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HEALTH RESPONSE TOFAMILY VIOLENCE:
2015 VIOLENCE INTERVENTION PROGRAMME EVALUATION
2015 Violence Intervention Programme Evaluation
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ChristineMcLean ResearchProjectManager
JaneKoziol-McLain,PhD,RN
ProfessorofNursing
NickGarrett,PhDBiostatistician
Acknowledgements
We acknowledgeDrJoSpangaro,SchoolofSocialSciences,UniversityofNewSouthWalesforherexternal peer reviewofthisreport.
TheevaluationteamwouldliketothankallDHBFamilyViolenceInterventionCoordinators,VIPportfoliomanagers,VIPchampions,otherDHBmanagersandstaffwhofacilitateandsupporttheVIPevaluation andauditprocess.Wewouldliketothanktheauthorsoftheservicespecificimprovementstories,RaewynButler,BayofPlentyDHB;MichelleCleary,NorthlandDHB;andKimTo’angutu,WaikatoDHB. WealsogiveourappreciationtotheMinistryofHealthPortfolioManager ViolencePrevention IssuesLead,Helen Fraser,NationalVIPManager forDHBs,MirandaRitchie, andtotheVIPNationalTrainer,SHINE,DrCatherineTopham.
ThisevaluationprojectwasapprovedbytheMulti-regionEthicsCommittee(AKY/03/09/218,includingannualrenewalto5December2017).TextfromCITRReportNo14(HealthResponseto Family Violence: 2014 Violence Intervention Programme Evaluation) is included withpermission.
Formoreinformationvisitwww.aut.ac.nz/vipevaluation.
DisclaimerThisreportwascommissionedbytheMinistryofHealth.Theviewsexpressedinthisreportare thoseoftheauthorsanddonotnecessarilyrepresenttheviewsoftheMinistryofHealth.
2016CentreforInterdisciplinaryTraumaResearch AucklandUniversityofTechnologyPrivateBag92006Auckland,NewZealand1142
CITRReportNo15ISSN2422-8532(Print)ISSN2422-8540(Online)
HEALTHRESPONSETOFAMILYVIOLENCE:2015VIOLENCEINTERVENTIONPROGRAMMEEVALUATION
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2015 Violence Intervention Programme Evaluation
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ContentsEXECUTIVESUMMARY.........................................................................................................................iii
INTRODUCTION.....................................................................................................................................1
METHODS..............................................................................................................................................3
SYSTEMINFRASTRUCTURE(DELPHIAUDIT)......................................................................................4
PROGRAMMEINFORMATION...........................................................................................................5
SNAPSHOT.........................................................................................................................................6
QUALITYIMPROVEMENT–PLAN-DO-STUDY-ACTCYCLES................................................................8
FINDINGS:SYSTEMINFRASTRUCTURE..................................................................................................9
PARTNERABUSEPROGRAMME.........................................................................................................9
CHILDABUSEANDNEGLECTPROGRAMME....................................................................................12
CULTURALRESPONSIVENESS...........................................................................................................15
FINDINGS:PROGRAMMEINFORMATION............................................................................................17
VIPIMPLEMENTATIONWITHINSERVICES.......................................................................................17
CAPACITYDEVELOPMENT(TRAINING)............................................................................................17
ASSOCIATEDVIPINITIATIVES...........................................................................................................18
INTERNALAUDITOFCHILD, YOUTH& FAMILYREFERRALS...........................................................18
FINDINGS:SNAPSHOT.........................................................................................................................20
PARTNERABUSEASSESSMENTANDINTERVENTION......................................................................20
