Start the Conversation
Last updated May 15, 2023
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If you suspect a patient may be experiencing Domestic Family Violence, follow your hunch and start the conversation. It could save a life.
Start the conversation using these four steps:
1. Ask the question
- “How are things at home?”
- “Is there anything else happening which might be affecting your health?”
- “What happens when your partner gets angry?”
- “Sometimes partners use physical force. Is this happening to you?”
2. Listen without judgement
- “I hear you. I believe you.”
- “I care, and I am here for you.”
3. Validate their feelings
- “I’m so sorry this has happened to you.”
- “Thank you for telling me. This is not your fault.”
4. Encourage action
- “Do you mind if I ask you some more questions about risk to help keep you safe?”
- “Before you leave, I’d like to develop a safety plan with you. Is this, okay?”
- “I would like to link you to a specialist support service. Is that okay?”
Practice Point
When you start the conversation, please remember to conduct a risk assessment and safety plan with your patient. Your DFV Local Link can help.
1. Ask the Question
When a patient presents to a practice with one or more clinical indicators of DFV, it is necessary for the practitioner to engage in a line of questioning to determine whether DFV is impacting on the patient. Funnel questioning starts with broad questions about the patient’s life and relationships, before moving into direct questions about abuse and violence.
An example of this is as follows:
2. Active Listening
When disclosing violence, it is important that the practitioner engage in active listening.
- Be patient, calm, let your patient tell their story at their pace, and allow your patient some silence for thinking
- Remain focused on your patient, use body language and verbal cues to indicate you are listening
- Verbally acknowledge how the patient is feeling
- Provide your patient with encouragement to continue to disclose
- Ask you patient what they would like your support with, then acknowledge and respect their wishes
(World Health Organisation, 2014).
3. Validation
When a person discloses that they have been impacted by DFV it is important for a practitioner to validate their disclosure. Ensure that the patient is explicitly aware that:
- You believe them
- They have the right to live a life free from harm and fear
- There is nothing they could do to justify being subject to DFV
- You care about your patient’s wellbeing and safety, and you want to support them
There are many ways women may present to you, they could be fearful, angry, in denial. The World Health Organisation (WHO) provides a helpful list of suggested responses to different presentations. Remember, there is no right way to react to DFV. Every reaction is valid.
Helping victim/survivors cope with difficult feelings
| The feeling | Some ways to respond |
|---|---|
| Hopelessness | “Many people do manage to improve their situation. Over time you will likely see that there is hope.” |
| Despair | Focus on their strengths and how they have been able to handle a past dangerous or difficult situation. |
| Powerlessness | “You have some choices and options today in how to proceed.” |
| Flashbacks | Explain that these are common and often become less common or disappear over time. |
| Denial | “I’m taking what you have told me seriously. I will be here if you need help in the future.” |
| Guilt and self-blame | “You are not to blame for what happened to you. You are not responsible for their behaviour.” |
| Shame | “There is no loss of honour in what happened. You are of value.” |
| Unrealistic fear | Emphasize, “You are in a safe place now. We can talk about how to keep you safe.” People impacted by DFAV are generally very good at assessing their own safety. Where a patient appears to have unrealistic fears, first ensure your patient is genuinely safe before assuaging any fears. |
| Numbness | “This is a common reaction to difficult events. You will feel again—all in good time.” |
| Mood swings | Explain that these can be common and should ease with the healing process. |
| Anger | Acknowledge that this is a valid feeling. |
| Anxiety | “This is common, but we can discuss ways to help you feel less anxious.” |
| Helplessness | “We are here to help you.” |
Adapted from Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook (World Health Organisation, 2014)
4. Encourage Action
Before allowing a victim/survivor of DFV to leave your practice it is vital that you complete a risk assessment to ensure they are safe to leave the surgery.
There are a variety of tools available to support risk assessment. The tools we recommend include the DFV Action Plan and the Domestic Violence Safety Assessment Tool (DVSAT).
DFV Action Plan
The DFV Action Plan includes a short risk assessment to help you identify when a patient:
- Needs an immediate crisis response
- Is safe to go home with a safety plan
If you disagree with the outcome of the DFV Action Plan, we recommend contacting your Local Link, or the Domestic Violence Line for additional support.
The DFV Action Plan also supports Safety Planning, Patient Planning, and acts as a referral to your Domestic Family Violence Local LINK.
DFV Action Plan, Guide, "How-to" Templates and Video Tutorial is available at the "Action Plan" Page of this Online Toolkit.
Domestic Violence Safety Assessment Tool (DVSAT)
The DVSAT is a standardised tool used by police, health, and human services workers who work with people impacted by DFV. It is a longer tool than the DFV Action Plan, so is better suited to longer appointments. This is a weighted tool that will inform you whether the patient is:
- At threat
- At serious threat
Where a patient is found to be at serious threat it is recommended that you immediately refer to an appropriate agency.
If you disagree with the outcome of the DVSAT, we recommend contacting your Local Link, or the Domestic Violence Line for additional support.
Safety Planning
When your patient leaves your practice, it is vital that they have a safety plan in place. This plan will help your patient to keep themselves, and any other persons in the home, safe in the event the violence escalates.
The DFV Action Plan has some suggestions for items to be covered in a safety plan. For additional support, please view the resources below.
Safe from violence: a guide for women leaving or separating
A comprehensive document for patients impacted by DFV. Pages 20 – 26 include safety planning worksheets.
Safety planning online tool
An online safety plan that can be reviewed and updated over time. Can be used by the patient alone or with practitioner support. Hosted on a LGBTQ+ focused website, however, is appropriate for use with any person impacted by DFV.
Online safety planning
An online safety plan can help your patient stay connected through technology while reducing the risks associated with tech abuse. Can be used by the patient alone or with practitioner support.
Workplace safety planning guide
A domestic violence safety planning guide to enhance the safety of employees impacted by DFV. Can be used by the patient alone or with practitioner support.
References
- World Health Organisation. (2014). Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook.