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RPA Children's Ward in Australian-first roll-out of domestic violence routine screening.

Not on our watch

August 2018

RPA Children's Ward in Australian-first roll-out of domestic violence routine screening.

RPA Children's Ward in Australian-first roll-out of domestic violence routine screening.

The Children’s Ward at RPA has become the first paediatric ward in Australia to roll out domestic violence routine screening to all mothers and female carers who are looking after a sick child.

The Domestic Violence Routine Screening in Paediatrics initiative has been recognised by the National Association for Prevention of Child Abuse and Neglect for its innovative approach to identifying and supporting victims of family violence.

Currently, routine screening for domestic or family violence takes place in antenatal and early childhood health services and for women attending mental health and alcohol and other drugs services.

RPA staff specialist paediatrician John Cass-Verco said the team on the children’s ward realised there was a missed opportunity to identify domestic violence victims and offer referrals to support services.

Violence in the home is common, with Australian Bureau of Statistics data indicating a 17 per cent prevalence rate in the community. However, there is still a stigma surrounding the issue and many victims fail to report the abuse out of fear of retribution and judgment.

“You can’t always tell just by looking at someone if they are a victim of domestic violence and you can’t know where someone is on the cycle of desire to disclose, so the more opportunities to ask, the more chances to intervene,” Dr Cass-Verco said.

This week, the RPA paediatrics team received a Play Your Part Award at a ceremony hosted by the Office for the Advocate of Children and Young People and NAPCAN at NSW Parliament House.

NAPCAN chief executive officer Richard Cooke said the project is “an inspiring example of how different organisations can play a role in protecting children”.

“We know that domestic violence has a huge impact on children in Australia, even in cases where they don’t directly see the violence. Preventing domestic violence is a key component of addressing child abuse and neglect,” Mr Cooke said.

“The RPA program does a great job of sensitively starting important conversations, raising awareness, reducing stigma, and supporting families to get the support they need.”

The paediatrics team required ingenuity and resourcefulness to successfully implement the strategy, such as devising a method to record women’s answers in their own medical record, rather than their child’s.

A process to screen women privately and discreetly on a small children’s ward away from their partner or ex-partner was developed, with care taken to ensure intervention did not increase the risk to the victim.

Same-sex couples are excluded due to difficulty predicting which partner is the victim and which is the perpetrator.

The project team, which comprised medical, nursing, social work, child protection, Aboriginal health and clinical quality staff, as well as a consumer with lived experience, also had to overcome the beliefs and attitudes of some healthcare workers towards domestic violence.

In its first 12 months, there have been 22 disclosures made from more than 700 screens – a disclosure rate of 4 per cent. Of these, six cases were referred to social work for review and a further two were supported to obtain legal assistance.

Dr Cass-Verco said providing a rapid response following a disclosure was vital to the project’s success, “because often we’re the first people they’ve disclosed to”.

Yolanda Miceli is the Nurse Champion for domestic violence routine screening on the Children’s Ward.

“I think the whole project has been really inspirational on the ward, we do a lot of things every day to look after families and children and this is just a really good extension of that,” she said.

Domestic Violence is the leading cause of illness, disability and death in Australian women aged between 15 and 44.

Dr Cass-Verco said the project had been rolled out within existing resources, meaning it is both sustainable and scalable. There has been no increase in length of stay due to disclosures.

Domestic violence refers to abuse and violence between adults who are partners or former partners. Living with domestic violence has a serious impact on short and long term psychological, emotional and physical health of victims and their children.

National Child Protection Week begins on Fathers’ Day and aims to promote the message that protecting children is everyone’s business.

“We’re really passionate about spreading the impact of the project so what we would like to see is that it occurs throughout every hospital in our District but also all the children’s wards around this state and hopefully Australia,” Dr Cass-Verco said.

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