required for programme progression
• enabling staff to interact directly with community agencies.

Community agencies involvement on the family violence intervention programme steering group:

• increases the agencies’ understanding of the programme
• signals their support of the programme
• enables the agencies to make presentations to the programme’s steering group to raise awareness of family violence and family violence interventions
• enables the agencies to be involved in the programme’s teaching team.

An example Memorandum of Understanding is available to download in PDF format:

• Example of interagency Memorandum of Understanding (PDF, 31 KB)

Supporting staff to implement the FVIG - Offering staff training

1. Principles of training

Collaboration is key to family violence intervention – engage community agencies on the teaching team, for their expertise and so staff can be directly informed of the agency’s role (Fanslow et al 1998).

Training ensures that all staff have the necessary knowledge and skills to include family violence intervention in their practice.

Training should take place once all policies, documentation, staff support processes, referral pathways and resources are available.

Training needs to be endorsed by management, and it needs to be mandatory to be effective.

Training works best when provided across a whole health service.

Training should be in a dedicated time, lasting for between 4 and 16 hours (Campbell et al 2001; Fanslow et al 1998).

2. Strategic approach to training

A brief one-hour introduction to family violence that covers prevalence, impact, the rationale for screening and barriers and enablers for change allows staff:

• time to think about family violence within their practice before they attend the full training day
• to recognise family violence as a legitimate health issue
• who have personal experience of family violence to seek any support required before attending the full training day.

Ideally this introduction would occur at least a month before the full training day.

The full family violence intervention training day should discuss:

• theories and models of victimisation
• why and how to screen for partner abuse and what to do if the woman discloses she has been abused
• the epidemiology of family violence and how it affects children
• child abuse principles and practice
• professional dangerousness – responses that don’t help
• the role of community agencies, partner abuse, and child abuse and neglect.

Role play abuse identification and intervention, using scenarios applicable to attendees clinical practice.

Annual refresher training may be required to update staff and ensure practice standards are revised. Refresher training can be tailored to the needs of the unit or department, or it can take the form of a generic presentation, depending on demand and staff members’ levels of confidence with family violence intervention.

Advanced training may be required for some staff in each service who can act as mentors, or to develop internal champions to advocate the programme among colleagues.

3. Examples of a pre-teaching questionnaire

An example of a questionnaire general staff is available to download in Word and PDF format below:

• Example of a questionnaire general staff (Word, 309 KB)
• Example of a questionnaire general staff (PDF, 16 KB)

An example of a questionnaire for Emergency Department staff is available to download in Word and PDF format below:

• Example of a questionnaire for Emergency Department staff (Word, 40 KB)
• Example of a questionnaire for Emergency Department staff (PDF, 20 KB)

4. Examples of training programmes

Please contact National VIP Manager for DHBs National.Manager@hawkesbaydhb.govt.nz for further information.

5. Training evaluations

Evaluations of the sessions using a pre- and post-teaching design offer an opportunity to assess understanding before training and demonstrate training effectiveness.

An example of pre- and post-training evaluation is available to download in Word and PDF format:

• Example of pre- and post-training evaluation (Word, 77 KB)
• Example of pre- and post-training evaluation (PDF, 18 KB)

6. Maximising training

Training alone is not enough; ongoing support, including one-to-one support for staff, is required to achieve and sustain change.

Management mandating training for staff is a key success factor. This is a visible demonstration of management’s commitment to the programme and demonstrates management has prioritised the programme in annual plans.

Family violence intervention trainers and resources

Resource	Focus	Contact person
Doctors for Sexual Abuse Care	Contract by the Ministry of Health to train GPs and sexual health services	Hayley Samuel Email: dsac@ihug.co.nz Phone: (09) 376 1422
New Zealand College of Midwives	Contract by the Ministry of Health to train midwives	Contract Manager Lesley MacLennan Email: projects@nzcom.org.nz Phone: (03) 377 2732
Family violence intervention programme Ministry of Health: Train the Trainers Package 2006	Training resource it with train the trainers package	Contact the National VIP Manager for DHBs Email: National.Manager@hawkesbaydhb.govt.nz
Video: Denise’s Story	Protection orders	Educational Resources Cost $35.50+GST
Video: She’ll be Sweet	Family violence awareness	Educational Resources Cost $49.95+GST
Video: Someone’s daughter Video:The Children are Watching	Family violence awareness (partner abuse) Family violence awareness (impact on children)	Safer Families Violence Prevention Network PO Box 33 681 Auckland Phone: (09) 488 0823 Email: nhfvpp@actrix.co.nz Resource education/$100 each

Family Violence Prevention Fund

Our mission

The Family Violence Prevention Fund works to prevent violence in the home and in the community and to help people whose lives are devastated by violence because everyone has the right to live free of violence.

