Setting Up a Domestic Violence Service

Abstract

Background: This paper describes some of the issues we confronted and resolved in setting up an independent dedicated domestic violence service. Method: In our project we work with violent behaviour that is known or suspected in the contexts of both assessment and therapy. We describe our policy on domestic violence, including confidentiality, our reflecting practices, our relationships with referrers as a means of managing the risk of violence, and the assessment and evaluation procedures we use for the assessment of risk of violence. We include some discussion of the effects of domestic violence on children and the effects of doing this work on ourselves. Conclusions: We conclude by discussing the moral issues involved for us as therapists in doing this work, the impact of the legal frame within which we work, and some of the social and psychological theories we find helpful in understanding the causes and effects of violent behaviour in the family.

Acompanhamento de crianças vítimas de violência: desafios para o pediatra

“…22 The health services that treat victimized children have regularly explained the importance and necessity of notification to parents and have underscored that they should not acquiesce to violent behavior, giving priority to their childrens safety. 4,25 In order not to jeopardize the childrens life or psychological and physical health, it is crucial that health professionals think their own convictions through and not act out of excessive caution (which leads to hasty notifications with little or no evidence) or lack commitment to making the notification. 22 Notification of suspected or confirmed cases of maltreatment is mandatory for health professionals, according to the Child and Adolescent Statute.…”

“…The ability of family members to work cooperatively and see others as potential supporters is the mainstay of a solid rehabilitation plan. 25 However, it is not uncommon that the offender does not accept the intervention for himself/herself, insisting that only the child needs to be treated, in an (often unconscious) attempt to shift the focus of attention. Helping to better understand the family situation can be a work carried out by the pediatrician in whom the family trust, whom they usually seek for advice and who will deal with later referrals.…”

“…Making the offender take the blame for the violent acts he/she committed often causes him/her to develop empathy and the desire to understand the victims point of view. 25 This facilitates compliance with the treatment, which aims to change his/her inappropriate behavior towards the child.…”

“…The participation of non-offenders in psychotherapy sessions is associated with benefits to sexually abused children, especially the younger ones. 16 Since children who live in homes where spouse abuse occurs are at greater risk of being abused and as most of them suffer emotional sequelae even if they are not directly abused, 25,35,37 fighting couples should be referred to treatment as a way to protect the child. U.S. studies show that spouse abuse occurs in approximately 40% of severe or fatal cases of child maltreatment and in over 50% of suspected cases of maltreatment treated at hospitals.…”

“…Sometimes, the possible result is the safe separation of the couple or the safe contact of a violent parent/surrogate with the child. 25 Such difficulties in obtaining satisfactory results should not be regarded as failure of health professionals. It is important to make it clear that we do not always manage to go as far as it is theoretically desirable, but that we go as far as it is possible for each family and institution.…”