TABLE OF CONTENTS

1.0 INTRODUCTION

2.0 DEFINITION OF DOMESTIC VIOLENCE

2.1 Forms of Violence in Relationships
2.2 Cycle of Abuse

3.0 EFFECTS OF DOMESTIC VIOLENCE ON WOMEN AND CHILDREN

3.1 Effects on Women
3.2 Effects on Children

4.0 WOMEN FROM SPECIFIC GROUPS

4.1 Pregnant Women
4.2 Issues for Indigenous Women
4.3 Women from Non-English Speaking Backgrounds
4.4 Some issues for Women with Disabilities
4.5 Same Sex Relationships

5.0 RECOGNISING DOMESTIC VIOLENCE

5.1 Physical Signs of Violence
5.2 Psychological and Emotional Signs and Symptoms
5.3 Signs of Homicidal Risk

6.0 ASSESSMENT AND CONFIDENTIALITY

7.0 HOW TO TALK TO YOU PATIENT

8.0 THE EXAMINATION

8.1 Physical Examination
8.2 Psychological Assessment
8.3 Assessment of her Social Situation

9.0 CLINICAL AND ETHICAL GUIDELINES FOR MEDICAL PRACTITIONERS WHO HAVE ABUSED WOMEN AND THEIR PARTNERS AS PATIENTS, AND DOCUMENTATION

10.0 DOCUMENTATION

11.0 SAFETY PLANING

12.0 DOMESTIC VIOLENCE AND THE LAW

13.0 REFERRALS

This manual has been developed as a basic guide for General Practitioners. The manual aims to provide the practical knowledge and skills to best support patients who have experience domestic violence.

While we acknowledge that not all survivors of domestic violence are female, research to date demonstrates that domestic violence is primarily perpetrated against women and children. Thus, when we talk in this manual about the victims or survivors of domestic violence we talk about women and children. Women are at a disproportionately high risk of physical, sexual and psychological violence from an intimate person such as a partner or ex-partner. Many children, too, are likely to experience violence from someone they know or to be witnesses to violence within their families. Health professionals are often the first ones outside of family and friends to whom victims of domestic violence turn to, placing health professionals in a central role in responding to domestic violence. The quality of care that a woman receives following a disclosure of domestic violence can have a direct bearing on her and her children's well being, and in some cases may increase their chances of survival. Identification of a woman as a victim is often made difficult by a woman's reluctance to discuss the issue of violence, even when there are presenting signs of abuse in the form of suspicious injuries. General Practitioners therefore, may have to rely on factors other than self-identification. We hope that this manual will be of assistance in this area.

Domestic violence can be defined as a situation where one partner in an intimate relationship uses violence to control and dominate the other partner. It is now accepted that domestic violence occurs extensively in Australia and that it occurs across all age groups and cultures. How victims themselves define domestic violence can be strongly mediated by cultural beliefs, values and previous experiences of abuse, and may not coincide with standard definitions of domestic violence in the literature. Domestic violence is characterised by the use of coercive control and psychological abuse. The experience of victimisation is therefore usually associated with modifications in the victim's perception of the perpetrator, especially a belief in his power, and alterations in the victim's perceptions of self. Feelings of self-blame, shame and loss of self-esteem are extremely common. The perpetrator can at times act in a kind manner towards the victim, which can give false hopes to the abused that the violence will end (Atsbury, J; Atkinson, J. & Duke, J.E: 2000; http://www.mja.com.au/public/issues/astburb.html).

Domestic violence is criminal behaviour and has tragic consequences in our society. Children are affected by domestic violence within the home even if they are not directly abused - many of the effects of witnessing domestic violence are the same as directly experiencing violence. The harmful effects of domestic violence can be seen on individual victims/survivors, their families, the community in which they live, and future generations. Domestic violence is the leading cause of injury to women, ahead of auto accidents, rapes and muggings combined. Although some women are successful in escaping a violent relationship after the first assault, most abuse is recurrent and escalates in both frequency and severity. In addition a woman's independence may be compromised by her partner's need to dominate her and control many aspects of her life. He may restrict her access to food, clothing, money, friends, transportation, health care or employment. It is important that we do not tolerate domestic violence nor regard it as less serious than other forms of violent crime.

