What is violence, abuse and neglect?
‘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:
What are Violence, Abuse and Neglect (VAN) Services and programs?
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:
- Aboriginal Family Wellbeing and Violence Prevention Program (AFWVP)
- Child Protection Counselling Services (CPCS)
- Child Protection Units/Teams (CPUs)
- Child Wellbeing Units (CWUs)
- Domestic violence services
- Education Centre Against Violence (ECAV)
- Joint Child Protection Response Program (previously the Joint Investigative Response Teams or JIRTs), including the Joint Referral Unit (JRU)
- Responses to children under 10 displaying problematic or harmful sexual behaviours (e.g. Kaleidoscope Sparks Clinic)
- New Street Services (for children and young people aged 10-17 years and engaging in harmful sexual behaviours)
- Sexual Assault Services (SAS)
- Specialist Services for Children and Young People in Out-Of-Home Care (OOHC), including the OOHC Health Pathways Program
- Whole Family Teams (WFTs)
Other key programs and roles that further support NSW Health’s VAN responses include:
- Domestic Violence Routine Screening (DVRS) Program
- Hospital and Community Health-based social workers who play a critical role in providing psychosocial services for people and their families affected by violence, abuse and neglect (this is between 40-90 per cent of their role)
- key inter-agency service responses including Safer Pathway Safety Action Meetings, which deliver coordinated responses to domestic and family violence victims at serious threat
What is the COVID-19 virus (SARS-CoV-2-2019)?
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).
Key messages about violence, abuse and neglect and COVID-19
- All VAN Services provide essential public health services. Many people who have experienced, or are at risk of violence, abuse and neglect present to NSW Health services and are in need of psychological and physical care.
- There are VAN Services in every district and in the Sydney Children’s Hospitals Network providing 24 hour integrated psychosocial (crisis counselling, information and support), medical and forensic assessment and treatment to people experiencing or impacted by violence, abuse and neglect.
- Recent media coverage on the impacts of COVID-19 has identified concerns around the increased risks to people experiencing, or at risk of violence, abuse and neglect. For example, reports from China have highlighted that COVID-19 and self-isolation have increased experiences of domestic violence and increased neglect of children and vulnerable people. This is consistent with what the evidence tells us about how the risk and impacts of violence, abuse and neglect increase during and after natural and other disasters as usual routines and supports are disrupted.
- The mental health implications of living through natural and other disasters can be cumulative and can intensify existing experiences of trauma. People’s complex coping responses to violence, abuse and childhood neglect, such as alcohol and other drug use, or the impacts on existing mental health issues, may also increase during times of natural and other disasters, requiring enhanced health care.
- Given the increased risks in times of community crisis, it is important that NSW Health services continue to identify and respond to violence, abuse and neglect and avoid any disruption to the provision of specialist NSW Health VAN Services.
- VAN Services and programs need to provide a comprehensive and consistent response to COVID-19 across the state.
- 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.
Frequently asked questions (FAQs) about violence, abuse and neglect and COVID-19
Should VAN Services and programs maintain operations in the context of COVID-19?
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.
How do VAN Services identify if a client or potential client has or is at risk of having COVID-19?
To help assess COVID-19 risk, NSW Health staff are to ask all clients or potential clients:
- Have you returned to Australia from overseas in the last 14 days?
- Have you been in close contact with a confirmed case of COVID-19 (i.e. novel coronavirus)?
- Do you have a fever, cough, sore throat or shortness of breath?
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.
Are there any additional infection control measures VAN Services should take in the context of COVID-19?
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:
- wiping down all computer keyboards, mouse and phones that are in examination rooms prior and after use
- if a patient requires a Hep B or other immunisation or treatment that is not standard practice for the VAN Service, consider the medical and forensic examiner providing this (where they are qualified to do so) to avoid the patient spending undue amounts of time in the Emergency Department.
- considering therapeutic aides used for both children and adults (e.g. toys, strength cards, sensory equipment etc.), clean aides between clients, and avoid the use of aides that cannot be easily cleaned between clients
- consulting local infection control officers to determine specific advice relevant to local circumstances.
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.
Should VAN Services and programs adopt telehealth facilities as standard practice for all clients in the context of 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.
When should VAN Services and programs adopt telehealth facilities for a client the context of COVID-19?
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:
- Procedures to support understanding and awareness of the client’s own advice on safe and preferred contact methods. Where face to face services can be delivered, services should work with clients to assess risk and review and update safety plans and strategies, including plans should the client need to self-isolate. A range of resources can be accessed to support discussions with clients about online safety, as well as apps that work to help protect the online safety of users. Further information can be found at:
- Services should also consider specific risks associated with the use of different technologies when planning the delivery of telehealth services to people experiencing violence, abuse and neglect. General information on risks and practice tips for using technology when working with victims and survivors can be found within WESNET’s Tech Safety for Agencies Toolkit
- Guidance to staff on communicating safely with clients experiencing, or at risk of experiencing violence, abuse and neglect via telehealth modalities include:
- Procedures for checking on clients’ capacity to speak safely and privately with them. This would include procedures for undertaking private sessions with children under 16, creating opportunities for joint work with children and parents toward the end of sessions as appropriate, and ensuring that there is a responsible caregiver available to attend to emotional needs of the child following the session.
