Domestic Violence Policy and Protocols TABLE OF CONTENTS: 1.  INTRODUCTION 1.1  Background 1.2  Victims of Domestic Violence 1.3  Definition of Domestic Violence 1.4  Legal Implications for Health Workers 1.5  Legal Choices for Victims       Apprehended Violence Orders (AVO)       Criminal Charge 1.6  Incidence and Hidden Nature of Domestic Violence 1.7  Why Women Don't Disclose 1.8  Why Do Women Stay? 2.  DOMESTIC VIOLENCE POLICY 2.1  Statement of Principles 2.2  Domestic Violence 2.3  Guidelines to Intervention In Domestic Violence       The Area Health Service        Prevention, Intervention and Advocacy       The Health Worker 2.4  Training of Staff 2.5  Record Keeping 2.6  Data Collection 2.7  Guidelines for Protocols 2.8  Referral to Police 2.9  Referral to Department of Community Services 2.10 Access 2.11 Discharge and After Care 3.  DOMESTIC VIOLENCE PROTOCOL 3.1  Identifying Domestic Violence 3.2  Principles of Management and Intervention 3.3  Assessment Process 3.4  Intervention        Crisis        Non-crisis 3.5  Women of Non-English Speaking Background 3.6  Aboriginal Women 3.7  Women with a Physical of Intellectual Disability 3.8.  Women with Mental Illness 3.9  Older Women 3.10 Principles of Family, Couple or Child Counselling 3.11 Perpetrator 4.  APPENDICES APPENDIX A:  Resources and Support Services APPENDIX B:  Victim's Compensation and Charter of Victim's Rights APPENDIX C:  Statement of Injury Form 5.  REFERENCES   1. INTRODUCTION 1.1 Background The South Western Sydney Area Health Service Domestic Violence Policy and Protocol has been developed within the framework, and in accordance with, the principles, definition and recommendations of the NSW Domestic Violence Strategic Plan. The Statement of Principles in Section 2 of this Policy and Protocol) is part of the NSW Domestic Violence Strategic Plan7. It was endorsed by the Premier of NSW in April 1991 and all policies, programs, or procedures relating to domestic violence must accord with it. The NSW Domestic Violence Strategic Plan was published in 1991 after the release of a discussion paper and a three-month consultation period with government departments and community organisations. It calls upon the Department of Health, Areas and Regions to develop, implement and monitor policies and procedures which will improve responses of health services to domestic violence. The NSW Domestic Violence Strategic Plan was developed to coordinate governmental responses to domestic violence and this process of coordination is overseen by the NSW Domestic Violence Advisory Council. In 1981, the NSW Taskforce on Domestic Violence first reported to the government, and as a result, a number of legislative changes were made regarding domestic violence offences. Subsequently, considerable advances with regard to domestic violence were made including an increase in the number of funded women's refuges, increasing acknowledgment of the issue by the media, training for police, and the development of some counselling and support programs for victims. At the same time there were State and federal campaigns to change public attitudes that supported domestic violence, increase public awareness of the extent of domestic violence, and improve services and treatment for victims of violence. 1.2 Victims Of Domestic Violence Studies quoted by the Office of the Status of Women and the Australian and NSW Bureaus of Criminology indicate that women and children are overwhelmingly the victims of violence in the home: • One in three wives is likely to be subject to domestic violence11,12 • 95% of domestic violence is carried out against women by the men with whom they live4,7 • Nearly 50% of people know someone who is affected by domestic violence9 • One in five people think the use of physical force by a man against his wife is acceptable9 • Female homicides are most likely to be committed by male partners or males known to the victim, and are most likely to occur after a history of domestic violence12 • In NSW, between 1968 and 1986, two-thirds of female victims of homicide were killed by family members and 48% of these were killed by their spouse or de facto partner compared to 9% of male victims6 • The NSW Bureau of Crime Statistics and Research reports that Campbelltown, Liverpool and Fairfield have some of the highest rates of Apprehended Violence Orders in the State: 205.4 per 100,000 residents in Campbelltown compared to 10.3 per 100,000 in Lane Cove.3 (Some of this difference may indicate higher rates of reporting.) 1.3 Definition Of Domestic Violence Domestic Violence is defined7 as violence and abuse perpetrated upon a partner in a marriage, marriage-like or intimate relationship. It is used to gain and maintain power and control in the relationship and may continue following separation or divorce. For a full definition, see 2.2 "Domestic Violence". Violence also occurs in other close relationships. A person may be threatened, molested, harassed or attacked by someone who is a relation or with whom she shares a household - for example, father, son, uncle, flatmate. Also older people may be abused by carers, such as sons and daughters. Although sections of this policy and protocol may be useful in assisting such victims, its primary focus is to assist women escaping violence from an abusive partner. 1.4 Legal Implications For Health Workers Domestic violence is a criminal offence and there is a presumption in law that information relating to serious criminal offences will be reported to police for further action. However, in order to strengthen the therapeutic relationship between the client and health worker, any notification to police will, if possible, be made with the client's agreement. The police will be notified regardless of the client's wishes when: • The perpetrator has access to a gun and particularly if threats have been made (police now have power to search for and seize firearms in domestic violence incidents) • Serious injuries have been inflicted, for example, broken bones, stab and gunshot wounds (committing serious injury is considered an offence punishable by imprisonment). Where a treating health professional or a senior health professional becomes aware that a serious crime may have been committed, or that there is a risk to public safety, the senior health professional may provide information from client health records to the police in order for them to initiate appropriate action (NSW Health Dept. Circular 90/93). In such circumstances the issue of client confidentiality is overridden by the duty to report a criminal offence, the justifiable circumstances requiring police intervention, the duty of care to the client and the wider public good. The victim's right to pursue, or not pursue, the matter with police will be respected in all other instances. If a victim presents with injuries suspected to be the result of an assault: • Explain to the victim their right to make a statement to the police with a view to: - police charging the offender - police applying for an Apprehended Violence Order (AVO) on her behalf (this may make a difference for some women regarding possible repercussions from the assailant). See 1.5 "Legal Choices for Victims". - the victim applying for victim's compensation • Comply immediately with any request by the victim to talk to the police Where police are reluctant to take out an AVO against a perpetrator of domestic violence with a psychiatric history, staff may need to advocate that an AVO is still necessary because the safety of the victim is paramount. Similarly, where police are reluctant to take out an AVO on behalf of a woman with a mental illness because they do not believe her, staff can advocate that she may still be subject to domestic violence and in need of protection (see 3.8 "Women with Mental Illness"). It is important when the client is Aboriginal, that an Aboriginal support worker be contacted immediately, particularly if there is police involvement (see 3.6 "Aboriginal Women"). Where domestic violence takes the form of sexual assault, the Sexual Assault Service will need to be contacted and protocols regarding sexual assault will be implemented. 1.5 Legal Choices For Victims Apprehended Violence Orders (AVO) An AVO is a protective order for victims or potential victims of domestic violence and is available through the local court. The order provides future protection for the victim by ordering the offender to do or not do things for as long as the court deems appropriate. It is not a criminal conviction, however, a breach of an AVO is a criminal offence. A woman can apply for an AVO herself by contacting the local court to see the Chamber Magistrate or Clerk of the Court (see Appendix A for phone numbers of local courts). Alternatively, police can do it on her behalf. For children under 18 years who seek protection, only a police officer can take out an AVO on their behalf. New Police powers for AVO's: Amendments to the Crimes Act now mean that, from May 1 1992, NSW Police must take out an AVO whenever they suspect or believe a domestic violence offence has been committed. The exceptions to this are when the victim has decided to take out an AVO or where the police can demonstrate they have "good reason not to". Criminal Charge (for example, physical or sexual assault) A criminal charge means that the offender is charged by the police for the physical or sexual assault that has occurred. The offender must then go to court where he or she, if found guilty, receives a criminal conviction, that is, a fine, a bond, or prison sentence. A criminal charge does not provide any future protection for the victim. The client can apply for an AVO and charge the perpetrator if she wishes, or she can just apply for an AVO. If a criminal charge is laid, it is recommended that an AVO is also sought if the client fears future violence or harassment. If an AVO is already in place and has been breached, encourage the client to report it to the police immediately. 