Ballarat Health Services - Part of Grampians Health is committed to ending family violence in our community.

Family Violence is a health issue that impacts both our staff and consumers. Family violence leads to poor physical and mental health and can affect a person's capacity to function.

Ballarat Health Services understands that family violence involves a spectrum of seriousness of risk and presentations and is unacceptable in any form, across any community or culture.

Our staff are committed to working collaboratively within our organisation and with key external stakeholders to provide coordinated effective risk management and management responses, including early intervention when family violence first occurs to avoid escalation into crisis and additional harm.

Ballarat Health Services has been prescribed by the Victorian Government to align to the Multi Risk Assessment and Management Framework (MARAM). This Framework has been established in law under a new Part 11 of the Family Violence Protection Act 2008, as part of reforms to ensure a system wide response to family violence. MARAM is based on the belief that to provide consistent, effective and safe responses for people experiencing family violence, services need a shared understanding of family violence and of the responsibilities of the professionals involved. In addition to this, MARAM also outlines expectations for engagement, risk assessment and management for victim survivors as well as perpetrators of family violence.

It is expected that all staff at Ballarat Health Services provide response to family violence. Each staff member will have a role to play in ending family violence.

All staff are responsible for the implementation of this policy.

In accordance with MARAM, Ballarat Health Services ensures that our staff will identify family violence and provide response to all consumers using the health service.

Grampians Health will support staff to implement the MARAM framework by;

• providing training in line with their responsibilities under the MARAM Framework to ensure that they can identify and respond to family violence.

• developing an organisation wide understanding of the drivers of family violence, predominantly gender inequality, which also intersect with other forms of structural inequality and discrimination.

• respect the agency, dignity and intrinsic empowerment of victim survivors by partnering with them as active decision-making participants in risk assessment and management of their family violence situation.

• have an awareness and understanding of the serious impact family violence may have on the current and future physical, spiritual, developmental and emotional safety and wellbeing of children who are directly or indirectly exposed to its effects, and should be recognised as victim survivors in their own right.

• ensure that family violence response provided to diverse communities and older people will be accessible, culturally safe, person centred, inclusive and non-discriminatory.

• encourage perpetrators to take responsibility and acknowledge their violent, controlling and coercive behaviour, and contribute to a coordinated and collaborative response to create opportunity for perpetrator accountability.

• Understand that family violence used by adolescents is a distinct form of family violence and requires a different response to family violence used by adults, because of their age and the possibility that they are also victim survivors of family violence. 

Child Victim Survivor and Young People: A child experiencing or witnessing family violence. As defined in the Family Violence Protection Act (2008) a child is a person under the age of 18 years and inclusive of unborn child. Note: The Royal Commission into Family Violence and the VIC Family Violence Data Collection Framework refer to children and young people comprising of individuals up to 25 years of age.

CISS: Child Information Sharing Scheme (CISS)

Coercive control: Coercive control refers to the micro-regulation of womens lives by an intimate partner (usually) in order to maintain dominance or control (Stark, 2007). This can involve a range of behaviours, including frequent belittling and derogatory comments, monitoring of their whereabouts, interfering with their relationships and financial abuse. For the purpose of this research, coercive control was operationalised in two ways: the co-occurrence of different categories of non-physical abusive behaviours, and the co-occurrence of physical or sexual violence combined with non-physical forms of abuse.

Collaborative Practice: contributing to the risk assessment of a victim survivor with other professionals who contribute their knowledge for ongoing risk management. Collaborative practice includes respectful and sensitive engagement with victim survivors as well as information sharing, referral and secondary consultation.

Consumer: Consumers are members of the public who use or are potential users, of healthcare services. This includes patients, clients, residents, participants, consumers, families, carer and other support people such as consumer representatives and advocates. It also includes community members and concerned citizens. It also includes people with a disability, people from culturally and linguistically diverse backgrounds, diverse socio economic status and social circumstances, people from LGBTIQA+ communities, Aboriginal and Torres Strait Islander people and any health and illness conditions. The use of the health service can be both direct and indirect in nature. POL0074 Partnering with Consumers

Contribute to MARAM Responsibility: Staff groups who are mapped to contribute to a MARAM responsibility are required to have an understanding and awareness of this responsibility and play a role in enabling others in the organisation to effectively perform and fulfil this responsibility. (RWH, MARAM Alignment Resource A)

Elder Abuse in the context of Family Violence: Is any harm or mistreatment of an older person that is committed by someone with whom the older person has a relationship of trust. In the context of family violence, this may be elder abuse by any person who is a family member (such as their partner or adult children) or carer. Elder abuse may take any of the forms defined under family violence. (MARAM Framework)

Emotionally abusive, harassing and controlling behaviours: Emotionally abusive, harassing and controlling behaviours refers to a broad range of behaviours or actions that are aimed at controlling a current or former intimate partners behaviour or causing them emotional harm or fear. These behaviours fall into five broad categories: financial abuse, verbally abusive and threatening behaviours, socially restrictive behaviours, stalking and monitoring behaviours, and reproductive coercion. These behaviours are also referred collectively to as non-physical abuse.

Family Violence: According to the Family Violence Protection Act 2008, family violence is behaviour towards a person that is;

physically or sexually abusive; or emotionally or psychologically abusive; or economically abusive; or threatening; or coercive; or in any other way controls or dominates the family member and causes that family member to feel fear for the safety or wellbeing of that family member or another person; or behaviour by a person that causes a child to hear or witness, or otherwise be exposed to the effects of the above behaviours.

FVISS: Family Violence Information Scheme (FVISS)

Intersectionality: Understanding that different aspects of a persons identity that can expose them to overlapping forms of discrimination and marginalisation. These aspects can include gender, class, ethnicity and cultural background, religion, disability and sexual orientation.

Intimate partner violence: Intimate partner violence is defined as physical violence, sexual violence or emotionally abusive, harassing and controlling behaviours that occur between current or former intimate partners.

MARAM: Multi Agency Risk Assessment and Management Framework

Perform and fulfil MARAM Responsibility: Staff groups who are mapped against a MARAM responsibility must be able to perform and fulfil this responsibility in their everyday practice. This requires staff to be able to competently perform the practice expectation and all the key capabilities associated with the assigned MARAM responsibility. (RWH, MARAM Alignment Resource A)

Perpetrator: Refers to any person that acts in violation of a victim survivors personal safety and wellbeing.

Physical violence: Physical violence is the occurrence, attempt or face-to-face threat of physical assault by an intimate partner, including:

• choking, strangling or grabbing them around the neck

• hitting them with something that could hurt them, beating them, or attacking them with a weapon (e.g. a knife, gun, bat or other household item) throwing

  anything at them that could hurt them, slapping, biting, kicking or hitting them with a fist (i.e. punching them)

• Pushing, grabbing or shoving them, physically assaulting them in any other way.

Sexual violence: Sexual violence is the occurrence, attempt or face-to-face threat of sexual assault by a current or former intimate partner. This includes an intimate partner forcing them, trying to force them or threatening to force them to take part in sexual activity against their will, which was also taken from the PSS (Australian Bureau of Statistics, 2017). It also includes image-based abuse, forcing a partner to watch pornography and forcing a partner to have sex without contraception (knowingly or otherwise).

Structured Professional Judgement: is coordinated and collaborative management practice to inform a clinicians approach to determining seriousness of risk as well as ongoing risk to a victim survivor. Risk assessment relies on a clinician or another professional ascertaining the victim survivors self assessment of their level of risk, fear and safety and the evidence based risk factors identified as present. Each element of Structured Professional Judgement can be considered collaboratively with other professionals who contribute their knowledge and expertise to the assessment process. This includes considering sharing relevant information (when authorised to do so) under the Family Violence Information Sharing Scheme, the Child Information Sharing Scheme or other relevant legislation. Evidence based risk factors are outlined in the Identifying and Responding to Family Violence Procedure Guideline Appendix C

Technology-facilitated intimate partner violence: Technology-facilitated intimate partner violence refers to non-physical forms of abuse that are perpetrated using digital technology. This can include certain forms of verbally abusive and threatening behaviours, socially restrictive behaviours, and stalking and monitoring behaviours which are perpetrated online or using devices such as smartphones.

Victim Survivor: A person experiencing family violence

Ballarat Health Services understands that everyone has a role in ending family violence in our community and is committed to implementing the MARAM framework in order to strengthen our family violence response to consumers.

MARAM outlines key understandings of family violence that should underpin the work of Ballarat Health Services, as part of a system wide approach to addressing family violence in our community. This includes an understanding by all staff in the organisation that:

• Family violence is a behaviour that controls or dominates a family member and causes them to fear for their own or another persons safety or wellbeing.

• Family violence is a choice by a perpetrator to use behaviours for the purposes of power and control. Perpetrators use coercive tactics and violent controlling behaviour to gain power over one or more victim survivors. Responsibility for the use of violence rests solely with the perpetrator.

• Family violence is deeply gendered and rooted in structural inequalities. While both men and women can be perpetrators or victim survivors of family violence, overwhelmingly, perpetrators are men, who largely perpetrate violence against women (who are their current or former partner) and children.

  Family violence can occur in a range of ways across different relationship types and communities, including but not limited to the following:

• Children and young people as victim survivors in their own right who have unique experiences, vulnerabilities and needs

• Older peoples experiences of family violence, often described as elder abuse, from intimate partners, adult children or carers, or extended family members

• The experiences of family violence may vary across communities and people from Aboriginal or diverse backgrounds may additionally experience structural inequalities.

Children and Family Violence

Ballarat Health Services recognises that children who witness or experience family violence are victims in their own right and as such child victim survivors should be supported through direct engagement where appropriate, safe and reasonable to do so. Engaging directly with children and young people can help them to feel safe (MARAM).

Being exposed to or witnessing family violence can have a traumatic impact on children. It is a form of child abuse that creates trauma, disrupts healthy attachment, impedes childhood development and compromises the development of core neural networks.

Ballarat Health Services understands that adolescents and children who have witnessed/experienced family violence may have complex needs related to mental health and behaviour management.

Our organisation is committed to identifying and responding to family violence early to prevent serious harm to children and adolescents and lessen the impact of trauma. We will do this by using the Multi Agency Risk Assessment and Management Framework (MARAM) to assess and respond to risk as well as sharing risk relevant information with internal and external Information Sharing and Risk Assessment Entities through the Child Information Sharing Scheme (CISS).

For further information on how to respond to children experiencing family violence as well as how to share information please refer to NCG0081 Family Violence and Child Information Sharing Schemes and CPP0636 Identifying and Responding to Family Violence Procedure.

Responsibilities of all Ballarat Health Services Staff

All staff have a responsibility to have a shared understanding of family violence including providing response based on responsibilities assigned to their role (see Appendix A MARAM Responsibilities & Appendix B. BHS Workforce Mapping). All action taken should be based on the following MARAM principles;

• family violence involves a spectrum of seriousness of risk and presentations, and is unacceptable in any form, across any community or culture

• professionals should work collaboratively to provide coordinated and effective risk assessment and management responses, including early intervention when family violence first occurs to avoid escalation into crisis and additional harm

• professionals should be aware, in their risk assessment and management practice, of the drivers of family violence, predominantly gender inequality, which also intersect with other forms of structural inequality and discrimination

• the agency, dignity and intrinsic empowerment of victim survivors must be respected by partnering with them as active decision-making participants in risk assessment and management, including being supported to access and participate in justice processes that enable fair and just outcomes

• family violence may have serious impacts on the current and future physical, spiritual, psychological, developmental and emotional safety and wellbeing of children, who are directly or indirectly exposed to its effects, and should be recognised as victim survivors in their own right

• services provided to child victim survivors should acknowledge their unique experiences, vulnerabilities and needs, including the effects of trauma and cumulative harm arising from family violence

• services and responses provided to people from Aboriginal communities should be culturally responsive and safe, recognising Aboriginal understanding of family violence and rights to self-determination and self-management, and take account of their experiences of colonisation, systemic violence and discrimination and recognise the ongoing and present day impacts of historical events, policies and practices

• services and responses provided to diverse communities and older people should be accessible, culturally responsive and safe, client centred, inclusive and non-discriminatory

• perpetrators should be encouraged to acknowledge and take responsibility to end their violent, controlling and coercive behaviour, and service responses to perpetrators should be collaborative and coordinated through a system-wide approach that collectively and systematically creates opportunities for perpetrator accountability

• family violence used by adolescents is a distinct form of family violence and requires a different response to family violence used by adults, because of their age and the possibility that they are also victim survivors of family violence

Leadership Responsibilities

Ballarat Health Services Chief Executive Officer, Executive Directors and Operational Management have additional responsibilities to ensure that;

• Ballarat Health Services provides training opportunities and resources for staff to build capability and capacity in order to provide family violence response.

• All disclosures of family violence are treated sensitively and confidentially

• Immediate action will be taken in the instance where a family violence incident is present in the health service

• Regular peer supervision is provided to all clinical and non-clinical staff who respond to family violence in an environment that is psychologically safe and does not put the wellbeing of the staff member at risk and that this support may need to be ongoing

• Policies, procedures and guidelines relating to family violence are consistently reviewed to ensure best practice response is being provided to consumers

• Continuous improvement of MARAM implementation occurs through regular governance, data collection, and regular evaluation of family violence response within the health service. Should gaps be identified in policy/procedure commissioning the development of new policy/procedure and practice guidance should occur in consultation with the Integrated Family Violence Steering Committee

• There is capacity building in the EMR system to embed MARAM screening and response tools in clinical practice