‘Violence, abuse and neglect’ is the umbrella term used by NSW Health for three types of interpersonal violence that are widespread in Australian communities: domestic and family violence; sexual assault; and all forms of child abuse and neglect. Children and young people with problematic or harmful sexual behaviour, who often present to NSW Health services, are also included. This is because they often have had personal experiences of violence, abuse and neglect and can be at heightened child protection risk.
If a person, including a child, is in immediate danger call Emergency Triple Zero: 000
In addition to NSW Health violence, abuse and neglect services (see below), 24 hour help and support for violence, abuse and neglect is available from:
The health sector plays a crucial role in efforts to prevent, respond to, and minimise the impacts of violence, abuse and neglect and these issues are core business for NSW Health (Integration Prevention and Response to Violence, Abuse and Neglect Framework).
Although preventing and responding to violence, abuse and neglect is the responsibility of the whole health system, NSW Health has a network of VAN Services which have principal responsibility for responding to these issues (i.e. it is their key focus or activity). These services are:
Other key programs and roles that further support NSW Health’s VAN responses include:
COVID-19 is a new strain of coronavirus that has not been previously identified in humans. It was first identified in Wuhan, Hubei Province, China, where it has caused a large and ongoing outbreak. It has since spread more widely in China. Cases have since been identified in several other countries. The COVID-19 virus is closely related to a bat coronavirus.
There is much more to learn about how COVID-19 is spread, its severity, and other features associated with the virus; epidemiological and clinical investigations are ongoing.
Outbreaks of new coronavirus infections among people are always a public health concern. The situation is evolving rapidly. More information about COVID-19 is available at COVID-19 (Coronavirus).
Yes. As essential public health services, VAN Services and programs are to be maintained as close to normal as possible. This is particularly important when taking into account that the presence of COVID-19 in our community is expected to heighten the incidence of violence, abuse and neglect.
VAN Services and programs will need to undertake local planning to ensure continuity of services and to mitigate risk. In principle, services are to be provided as normal, while taking into account and adapting to any specific risks related to COVID-19.
As the COVID-19 pandemic evolves, The Ministry will continue to assess the impact of the COVID-19 pandemic on VAN service delivery, and will issue further guidance as required.
To help assess COVID-19 risk, NSW Health staff are to ask all clients or potential clients:
If they answer yes to questions 1 and/or 2 they should be self-isolated (refer to Home isolation guidance for close contacts and Home isolation guidance for recently returned travellers).
If they answer yes to question 3 they should seek medical attention (refer to COVID-19 (coronavirus)).
If the client or potential client answers yes any of these three questions they should still receive a VAN Service. VAN services should prepare to respond to this patient group by discussing local provision of PPE in their health settings and following the guidance of local Infection Prevention and Control staff as well as the wider public health advice as regularly updated. Case specific public health advice will be required in the case of a client or potential client that is or needs to self-isolate.
VAN medical and forensic services should ensure attending staff follow PPE procedures, and the rapid, yet safe movement of the patient through Emergency Department and into appropriate isolation facilities.
More information about COVID-19 is available at COVID-19 - Health professionals.
For crisis presentations (particularly recent assault or abuse) or where medical and forensic services are not required, VAN Services should plan for alternative service locations outside of Emergency Departments / hospitals (e.g. in Community Health Services or other non-hospital facilities). Please note that all crisis presentations must be medically triaged. This triage may be provided through the Emergency Department, or through a medical assessment by the SAS/CPU medical forensic examiner at an alternative but appropriate service location.
Where VAN Services will continue to be provided in an Emergency Department / hospital setting, these services, particularly Sexual Assault Services, need to have clear guidance concerning contamination reduction procedures (see Section 15.8.4 of Responding to Sexual Assault (Adult and Child) Policy and Procedures).
VAN Services are to strengthen normal infection control measures by:
Working from home may also be an alternative where face-to-face client services are not required, especially when work sites do not enable current social distancing arrangements (e.g. shared, confined office space).
More information about infection prevention and control measures specific to COVID-19 are available at Clinical Excellence Commission - COVID-19.