1.6 Incidence And Hidden Nature Of Domestic Violence Studies in Australia and overseas suggest that the incidence of physical violence in marriages and marriage-like relationships is between one in three and one in ten.4,11 Despite such a high prevalence the majority of cases remain hidden. While women presenting with physical injuries may be easier to detect as victims, particularly if the injuries do not fit the history of the occurrence, psychological or emotional abuse may be more difficult to identify. Domestic Violence is often identified during pregnancy when it often starts or escalates. An overseas study suggests that between 1 in 2 and 1 in 4 injuries treated in women in Emergency Departments occur in the context of domestic violence. Despite this, only 1 in 25 women are diagnosed as victims.8 Such low identification rates can be largely attributed to the absence of a protocol and appropriate training for staff in early identification and appropriate intervention and referral. 1.7 Why Women Don't Disclose The reasons many women find it difficult to disclose that they are suffering domestic violence include: • Fear of not being believe • Shame attached to violence perpetrated by someone you love • Judgemental attitudes displayed by workers • Threats from perpetrator to woman and/or children • Concern for the future, especially true for pregnant women. 1.8 Why Do Women Stay? The reasons many women find it difficult to escape a violent relationship include: • Financial dependence on the perpetrator and fear of not having an incom • Violent repercussions and threats (including murder) from the perpetrator • Cultural exclusion and/or condemnation from family and community • Concern about the break up of a family and the effect on children • Taking responsibility for their marriages and homes • Religious and/or cultural beliefs which preclude divorce or separation • Wanting the violence to end but not the relationship • Hope for change • Ignorance of community resources and legal rights • Concern about custody of children. 2. DOMESTIC VIOLENCE POLICY This policy adopts the NSW Domestic Violence Committee's "Statement of Principles" which was endorsed by the Premier in April 1991 (see also 1.1 "Background"). 2.1 Statement Of Principles • Women and children have a right to live safely and free of fear within their own homes • Domestic violence is a range of abusive behaviours, perpetrated by one partner upon the other to gain and maintain control • Domestic violence damages the well-being and future life chances of women and children • Domestic violence occurs across all cultural and socioeconomic groups • Domestic violence is a phenomenon based in and perpetuated by existing societal conditions and social relations which reflect gender inequality and promote male power • Domestic violence is perpetrated by men in an overwhelming majority of cases (95% of reported cases) • Acts of domestic violence and its consequences are the sole responsibility of the perpetrator • Domestic assault is a crime • The safety and ongoing protection of women and children who have experienced or are experiencing domestic violence are paramount considerations in any response • Essential to any response are early identification, appropriate intervention and long-term solutions to provide for the well-being and life chances of women and children who have experienced domestic violence • Language and cultural needs of women of non-English speaking background and Aboriginal women must be considered in any response • Prevention of domestic violence is the ultimate objective • Education and programs to promote gender equality are required to redress community apathy towards the tolerance of domestic violence • Any response to domestic violence requires a consistent planned approach across all sectors of the community and at all levels of Government • All services which respond to domestic violence will adopt policies, procedures, programs and training in accordance with the above principles. 2.2 Domestic Violence Domestic violence is a range of violent and abusive behaviours perpetrated by one partner against another. It may occur within the context of marriage or de facto relationships and includes couples who are separated or divorced. In Australia, domestic violence is a crime. All acts of physical and sexual violence constitute assault which are criminal offences.7 Reported incidents of domestic violence indicate that 95% of perpetrators are men. It occurs in all age groups, income levels, ethnic and cultural groups. A small minority of cases of domestic violence involve violence perpetrated by women against their male partner. Violence in homosexual relationships also occurs, however statistics about its prevalence are unavailable. Because the overwhelming majority of cases of domestic violence involve women, this document will refer to perpetrators as male and victims or clients as female. The policy will apply to adult female victims of domestic violence irrespective of age, nationality, race or financial status. Children who witness domestic violence or experience violence in the home can be profoundly affected. Consequently, the safety and protection of children will require cooperation between the Health Service, the Department of Community Services and possibly the police. Although some domestic violence cases present as obvious abuse and clients may speak openly about the problem, the majority of abuse cases remain hidden (see 1.6 "Incidences and Hidden Nature of Domestic Violence"). Much domestic violence goes unreported by women for fear and safety reasons and health workers need to be able to identify indicators of abuse and sensitively respond to them. There are five broad categories of domestic violence : • physical assault • psychological/emotional/verbal abuse • social abuse • economic abuse • sexual assault Physical assault includes slapping, pushing, punching, kicking, choking, or use of weapons against a partner to inflict injury. All acts of physical assault are criminal offences. Psychological/emotional/verbal abuse is the use of language, threats, insults and abuse to denigrate or degrade the victim. Such abuse may destroy self-esteem, undermine self-confidence and challenge perceptions of reality. Threats to children's well-being and safety as well as damage to property are also used by perpetrators to inflict psychological and emotional abuse. Social abuse refers to social isolation imposed upon a partner by conduct that impedes or curtails her access to family and friends and community agencies. This includes geographic isolation, cultural isolation and denial of access to community cultural resources such as places of worship and ethnic welfare organisations Economic abuse refers to the controlling and withholding of access to family resources including money and the purchase and ownership of goods and property. Sexual assault is a criminal offence. It includes a range of sexually abusive and exploitative behaviours including rape - with or without use of threats or other violence being inflicted, indecent assaults, and forced viewing of pornography. These behaviours are used to instil fear and to maintain power and control over the victim. 2.3 Guidelines To Intervention In Domestic Violence The Area Health Service The role of the Area Health Service is to: • Ensure that crisis intervention, medical intervention, appropriate counselling, and advocacy and referral services are provided to victims and non-offending family members when they present to health facilities such as hospitals and community health services • Ensure that all these services are provided in a manner that is linguistically and culturally appropriate to the victims' needs • Direct health services to the needs of victims and their children • Identify and utilise existing and additional resources needed to ensure a consistent approach to high quality care and assistance across all services. For example, emergency services, community health services, interpreters and bilingual counsellors, ambulance and other health services • Undertake health promotion for the prevention, early identification of and intervention in domestic violence. This will include intersectoral cooperation with local community organisations in forums such as Domestic Violence Liaison Committees and involvement in community development activities. A focus on counselling perpetrators cannot commence until guidelines are in place to ensure that any treatment is provided within the context of the criminal justice system (see 3.11 "Perpetrator Counselling").  Prevention, Intervention and Advocacy Health services are involved with victims of domestic violence and their children in the following ways: •Prevention - through health promotion, community education programs and intersectoral cooperation to increase community awareness of the effects of domestic violence. Also by early identification, intervention in, and referral to other resources to prevent the violence continuing. • Intervention - in physical, psychological and social crises and by assisting women and children to overcome the effects of violence. • Advocacy - by providing assistance to the client in a linguistically and culturally appropriate manner in order to minimise further anxiety and trauma and to empower the client by: - Enabling her to act on her own behalf wherever possible - Informing the client of her legal rights and providing assistance to ensure these rights are being exercised - Insuring that the client is aware of her right to protection (see 1.5 "Legal Choices for Victims"). • Notification of children at risk - to the Department of Community Services in accordance with NSW Health Department guidelines.  