The Brick Wall The Development Of A Routine  Screening Tool To Identify  Same Sex Relationship Violence  Robert Ball Servi...
<ul><ul><li>The SSWAHS HIV/AIDS  & Related Programs Strategic Framework 2008-2012 identifies a need to increase the capaci...
Physical Psychological Bruises and welts Depression and anxiety Body injury Alcohol and drug abuse Chronic pain Sleeping d...
Sexual and reproductive Fatal health Gynaecological disorders AIDS related Mortality Infertility Death Pelvic inflammatory...
THE INITIAL RESPONSE TO THIS PROPOSAL <ul><li>When this proposal was first canvassed there were three main responses: </li...
Some consequences to consider are those  relating to HIV testing, treatment access  including PEP and medication complianc...
WHAT THE SCREENING TOOL IS This screening tool is not part of the support, counselling and care of an individual experienc...
What the screening tool is (continued) <ul><li>to give the victim of such abuse the opportunity  </li></ul><ul><li>to reco...
<ul><li>they are believed </li></ul><ul><li>they are respected </li></ul><ul><li>they are not alone </li></ul><ul><li>abus...
<ul><li>Sexual Health Services </li></ul><ul><li>HIV/AIDS Treatment Services including PEP </li></ul><ul><li>HIV/AIDS Supp...
<ul><li>Identified GLBT people over the age of 16 years </li></ul><ul><li>Preamble outlining purpose, choice  </li></ul><u...
<ul><li>Screening is not to be carried out if: </li></ul><ul><li>The person is not physically or mentally well  </li></ul>...
<ul><ul><li>In this health Service we ask all people  </li></ul></ul><ul><ul><li>about types of violence in their lives </...
<ul><li>This information will remain confidential to the  </li></ul><ul><li>Health Service except where there are serious ...
THE QUESTIONS <ul><li>Within the last year have you been hit, slapped, hurt, intimidated, threatened or coerced in some wa...
<ul><li>If the person answers YES to any of the above questions: continue with following questions:  </li></ul><ul><li>Are...
<ul><li>Who took part in the focus testing? </li></ul><ul><li>Health Care workers within SSWAHS Liverpool and </li></ul><u...
<ul><li>The focus testing identified </li></ul><ul><li>The parties may or may not share an abode </li></ul><ul><li>The con...
<ul><li>The focus testing asked </li></ul><ul><li>Are there services that will work with the perpetrators of the violence ...
<ul><ul><ul><ul><ul><li>THANK YOU </li></ul></ul></ul></ul></ul><ul><li>Alison & Kim, Anthony, Chas, Colin, Joe, Kathleen,...
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The Brick Wall

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Robert W Ball, Service and Workforce Development,
HIV/AIDS & Related Programs (HARP)
This presentation will discuss the focus testing of the same-sex domestic violence identification tool for health and community care workers developed by the HARP Unit of Sydney South West Area Health Service. Now in its final design, the screening tool is
flexible enough to be used both within government health care settings and throughout non-government support and care organisations.

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The Brick Wall

  1. 1. The Brick Wall The Development Of A Routine Screening Tool To Identify Same Sex Relationship Violence Robert Ball Service and Workforce Development HIV/AIDS and Related Programs SSWAHS.
  2. 2. <ul><ul><li>The SSWAHS HIV/AIDS & Related Programs Strategic Framework 2008-2012 identifies a need to increase the capacity of HARP funded services to identify and respond to sexual assault and domestic violence issues amongst clients. </li></ul></ul><ul><li>SSWAHS HARP Framework 2008-2012 Action Plan (5.4) </li></ul><ul><ul><li>As a means of accomplishing this, the plan calls for the piloting of a domestic violence screening tool for same sex attracted clients of HARP funded services. </li></ul></ul>WHY DID WE EMBARK ON THIS?
  3. 3. Physical Psychological Bruises and welts Depression and anxiety Body injury Alcohol and drug abuse Chronic pain Sleeping disorders Disability Eating disorders Gastrointestinal disorders Physical inactivity Ocular damage Poor self esteem Reduced physical function Suicide and/or self harm Irritable bowel syndrome Unsafe sexual behaviour THE HEALTH CONSEQUENCES OF DOMESTIC VIOLENCE
  4. 4. Sexual and reproductive Fatal health Gynaecological disorders AIDS related Mortality Infertility Death Pelvic inflammatory disease Homicide Pregnancy complications Suicide Sexual dysfunction Sexually Transmitted Infections, including HIV/AIDS NSW Policy & Procedures 2003 P.49 The health consequences of domestic violence (continued)
  5. 5. THE INITIAL RESPONSE TO THIS PROPOSAL <ul><li>When this proposal was first canvassed there were three main responses: </li></ul><ul><li>Does that happen is gay or lesbian relationships? </li></ul><ul><li>Are you stereotyping “girly boys” and “butch dykes”? </li></ul><ul><li>Domestic violence is about men bashing their wives </li></ul>
  6. 6. Some consequences to consider are those relating to HIV testing, treatment access including PEP and medication compliance. & Where the form of abuse centres around; psychological (outing), social (isolation), immigration or residency issues, sexuality or sexual practices and health status. What are the unique impacts of domestic violence in Gay or Lesbian relationships?
  7. 7. WHAT THE SCREENING TOOL IS This screening tool is not part of the support, counselling and care of an individual experiencing domestic or relationship abuse/violence and should not be used for that purpose. <ul><li>Its purpose is: </li></ul><ul><li>To assist health care workers to identify the </li></ul><ul><li>possible presence of domestic or relationship </li></ul><ul><li>abuse/violence. </li></ul>
  8. 8. What the screening tool is (continued) <ul><li>to give the victim of such abuse the opportunity </li></ul><ul><li>to recognise it for what it is and seek support and </li></ul><ul><li>help should they choose to do so. </li></ul><ul><li>the tool has the added benefit of assisting the </li></ul><ul><li>health care worker to identify their mandatory </li></ul><ul><li>reporting responsibilities. </li></ul>
  9. 9. <ul><li>they are believed </li></ul><ul><li>they are respected </li></ul><ul><li>they are not alone </li></ul><ul><li>abuse happens to other people as well </li></ul><ul><li>such abuse can affect their health </li></ul><ul><li>the health worker is willing to listen </li></ul><ul><li>the issue is being taken seriously </li></ul>SCREENING TELLS THE PERSON <ul><li>they can get help </li></ul>
  10. 10. <ul><li>Sexual Health Services </li></ul><ul><li>HIV/AIDS Treatment Services including PEP </li></ul><ul><li>HIV/AIDS Support Services </li></ul><ul><li>Mental Health Services </li></ul><ul><li>Alcohol and other Drug Services </li></ul>PROGRAM AREAS
  11. 11. <ul><li>Identified GLBT people over the age of 16 years </li></ul><ul><li>Preamble outlining purpose, choice </li></ul><ul><li>and limits to confidentiality </li></ul><ul><li>Scripted questions during assessment </li></ul><ul><li>Questioning in safe and private space </li></ul><ul><li>Information card offered to all </li></ul><ul><li>Follow-up and documentation </li></ul>PROTOCOL
  12. 12. <ul><li>Screening is not to be carried out if: </li></ul><ul><li>The person is not physically or mentally well </li></ul><ul><li>enough to respond to the questions coherently </li></ul><ul><li>The person has already disclosed domestic </li></ul><ul><li>violence as the presenting problem </li></ul><ul><li>Maximum privacy cannot be given </li></ul><ul><li>In the presence of a partner, children over three </li></ul><ul><li>years old, other family member or friend </li></ul>WHEN NOT TO SCREEN
  13. 13. <ul><ul><li>In this health Service we ask all people </li></ul></ul><ul><ul><li>about types of violence in their lives </li></ul></ul><ul><ul><li>This is because violence can be very </li></ul></ul><ul><ul><li>common and can be serious and we </li></ul></ul><ul><ul><li>want to improve how we respond to </li></ul></ul><ul><ul><li>those experiencing this </li></ul></ul><ul><ul><li>You don’t have to answer the question if </li></ul></ul><ul><li>you don’t want to </li></ul>THE PREAMBLE