Visit the Family Violence Prevention Fund website.

More information

More information on staff training is provided on the Questions and Answers page:

• How do you manage training? Is it specific to the providers' roles, or do nurses, doctors and other clinicians attend the same training?

Supporting staff to implement the FVIG - Providing resources pamphlets posters

Patient resources

Resource	Focus	Source
Poster, HP4097	We Talk About Family Violence Here	Ministry of Health www.moh.govt.nz/moh.nsf/indexmh/familyviolence-resources Email: moh@wickliffe.co.nz Ph: 04 496 2277 Cost: free
Poster A4, HP 4445 Poster A3, HP 4444	Treating Violence as a Health Issue: Poster with 5 quotes
Poster A4, HP4441 Poster A3, HP4440	Treating Violence as a Health Issue: Poster with 3 quotes
Poster A4, HP 4443 Poster A3, HP 4442	Treating Violence as a Health Issue: Poster with photo of Denise Wilson
Poster	10 Things Children Need	Child, Youth and Family CYF Public order form www.cyf.govt.nz
Pamphlet English, HP 4096 Maori, HP 4437 Tongan, HP 4436 Samoan, HP 4433 Korean, HP 4434 Farsi, HP 4435 Chinese, HP 4432	This is Not Love Pamphlet for victims of abuse, offering information and support options	Ministry of Health Email: moh@wickliffe.co.nz Ph: 04 496 2277 Cost: free
Pamphlets	Women’s Refuge Women’s Refuge Violence and Children How to Support Someone in an Abusive Relationship Lesbian Relationship Safety Planning Resource	Womens Refuge www.womensrefuge.org.nz Cost: post and packaging charges
Blue folder with pamphlets	Ministry of Social Development Folder includes the following resources: Changing attitudes changing lives Women’s Refuge Safety Plan Violence at home: effects on children Jigsaw Child safety The ‘It is OK to ask for help’ mini booklet	Ministry of Social Development www.familyservices.govt.nz/documents/our-work/preventing-violence/fvip-resources-order-form.doc www.areyouok.org.nz/resources.php
Pamphlet	Everyday Families, (available in English, Māori, Samoan and Tongan)	Child, Youth and Family CYF Public order form www.cyf.govt.nz
Child safety card	Children safety card	Jigsaw PO Box 7285 Wellington www.jigsaw.org.nz
Pamphlet	Family violence can harm your child for life	Ministry of Social Development & Brainwave www.familyservices.govt.nz/documents/our-work/preventing-violence/fvip-resources-order-form.doc
Pamphlet	Domestic Violence Protection orders	Ministry of Justice Ministry of Justice Order form
Pamphlet & Poster	Red folded card This isn’t love this is control	Family Planning Services www.familyplanning.org.nz/Portals/5/Pamphlet%20Order%20Form%20February%202008.pdf Resources free to order, postage $12.50 charged.

Health professional resources

Resource	Focus	Source
Family Violence Intervention Guidelines: Child and partner abuse (HP3563)	Brief intervention model (six steps)	Ministry of Health Email: moh@wickliffe.co.nz Ph: 04 496 2277 Cost: no charge
Cue cards/health professional resource (HP4061 A & B)	Partner abuse intervention	Ministry of Health Email: moh@wickliffe.co.nz Ph: 04 496 2277 Cost: no charge
Cue cards/health professional resource	Child abuse and neglect	Ministry of Health Email: moh@wickliffe.co.nz Ph: 04 496 2277 Cost: no charge
Child abuse flow chart (HP 4063) Partner abuse flow chart (HP 4062)	Brief plan of action (attached)	See page 41 of the Family Violence Intervention Guidelines: Child and partner abuse Ministry of Health. 2002. Wellington: Ministry of Health: 26, 41.
Standardised documentation forms	Encourage methodical documentation	See Appendices D, E, F & I of the Family Violence Intervention Guidelines: Child and partner abuse Documentation form for partner abuse disclosures See Appendix I of the Family Violence Intervention Guidelines: Child and partner abuse (page 67-8) Ministry of Health, 2002. Documentation form for child abuse disclosures See Appendix D of Family Violence Intervention Guidelines: Child and partner abuse (page 60–1) Ministry of Health, 2002 Documentation form: referral fax to Child, Youth and Family See Appendix F of Family Violence Intervention Guidelines: Child and partner abuse (page 63) Ministry of Health, 2002. Documentation form: photographing patient injuries See Appendix E of Family Violence Intervention Guidelines: Child and partner abuse (page 62) Ministry of Health, 2002.
Community directory for family violence agencies	Template	DHB to complete Cost: no charge