Violence in relationships can take many forms. The aim of all such forms of violence is to assert power and control, and to remind the woman that (in the mind of the perpetrator) she is subordinate, inferior and worthless. The abusive person benefits from their actions by having the woman's undivided attention, getting his own needs and wants met, and feeling important and powerful.

Emotional/Psychological Abuse

This is where the perpetrator does or says things that make their partner feel scared or intimidated. Some examples include threatening to harm or kill, constant criticism, threats to abduct or harm children, hurting or killing pets, threatening with the guns or other weapons. Prolonged silence, doing things to confuse the person, withholding important information or exclusion from decision making, are all forms of psychological abuse.

Damage to Property

Damage to property occurs when the house, household furniture, or anything else that the victims owns or uses is damaged or broken. This includes breaking plates, kicking holes in walls, or damaging cars.

Social Abuse

Perpetrators often aim to control all aspects of their partner's life. Social abuse involves manipulation, isolation and/or intimidation. A survivor may be prevented from making contact with family and friends. Restricting use of the telephone or the family car or using insults, shaming and public humiliation are all forms of social abuse. Social and emotional abuse can be easily overlooked, yet their impact on psychological well-being is enormous.

Physical Abuse

Physical abuse is defined as the use of physical force with the intent to harm or frighten, and includes the use of weapons. Neglect can also be seen as a form of physical abuse. The majority of domestic violence victims will, at some point, suffer physical abuse. Their injuries range from bruising, broken bones, head injuries or nervous breakdown.

Sexual Abuse

Sexual abuse is forced sexual activity including rape. Unwanted kissing or touching, or forcing someone to do something they don't want to do (eg. looking at pornography) is also sexual abuse.

Financial Abuse

Controlling money by denying access to bank accounts, forcing the surrender of bankcards to gain control of a partner's income, preventing them to seek or maintain employment, and denying input into financial decisions are all examples of financial abuse.

Spiritual Abuse

Spiritual abuse undermines the victim's self-identity by behaviours such as criticising their spiritual beliefs; the quoting of religious texts to justify abusive behaviour; and abusing in ways that involve symbols of religion or spirituality.

Self-Esteem

Our self-esteem or self-concept is a measure of how we feel about ourselves. Low self-esteem creates feelings of self-doubt and worthlessness, taking away the self-confidence needed to make decisions and to solve problems. When our own feelings and judgment cannot be trusted, solving even small problems becomes difficult. In many cases low self-esteem and poor self-concept may lead to depression. Low self-esteem can also result in a disregard for personal appearance and health.

Feelings of Helplessness

In abusive relationships, the abusive man maintains control of his partner's actions by physically, sexually, and psychologically abusing her. If the assaulted woman tries to regain some control, the abuser may become more controlling. Her repeated unsuccessful attempts at stopping his violence reinforce her feelings of helplessness. As a result the assaulted woman may give up trying to break the cycle of violence.

Self-Blame and Guilt

Many women are used to looking after the emotional needs of their families. When the emotional well-being of the family is suffering, as it does when abuse is present, the woman can tend to blame herself and believe she is failing in her role to 'look after' her family. Some women have hidden the abuse for years because of the guilt and shame they feel. The partner usually encourages this thinking by blaming her for the abuse. This results in the woman falsely believing she has failed as an emotional caretaker and that she causes and deserves the abuse.

Denying and Minimizing

Although ineffective, denying and minimizing abuse are two ways of coping with his violence. They increase the danger already present by encouraging the victim to disregard signals, which can warn her of further assaults.

Abused women frequently deny being victims of domestic violence and that a pattern of abuse has been established. A false sense of responsibility for the violence and embarrassment may prevent her from telling others about it. Excuses may be sought by the victim to explain away the violence and to renew hope for the relationship. Minimizing abuse downplays its seriousness. Often women avoid accepting the reality that they are being abused by comparing themselves to others who have endured more extreme acts of physical and psychological abuse. Their own situations then seem much less serious and much less dangerous.

Drug and Alcohol Abuse

Victims of domestic violence suffer from stress and tension. Many abused women turn to drugs and alcohol to avoid confronting their abusive situations. Continued used of these substances leads to dependency for many women. The abused partner who tries to deal effectively with her substance dependence and her violent situation at the same time can become easily overwhelmed.