Telehealth should not be adopted as standard practice for the provision of all VAN services unless it is accompanied with comprehensive clinical guidance about: how to appropriately provide telehealth service that supports the identification, management and monitoring of risks to patients’ safety, privacy, and confidentiality and to service integrity.
Perpetrators of domestic and family violence, and other forms of violence and abuse often use technology to monitor, control or abuse victims, including technology facilitated abuse. There is significant risk that a perpetrator will become aware of an intervention being provided through technology, such as through Telehealth, due to the need to stay at home due to social distancing requirements. This may lead to increased risk of surveillance and control by perpetrators throughout the crisis and, if this occurs, it can increase the risk or compound existing violence, abuse and neglect for the survivor.
Telehealth options may be used in individual circumstances. This should be done only after undertaking a risk assessment that takes into account COVID-19 related risks, as well as violence, abuse and neglect and other safety risks and confidentiality (please refer to Should VAN Services and programs adopt telehealth facilities as standard practice for all clients?).
The development of clinical guidance and local procedures to deliver telehealth services in the context of COVID-19 should adhere to the Agency for Clinical Innovation’s Telehealth in Practice Guide. As noted in the ACI Guide, telehealth services should enable the same level of privacy as face to face consultations. This is of great importance for the delivery of services and supports to people experiencing or at risk of, violence, abuse and neglect (as detailed in FAQ 4).
Local guidance and clinical procedures should therefore consider the increased risks to the emotional, psychological and physical safety of clients, families and carers where telehealth services are proposed. This should include consideration of, but is not limited to:
Please note that the above resources are for general guidance only. Services need to adhere to NSW Health policy on the use of online secure platforms for telehealth health services and services introducing telehealth responses and/or seeking to introduce new technologies should consult with the relevant District/Network Telehealth contacts and discuss the specific VAN related risks. For contact details refer to ACI - Telehealth.
NSW Health services participating in the Domestic Violence Routine Screening Program should continue to adhere to the current policy requirement that routine screening only be conducted through face to face interactions. This is because privacy cannot always be established through other means and conducting Domestic Violence Routine Screening in front of others may increase risks to women experiencing domestic violence, particularly if their partner is present or it is possible the person will report back to a partner who is using violence. It is important however that services continue to respond appropriately to any disclosures or concerns about violence, abuse and neglect. Practitioners should check that it is safe to talk and seek to assess clients’ immediate safety. Practitioners should contact Police if they have reasonable grounds to believe the person or others are at serious and imminent threat. Further guidance on responding to disclosures or concerns about violence, abuse and neglect during telehealth consultations is being developed.
No. Medical and forensic examinations in NSW are provided in a health context (rather than a justice context). They take place within a broader context of more general integrated health care provision to optimise health and wellbeing outcomes. The refusal or restriction of services to victims of violence, abuse and neglect, in general or during the COVID-19 response, based on Justice considerations (e.g. reporting to Police) is not supported. Such action does not align with NSW Health’s priorities of safety, wellbeing and crisis care and may also increase infection risk as victims will likely seek to address medical needs not addressed by VAN Services elsewhere, including through Emergency Departments.
VAN Services should ensure local service guidelines and mitigation strategies are followed for assessing and managing risk. VAN Services should consider whether services can be safely provided without conducting home visits at this time.
Prior to conducting a home visit staff should ask clients:
If the client or potential client answers yes to any of these four questions, the VAN Service should not conduct a home visit however they should still receive a VAN Service. VAN services should prepare to respond to this patient group by discussing local provision of PPE in their health settings and following the guidance of local Infection Prevention and Control staff as well as the wider public health advice as regularly updated. Case specific public health advice will be required in the case of a client or potential client that is or needs to self-isolate.
VAN Service managers should liaise with Emergency Departments to ensure normal referral pathways into VAN Services (particularly 24 hour crisis services) are maintained and activated during the COVID-19 response to:
No. Patients should be met as soon as possible by the rostered doctor and counsellor on-call and escorted from ED to SAS and/or CPU examination rooms or alternative service locations. This will help to move patients quickly through Emergency Departments (ED) and help to reduce the time clients’ spent in hospital.