The Health Worker Attitudes See also Charter of Victim's Rights in Appendix B. Community attitudes to the victims of domestic violence range from compassion and understanding to stigmatisation and blame. Unfortunately victims are still often treated with derision and scorn. Thus, it is important that staff: • Adopt a non judgemental attitude to victims. Such an attitude may assist the woman in her disclosure, even if a woman does not wish to take action, chooses to remain with or return to her partner, has made numerous presentations to the Health Service previously • Regard domestic violence as a crime that is never justified • Provide empathy and support to victims • Do not absolve the perpetrator from responsibility for the crime • Are sensitive to the particular difficulties confronting Aboriginal women, women with disabilities and women from non-English speaking backgrounds when they disclose as victims of domestic violence. This includes reassuring confidentiality, using appropriate Interpreter Services and not relying on family members and other workers, and contacting Aboriginal and ethno-specific workers to assist • Do not attempt to mediate violence between the victim and the perpetrator. While other issues in the relationship may be mediable, violence is not • Are aware of and respect the role of other support workers who are, or may become, involved for example Refuge Worker, Neighbourhood Centre Co-ordinator, Aboriginal Health Worker, Court Support Worker. Role • Assist the woman and children to attain safety • Assist the woman to consider her empowerment and control over her life situation through choice of legal and/or other options • Provide or assist the client to receive medical treatment if required • Provide information and practical assistance, both written and verbal, regarding services available - legal, medical, social, financial, housing, counselling (see Appendix A). • Ensure the client is aware of and has access to, court order procedures for her future protection (see 1.5 "Legal Choices for Victims") • Ensure the same quality service is provided regardless of the number of presentations • Ensure language, cultural and social needs of clients with special needs are considered in any response, for example, the use of interpreter services and ethnic health workers, and the particular needs of women with disabilities and Aboriginal women (see 3.5 - 3.9 and Appendix A for further information). • Notify the Department of Community Services of children at risk of abuse. 2.4 Training Of Staff The Area Health Service is committed to the provision of relevant training for workers in the public health sector and will ensure staff have time to attend training sessions. Training will: • Ensure that staff are informed about and understand that domestic violence is a social, criminal, legal, psychological and medical issue. • Promote the identification of domestic violence • Promote the provision of appropriate and sensitive support • Assist in the development of trusting relationships with victims • Ensure a consistent approach in the provision of quality services and support to victims of domestic violence. Services and support need to be sensitive also to specific needs in local areas such as isolated rural communities and Aboriginal communities • Promote the provision of culturally appropriate and sympathetic services to people living in a multicultural society • Ensure that staff understand the role of police and are aware of the legal options available to ensure safety for victims of domestic violence. Training is essential for staff who are well placed for early identification of women who are experiencing domestic violence. They include: crisis and extended hours workers, all staff in emergency departments, mental health teams, reception and intake staff in Community Health Centres, Child and Family Teams, antenatal, obstetrics and gynaecology staff, bilingual counsellors and interpreters, community educators, primary health nurses, paediatric staff and psychiatry staff. 2.5 Record Keeping See also 3.3 "Assessment Process". When suspected or known victims of domestic violence present at hospitals or other public health facilities all physical injuries, including minor injuries and any emotional or psychological symptoms, need to be carefully documented (see 3.1 "Identifying Domestic Violence"). When recording information, it is important to be aware that: • The documentation of injuries may provide medico-legal evidence for court • The name of counsellor, police, family and/or others in attendance must be recorded • Although all medical records are confidential, they can be released under law, for example, by subpoena or search warrant (as outlined in NSW Health Dept circular 90/126). • Women who are victims of domestic violence often offer explanations for their injuries that disguise the true situation. The explanations given may often appear plausible and it may therefore be several days or months before the real cause of the injuries is revealed. Even if domestic violence is not identified by the worker until some point after initial contact, make a note on the health record. 2.6 Data Collection The Department of Health has recognised that the development of a database on domestic violence is essential. The Area Health Service will cooperate with the Department in establishing a database to collect minimum core data following appropriate consultation. An example of core data is the Adult Sexual Assault Initial Presentation Form (Appendix D). 2.7 Guidelines For Protocols Area Protocols for the management of victims of domestic violence will: • Comply with the Charter of Victim's Rights • Address the issue of safety and protection of women and children • Ensure that medical, emotional, legal and social considerations are identified and dealt with by appropriate staff members, or referred appropriately to other services • Provide for interviews with victims to be conducted in private (At no time will the alleged perpetrator be present during interviews) • Ensure that staff have a safe working environment in compliance with occupational health and safety legislation. The safety of staff who make home visits must be ensured. Staff will be accompanied by police where safety is not ensured. 2.8 Referral To Police Domestic violence is a crime. There is a presumption in law that information relating to criminal offences will be reported to the police for further action. The Crimes Act makes it an offence for any person to fail to do so, but only if the failure to report occurs "without a reasonable excuse". This offence (and general duty to report) will be viewed in the context of the crime in question. While the wishes of the victim are always respected, they are not paramount and absolute. In relation to domestic violence offences, there are two main concerns for the victim: • safety - where the concern is the serious risk to the victim or others involved, for example, the perpetrator is armed and has made threats, or serious injuries (broken bones, stab or gunshot wounds) have been inflicted. In such circumstances, staff will notify the police regardless of the victim's wishes. The victim should be informed of this decision • choice - in all other instances the victim's right to pursue the crime with police and report the offence needs to be respected. Victims presenting with injuries suspected to be the result of an assault will be given an explanation of her right to make a statement to the police with a view to: • Police charging the offender • Police applying for an AVO • The victim applying for victim's compensation All requests by the victim to notify the police will be complied with immediately. See also 1.4 "Legal Implications for Health workers" and 1.5 "Legal Choices for Victims". 2.9 Referral To Department Of Community Services Section 22 (1) of the Children (Care and Protection) Act states that any person who forms the belief upon reasonable grounds that a child: • has been, or is in danger of being, abused; or • is a child in need or care may cause the Director-General (DCS) to be notified of that belief and the grounds therefore, either orally or in writing. Medical practitioners are required by law to notify all forms of child sexual assault, physical abuse and neglect. All other employees of the Department of Health and Areas/Regions are required by Ministerial directive (NSW Health Dept.Circular 89/161) to notify. In addition, the Department of Community Services considers the witnessing of domestic violence between his/her parents to be a child protection issue. In these instances, staff can notify the Director-General and request investigation by the Department. 2.10 Access Access means that when victims of domestic violence present to a public health facility, staff ensure they are offered appropriate support services, including services offered by the Area Health Service. Thus, women of non-English speaking background and deaf women will be informed of their right to an interpreter and, if at all possible, a female interpreter will be used. Women with disabilities and Aboriginal women will need to have their special needs taken into account. It also means that where possible culturally appropriate welfare/support personnel will provide assistance. Each health facility must ensure that accurate and up-to-date information is available and on display in a range of community languages and is suitable for Aboriginal women (for example, posters, pamphlets, lists of referral agencies) to ensure that clients are informed about resource options available to them. See sections 3.5 to 3.9. 2.11 Discharge And After Care In some instances victims sustain physical injuries that necessitate admission to hospital. In other cases where their physical injuries do not otherwise necessitate admission, an overnight admission may be advisable if there is no safe alternative available, or where the victim shows signs of emotional trauma and requires respite. As soon as possible after admission, ascertain the victim's safety after discharge and, where necessary, arrange for a consultation with appropriate support services. Refer the client to the hospital social worker on admission and community health services prior to discharge. Every effort needs to be made to discharge the victim into an environment where there is no likelihood that the violence will continue. The whereabouts of the victim must not be disclosed to any person unless the victim has indicated otherwise. In such circumstances it is important to reassure the victim that confidentiality will be maintained. 3. DOMESTIC VIOLENCE PROTOCOL 3.1 Identifying Domestic Violence Health workers need to possess a high level of awareness, a non-judgemental attitude and be non-threatening while history-taking in order to uncover a history of abuse in cases where the victim is not openly talking about violence. Domestic violence will be suspected where the injuries or the emotional/behavioural manifestations do not match the explanation given by the victim or perpetrator. It is important that the client needs to be interviewed in private, in the absence of the perpetrator. This may be difficult for triage staff in an Emergency Department, however it is necessary when domestic violence is suspected. The client may elect to have a support person with her as long as their presence does not hinder an accurate assessment. It is most important she feels safe. Many women and children will present to services with a range of health problems. Most often domestic violence will not be the presenting problem but may be disclosed at some stage during the session. For example, women presenting at antenatal or maternity services; with their children at Emergency Departments or Paediatrics; at Community Health Centres for drug and alcohol counselling or with children who have behavioural problems. In such circumstances, sensitive questioning about relationships and conditions at home may uncover evidence of physical abuse including sexual assault. Where domestic violence appears to be occurring and has not been disclosed at all, it is important to engage in direct questioning with the client about domestic violence, especially if there are any physical and emotional/behavioural manifestations. See below. Physical Symptoms of Domestic Violence • Injuries will often be minimised by the woman and/or her husband or partner • Serious bleeding injuries are common, especially to the face, head and internal organs • Breast, chest and abdomen are often specific target areas, especially if the women is pregnant • Violence often escalates during pregnancy • Single or multiple bruising to any or all parts of the body is common • Burns - appliance, stove or cigarette burns and acid burns are common • Dental problems - soft tissue injuries to the mouth area, fractured teeth or facial features • Perforated ear drums • Injuries that appear untended such as old untreated fractures • Physical injuries could be any of these or a multiple of same and may appear in combination with psychological injuries Emotional/Behavioural Manifestations Domestic violence may result in health problems which are not easily linked to violence, particularly if the client does not disclose that she is being abused. She may be suffering depression or state that she unable to cope. Signs may include: • Panic attacks • Heart palpitations • Severe crying spells • Signs of depression • Suicidal behaviour • Drug abuse or non-compliance with medication • Constant presentations to health services without detection of a cause for the signs. She may also complain of headache, insomnia, choking sensation, hyperventilation, gastrointestinal pain, chest or back pain. She may also be suffering low self-esteem. Violence often increases or starts for the first time during pregnancy and that is often when domestic violence victims come to the attention of health workers. One Australian study found that two-thirds of pregnant patients in an Emergency Department were there because of domestic violence.2 3.2 Principles Of Management And Intervention It is important that medical and health personnel believe the client. Someone who has suffered domestic violence (often for many years) is in need of respect, protection, information and access to support services. Thus, it is important that the client be listened to and believed. Some clients may have special needs, for example, migrants who have suffered torture and trauma before coming to Australia, women with disabilities or a history of mental illness. It is vital that staff consider any special needs in intervention and management (see sections 3.5 - 3.9). Clients of non-English speaking background always need to be informed of their right to an interpreter. A professional interpreter can be called through the Health Interpreter Service (HCIS) or Telephone Interpreter Service if HCIS is unable to assist. Use of non-professional interpreters including other staff members and family members is inappropriate. Counselling across cultures may be difficult. If it becomes apparent that cultural differences are a barrier to the management of the case, co-working with an ethnic health worker may be a more appropriate way of continuing assistance. It is important that health workers understand that the client will make her own choices about whether she wishes to leave a violent home or take action to protect herself. Do not attempt to "rescue" the victim by making decisions for her or directing her choices. It is important that staff aim to empower women to make these decisions for herself. At the same time, however the health worker has a key role in advising the client of her options and their likely implications and supporting her decisions. The health worker assists an empowering process even if the victim's final decisions go against the advice of the worker. Continued support of the client on subsequent presentations to the Health Service also assists this process. Direct (but delicate) questioning by the staff member is important in supporting the client to disclose domestic violence. Most women respond readily to being asked directly and appear relieved that someone has asked them how they have been hurt. Women who have not been abused will generally not mind being asked if their injury was as a result of being hit or injured by someone. Seek the advice of an ethnic health worker/interpreter regarding the most appropriate ways of phrasing questions for women of different cultures. The safety of the victim is crucial. Staff will ask the client if she fears for her safety or for the safety of her children. Take all threats seriously. They may lead to murder or suicide. Staff need to also consider their own safety and, when making home visits, be accompanied by police where safety is not assured. For more information about safety in the workplace, consult the NSW Health Department's Policy and Guidelines for the Minimisation and Management of Aggression in NSW Public Health Care Establishments. Staff should avoid making any attempts to mediate the violence between the victim and the perpetrator. In domestic violence situations the power between the parties is not equal and the violence cannot be negotiated. 3.3 Assessment Process (for all staff) When the client is of non-English speaking background, she is to be informed of her right to an interpreter. Contact the Health Interpreter Service TELEPHONE: 757 1800. AFTER HOURS: 609 8111 (The Deaf Interpreter Service is also available on this number). • Prior to the interview ask the client in private if she would like a support person (other than the perpetrator) to accompany her. Interview the client in private and without interruption. Ask questions about domestic violence in a direct but sympathetic manner, for example: ASK "We see a lot of women who have injuries like these. Did your husband/boyfriend do this to you?" • Assess the safety of the client and any children, for example: ASK "Will you be/feel safe when you return home?" If the client (and children) are in immediate danger of being abused, take steps to ensure that they have a safe place to stay, for example at a women's refuge, friend's house or overnight admission in Emergency Dept if necessary. • Ask if there has been a sexual assault. If there has been a sexual assault, contact the sexual assault team in Community Health. • When children are subject to, or at risk of, physical violence staff must notify the local office of the Department of Community Services (DCS) or the 24-hour Child Protection and Family Crisis Service (008 425 288). • Assess the need for specific professional or personal support, for example, Aboriginal health or support workers, ethnic health worker, disability service, sexual assault services. • Explain to the client that domestic violence is both unacceptable and a crime in Australia. Inform the client of her legal options, namely Apprehended Violence Orders (see 1.5 "Legal Choices for Victims"). Record details of: 1. Time of arrival 2. Language and dialect spoken and need for interpreter 3. Physical/emotional/behavioural manifestations    (see 3.1 "Identifying Domestic Violence") 4. History given by client regarding the assault or abuse including     threats made to and any fear expressed by the client 5. Own observations and whether this is consistent with the history given by the client 6. Any treatment and referrals given 7. Any police, Department of Community Services or sexual service    involvement and the contract officer. 3.4 Intervention CRISIS  When the client is of non-English speaking background, she is to be informed of her right to an interpreter. Contact the Health Interpreter Service TELEPHONE: 757 1800. AFTER HOURS: 609 8111 (The Deaf Interpreter Service is also available on this number).   1. MEDICAL ATTENTION Community Health • Ensure the need for immediate medical attention is met. Contact Hospital: Bankstown Ph: 790 0444 Fairfield Ph: 609 8111 Liverpool Ph: 600 0555 Campbelltown Ph: 046 25 9222 Camden Ph: 046 29 1000 or sympathetic local General Practitioners • Assist the client to obtain transport to receive medical attention if necessary • Document any history given by the client as to the cause of injury. Hospital • Assess the need for immediate medical attention and ensure medical needs are met • Check patient's file for previous record of injuries/symptoms consistent with domestic violence • Ensure all information is recorded including: - Physical injury: size, colour, shape of markings, type etc. Use colour photographs and body maps - Emotional/Behavioural manifestations: distress, anxiety, headaches, back pain etc. - History given by victim: whether assaulted, by whom, what with, when, number of reported blows, implement used etc. - Own observations and whether this is consistent with the history given by the client. - All treatment given, for example, any drugs prescribed, referral for X-ray, admission and reason. - Any Police or Department of Community Services officers involved. • Offer RMO's Statement of Injury to the client - Appendix C. 2. SAFETY • Assess the safety of the client and any children, for example: ASK "Will you be/feel safe when you return home?" Victims usually understate danger. • If there is immediate danger of further abuse, ask the client if she has a safe place to stay, for example, safe relative/friend's house where the perpetrator will not harass her. Contact a women's refuge directly (see Appendix A) or ring the 24-hour Domestic Violence Service (008 047 727). If there is no other safe alternative consider an overnight admission. • If the client is admitted, notify Hospital security if there is a concern that the perpetrator will continue harassment while she is in hospital. • Ask if the perpetrator has access to firearms or other weapons and contact the police if this is the case. • Notify the local office of the Department of Community Services if the children are at risk of physical and/or sexual abuse. 3. CRISIS COUNSELLING • Contact an Aboriginal health/support worker if the client is Aboriginal or an appropriate ethnic health worker/bilingual counsellor for women of non-English speaking background if the woman wishes (female worker if possible). Hospital • Contact the hospital's social worker for immediate crisis counselling. Where there is no social worker available, contact the extended hours or mental health team or contact the 24-hour Domestic Violence Service (Ph: 008 047727) • Refer the client to the hospital social worker and/or Community Health for follow-up and support. Community Health • Intake officer or appropriate staff member to provide crisis counselling or contact the 24-hour Domestic Violence Service (Ph: 008 047727) • Make arrangements for follow up by Community Health staff for long term counselling and support. 4. POLICE & LEGAL ASSISTANCE (See also Sections 1.4 "Legal Implications for Health Workers" and 1.5 "Legal Choices for Victims"). • Ask the client if the police have already been contacted. • If the client reports that the perpetrator has access to guns and has threatened to use them or if serious injury has been inflicted (broken bones, stab or gunshot wounds) then inform the police of the details, including the number of weapons, regardless of the client's wishes. • In all other instances, ask the client if she wishes to inform the police. If the client wants to report the violence and any assault or to charge the perpetrator, contact the local police station and ask to speak to a police officer. Most patrols have a Domestic Violence Liaison Officer (DVLO). If there is a DVLO, ask to speak to him/her. • If the police are contacted, it is recommended that the officer be asked to attend the interview in the Unit/Centre. This is preferable to having the client attend the station. If the client is required to go to the station, ensure the health worker or another support person attends with her. • Inform the client of the kinds of questions the police are likely to ask, for example, specific occasions of abuse, threatening words or actions against her or others. The police will usually ask her to make a statement. • Inform the client that she can either charge the perpetrator and/or apply for an Apprehended Violence Order (AVO) to be taken out for her future protection, or the Police can apply for an AVO on her behalf (see 1.4 "Legal Choices for Victims"). If she wishes to apply for an AVO herself she can contact the local court to see the Chamber Magistrate or Clerk of the Court. Offer referral to Community Legal Centre or Legal Aid Service (see Appendix A). 5. INFORMATION & REFERRAL • Provide pamphlet and information on domestic violence and the Power and Control handout (Appendix E). • Provide information on legal options (see 1.4 "Legal Choices for Victims") • Ensure the client is informed of local services, welfare and ethno-specific agencies and other community organisations that give support (see Appendix A). • Assist with referrals if necessary which may include telephoning refuges, making an appointment with the Chamber Magistrate and organising support in conjunction with ethnic welfare organisations. • Inform the victim of her right to apply for Victim's Compensation under the Victim's Compensation Act 1987 (see Appendix B). NON-CRISIS Hospital and Community Health  When the client is of non-English speaking background, she is to be informed of her right to an interpreter. Contact the Health Interpreter Service TELEPHONE: 757 1800. AFTER HOURS: 609 8111 (The Deaf Interpreter Service is also available on this number). As stated elsewhere, many women and children present to services with a range of health problems and domestic violence, while not the presenting problem, may be disclosed as a result of direct questioning of the client about domestic violence. Direct questioning is particularly important where there are physical and emotional/behavioural signs of domestic violence (see 3.1 "Identifying Domestic Violence"). Once disclosure occurs the client may enter an emotional crisis phase. This may be the first time she has been able to discuss the abuse and may result in her experiencing a range of feelings and emotions. 1. SUPPORT • Provide support, counselling and information to the client in a safe and private area: - Assist the client to clearly assess what her choices are - Ensure the client is informed of local services and welfare agencies for further support, assistance and information - Provide local contact telephone numbers for crisis care together with pamphlet Domestic Violence - We can do something about it! - Provide information about the patterns of domestic violence (see Appendix E) - Inform the client of her legal rights and assist her to exercise those rights. • Ensure the client is fully aware of the need for protection and the use of an Apprehended Violence Order (AVO). • Liaise with medical and nursing staff regarding the client's on-going care. • Assist with the arrangements for follow up appointments for doctors, police and other services. • Document physical, emotional and psychological manifestations as reported by the client. • Request permission to follow up by phone. • Reassure client that support will be provided regardless of any decision she makes and at any future presentation to the Health Service. 2. SAFETY • Inform the client of refuges and emergency accommodation (see Appendix A) and stress the importance of ensuring her and her children's safety. • Inform the client of the choices available to protect her safety, for example, taking out an AVO against her partner or leaving the home. • Ask the client if the perpetrator has access to firearms and weapons and inform the police if this is apparent. • In instances where the client does not wish to take legal measures to protect herself, inform the client of some strategies that could provide protection if physical violence erupts again. This would include: - removing herself from the situation immediately - contacting the police as soon as she is able whenever violence occurs - making plans in case she needs to escape quickly, such as organising with a friend for safe emergency accommodation if necessary; getting a spare set of car/house keys cut; having a list of contact numbers handy; having personal documents and spare money in a safe and accessible place. • Ensure the client is fully aware of the need for protection and the danger of the situation. 3. POLICE & LEGAL ASSISTANCE As for "Police and Legal Assistance" in a crisis intervention situation on p 19. 4. INFORMATION & REFERRAL As for "Information and Referral" in a crisis intervention situation on p 20. 3.5 Women Of Non-English Speaking Background The following guidelines address some of the issues specific to women of non-English speaking background (NESB) who are victims of domestic violence and will assist staff in applying the general protocol. • Inform the client of her right to an interpreter. It is important to recognise that cultural issues are as much a factor in appropriate intervention as the language barrier. The following response from the client may indicate an interpreter would be helpful: - brief YES/NO responses - answers that are not related to the open-ended questions - generally compliant answers - no questions asked by the client - confused facial expressions. Each SWSAHS facility will have: - a language identification sheet - a sheet with You have the right to an Interpreter or I will call the Interpreter, translated into 20 languages. These will assist staff, where the client is literate in her first language. See also "Using Interpreters" below. • Remember to treat the client as an individual. Avoid cultural stereotyping, for example, "All Vietnamese women are submissive". It is also important to remember that an Australian migrant is subject to other cultural influences in Australia as well as those from their country of origin. It is important to be sensitive but not to stereotype. Stereotyping will prevent communication and hinder the health worker's ability to assist. • Establishing trust and rapport with the client is a priority and in order to develop trust, it is important that there is respect for the client, her culture and beliefs, and her decisions regarding legal action. NESB women may need more reassurance and explanation of how the law operates in Australia before they will take the step of asking for police and legal protection. Migrant women may be especially fearful of becoming cut off from their community or other family members in Australia if they take action around domestic violence. They may not know of support services for NESB women. In their country of origin there may not be any Social Security system. • Make sure the client understands that domestic violence is a crime in Australia and that there are laws which will give assistance and protection. Many NESB women may be misinformed about Australian laws. They and the perpetrator may not know that in Australia you do not have to prove fault (for example, mental or physical cruelty) in order to get a divorce. Misinformation may be one reason for strong resistance to legal protection. • For many NESB women and especially women who are refugees, the cultural significance of the police being involved and the legal implications of domestic violence are frightening. Some migrants have suffered torture and trauma in their own countries and may find police involvement or the hospital environment intimidating. • Give the client the option of using ethnic health workers and other migrant health workers. While some women will be grateful for the option of working with someone who has an understanding of the cultural context of her situation, other women will prefer the anonymity of working with someone who is not from the same community. • It is important that health services do not simply refer the client to other migrant services but that they work in cooperation with them. The more avenues a client has for support, the better, particularly if she decides she is not yet ready to take action to protect herself. • For women who are not permanent residents of Australia, there is now a special provision for them to leave a violent spouse and still become eligible for permanent residence. If the client wishes to remain in Australia she will need evidence of either an Apprehended Violence Order or a proven charge or conviction for assault. She will need to contact the nearest DILGEA Office (Department of Immigration, Local Government and Ethnic Affairs) and ask to speak to the Domestic Violence Contact Officer. DILGEA (South Western Region) Ground Floor 36-38 Raymond St Bankstown 2200 Ph: (02) 707 5777 Advice may also be obtained from:| Immigration Rights and Advice Centre Ph: 281 8355 Using Interpreters • It is important to remember that even if she is fluent in English the client may feel more comfortable speaking in her own language in a time of crisis. • Always request a female interpreter for women who are victims of domestic violence. It is not appropriate to use family members as interpreters. • Avoid allowing the interpreter to become in any way a counsellor. Although staff may be busy, it is important to stay with the client to prevent this from happening. By speaking directly to the client instead of speaking to the interpreter, it will also be clearer who is the primary support worker or counsellor. • It is important to trust the interpreter. Be careful not to interrupt the conversation prematurely. Trust that the interpreter will convey the information. • Try and talk to the interpreter to improve rapport with him/her before seeing the client. Briefing and debriefing are essential to effective intervention. The interpreter can be a useful source of advice and information about cultural issues if she/he is of the same cultural as well as language background as the client. For staff and organisations which may be of assistance, see Appendix A, Ethnic/Migrant Services. For further details, refer to NSW Health Dept Circular 87/163, Standard Procedures for Improved Access to Area and Other Public Health Services for People of NESB. 3.6 Aboriginal Women Aboriginal women are often reluctant to use hospital and community health services. There are a number of reasons for this including: • Negative and even hostile attitudes of some health workers • Fear of police attitude and involvement and, in relation to domestic violence, both disbelief of the client and possible brutality for the perpetrator • Lack of Aboriginal people employed by health services as generalist workers or Aboriginal Health Workers, who can provide cultural understanding and support for Aboriginal women • Lack of information that is written and designed in a way that is appropriate to Aboriginal people • If health workers are often reluctant to ask questions about injuries and the possibility of domestic violence, the victim may be similarly reluctant to disclose violence and use health services because of the belief that the violence is being condoned by silence • Lack of information about rights and support services • Lack of community support for women who speak out against domestic violence (NSW Domestic Violence Strategic Plan Vol.2)7. In addition to the general protocol, the principles to be adopted when working with Aboriginal women are: • If an Aboriginal client presents at the Emergency Department with indications of domestic violence, ask if she would like an Aboriginal health worker or support worker to give support. Contact a female worker if possible. A list of Aboriginal workers who are able to provide assistance will be retained by each Service. • The Aboriginal Legal Service will not represent Aboriginal women, however, when the perpetrator is an Aboriginal man. This may result in Aboriginal women not receiving appropriate legal representation, so supportive legal representation from the Domestic Violence Advocacy Service or Community Legal Centres would be advised. • Reassure the client of confidentiality and of her choice in relation to any legal/police options she may take. • Have on display Aboriginal health posters/pamphlets and material regarding patient's rights in each health facility. For staff and organisations which may be of assistance, see Appendix A Aboriginal Services. 3.7 Women With A Physical Or Intellectual Disability Principles to adopt when the victim of domestic violence has a physical or intellectual disability: • The victim is entitled to the same rights as any other person in relation to access to support from health services, police and the law. • It is most important that staff take the issue seriously. The client may have already encountered staff in other services who would not believe her. • Actual or suspected physical or sexual abuse of a person with a disability requires prompt attention. The decision to report an assault to the police however is a decision for the victim (except as outlined in 1.4 "Legal Implications for Health Workers"). • It is important that staff be aware of the effects of her disability or disabilities particularly in relation to communication, for example, the ability to make or take phone calls, or to write messages or statements, the effect of short term memory problems on decision making, physical access issues. These may affect her ability to utilise health and other support services including police and legal services. • Call on other support people (at the client's request) who will know more of her history, for example, the disability worker, the Department of Community Services caseworker (for people with an intellectual disability), non-offending family members. • Many people with a disability rely on income from the Department of Social Security and are eligible for legal aid services. • It is important to keep in mind that the client may be dependent on the perpetrator for assistance with personal care. • A woman with a disability who is experiencing domestic violence may not want to report it or take legal action because: - She does not know that domestic violence is both unacceptable and a crime - She may have lived with violence as a child and as an adult and see it as a normal part of life - Her disability may prevent her from accessing information on how to stop the violence - She may fear retaliation or be unable to escape or respond quickly - She may fear losing her accommodation or personal support services. Health workers have a responsibility to ensure the client understands the seriousness of the situation and the options available to her, and support her to make informed decisions. Intellectual Disability • The victim may desire an advocate more so than other women for liaison between her and the police or legal services (for example, visiting a Chamber Magistrate or applying for an AVO). The role of the advocate may even involve communicating on her behalf. Because she may have been in the position where others have been making decisions for her, advocacy may require time to communicate and time for the client to make decisions, as well as support from the worker for these decisions. • Documentation of evidence of abuse (physical injury, emotional/social assessment, observations by staff) will be crucial if the victim is not able to give evidence in court. Many women with an intellectual disability can give evidence in court if appropriate support is given to them. • The victim may be in group accommodation. Discuss options with the client's case worker at the Department of Community Services. Alternative accommodation for the perpetrator and an Apprehended Violence Order may need to be arranged. • If the client is unable to make decisions about the violence for herself, guardianship may be appropriate. Contact the Guardianship Board for further information and advice. • Communication problems may arise when the victim has an intellectual disability. The following strategies may assist in overcoming some of these problems: - Schedule extra time for the interview - Take frequent breaks - Encourage the client to ask questions - Use simple language and encourage the client to ask you to explain unfamiliar words - Be creative - use pictures, examples and role plays - Ask open ended questions - Ask the victim to explain any advice back to you - Try to ensure that the client is not being pressured about a decision - Help the client to identify the real issue. Do not confuse the issue by giving unnecessary information - Do not assume the client has understood the advice if she fails to ask questions - Do not ask questions that suggest answers. A study carried out by the Office of the Public Advocate in Victoria, called Silent Victims, has confirmed that people with an intellectual disability are particularly vulnerable to crime. Assault is one of the most common crimes against people with an intellectual disability. For staff and organisations which may be of assistance, see Appendix A, Disability and Aged Services. 3.8 Women With Mental Illness Women with a psychiatric history who are subject to domestic violence have a right to be believed despite their illness. It is a common experience for these women to be disbelieved, and for their beliefs about being abused to be considered a manifestation of the illness. Such attitudes from health workers exacerbate their feelings of powerlessness. It is important that staff also recognise that domestic violence can help precipitate and exacerbate acute episodes of mental illness. In addition to the general protocol and policy the following principles apply for women with mental illness suffering domestic violence. • Statements and actions made by the client will not be automatically discarded as manifestations of the illness. • Ask questions about domestic violence in the initial interview in a direct and sympathetic manner. • If the client wishes to be admitted, clarify whether she is really requesting respite from domestic violence or if she is genuinely mentally ill at the time. • If she is admitted primarily for respite reasons in order to avoid the domestic violence precipitating or exacerbating the mental illness, then this will be noted as the reason for admission. • A refuge specifically for women with mental illness would be the first and most appropriate option for respite, for example, Charmian Clift Cottage or Alice's Cottage's. If this is not possible, admission to prevent the onset of an acute phase may be necessary. Advocacy • Staff in psychiatric inpatient units can act as advocates for women with mental illness who are also suffering domestic violence. With staff support, the inpatient unit can be a "safe" place for a client to disclose domestic violence, receive support and information, and get overnight respite if in crisis. Support both her right to be believed and the fact that she is believed when liaising with the police, family, and other services. • Inform the client of her right to take out an Apprehended Violence Order or pursue other legal options. If a client is acutely mentally ill, staff may need to act as an advocate on her behalf with the police or the perpetrator. • It may be the most appropriate time for the client to take up the opportunity to pursue an AVO while an inpatient and "safe". If this is not the best time, then discuss options for pursuing legal avenues for stopping the violence with the client while she is an inpatient. Options for alternative housing and finance could also be discussed while the client is an inpatient. For staff and organisations which may be of assistance, see Appendix A Disability and Aged Services. 3.9 Older Women Women who have been victims of domestic violence for many years may continue to be abused in their old age. Where abuse is a continuation of a history of domestic violence, gender and power relationships are involved. In addition, some elderly victims are frail and may be dependent on the offending partner for care. Refer to the preceding protocols (sections 3.1 - 3.4) regarding intervention for independent older victims of domestic violence. Where elderly victims of domestic violence are frail and dependent on the abusive partner for care, they may require additional support including: • An advocate/case manager from a community agency or Aged & Extended Care team • Assistance from the Guardianship Board • Assistance from the Protective Commissioner regarding financial management in instances of financial exploitation. Abuse of older people is recognised as a serious health issue. Physical and/or mental disability is the main reason why both men and women can fall victim to abuse in their old age. The perpetrators are often family members, either spouse, child or other close relative, usually living with the victim.1 There are a number of theories regarding the causes of abuse of older people including the vulnerability of older people, the stress on their carers, and negative attitudes towards older people.8 These theories raise issues that are better addressed by the development of separate protocols regarding the abuse of older people. For staff and organisations which may be of assistance, see Appendix A Disability and Aged Services. 3.10 Principles Of Family, Couple Or Child Counselling Often in a counselling situation domestic violence does not present as 'the primary problem' for victims or their children. It is most likely that domestic violence will be discovered by the worker in the course of the therapy process. It is most important that steps be taken to address the issue of violence should this occur. Domestic violence is a crime perpetrated against the victim, for which the perpetrator has sole responsibility. It is not the problem of the victim. The safety of the victim and any non-offending family members is paramount. Family and couple counselling as well as mediation are not appropriate responses to domestic violence.5,7 It can be deleterious to continue to engage in family, couple or child therapy where the violence is continuing for the following reasons: • the possible increased risk to safety of victim and children • it reinforces the unequal power relationship between the victim and the perpetrator by suggesting that they are equally responsible for the problems in the relationship • it places an unfair responsibility on the victim to solve the violence • it allows children's behavioural problems to continue to be the focus for underlying problems of violence • it allows the victim and the perpetrator to continue to ignore the violence as the real issue • it gives the parents the message that the problem is the child and not the violence. Counselling will not begin or continue unless at least one of the following measures are in place to ensure there is some safety for the victim and children: • The violence has stopped • The couple are separated • An AVO is in place. Therapy with children who are disturbed by domestic violence, and are having behavioural problems as a result, will not continue while violence occurs unless options for curtailing the violence are addressed with the child and non-offending family members. If the adult victim elects to stay in a violent relationship and requests counselling, it will be made clear that the focus of counselling will not be on how to cope with the violence, but rather will focus on empowering the victim by providing her with information regarding her rights and options for escaping from the violence. 3.11 Perpetrator Counselling This area of work is specialised and long term. It is also difficult and has the potential for danger for both the worker and the perpetrator's partner and family. Previous studies have shown that both group and individual counselling for perpetrators have very limited success rates in achieving either an end to violence or a change in the perpetrator's attitude (NSW Domestic Violence Strategic Plan Vol.4).7 Perpetrators will frequently use counselling, or that they are on a waiting list for counselling, as a reason for receiving lesser charges. They may have no intention or commitment to changing their violent behaviour. The NSW Domestic Violence Strategic Plan states: No government funding should be used to provide counselling or support for perpetrators of domestic violence, except legal aid, until the criminal justice response has been strengthened to clearly criminalise domestic assault through police action and court sanctions; and • appropriate therapeutic, support and legal services are firmly in place for women and children; and • local independent research evidence indicating the success of perpetrator treatment programs is available; and • firm guidelines and controls are in place; and • appropriately trained and accredited counsellors are available and can be supervised and independently monitored.7 At this time, advice from the NSW Domestic Violence Committee and the NSW Department of Health indicates that the conditions outlined above cannot be assured and therefore perpetrator counselling cannot be offered by the Area Health Service. The provision of perpetrator counselling will be reconsidered when approved guidelines and training are developed. Protocol If it becomes apparent during the course of treatment for some other reason such as mental illness or drug and alcohol counselling, that the client is a perpetrator of domestic violence the following principles will apply: • No court reports stating that the person is attending counselling for violence will be given in relation to a charge for assault, application for or breach of an AVO or custody application. • Non-offending partners and children are to be offered separate counselling with the appropriate team. If the perpetrator requests referral for therapeutic counselling, referrals will be made to those non-government organisations which offer perpetrator programs in accordance with the guidelines outlined in "Programs for Perpetrators" in the NSW Domestic Violence Strategic Plan Vol.4 (A framework for evaluating programs for violent men is attached in Appendix F). 4. APPENDICES APPENDIX A: RESOURCES AND SUPPORT SERVICES  24-Hour DOMESTIC VIOLENCE CRISIS LINE 008 047 727 (telephone crisis counselling & referral service) 1. WOMEN'S REFUGES AND CRISIS ACCOMMODATION 24 hour Women's Refuge Referral Centre - 560 1605 For women with children Bankstown Women's Service- 796 2577 (Greenacre) Bonnie Women's Refuge - 609 3939 (Canley Heights) Marcia Women's Refuge - 046 283 034 (Campbelltown) Crisis Accommodation Services Southern Highlands - (046) 713 235 For single women Amberleys Women's Refuge - 602 9160 (Liverpool) For Aboriginal women Cawarra - 047 21 8922 (Penrith) For Muslim women Muslim Women's Refuge - 750 6916 (Lakemba) For Indo-Chinese women Mimosa House - 636 2081 (Greystanes) Lotus House - for young women 14-18 years - 727 0836 (Fairfield) Homeless Persons Information & Referral Service - 265 9081 (Monday-Friday 9 am - 5 pm 265 9087) Department of Housing Crisis Accommodation - 821 6111 (Monday-Friday 9 am - 5 pm) Special Housing Schemes Charmian Clift Cottage Crisis Accommodation and Support Service - for women with a psychiatric history and their children - 622 3066 (Doonside) Women's Emergency Shelter and Training Scheme - for women with a drug and alcohol or criminal justice history - 516 5588 (Enmore)   2. POLICE STATIONS Ask for Domestic Violence Liaison Officer or Police Officer Bankstown Bankstown - 707 5299 Bass Hill - 645 9999Punchbowl - 750 0267 Revesby - 774 2444 Fairfield Fairfield - 728 0399 Wetherill Park - 725 5177 Cabramatta - 727 4100 Liverpool Green Valley - 608 4999 Liverpool - 821 8444 Moorebank - 825 1511 Campbelltown Campbelltown - 046 25 7844 Camden - 046 55 9228 Macquarie Fields - 618 2777 Ethnic Liaison Officers Some Police Stations employ Ethnic Community Liaison Officers to assist people of non-English speaking background in using police services. At September '92, languages spoken by the Liaison Officers were: Serbo/Croatian - Fairfield Police Chinese/Mandarin - Fairfield Police Laotian - Cabramatta Police Vietnamese - Cabramatta Police Vietnamese- Bankstown Police   3. HEALTH SERVICES Emergency Medical Hospital Emergency Departments Bankstown - 790 0444 Fairfield - 609 8111 Liverpool - 600 0555 Campbelltown - 046 25 9222 Camden - 046 29 1000 Community Health Services Bankstown Community Health - 790 0055 Liverpool Community Health - 828 4844 Hoxton Park Community Health - 827 2222 Fairfield Community Health - 727 4244 Campbelltown Community Health - 046 29 2111 Narellan Community Health - (046) 40 3500 Bowral Community Health - (048) 61 2744 Bradbury Community Health - (046) 29 2198 Ingleburn Community Health - (046) 29 2100 Sexual Assault Services Bankstown Community Health - 790 0055 Liverpool Community Health - 828 4844 Campbelltown Community Health - 046 29 2111   4. LEGAL SERVICES Chamber Magistrate or Clerk of the Court (see local courts) Bankstown - 790 0277 Fairfield - 728 6333 Liverpool - 821 7999 Campbelltown - 046 29 9600 Camden - 046 55 8537 Bowral - (048) 611 535 Moss Vale - (048) 681 130 Picton - 046 77 1527 Community Legal Centres South West Sydney Legal Centre (Liverpool) - 601 7777 Campbelltown Community Legal Service - 046 28 2042 Neighbourhood Law Centre (Liverpool) - 601 7434 Legal Aid Offices Bankstown - 707 4555 Liverpool - 601 1200 Fairfield - 727 3777 Campbelltown - 046 28 2922 Domestic Violence Advocacy Service - 673 3741 Free legal Advice available at Immigration Women's Health Information Service and WILMA Women's Health Service Centre by appointment. Court Support Services Available at local Courts: Bankstown Fairfield Liverpool Campbelltown Bowral Moss Vale   5. WOMEN'S HEALTH CENTRES Bankstown Women's Health Centre - 790 1378 Multicultural Family Planning Centre (Fairfield) - 754 1322 Immigration Women's Health Information Service (Fairfield) - 726 4059 Liverpool Women's Health Centre - 601 3555 WILMA Women's Health Centre (Campbelltown) - 046 27 2955 Benevolent Society Domestic Violence Service (Campbelltown) - (046) 27 2792   6. CHILD PROTECTION Department of Community Services (for notification of children) Contact Community Service Centres Bankstown - 790 4066 Fairfield - 728 1911 Cabramatta - 725 8100 Liverpool - 602 8044 Campbelltown - 046 25 5911 Bowral - (048) 611 744 Child Protection and Family Crisis Service - 008 04 7727 (24 hours)   7. ABORIGINAL SERVICES Aboriginal Legal Service Redfern - 699 9277 Blacktown - 831 1066 Tharawal (Aboriginal Medical Service) - 046 28 4837 Aboriginal Health Workers Hoxton Park Community Health Service - 827 2222 Ingleburn Community Service - (046) 29 2100 Liverpool Women's Health Centre - 601 3555 Aboriginal Support Workers Green Valley Family Support Service - 607 9503 Aboriginal Womens Refuge "Cawarra" - 047 21 8922 Emergency Accommodation Ngura Hostel - 799 8446 Campbelltown and District Aboriginal Co-op.(referral and support services) - 046 264 100   8. ETHNIC/MIGRANT SERVICES Interpreter Services Health Care Interpreter Service (South Western) - 757 1800 After Hours: 609 8111 Telephone Interpreter Service - 221 1111 Ethnic Health Workers (for support and better access to health services) 8.30 am - 5 pm located at Community Health Centres. Staff at June 1996 are: Vietnamese - Fairfield Community Health Bankstown Community Health Spanish - Liverpool Community Health Polish - Bankstown Community Health Lao - Cabramatta Community Health Khmer - Fairfield Community Health Arabic - Bankstown Community Health - Liverpool Community Health Italian - Liverpool Community Health Bilingual Counsellors (for individual assessment, casework and groupwork) 8.30 am - 5 pm located at Community Health Centres. Staff at June 1996 are: Italian - Fairfield Community Health Vietnamese - Cabramatta Community Health Lao - Campbelltown Community Health Spanish - Prairiewood Community Health Migrant Resource Centres Liverpool Migrant Resource Centre - 601 3788 (sessional community workers in Polish, Italian, Serbian, Croatian, Vietnamese, Filipino, Spanish, Muslim, Arabic, Kurdish) Fairfield Migrant Resource Centre - 727 0477 (sessional caseworkers in Chinese, Khmer, Samoan, Arabic, Turkish, Vietnamese, Spanish) Canterbury/Bankstown Migrant Resource Centre - 789 3744 (sessional caseworkers in Chinese, Samoan, Vietnamese, Tamil, Korean) Torture and Trauma Survivors STARTTS (Service for the Treatment and Rehabilitation of Torture and Trauma Survivors) - for refugees and migrants who suffered torture/trauma in their country of origin - 726 1312 / 728 3843  Immigration Issues Department of Immigration, Local Government and Ethnic Affairs in Australia (DILGEA) - for domestic violence victims who want to apply for permanent residence on spouse grounds South Western Regional Office (Bankstown) - 707 5777 Women's Associations Vietnamese Womens Association - 821 1005 Muslim Womens Association - 750 6916 Immigrant Womens Speakout - 646 1170   9. FAMILY SUPPORT SERVICES Bankstown - 709 5302 Fairfield - 724 1307 Liverpool - 821 1014   10. DEPARTMENT OF SOCIAL SECURITY Bankstown - 795 0333 Fairfield - 794 7333 Cabramatta - 728 8333 Liverpool - 827 7333 Campbelltown - 046 29 9333   11. DOMESTIC VIOLENCE SUPPORT GROUPS (for victims and survivors) Liverpool - contact Liverpool Womens Health Centre - 601 3555 Campbelltown - contact Campbelltown Community Health - 046 29 2111 Camden - contact Camden Community Health Centre - 046 55 3375 Bankstown - contact Bankstown Community Health (Adult Mental Health team) - 709 6044 Mt Pritchard - contact Centacare - 610 6955   12. DISABILITY AND AGED SERVICES Intellectual Disability Rights Service - 698 7277 Department of Community Services - Community Service Centres Bankstown - 790 4066 Fairfield - 728 1911 Liverpool - 602 8044 Campbelltown - 046 25 5911 Citizen Advocacy - 369 2411 Disability Complaints Service - 746 3230 Guardianship Board - 555 8500 Mental Health Advocacy Service - 745 4277 Protective Commissioner - 265 3131 Liverpool/Fairfield Aged & Extended Care Team - 828 4762 Bankstown Aged & Extended Care Team - 708 7171 Camden/Campbelltown Aged & Extended Care Team - 046 291116   13. PAMPHLETS, POSTERS AND RESOURCES Womens Health Education Officers Bankstown Community Health Centre - 709 6044 Campbelltown Community Health Centre - (046) 29 2111 Fairfield Community Health Centre - 727 4244 Domestic Violence Unit Department for Women - 334 1110 APPENDIX B: VICTIM'S COMPENSATION AND CHARTER OF VICTIM'S RIGHTS The Victim's Compensation Scheme is designed to provide compensation for bodily harm, nervous shock, mental illness/disorder, or pregnancy resulting from the act of violence under the Victim's Compensation Act, 1987. Compensation is available under the scheme for : • pain and suffering • loss of enjoyment of life • loss of earnings • medical expenses • loss of personal effects • other incidental expenses. Domestic violence victims, their children and other relatives may be eligible for compensation if the person is : • injured as a result of being a victim of violence • injured as a result of witnessing an act of violence • the husband, wife, de facto, parent or child of a person killed as the result of an act of violence • injured in the course of law enforcement while trying to: - prevent someone from committing an offence - arrest someone who is committing an offence - help or rescue someone against whom an offence is being committed. If the victim is a child, an a