Alcohol and illegal drugs are obvious examples, but abuse of prescription drugs accounts for much of the substance abuse among women who experienced violence. Sleeping pills, painkillers and tranquillisers are the more commonly abused prescription drugs.

Children living in violent homes may have witnessed verbal threats of injury, objects being thrown, floggings, threats with weapons, sexual torture, suicide attempts and murder. Children are not only witnesses to the violence but may also be assaulted during violent incidents. How children are affected by witnessing abuse depends on a number of factors such as their age when the abuse began, how their mother coped, and what help and support the child and mother received.

Infants

During the crisis, the baby's routine can be interrupted, causing the baby stress
An abused mother may have difficulty coping with a baby's demands at this time
The baby may not form a healthy emotional connection with either parent, and so may grow up with psychological problems
The baby may tend to sleep poorly, scream excessively, have poor health, or fail to thrive

Pre-school and school age children

Children deal with the stress of witnessing domestic violence in two ways: they hold it inside (internalise) or they express it (externalise).
A child may learn the role of either the abuser or the victim and act out these roles. They may, for example, use aggression to solve problems with others at school. Children as young as 2 years old have been observed to act out adult violence they have witnessed
Boys are more likely to be aggressive, while girls more frequently act out their stress and anxiety by having health complaints (head-aches, stomach-aches) and by passive, dependent behaviour (they get "picked on" and don't stand up for themselves assertively)
Children who witness domestic violence can have low self-esteem, feel anxious and fearful much of the time, can misunderstand the actions of others, become withdrawn and confused, and have difficulty getting along with other children
Preschoolers tend to yell more, be more irritable, stutter, shake, rock, and have nightmares and other sleep disturbances
Children under 10 years tend to blame themselves and believe that they are the cause of the violence
In general, young children who witness domestic violence are less able to solve personal problems in assertive and healthy ways

Adolescents

Boys may become abusive in their own dating relationships. Girls may accept abuse from boys as a normal part of having a boyfriend
May act out in aggressive or delinquent ways: by running away, assaulting their mother and younger family members, attempting suicide, drug and alcohol abuse, or poor school performance
Teens frequently assume parenting roles in their family and assume the role of protector. They become "too old, too fast" and don't get to enjoy their teen years

Children 11 years and up don't usually blame themselves for the violence, but they don't necessarily assign responsibility to the abuser either. They may well excuse the abuser and may side with him because he has the power in the family. They may feel angry with their mother for not protecting herself or them from the violence.

In addition to the common impacts of domestic violence, particular groups of women, such as pregnant women, Indigenous women, women from non-English speaking backgrounds and women with disabilities, will experience additional impacts from domestic violence. Here we will examine these specific impacts in more detail.

The number of unwanted and unplanned pregnancies and terminations is higher among women experiencing domestic violence. Pregnancy itself is a time of heightened risk and the abdomen is targeted more frequently and more severely in pregnant women. Women experiencing violence during pregnancy often obtain minimal or late antenatal care. They are at increased risk of having poor weight gain, anaemia, infections, or pre-term labour; of bearing a low birth- weight infant; and experiencing postnatal depression. They are also more likely to engage in behaviours harmful to health, such as smoking, drinking excessive amounts of alcohol and substance misuse (Astbury, J .& Atkins n, J. & Duke, J.E.(2000).The impact of domestic violence on individuals (online). http://www.mja.com.au/public/issues/173_08_161000/astburby/astburby.html)

According to a 1994 study in Western Australia, Aboriginal women are 45 times more likely to be victims of domestic violence than Anglo women. Most Aboriginal women have been directly involved in, or have a close relationship with someone who is involved in, domestic violence. The Aboriginal and Torres Strait Islander Women's Task Force on Violence report indicates that:
Many women in isolated communities have little access to information about their options
The isolation is not only geographical; urban women are also isolated through lack of access to service information
Many women have no knowledge about their legal rights and for many using the law is not a viable option as they have little knowledge about relevant legislation and court processes. The process of informing indigenous women about their legal rights and using the law needs to take place
Indigenous women may feel that the court system is not sensitive to their cultural needs
In some rural areas there are not enough police to respond to domestic violence incidents. Many women disclose that police are not sensitive to their cultural needs and some police officers consider domestic violence to be a cultural problem. Thus, many women are reluctant to call police
Many women are not using the police, courts and legislation because of racism, lack of knowledge, and lack of support

What can you do?

