Whole of Practice Approach
Last updated May 15, 2023
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The World Health Organisation recommends that health services use a whole of practice team response when working with patients experiencing DFV.
The roles of individual team members in supporting this work will be influenced by the scope of practice, resources, knowledge, skills, and experience of practice staff.
General Practitioner Role
spot the signs
- Professional Development i.e. DFV training through the PHN
- Understanding underlying risk factors and the psychological, physical and behavioural presentations of DFV
starting the conversation
- Risk assessment and safety planning
- Use practice tools such as DFV Primary Care Action Plan, LIVES, Motivational Interviewing, non-directive goal setting
LINK FOR SUPPORT
- DFV Primary Care Action Plan to your Local LINK
- Identify and refer to additional supports as required
RECORD FOR SAFETY
- Use covert code
- Document presentations of DFV clearly, accurately and regularly
- Seek legal advice before responding to record requests
Practice Nurse Role
SPOT THE SIGNS
- Professional Development i.e. DFV training through the PHN
- Understanding underlying risk factors and the psychological, physical and behavioural presentations of DFV
STARTING THE CONVERSATION
- Provide a safe and caring setting for patient discussions
- Risk assessment and safety planning
- Use practice tools such as DFV Primary Care Action Plan, LIVES, motivational interviewing, non-directive goal setting
- Know your practice's policy when managing a DFV crisis and enact the policy as needed
LINK FOR SUPPORT
- DFV Primary Care Action Plan to your Local LINK
- Identify and refer to additional supports as required
RECORD FOR SAFETY
- Use covert code
- Document presentations of DFV clearly, accurately and regularly
- Seek legal advice before responding to record requests
Practice Manager Role
SPOT THE SIGNS
- Create a climate of disclosure and let your patients know your practice is a safe place to talk about DFV. TIP: use waiting room posters and social media kit
- Facilitate opportunities to upskill and share knowledge within the practice
STARTING THE CONVERSATION
- Implement policies to support staff who are experiencing DFV
- Download DFV Primary Care Action Plan into clinical software and promote its use with clinicians
- Implement a process that alerts reception staff has disclosed DFV. TIP: Ask victim if they would like to wait for their appointment in a private area as to not compromise safety and security if they are at high risk
- Implement processes to ensure the victim and person using violence are not booked into the clinic on the same day
- Implement at DFV-specific crisis response policy
LINK FOR SUPPORT
- Download DFV Primary Care Action Plan into clinical software and promote its use with clinicians as a referral form through secure messaging
RECORD FOR SAFETY
- Encourage clinicians to record DFV using covert code for continuity of care
- Use covert code to collect and collate data to monitor the health response to improve services
Reception role
SPOT THE SIGNS
- Promote primary prevention approaches (stopping violence before it happens) by visually reinforcing the right to healthy and respectful relationships in general practice
STARTING THE CONVERSATION
- Respond to patients impacted by DFV with compassion and offer a private waiting area (if possible)
- Follow Practice processes that ensure the victim and person using violence are not booked into the clinic on the same day
- Confidentiality is paramount. There are many ways that patient information could be unintentionally disclosed to a person using violence, such as through other patients in a waiting room, or the use of apps. It is important not to assume that, because the perpetrator of violence is not present, the patient’s information is safe
- Do not confirm victims’ personal details verbally at reception, get them to write address on a piece of paper instead
- Provide patients with an option of written check ins to the practice during Covid-19, rather than using the QR check in through Services NSW app. This app can be used to track location of victim
LINK FOR SUPPORT
- If a patient discloses that they are impacted by DFV, provide them with information about GPs and Practice Nurses available to support them, and facilitate a walk-in appointment
- Ensure information about DFV services is available to patients in the waiting room and other accessible spaces
- Bathrooms are a great place to display DFV information such as posters and stickers without alerting perpetrators
RECORD FOR SAFETY
- Follow practice processes to ensure the covert code is recorded in patient files when it has been identified they are impacted by DFV. This ensures continuity of care and increases safety
TIP: Know your practice’s policy when managing DFV crisis, and enact the policy as needed
The PHN Role
SPOT THE SIGNS
- Advocacy, awareness and primary prevention strategies
STARTING THE CONVERSATION
- Support for the uptake and implementation of QI activities to identify and manage patients
LINK FOR SUPPORT
- Information regarding local support services, referral pathways
RECORD FOR SAFETY
- Support to collect and collate data pertaining to DFV
Practice Governance
- Nominate a DFV Clinical Champion.
- Ensure there is time and budget dedicated to on-going training and skill development.
- Consider bulk billing appointments for people impacted by DFV to ensure it doesn’t create financial burden and risk patient disengagement
- Implement policies to ensure staff impacted by DFV are appropriately supported.
DFV Clinical Champion
- Lead the whole of practice DFV response.
- Implement clinical group supervision.
- Support the implementation of whole of practice processes, to promote safety and ensure continuity of care.
Domestic and Family Violence Service Sector
- Local Coordination Point can provide advice on DFV services and triage referred patients
- DFV services to provide patient feedback to referring clinicians for inclusion in the DFV Primary Care Action Plan
- Communicate relevant DFAV sector changes to general practice