- Reviewing procedures to ensure requirements to gain informed consent and explain limits to confidentiality are maintained.
- Practical Guidance on communicating safely with clients by phone and where applicable, texting. Some tips on phone communications can be found in the following resources: Frontline Services’ Best Practice Guide: Communicating with Survivors via Phone and Frontline Services’ Best Practice Guide: Texting with Survivors
- Practical guidance should be provided to staff on establishing strategies with clients for debriefing and further supports to manage any distress following sessions.
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.
Should Domestic Violence Routine Screening be conducted by teleheath in the context of COVID-19?
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.
Can VAN Services only provide medical and forensic services to victims of violence, abuse and neglect who are reporting to the NSW Police Force?
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.
Is a VAN Service still able to do a home visit in the context of COVID-19?
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:
- the three questions for screening COVID-19 risk (referred to in How do VAN Services identify if a client or potential client is at risk of having COVID-19?)
- has anyone had a confirmed case of COVID-19 (i.e. novel coronavirus) or who is self-isolated, been in the home in the last 14 days?
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.
How should VAN Services collaborate with Emergency Departments during COVID-19?
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:
- inform them of the heightened risks of violence, abuse and neglect at this time
- help ease the pressure on Emergency Departments
- ensure VAN Services clients are not over-looked in any changes to normal triage processes in response to COVID-19.
Should crisis presentations to sexual assault services and child protection medical and forensic services which occur after-hours be held over until normal business hours as part of the response to COVID-19?
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.
Should the rationale for offering Early Evidence Kits (EEKs) to sexual assault crisis presentations be broadened as part of the response to COVID-19?
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.
How should VAN services respond to crisis presentations who are at higher risk of COVID-19 infection or have tested positive for COVID-19?
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.
What precautions should VAN staff at high risk of serious complications from COVID-19 infection take?
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.
Will the Child Protection Helpline and the NSW Health Child Protection Wellbeing Units (CWUs) maintain operations during the COVID-19 Pandemic?
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:
- Use eReporting (instead of phoning reports) to both the Child Protection Helpline and to our NSW Health CWUs
- It is important that any staff who may need to report and are not already registered for eReporting complete their registration now. Sign up to eReport.
- Complete the Mandatory Reporter Guide, when you have sufficient information about any abuse, neglect or wellbeing concerns.
- This will assist in determining the need to report to the Helpline or CWU and to access the eReporting link.
- Start your eReport (text field) with the word URGENT if indicated.
- Aim to convey all key information, including child/young person/family details, as well as the nature of the abuse/harm and impact on the child/young person. This will assist in triaging at the Helpline or CWU.
- When seeking advice or child protection history information, email the NSW Health CWUs, as an alternative to phoning,:
- Southern CWU: SCHN-CWU@health.nsw.gov.au
Receive contacts from workers (including specialty Network staff) geographically located in SCH, SLHD, NSLHD, SESLHD, ISLHD, MLHD and SNSWLHD.
- Northern CWU: HNELHD-NCWU@health.nsw.gov.au
Receive contacts from workers (including specialty Network staff) geographically located in CCLHD, HNELHD, MNCLHD and NNSWLHD
- Western CWU: WNSWLHD-ChildWellbeingUnit@health.nsw.gov.au
Receive contacts from workers (including specialty Network staff) geographically located in CHW, WSLHD, SWSLHD, NBMLHD, WNSWLHD and FWLHD
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.
How should I participate in Safety Action Meetings (SAM) during the COVID-19 pandemic?
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:
- follow the same guidelines as if attending in person i.e. sign the confidentiality agreement and be in a private room for confidentiality reasons;
- inform the SAM Chair when they cannot hear other participants clearly;
- state their name and agency when contributing in the SAM when there are multiple remote attendees; and
- mute themselves when not speaking to minimise background noise.
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.
Additional resources
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:
- Australian Gender and Disaster (GAD) Pod, Women’s Health Goulburn North East (WHGNE), Women’s Health In the North (WHIN), and Monash University Disaster Resilience Initiative (MUDRI).
- COVID-19: Online safety help for domestic and family violence workers, eSafety Commissioner.
- Understanding and responding to violence in times of disaster, 1800 Respect and the Gender and Disaster Pod.
- Responding to community trauma and family violence after natural disasters, No To Violence.
- Interpersonal violence and mental health outcomes following disaster, Molyneux et al., BJPsych Open 6(1), 2019.
- Community Trauma Toolkit, Emerging Minds.
- Looking after yourself and your family, tips for taking care of yourself and advice on how to help others when there’s a crisis, The Red Cross.
- Coping with disaster factsheet, Network of Alcohol and Other Drugs (NADA).
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