Keep information about appropriate referral options for indigenous patients
Do not make the assumption that all indigenous patients will necessary want to access indigenous services, always ask your patient. If possible, find various referral options and let your patient choose
Inform victims of the criminality of the violence, and the right for the individual and their family to live in a safe environment

The lack of information and resources about domestic violence protection orders in different languages prevents women:

from understanding the process of obtaining a protection order
from understanding the court process, especially if their English is limited. They may be afraid for example, that by going ahead with the order their partner would face a jail sentence and they would also have to pay for court costs

Strategies based solely on the experiences of "Anglo-Australian" women are limited in their assistance to women from non-English speaking backgrounds. While there are similarities for women from all cultures and races in their experiences of domestic violence, additional barriers exist which must be addressed before effective assistance can be provided for women of non-English speaking backgrounds. These additional barriers arise from issues of ethnicity, race, class, immigration and/or refugee experiences. It is not that culture and race cause women of non-English speaking backgrounds to become victims of domestic violence, but culture and race impact on a women's access to appropriate assistance in dealing with the domestic violence.

There are many obstacles for NESB women to overcome in accessing information, support services and legal systems:

Lack of access to information
Little knowledge of services
Communication difficulties
Fear of not being understood
Fear of authority particularly on the part of women from corrupt or oppressive regimes
Social isolation, especially where there are marked language and cultural differences between Australia and their country of origin, and where social abuse is used in the violent relationship
Reluctance to use services such as counselling because of misunderstandings of what counselling offers based on their experiences with services, or lack of such services, in their country of origin
Socialisation around keeping a family together no matter what
Fear of being judged and blamed
Discriminatory or insensitive work practices by services providers
Fear of losing children if a complaint is lodged
Fear of bringing shame and dishonour to the family
Fear of being judged by family and community
Fear of deportation
A lack of multilingual and culturally appropriate information about legal entitlements and processes
A lack of appropriate outreach programs by service providers
The intimidating nature of court proceedings

Non-English speaking background women's perceptions, experiences and expectations of the legal and administrative system in Australia vary considerably. Many are fearful, particularly those who came from oppressive regimes, many are cynical, and many expect processes to be corrupt. Many women have no knowledge about the requirements of the domestic violence provisions in immigration law; are advised by their community to be a better wife and not embarrass their community by making trouble, and/or do not realise that domestic violence is a crime in Australia.

How can you help?

Remember that women's needs vary and may be influenced by cultural and religious beliefs, length of residence in Australia, level of English fluency, family and social networks and economic dependence
Inform the patient of the availability of trained interpreters where the need arises.
Request an interstate telephone interpreter if your patient is concerned about confidentiality within her community group
Know how to use the Telephone Interpreter Service
Always use TRAINED interpreters; never rely on family, friends or her children

Problems experienced by women with disabilities in relation to domestic violence include:
Under-reporting of domestic violence
Greater physical, financial and emotional dependence, for many women, on the perpetrator of domestic violence as well as fewer alternative options for financial and accommodation support
Lack of credibility given to women with disabilities' accounts of violence when they do report to police or other professionals
Lack of recognition of the victim's legal status, due to limited capacity to consent in certain instances, or assumptions made by police and the criminal justice system about lack of legal status and witness credibility
An emphasis placed on their disability as the problem, rather than the perpetrator of violence as the problem
Lack of information or knowledge on the part of women as to what constitutes sexual assault and violence
Inaccessible information in relation to violence, violence prevention and services
Lack of access to existing services (eg shelters, court support services, counselling) due to both problems of physical access and the attitudes of service providers

What to take into account:

Make appropriate referrals for support services but ensure the service you are referring her to is able to meet her needs
A person with a disability may be relying on the perpetrator for care and support. Neglect is also a form of abuse. If a person is dependent on another for all or some of their needs and these needs are ignored, this is abusive behaviour

Early detection of domestic violence is critical partly because domestic violence episodes tend to increase and become more damaging over time. Being aware of the warning signs and asking the patient the right questions will allow for effective intervention.
It may be necessary for you to take the initiative to look for the signs of domestic violence because:

Victims of domestic violence rarely complain directly of violence
Victims may use a number of doctor surgeries to draw less attention to themselves
Victims may blame themselves for the abuse

Head, neck and facial injuries
Unexplained physical injuries
Multiple and bilateral soft tissue injuries especially contusions and abrasions
Injuries on parts of the body hidden from view (eg. injuries to the breasts, abdomen and/or genitals)
Bruises of various ages
Patterns of repeated injury
Ongoing complaints of poor health (eg. chronic pain syndrome)
Back pain
Neck stiffness
Ulcers
Headaches
Dizziness
Numbness
Miscarriage and other pregnancy complications
Ruptured eardrums
Substantial delay between time of injury and presentation for treatment
Gynaecological problems, miscarriages, chronic pelvic pain
Joint pain, muscle pain

5.2 Psychological and Emotional Signs and Symptoms:

Recurring abuse will often result in other illness and emotional problems that on the surface may not appear related to domestic violence:

Emotional distress e.g. anxiety, indecisiveness, confusion, hostility
Unexplained somatic complaints
Repetitive visits to hospital emergency departments or GPs for stress related symptoms. These may have previously been treated with pain killers
Sleep disturbances
Eating disorders
Depression
Substance abuse, including prescribed drugs
Self-harm behaviours or suicide attempts
Withdrawal from touch
Patient is evasive or embarrassed about injuries
Partner continually speaks for the client and/ or insists on remaining with the patient

The risk of homicide is high and should be taken seriously if the perpetrator:

Has access to guns or other weapons
Has killed pets with the intention of terrifying family members
Has threatened to kill the victim
Uses drugs and alcohol
Is known to be violent outside his family

Information taken from: Eastern Perth Public and Community Health Unit (2001). Responding to Family & Domestic Violence- A guide for Health Care Professionals, State of Western Australia and the Department of Health.

The following sections of the manual were developed to assist and serve as guidelines for general practitioners in their assessment and support of patients that are victims of domestic violence. There is no requirement to follow all the steps. GPs are always welcome to contact the Ipswich Women's Centre Against Domestic Violence (Ph: 3816 3000) at any time of their involvement with the patient.

Assessment

What if a woman has suffered injuries? Consider the following:

Are the injuries consistent with the cause described?
Are the injuries on an area of the body normally covered by clothing, such as breast, chest and abdomen?
Was there a delay between time of injury and time of reporting?
Are there signs of previous unexplained injuries or wounds?
Does the patient seem embarrassed, evasive or ashamed of their injuries?
Is there any previous history of suspicious injuries or other symptoms?

Confidentiality

There is often a fine line between the duty of care and confidentiality. Patient consent with respect to reporting incidents should be respected at all times. Encourage your patients to report incidents of domestic violence to the police or get their consent to you reporting incidents of domestic violence in response to sustained injury or abuse. Ideally this consent should be obtained in writing.

All general practitioners owe their patients a duty of confidentiality. In the absence of consent, that duty can only be breached in some exceptional circumstances, such as where there is an overriding public interest. A breach of confidentiality must be fully documented.

It is very important to provide a supportive environment if you believe that your patient is a victim of domestic violence. You should encourage the victim to talk about her experience of abuse. The process of listening and validating is therapeutic in itself. Information obtained can assist you to assess immediate medical needs and safety risks:

Conduct the interview in a private room where possible
Interview the patient alone, unless a specific request is made for a second party to be present (eg. advocate or support person; not partner).
Exclude the suspected perpetrator from attendance at the interview
Provide staff of the same sex where deemed appropriate.

Be firm about excluding others whose presence could interfere with your assessment.

Asking about violence

The detail of your questions will depend on how well you know the patient and what indicators you have observed. For example: Is there anything else happening that could be affecting your health?
How are things at home?

Examples of specific questions linked to your observations may include: You seem very anxious and nervous. Is everything all right at home?
When I see injuries like this I wonder if someone could have hurt you?
Is there anything else that we have not talked about that may contribute to your condition?

Examples of direct questions include: Are there ever times when you are frightened of your partner?
Do you feel safe at home?