CHILDABUSE&NEGLECTASSESSMENT&INTERVENTION.............................................................34
ETHNICITY........................................................................................................................................37
FINDINGS:QUALITYIMPROVEMENTandPDSACYCLES......................................................................38
DISCUSSION.........................................................................................................................................41
REFERENCES........................................................................................................................................44
APPENDICES........................................................................................................................................41
APPENDIXA:FamilyViolenceProgrammeLogica...........................................................................41
APPENDIXB:DistrictHealthBoardHospitals..................................................................................42
APPENDIXC:VIPSnapshotAuditInformationSheet......................................................................57
APPENDIXD:DHBSelfAuditReport:2015Follow-upForm...........................................................64
APPENDIXE:DelphiScoringWeights..............................................................................................68
APPENDIXF: 2015AuditRoundProcess........................................................................................69
APPENDIXG:HowtoInterpretBoxPlots........................................................................................73
APPENDIXH.PartnerAbuseBaselineandFollow-UpScores.........................................................74
APPENDIXI:PartnerAbuseDelphiItemAnalysis............................................................................75
APPENDIXJ.ChildAbuseandNeglectBaselineandFollow-UpScores.........................................82
APPENDIXK.RevisedChildAbuseandNeglectDelphiToolItemAnalysis......................................83
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TheMinistryofHealth(MOH)Violence InterventionProgramme (VIP)seeksto reduceand preventthehealthimpactsoffamilyviolenceandabusethroughearlyidentification,assessmentand referralofvictimspresentingtodesignatedDistrictHealthBoard(DHB)services.TheMinistryof Health-fundednational resources support a comprehensive, systems approach to addressing family violence,particularlyintimatepartnerviolence(IPV)andchildabuseandneglect(CAN).1,2
Thisreportdocumentstheresultsoffourworkstreamsforthe2015VIPProgrammeEvaluation.Theseare:(1)DHBDelphiselfauditsofprogrammeinputs(systeminfrastructure)assessedagainstcriteriaforanidealprogramme;(2)VIPSnapshotclinicalaudits(outputs)insixservicestomeasureprogrammeservicedelivery;(3)assessmentofVIPselfauditfindingsandprogrammeimplementationwithinDHBs;and,(4)descriptionofDHBsubmissionsofModelforImprovementPlan-Do-Study-Act(PDSA)cycles.This report provides Government, the Ministry, DHBs and service users with information andaccountability data on family violence intervention programme implementation. VIP contributestowards the NZ Government’s cross-government work programme to reduce family and sexualviolence,3theNZGovernment’sDeliveringBetterPublicServices,SupportingVulnerableChildrenResultActionPlan,4andtheMinistry’sStatementofIntent2014to2018.5
VIPDelphiAuditsScalingupaquality,sustainablehealthresponsetofamilyviolenceisreliantonqualitysystems.6-12DHBsreportedachievementof IPVandCANindicatorsfortheperiod1July2014to30June2015.Standardised Delphi audit scoresmay range from 0 to 100. TheMinistry’s minimal achievementthreshold(target)for2015wasascore≥80.DelphiFindingsThe median DHBfamilyviolenceinfrastructurescorewas 92forintimatepartner abuse and 94forchild abuse and neglect programmes.With current resources, theoverallmedian scoreshavebeenconsistentlyhighoverfourauditperiods(Figure1).
Ø Overallchildabuseandneglectprogrammescores≥80wereachievedbyall(n=20)DHBs.
Ø Overallpartnerabuseprogrammescores≥80wereachievedby95%(n=19)ofDHBs.