Managing the Privacy of Documentation Recording Partner Abuse Disclosures: A discussion document

This discussion document was written to study the process of recording partner abuse disclosures.

Three principles require consideration when developing a system of recording partner abuse disclosures.

• Developing a method for maintaining the privacy of disclosed information
• Maximising the victim’s safety
• Ensuring the information is communicated appropriately, thereby minimising risk to the patient and the organisation.

The document considers three areas.

1. Confidentiality of patient information especially from the perpetrator of abuse

While every effort is made to protect the disclosed information while the patient is in clinical areas, this cannot always be controlled. There is concern that a partner might access this information if the documentation form were filed in the general notes, and this might place the victim patient at risk of retaliation. While every effort is made to avoid this, there will be times when patients carry their own notes to appointments.

2. Communication of patient family violence risk between health services

There is a requirement to communicate information between health care services. A system is necessary to ensure that when family violence has been identified by one service, the information is made available to all other services. This is based on the principle of taking action to ensure the information is communicated to appropriate services, rather than being held in isolation and potentially placing the patient at risk (Commissioner for Children 2000).

3. Recording abuse information disclosed by mothers of child patients

The guidelines recommend questioning mothers of all children presenting to health services. This raises the issue of where to store the documentation of partner abuse disclosed, because the mother’s information should not be held in the child’s records. This recognises the mother’s right to privacy and the risk of the partner accessing the child’s notes if that partner is a legal guardian.

See Appendix K of the Family Violence Intervention Guidelines: Child and partner abuse (page 72)

For more information email National.Manager@hawkesbaydhb.govt.nz

Supporting staff to implement the FVIG - Offering staff supervision and support

Programme Maintenance and Sustainability

How a successful programme fits in everyday practice

Evaluations of family violence intervention highlight that a systematic approach can achieve organisational and attitudinal change. Central to this is developing training programmes, practice protocols, standardised documentation, support processes, posters, monitoring and evaluation (Campbell et al 2001).


The pie chart above depicts the ‘systems check’ for each service to ensure that all support processes are established, prior to beginning the FVIP. These mutually reinforcing activities include: 1. Senior management support and community collaboration, 2. Staff support including, peer support, policy and documentation, 3. Reorientation of staff that FV is a heath issue 4. Resources including cue cards, posters, pamphlets and flowcharts, 5. Training, 6. Monitoring, audit and evaluation.

1.1 Management support

Management endorsement is the key to a successful programme.

Management endorsement is demonstrated in:

• key documents, containing child abuse and partner abuse interventions, for example, District Annual Plans
• funding supports, having dedicated co-ordinators to ensure a co-ordinated approach to programme development, implementation and evaluation
• mandates from management for staff training.

1.2. Staff support, supervision and policy

Support

Internal champions
Internal champions are clinically credible staff who include family violence intervention into their practice and advocate introducing family violence interventions into department or unit practice.

Staff who adopt the role of internal champion support change by talking informally with colleagues about the importance of family violence intervention in practice.

A champion will encourage staff to ask patients about family violence in formal and informal ways. This may include reminding staff at the beginning of a shift to ask all female patients during that shift about family violence, reminding staff if they note that the question hasn't been asked yet or initiating a conversation between staff about the importance of family violence interventions within practice.

A team of champions within the department or unit supports the family violence intervention and expands the resources available for staff as they begin to adopt the interventions in their practices.

Mentor programme

What is mentoring?
Mentoring is an important part of the internal support that is needed to implement the DHB family violence intervention programme.