However, if a patient contacts services prior to presenting to an ED, services can offer them the option to be seen during business hours if this is thought to help mitigate local risk. For instance, services who are moving patients to community health settings may provide clients with the option to be seen in business hours. This would help to reduce time spent in hospital.
No. Shifts in VAN service delivery are designed to reduce pressure on EDs without compromising service delivery for sexual assault and child physical abuse and neglect presentations. Early Evidence Kits (EEKs) are usually conducted in EDs and providing an EEK in place of a full medical and forensic examination is unlikely to reduce pressure on Emergency Departments. The Ministry recognises there may be staff shortages as a result of the COVID-19 pandemic, and under the current rationale, an EEK may be offered if a medical forensic examiner is unavoidably delayed, and a full SAIK provided as soon as the examiner is available.
As essential health services, VAN Services will continue to provide care to victims, which may include people at risk of COVID-19 infection or who have tested positive. VAN Services should prepare to respond to this patient group by discussing local procedures and provision of PPE in their health settings. VAN Services providing a face-to-face responses should ensure all attending staff follow appropriate screening and PPE procedures, and ensure rapid movement of the patient through ED and into appropriate isolation facilities.
The Forensic & Analytical Science Service (FASS) has completed a risk assessment and recommends no changes to current specimen collection practice for patients at high risk or positive for COVID-19. FASS has introduced additional infection control procedures to minimise the risk to staff from all sample types, including oral rinses.
Please note that the gown supplied in the SAIK DNA decontamination pack meets the PPE standard but additional nose, mouth and eye coverage is required as per PPE guidelines.
For further details about Infection Prevention and Control related to the COVID-19 in hospital settings please refer to: Infection Prevention and Control Novel Coronavirus 2019 (2019-nCoV) – Hospital setting.
VAN service staff at high risk, including those staff caring for elderly relatives and with underlying health conditions, should consult with their local manager about availability of protective personal equipment, risk mitigation strategies, planning for crisis presentations at risk of COVID-19 infection, and local roster coverage considerations.
The Child Protection Helpline and the NSW Health Child Wellbeing Units (CWUs) have developed business continuity plans to ensure they maintain operations while navigating the Covid-19 environment. However, some staff are working remotely and may have less capacity to take direct calls. We therefore strongly encourage Health workers to:
Please be aware that if staff call the CWU they may be asked to leave a message. CWU staff are checking and responding to messages, eReports and emails then calling health workers back as soon as practicable.
All Safety Action Meetings across NSW are being conducted via Audio Video Link (AVL), Skype or teleconference until further notice. The local SAM is responsible for ensuring that all members are supported and able to attend via AVL, Skype or teleconference.
All NSW Health representatives or their delegates should participate in SAMs using one of these modes and should liaise with their local SAM to determine the AVL or teleconference capabilities of the meeting and decide how they can participate and contribute to the meeting remotely. A teleconference phone should be available in the SAM meeting room and should allow multiple SAM members to call in at once if needed. A normal landline or mobile phone on ‘speaker’ is not advised.
When attending remotely, SAM members should:
Please note that Legal Aid NSW has cancelled the Safety Action Meeting training scheduled for Wednesday, 29 April 2020 in Narooma and Wednesday, 20 May 2020 in Sydney.
The NSW Health website provides information on COVID-19 for the general public and health professionals: COVID-19 (Coronavirus).
A number of resources about COVID-19 have been developed to provide information for and support to Aboriginal and Torres Strait Islander people, including:
The following resources are also available for NSW Health Staff responding to violence, abuse and neglect in the context of COVID-19. Some of these resources were provided in the special bushfire edition of the PARVAN adVANsing newsletter in February and others have been developed specifically in response to COVID-19. These resources may be of use in planning responses to COVID-19:
NSW Health also recognises that professional practice of health workers often intersects with personal experiences of violence, abuse and neglect, and that during this time of increased distress, NSW Health staff have access to a range of supports in addition to those including but not limited to domestic and family violence leave provisions and Employee Assistance Programs. Employees are encouraged to speak with their supervisor or human resources team for further information and support.
If you have any further questions about this fact sheet, please email:MOH-PARVAN@health.nsw.gov.au