EXECUTIVESUMMARY
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Figure1.MedianViolenceInterventionProgramme(VIP)scores(2004-2015)
Whileoverallscoresarehigh,thereremainsvariationinprogrammedomainscores.Amongthe20DHBS,oneinthree(35%,n=7)achievedscoresgreaterthan80acrossallpartnerabuseandchildabuseandneglectdomains.TheEvaluationActivitiesdomainscores,signallinginternalprogrammemonitoring,remainvariable:15and13DHBsachievedanEvaluationActivitiesscore≥80forpartnerabuseandchildabuseandneglectprogrammesrespectively.Furthersystemdevelopmentisalsoneededforselectedkeyindicators.Forexample,only55%(n=11)ofDHBsreportedevaluatingpartnerviolenceserviceeffectivenessforMāoriand40%(n=8)ofDHBsreportedevaluatingchildabuseandneglectserviceeffectivenessforMāori.Thisisacriticalindicatortoreducehealth inequities. Inaddition,whileall20DHBshavebeenapprovedtodelivertheMinistry-approvedstandardisednationalVIPtrainingpackage, theproportionofstaff thathavebeentrainedvariesacrossprofessionsandservices.Andfinally,whileallDHBsreportedVIPhumanresource,thereisongoingturnoverofFamilyViolenceInterventionCoordinators(FVICs),ChildProtectionCoordinators,theirmanagersandVIPclinicalchampions.Fifty-fivepercent(n=11)ofDHBshadatleastonechangeintheirVIPteamintheoneyearauditperiod.Thisturnover,withassociatedperiodswithnoincumbent,poseasignificantriskforVIPqualityandsustainability.VIPSnapshotClinicalAuditsVIP Snapshot audits use a nationally standardised reporting process tomonitor service delivery andinformperformanceimprovements.Theysignalaprogrammaticfocusonaccountability,measurementandperformanceimprovements13inthedeliveryofservicesfor vulnerablechildrenandtheirwhānauandfamilies.SnapshotauditsallowpoolingofDHBdatatoestimate(a)VIP output–womenandchildrenassessedforviolenceandabuse–aswellas(b)VIPoutcomes– womenandchildrenwithaviolenceconcernwhoreceivedspecialistassistance.
TheinauguralIPVservicedeliverySnapshotclinicalauditsin2014includedwomen(≥16years)withintwo services (child health inpatient and postnatalmaternity). An additional two services (emergencydepartmentandsexualhealth)wereaddedin2015.TheCANSnapshotclinicalauditsin2014and2015included assessment for children aged under two years presenting for any reason to emergencydepartments.Snapshotauditsinvolveretrospectivereviewsofarandomselectionofclinicalrecordsfromthethreemonthperiod1Aprilto30June.
20
3728
5149
5967
75748184 87
91 9192 9292 9392 94
0
20
40
60
80
100
PartnerAbuseProgrammes ChildAbuse&NeglectProgrammes
2004 2005 2007 2008 2009 2011 2012 2013 2014 2015
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In2015allDHBswererequiredtosubmitVIPSnapshotAuditsinthefiveserviceslistedabove,whetherornottheyhadimplementedVIPintheservice.Thisallowednationalestimatesofservicedelivery.Snapshotclinicalauditbenchmarkshavebeenidentified:
• System reliability is achieved when a standard action occurs at least 80% of the time.14Therefore,theVIPaimstoachieveIPVandCANassessmentrates≥80%.
• ThequalityofIPVscreening(routineinquiry)influenceswomens’decisionwhetherornottodisclose IPV to a health worker.15,16 The estimated New Zealand population past year IPVprevalencerateamongwomenis≈5%.17,18TheprevalenceofIPVreportedbywomenreceivinghealthcareservicesishigherthanthepopulationprevalenceinbothinternationalandNewZealandresearch.19-23ThisisnotsurprisinggiventhenegativeimpactofIPVonhealth.24TheVIPexpectsIPVdisclosureratesamongwomenseekinghealthcaretobe≥5%.
• BasedontheprevalenceofCANindicators(suchasCANalerts),VIPexpectstherateofchildprotectionconcernidentificationtobe≥5%.
ChildAbuseandNeglectSnapshotFindings
Ø Clinicalassessmentofchildrenundertwoyearsofagepresentingtoanemergencydepartmentincludesachildprotectionscreenforapproximatelyoneofeveryfour(26%).
Ø Specialist child abuse and neglect consultation occurs consistently (100%) when a childprotectionconcernisidentified.
Table1.Emergencydepartmentpopulationestimatesofchildrenundertwoyearsofagewhoreceivedchildabuseandneglect(CAN)assessmentandservice(April-June2014and2015)
ChildrenassessedforCANindicators
CPConcern(≥1positiveindicator)
SpecialistConsultation
2014 2015 2014 2015 2014 2015Populationestimate 4163 4242 549 374 489 374
Weightedmean 27% 26% 13% 9% 89% 100%95%CI 20%,34% 21%,32% 8%,18% 6%,12% * *
Notes:proportionofchildprotection(CP)concernisamongthosewhoreceivedaCANassessment;proportionofspecialistconsultationisamongthosewithanidentifiedCPconcern;confidenceintervalsnotcalculatedforspecialistconsultationduetosmallnumberswithinindividualDHBs.20DHBs(100%)undertookVIPCANsnapshotaudits.IntimatePartnerViolenceSnapshotFindings
Ø Approximately one in every two women (48%) presenting to sexual health services areassessedforIPV.
Ø Approximatelyoneineverytwo(48%)womenadmittedtopostnatalmaternityservicesareassessedforIPV(asignificantincreasefrom33%in2014.)
Ø Forchildrenadmittedtochildhealthinpatientservices,approximatelyoneofeverythree(35%)oftheirfemalecaregiversareassessedforIPV.
Ø Approximatelyoneineveryfourwomen(23%)presentingtoemergencydepartmentservicesareassessedforIPV.
Ø TheIPVdisclosurerateamongwomeninsexualhealthservices(20%)isatleastthreetimeshigherthanthedisclosurerateforwomeninpostnatalmaternity(4%),childhealth(4%)andemergency(6%)services.
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Table2:Populationestimatesofwomenwhoreceivedintimatepartnerviolence(IPV)assessmentandservice(April-June2014and2015)
National estimates indicate thatmost women who receivedspecialistfamilyviolenceservicesin2015 were referred through theemergency department (n=982) orsexualhealth(n=446).Bothserviceshad IPV disclosure rates greaterthan5%;inaddition,theemergencydepartment has high patientvolumes(Figure2).Average scores mask variability inservicedelivery.In2015,therewereseven service locations (includedpostnatalmaternityorsexualhealthservices within six DHBs) thatachievedscreeningrates≥80%anddisclosures rates ≥ 5% (within thetargetzone)
Womenscreened Disclosures ReferralsService 2014 2015 2014 2015 2014 2015PostnatalMaternityInpatientPopulationestimate 2935 4,637 257 197 193 197
WeightedMean 33% 48% 9% 4% 75% 100%95%CI 26%,39% 42%,55% 3%,14% 2%,6% * *
ChildHealthInpatientPopulationestimate 4869 4513 259 160 181 160
WeightedMean 39% 35% 6% 4% 70% 100%95%CI 31%,48% 33%,38% 4%,9% 2%,5% * *
SexualHealthPopulationestimate 2703 537 446
WeightedMean 48% 20% 83%95%CI 42%,55% 13%,27% *
EmergencyDepartmentPopulationestimate 21,924 1310 982
WeightedMean 23% 6% 75%95%CI 20%,26% 4%,8% *
Notes:ProportionofIPVdisclosuresisamongthosewhowereassessedforIPV;proportionofIPVreferralsisamongthosewhodisclosedIPV;confidenceintervalsnotcalculatedforreferralsduetosmallnumberswithinindividualDHBs.Sexualhealthandemergencydepartmentservicesnotauditedin2014.
Figure2.2015nationalaverageintimatepartnerviolenceSnapshotscreeninganddisclosurerates.