  14. 14. <ul><li>This information will remain confidential to the </li></ul><ul><li>Health Service except where there are serious </li></ul><ul><li>safety concerns for you or your children should </li></ul><ul><li>you have any </li></ul>The preamble (continued) In the Fair’s Fair DV Survey 13.8% of respondents reported they had children under the age of 16 years in their care, being 26.6% women and 5.2% men Fair’s Fair Survey 2006 A snapshot of violence and abuse in Sydney LGBT relationships. Same Sex Domestic Violence Working Group. AVP. ACON. P16
  15. 15. THE QUESTIONS <ul><li>Within the last year have you been hit, slapped, hurt, intimidated, threatened or coerced in some way, in a relationship or by an ex-partner or a casual partner? YES NO </li></ul><ul><li>Did this upset you or are you frightened of this person? YES NO </li></ul><ul><li>If the person answers NO, give the information card to them and say: “Here is some information that we are giving to all people about relationship violence”. </li></ul>
  16. 16. <ul><li>If the person answers YES to any of the above questions: continue with following questions: </li></ul><ul><li>Are you concerned this could happen with them again? </li></ul><ul><li>YES NO </li></ul><ul><li>Do you feel safe in your home? YES NO </li></ul><ul><li>Do you have someone to support you if this happens again? YES NO </li></ul><ul><li>Would you like some assistance with this? </li></ul><ul><li> YES NO </li></ul>THE QUESTIONS
  17. 17. <ul><li>Who took part in the focus testing? </li></ul><ul><li>Health Care workers within SSWAHS Liverpool and </li></ul><ul><li>Royal Prince Alfred Hospitals. </li></ul><ul><li>(Sexual Assault, Youth Health, Haemophilia, </li></ul><ul><li>Allied Health and Nursing) </li></ul><ul><li>A number of Community Workers from </li></ul><ul><li>Non-government Organisations and the SESIAHS </li></ul><ul><li>(ACON, SSDV Working Group, The Gender Centre, </li></ul><ul><li>Lesbian & Gay Anti-Violence Project, CSN, </li></ul><ul><li>Positive Life, SESIAHS Community Health) </li></ul>
  18. 18. <ul><li>The focus testing identified </li></ul><ul><li>The parties may or may not share an abode </li></ul><ul><li>The connection with each other may be through sexual play only without an emotional or other social bond </li></ul><ul><li>The community status of a person may hold </li></ul><ul><li>relevance to the possibility of psychological abuse through the threat of “outing” </li></ul><ul><li>That the package supporting the introduction of the testing tool was too long and attempted to educate about domestic violence and legal issues/obligations </li></ul>
  19. 19. <ul><li>The focus testing asked </li></ul><ul><li>Are there services that will work with the perpetrators of the violence as a control issue rather than anger management ? </li></ul><ul><li>Should we identify Same Sex Domestic or Relationship Violence when there are few specific same sex support or referral services; will they feel abandoned? </li></ul>
  20. 20. <ul><ul><ul><ul><ul><li>THANK YOU </li></ul></ul></ul></ul></ul><ul><li>Alison & Kim, Anthony, Chas, Colin, Joe, Kathleen, Kim, Liam, Mick & Robbie, Norman, Victoria. </li></ul><ul><li>Warwick Allan – Senior counsellor Sydney Sexual Health Centre SSEIAHS. </li></ul><ul><li>Denise Cummins – CNC HIV Community Health SSWAHS. </li></ul><ul><li>Sekneh Hammoud – Psychologist (Private Practice) Sydney. </li></ul><ul><li>Caron Hewett – Educator Education Centre Against Violence Parramatta. </li></ul><ul><li>Susan Hill – Training & Educator Child Protection Service SSWAHS. </li></ul><ul><li>Corrine Maynard – Quality improvement Coordinator Drug Health SSWAHS. </li></ul><ul><li>Joan Silk – Health Education Officer Harm Reduction Program SSWAHS. </li></ul><ul><li>Anthony Schembri – General Manager Fairfield Hospital SSWAHS. </li></ul><ul><li>Helen Young – Social Worker HIV Bigge Park Clinic SSWAHS. </li></ul><ul><li>And the many people who gave their time and advice at the Focus Testing Sessions. </li></ul>

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