Abstract
Improving health outcomes and inequities associated with intimate partner violence (IPV) and child abuse (CA) has been an ongoing challenge in health care for decades, both internationally and here in Aotearoa New Zealand. Nationally, the Ministry of Health (MOH) has recognised the detrimental effects of family violence on health and health outcomes and recognises the key contribution that health professionals play in its management is of fundamental importance. First developed in 2002, The Ministry of Health: Family Violence Assessment and Intervention Guidelines (FVAIG) has gradually evolved over 20 years in its commitment to managing family violence in the health sector. Key developments of the FVAIG include policy creation, changing the culture around family violence and increasing education. The standardisation of screening methods, along with improving accessibility to resources for people effected by family violence have been consistently evaluated for performance. The MOH has integrated with government legislative boards and district health boards (DHBs) to provide a whole systems approach' to managing family violence with gradual plans to integrate this into primary health care over time.
The following research was undertaken at an urban urgent care facility that operates under the umbrella of primary health care, but also has contracts with the local DHB to achieve health outcomes. The primary aim of the research was to identify the perceived barriers to the detection of IPV and CA in an urgent care setting. Objectives were to ascertain if government led policy and legislative guidelines are being utilised at the first point of care in an urgent care setting, and to identify key areas that health professionals identified as barriers and provide recommendations for future practice.
Methods: A qualitative research approach was chosen for data collection with a cross-sectional descriptive design utilised to capture demographic and narrative data simultaneously. The data was obtained through a one-off survey that was completed by participants online. The survey consisted of a variety of multi-choice, Likert scale, and open-ended questions. All data was anonymised and stored in password protected software provided by the University of Otago.
Key Results: The key findings from the study informed an understanding of the perceived barriers for participants.
1) 53% of participants had no formal education for both IPV and CA, and the education for child protection was not as standardised as IPV education within the organisation
2) 48% of staff would refer concerns they had to senior doctors within the organisation when concerned about IPV or CA. These doctors may have deficits in education around IPV and CA as there is currently a less standardised approach to the doctor's education within the organisation
3) The main barriers to detection of IPV and CA were focussed on education and training. Confidence in referral systems were substantially below average on the Likert Scale at a mean average of 37 and with 58% of staff feeling they had low confidence in their ability to utilise referral systems appropriately.
(4) Respondents' considered education was the key to them improving their knowledge at 84% thus identifying that there was a major deficit in the education/knowledge gap.
Conclusion: The research highlighted there are many barriers to detect IPV and CA in an urgent care setting. Common barriers were comparatively found in other clinical settings such as emergency departments with similar presentations of patients. Although there were many identified barriers through the research, the implementation of a systematic, evidence-based approach to the management of to this health topic can be achieved over time resulting in improving health outcomes for these populations.