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VIPImplementationAcrossMinistryofHealthtargetedservices,in2015,VIPserviceswerebeingdeliveredin:
• 19(95%)DHBChildHealthinpatientservices• 19(95%)DHBPostnatalMaternityinpatientservices• 19(95%)DHBEmergencyDepartments• 13(65%)DHBSexualHealthcommunityservices
o 2 (10%) DHBs have amalgamated their sexual health community services under aregionalservice
o 3(15%)DHBsfundNGOstoprovidesexualhealthcommunityserviceso 2(10%)DHBshavenotimplementedVIPinsexualhealthcommunityservices
QualityImprovementInitiativesModelforImprovementPlan-Do-Study-Act(PDSA)In2015,allDHBswererequiredtoapplytheModelforImprovementPDSAprocess25toimprovetheconsistency and quality of their family violence service delivery response by submitting two PDSAplans.2014Snapshotresultsprovidedbaselinedatatofocus2015programmeimprovementchangeefforts.SomesubmittedplanswerecomplexandbeyondthescopeofaPDSAcycle.SeveralDHBssuccessfullyappliedthePDSAcycletoenhanceperformance.SummaryVIP evaluation data provides important information about system inputs, outputs and outcomes.ClinicalSnapshotauditspromoteprogrammeaccountabilityandcanusefullydirectnational,DHBandservicelevelimprovements.2015dataindicatesthatVIPisbeingsuccessfullyimplementedinasmallnumberofservicelocationsinselectedDHBS.Furtherimprovementsareneededtodeliveraconsistent,qualityservicenationwidetoallvulnerablechildren,womenandwhānau/familiesexperiencingviolenceintheireverydaylives.SeniorclinicalleadershipandqualityimprovementinitiativeswillcontinuetobeafocusfortheVIPprogrammeintheforeseeablefuture.
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Internationally andwithinNewZealand, familyviolence is acknowledgedasapreventablepublichealth problem and human rights violation that impacts significantly on women, children,whānauandcommunities.10,26-29 Early identificationofpeoplesubjectedtoviolencefollowedbyasupportiveandeffectiveresponsecanimprovesafetyandwellbeing.10Thehealthcaresystem isanimportant point of entry for the multi-sectoral response to family violence, including bothpreventingviolenceandtreatingitsconsequences.
TheMinistryofHealth(‘theMinistry’)begantheFamilyViolenceHealthInterventionProjectin 2001(seeAppendixA)andlaunchedtherenamedViolenceInterventionProgramme(VIP) in 2007.VIPseekstoreduceandpreventthehealthimpactsofviolenceandabusethroughearly identification,assessment and referralof victims presenting to health services. This programme provides theinfrastructureforthehealthsectorresponse,whichisonecomponentofthemulti-agencyapproachto reduce family violence in New Zealand led by theMinisterialGrouponFamilyViolenceandSexualViolence.3The Violence Intervention Programme is strategically aligned with theNZGovernment’sDeliveringBetterPublicServices,SupportingVulnerableChildrenResultActionPlan,4andtheMinistry’sStatementofIntent2014to2018.5TheBetterPublicServicesTargetspecifies,“By2017,we aimtohalttheriseinchildrenexperiencingphysicalabuseandreducecurrentnumbersby5 per cent”.4 Thistarget isbasedonChild,YouthandFamilysubstantiatedcasesofphysicalabuse.TwoViolenceInterventionProgrammeoutputsofinterestlinkedtothistargetincludetheproportionofchildrenseenintheemergencydepartmentwithevidenceofachildprotectionassessmentandinitiationofcollaborationwithChild,YouthandFamilywhenrisk indicatorsarepresent.
VIPinDHBsispremisedonastandardised,comprehensivesystemsapproach10-12,30supportedby sixprogrammecomponentsfundedbytheMinistry(Figure3). Thesecomponentsinclude:
• District Health Board Family Violence
InterventionCoordinators(FVIC).• Ministry of Health Family Violence
Intervention Guidelines: Child andPartnerAbuse(20021,20162).
• Resources that include a Ministry FamilyViolence website, a VIP section on theHealth Improvement and InnovationResourceCentre (HIIRC) website,posters,cuecards,pamphlets and the VIP QualityImprovement Toolkit.
• TechnicalAdviceandsupportprovided bya National VIP Manager for DHBs,National VIP Trainer and national andregional Family Violence InterventionCoordinatornetworkingmeetings.
• National training contracts for DHB staff,midwives and primary careproviders.
• Monitoring and evaluation ofDHB familyviolenceresponsiveness.