Your role is to:

Hear a disclosure and be supportive
Be aware of your own feelings and remain calm; an emotional response may silence her
Do not blame or judge her or her partner
Inform the patient that she is not alone; there are other women experiencing domestic violence and help is available
Affirm that the she has made an important step by seeking help
Believe the woman
Listen to her
Communicate to her that she is not responsible for the violence
Respect the cultural values and beliefs that affect her behaviour. Know that these beliefs may have been a source of security for her in the past and their importance to her should not be minimised
Be aware of the potential issues for rural and urban women
Know that she does not need rescuing. Help her to identify her own needs
Provide appropriate referrals to services available to help her
Ensure that she has the opportunity to make decisions about events that affect her life

Never:

Deny that the violence has been committed
Minimise the violence
Blame her
Respond to her disclosure by prescribing tranquillisers unnecessarily
Refer her to a psychiatrist inappropriately (hence implying that she is the problem)
Refer the couple to marriage counselling when he is not admitting to using domestic violence or wanting to change
Set explicit criteria that must be met before you will offer her your assistance, for example, offering assistance only if she leaves him

<sub>Source of information:
1.The Royal Australian College of General Practitioners (1998). Women & Violence, Melbourne.
2. Eastern Perth Public and Community Health Unit (2001). Responding to Family & Domestic Violence - A guide for Health Care Professionals, State of Western Australia and the Department of Health.</sub>

Always examine the woman separately from the suspected perpetrator, be sensitive to her needs and try to understand how difficult this may be for her.

Perform a complete physical examination including a neurological examination
Differentiate between accidental and non-accidental injuries
If appropriate, x-rays should be taken to determine old and new fractures
Assess general health, including nutrition (as victims of domestic violence very often neglect their own diet) and signs of stress

Determine how long the violence has been going on
Assess types of abuse
Assess if the violence has escalated in frequency and severity
Assess if the partner has threatened to use a gun or other weapon
Assess if the patient has recently left or is planning to leave the abusive relationship

Exploring whether there are children at risk
Exploring her current financial circumstances
Exploring her support network

_{Source of information: Eastern Perth Public and Community Health Unit (2001). Responding to Family & Domestic Violence- A guide for Health Care Professionals, State of Western Australia and the Department of Health.}

It is not a conflict of interest for practitioners to deal with abuse of the female partner of their patients
Ensure that both patients are extended their right to individual autonomy, confidentiality and honesty
Patients should be handled independently
Do not discuss domestic violence with the perpetrator unless prior consent is received from the abused party
Joint counselling is not advised. Couples counselling should only be pursued once ample evidence is indicated that violence has ceased
Only provide counselling if you are a skilled counsellor
Be familiar with the specialised counselling services and domestic violence services in the local area and make appropriate referrals
If you are uncomfortable in dealing effectively with a patient due to the nature of the patient-doctor relationship, it is ethical and professional to refer the matter to another qualified physician
Acknowledge your limitations

_{Information taken from: Eastern Perth Public and Community Health Unit (2001). Responding to Family & Domestic Violence- A guide for Health Care Professionals, State of Western Australia and the Department of Health.}

Case notes should be written with a clear understanding that the information can be used for legal purposes in the future.

Clear and accurate case note records will:

Detail all relevant medical history obtained during assessment
Record the type of abuse and whether identified or suspected
Detail the injury/ies suffered
Record the medical treatment needed and/or other type of intervention provided and referrals made
Record whether a weapon has been used in inflicting the injury
Record the relationship to the perpetrator
Use factual language and the patient's own words in describing injuries/ situation (separate from your own assessment).
Contain relevant photographic evidence after obtaining patient consent and an indication in the notes if a photograph was taken
Record domestic violence as a "suspected" cause of injury if it has not been disclosed
Record your observations of patient's behaviour around family members/partner
Document details of police involvement if applicable, e.g. Name of Police Officer (if known)

_{Information taken from: Eastern Perth Public and Community Health Unit (2001). Responding to Family & Domestic Violence- A guide for Health Care Professionals, State of Western Australia and the Department of Health.}

Safety is the paramount issue in responding to domestic violence:

Assist the woman to assess her own safety. Is it safe for her to go home?
Are the children safe?
Discuss with the patient her options for safe accommodation. Provide her with relevant phone numbers for shelter accommodation e.g. DVConnect 24hr refuge referral 1800 811 811
Are there friends or family she could stay with?
To promote future safety, encourage your patient to access specialist support services. These may include domestic violence services, women's health centres and other counselling services
Help her to make a safety plan which may include following suggestions:

Keep an extra key to the house and car in a safe place
Make a list of emergency phone numbers
Save some money for emergency transport
Consider keeping some clothing, medication, and important papers (eg. Birth Certificates passports), keys and cash at a friend's place or in any safe place
If possible, deposit money into a bank account each week, or take small items out of the house in preparation for leaving
Talk to her about when would be a safe time to leave and help her to plan where she would go. When he is out on business or at work? Attending doctors or other appointments? Shelter accommodation is an option for women and their children who feel they are in immediate danger. Women need to contact DV Connect on 1800 811 811 (24 hours) for a shelter placement
Does he have firearms? Consider hiding bullets
Advise her not to tell anyone that she is intending to leave until she has left and is in a safe place, as family and friends can sometimes pressure a woman to stay
Inform her that she can consider changing her name and opening a bank account in a new name. She needs to advise Centrelink about her reasons why she changed her name.

_{Source of Information: Domestic Violence Resource Centre (1999) "Reaching Out-a domestic violence resource for family and friends", G & E Printing, Australia.}

Victims of domestic, family and dating violence; and of abuse in informal care relationships, can seek protection by applying at the local Magistrate Court for a Protection Order. Each state and territory in Australia has its own legislation dealing with protection for victims of domestic violence. They may be named differently in each state or territory but they serve the same purpose of preventing future abusive behaviour.

What is a Protection Order?

Protection Orders are court orders designed to prevent future violence and abuse by describing behaviour that a violent person may not engage in.

The perpetrator of the abuse will not have a criminal record unless he breaches the conditions of the order.

Who can apply?

The victim of domestic violence; a police officer; or in some cases an authorised person e.g. someone with Power of Attorney

What relationships are covered?

Spousal Relationships

People who are married, separated or divorced
People of the same or opposite sex who are living together or have previously lived together as a couple
People who are the biological parents of a child

Intimate Personal Relationships

People who are or were engaged to be married to each other including a betrothal under cultural or religious tradition
People who are or were previously dating and whose lives have become enmeshed

Family Relationships

People who are relatives of each other by blood or marriage such as a grandparent, aunt, uncle, step-parent, sibling, cousin or child (all parties must be 18 years and over)
The relatives of those who are in or have been in a de-facto relationship are included
A relative also includes a person it is reasonable to regard as a relative. This is considering that for some people the concept of a relative may be wider such as for Aboriginal people, Torres Strait Islanders, members of certain Non-English Speaking Background communities and people with particular religious beliefs

Informal Care Relationships

People where one person is or was dependent on another person (a carer) who helps the person in an activity of day to day living (personal care activities). This may include dressing, preparing meals or shopping. The personal care must be required because of a disability, illness or impairment. The care must be provided in an informal way and not involve the payment of a fee or care as part of an arrangement, for example in-home care nurses. A fee does not include a pension or allowance in the carer's own name from the Commonwealth Government

Where do you apply?

Applications can be made at a local Magistrate Court or via a local police station. The application form can be obtained at courts, police stations or selected welfare services. The police may apply for a temporary or urgent order on behalf of the victim, by fax, if on weekends or after hours. The role of the police in making applications is particularly important in rural areas

How can you help:

It is important that you provide her with a message that it is not her fault, that is not acceptable, and that domestic violence IS A CRIME
Refer to appropriate services that will be able to answer all her questions and assist her in obtaining a protection order if she wishes to do so

_{Source of Information: The Domestic and Family violence protection Act 1989-information pamphlet, 2003,Violence prevention Unit, Department of Families, Australia}

It is now accepted that no agency acting in isolation can hope to provide the diversity of support services required for victims of domestic violence. Domestic violence intervention is a complex task requiring a multidisciplinary framework, involving parties such as police, justice, welfare and health services working in partnership with community based organizations such as domestic violence services and advice and referral services.

Before making a referral ensure that you have the following information:

Patient's consent for referral
Full name, address and the date of birth of the woman and her children
Name, address, date of birth and relationship to the perpetrator

Provide a history of the abuse and any significant facts that may be of use such as:

Does she have current domestic violence protection order?
Are there any Family Court orders in relation to the care of children?
Has there been police involvement?
Are there immediate concerns for her safety? If yes, does he know where she is now?

A woman may choose to return home to an abusive relationship. Respect this choice. Encourage her that support is there should she require it in the future. Provide contact numbers for support agencies.

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