Abstract:
Background: Intimate partner violence (IPV) is commonly experienced by women throughout the world and results in adverse physical and mental health consequences, indicating that clinicians are ideally placed to respond to clients experiencing IPV. Little is known about clinician responses to IPV in practice, as most previous research has focused on identification and description of clients experiencing IPV rather than clinician responses. Aim: To describe clinician responses to IPV within New Zealand’s Violence Intervention Programme. Method: A descriptive epidemiological approach was used, involving secondary analysis of routinely-collected data from forms documenting clinician assessments of and responses to IPV at one district health board during 2019. Findings: Few IPV positive presentations (N = 337 out of 80,432 visits for women and men aged over 16 years, 0.5%) were identified with one third of these (35.3%) being identified due to assault presentations, indicating that routine enquiry was not happening. Large proportions of risk assessment data were missing (9.3% to 45.4%). Risk assessment information that was documented identified that: many IPV positive clients reported multiple indicators of risk for further harm from their abuser (women 71.4%, men 66.6%); large proportions disclosed mental health risks (self-harm/suidical thoughts: women 51.2%, men 48.8%; alcohol misuse: women 22.2%, men 19.4%; and substance misuse: women 25.9%, men 29.4%); and, of the 191 cases with children in the home, in many instances the violence was witnessed by the children (61.3%), with smaller numbers disclosing that the children had been physically abused (7.8%). Despite identified risks, substantial proportions of data for referral responses were missing (28.4% to 78.2%). Alluvial diagrams illustrated the flow of IPV positive presentations through the Violence Intervention Programme and showed that, even when risk of further harm from the abuser was documented for clients, in many instances (44.8%) no referral responses were
documented. Conclusion: Considerable discrepancies existed between recommended clinician responses to IPV and what happened in practice, identifying under-utilisation of valuable opportunities within the health sector to address the health harm associated with IPV. Further engagement at the policy and executive leadership level may support improved clinician responses. Qualitative research may identify additional barriers and enablers and support improved response practices.