Mentoring takes place in a co-operative and supportive relationship that is based on mutual trust and respect. A professionally experienced and competent worker provides support, guidance and advice to assist a less experienced colleague as they develop job skills and improve competences.

What makes a good mentor?
A mentor has:

• professional role experience
• clinical competence
• an interest in the specific work task
• the professional respect and trust of co-workers and seniors
• effective interpersonal and communication skills
• an empathy and commitment to the process of learning and change.

Skills and abilities related to family violence intervention
Mentors should be competent in the following skills and knowledge in family violence intervention:

• dynamics, indicators and impacts of family violence
• the DHB policy (procedures and protocols), including support and referral
• managing confidentiality and documentation
• using screening questions and offering family violence interventions.

Role of the mentor
Mentors:

• actively encourage trained staff to use their new skills in practice
• invite staff to share their new experiences with others
• provide guidance and support when difficulties arise
• clarify and reinforce family violence intervention policy (procedures and protocols)
• suggest further networks, resources and personnel if a problem lies beyond their area of expertise or experience.

Mentor accountability
Mentors are accountable to the team leaders or charge nurses only for carrying out their role and responsibilities as mentors.

Mentors do not have 'line' authority over the mentored, and they are not in a supervisory relationship with the mentoree. They do not report to team leaders or charge nurses on the mentoree's performance or any matters raised between mentors and mentorees.

Supervision
Clinical supervision is a vital component of the family violence intervention programme to ensure staff and patient safety is optimal.

Clinical supervision must be easily accessible for staff within their clinical setting and should incorporate three components

• Maintenance of professional standards
• Development of the practitioner through self-reflective learning in a supportive environment and expansion of practitioner awareness
• Support of the practitioner (Bond and Holland 1994).

Supervision should be offered after any disclosure of abuse to ensure the staff's learning and support can be maximised.

Confidentiality must be maintained, except where patient or staff safety is at risk.

Policy (organisation-wide and unit level)
There needs to be generic policy that supports the establishment of a family violence intervention programme.

Units can develop their own polices in their service to identify unit-specific processes. Developing their own policies encourages Units to assume ownership for the process.

1.3 Reorienting services and starting where success is likely

A key message that can be shared with staff is that family violence intervention is core to a health professional role. Health professionals have a responsibility to identify family violence, assess risk and refer victims of abuse because the prevalence of violence and its health impact make it our business.

Most health professionals are taught to fix a problem, but this does not work in partner abuse intervention. Partner abuse intervention is not a 'quick fix'; instead we are successful when we empower the person experiencing abuse. Offering the intervention is the intervention.

A family violence intervention programme, which includes sensitive screening questions, requires an environment that is ready and receptive to change. Start where the programme is wanted and where success is likely to occur. This may vary from DHB to DHB.

1.4 Resources (cue cards, community directories, flow charts)

Resources support and educate staff every day, acting as a conscious and subconscious reminder of the need to include the question in staff practice.

Resources for staff need to be available before the programme is launched in the unit or service. Such resources include:

• readily available policies to direct practice
• cue cards for staff, with framing questions
• community directories
• flow charts in care areas
• posters
• victim resources, including community agency resource cards, safety plan sheets and pamphlets on agencies
• victim assessment forms amended to record the questioning process. This information may need to be coded to ensure a victim's partner does not inadvertently view the disclosure, which may put the victim at risk.

Here is an example of coded family violence question as presented on the emergency department assessment form:

FV

RQ

Y

+ve

-ve

N

Initial

Key:
FV = Family Violence
RQ = Routine Question
Y = Yes, question asked
+ve = abuse disclosed
-ve = no abuse disclosed
N = No, question not asked
Initial = Initial of staff member asking the question

1.5 Training

Before launching screening in any area, most staff will need to be trained, including medical and nursing or midwifery staff.

Supervision training may also be required if supervision is not a usual process within practice.

1.6 Monitoring and evaluation

Clinical audits and evaluation processes support change because staff appreciate feedback and hearing about how the family violence intervention programme is being implemented.

It is useful to involve staff in programme evaluation because they are well placed to provide feedback on how the new programme is impacting on clinical practice. They are also well placed to tell the researcher about the barriers and enablers for screening that they are experiencing.

Evaluation also provides useful information to the staff and conveys a message of collaboration.

Page last updated: 7 May 2008