This report documents the results of four evaluation work streams. Firstly, DHB programme inputs(systeminfrastructure)areassessedattheDHBlevelagainstcriteriaforanidealprogrammeusingDelphitools. 3 1 - 3 3 The quantitative Delphi scores provide a means of monitoring infrastructureacrossthe20New Zealand DHBs over time. This work stream has led to important national initiatives directingprogramme funding, development of the VIP Quality Improvement Toolkit,Model for ImprovementworkshopsandaWhānau-Centredresource.34Secondly,programmeservicedeliveryismeasuredbyVIPSnapshotclinicalaudits.SnapshotauditsconductedinNewSouthWaleshaveprovedusefulinmonitoring
INTRODUCTION
Figure3:MinistryofHealthVIPSystemsSupportModel(DHBs)
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service delivery.35Snapshotclinicalauditsmeasurewomenandchildrenassessedforviolenceandabuseandwomenandchildrenwithaviolenceconcernwhoreceivespecialistassistance.TheSnapshots provideaccountabilitydataandtheinauguralauditsin2014serveasbaselineformonitoringtheeffectofsystemchanges.Thirdly, programme implementation is assessed by collating and analysing DHB submittedinformation regardingVIPselfauditfindingsandobservationswithineachDHBincludingsignificantachievements,programmestrengths,areasforimprovementandrolloutacrossservices.Lastly,forthefirsttimein2015,ModelforImprovementPlan-Do-Study-Act(PDSAs)25becamepartoftheevaluationprocess as aquality improvement initiative.DHBs complete twoPDSAs focusedon improvingDHB IPVscreening(routineenquiry)anddisclosureratesorCANchildprotectionassessmentandconcernrates.
Thisevaluation reportprovidespractice-basedevidenceof thecurrentviolence interventionprogrammeinputs,outputsandoutcomes(Figure4).Together,theDelphiinfrastructure,programmeinformationandSnapshotauditsdeliverdatatotheMinistryofHealth,theVIP NationalManagement Team andother keygovernmentdepartments involved in strategies, resourcinganddevelopments,toreducetherateofchildabuseandneglectandpartnerabuse experienced within New Zealand families and whānau. It alsocontributes to thewhole of governmentprioritiesonprotectingvulnerablechildren36andWhānauOra.37
Inputs Outputs‘thewhat’
Outcomes‘what
difference’Impact
Infrastructure
PolicyWorkforceFinancing
DeliveryofService
Assessment&Intervention
Benefittoclient:
Whatmatterstowomen,children,whānau
Improvedhealth
outcomesand
reductioninviolence
VIPMonitoringData
DelphiToolSnapshotClinicalAudit
Assessment&Identification
AccesstoSpecialistServices
Figure4:VIPEvaluationMonitoringDataSourcesTheViolenceInterventionProgrammeevaluationin2015aimedto(a)measureservicedeliveryconsistencyandqualityinMinistryofHealthtargetedservicesand(b)fostersystemimprovements.
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ParticipationintheevaluationprocesswasspecifiedinMinistryofHealthVIPcontractswithDHBs.All20NewZealandDHBsparticipated(seeAppendixB).Theevaluationprojectwasapprovedbythe Multi-regionEthicsCommittee(AKY/03/09/218withannualrenewalupto5/12/17).
Evaluation procedureswere conducted based on a philosophy of supporting programme leaders inbuildingacultureofimprovement.25,38 Detailsofthe2015evaluationprocessesareoutlined inFigure5 andAppendix CandD. The process beganon29September2015with a letter from the MinistryadvisingDHBsoftheupcoming2015auditround.
DHB Self Audits Snapshot Clinical AuditQuality ImprovementPLAN DO STUDY ACT
(PDSA) cycles
DHB Final Report
All DHBs submit:- Delphi Partner Abuse audit tool- Delphi Child Abuse & Neglect
audit tool- DHB VIP Programme Report
All DHBs provide data from random samples of 25
patient files retrospectively selected from five services:
For IPV Audit:Postnatal Maternity
Child Health InpatientsSexual Health
Adult Emergency Dept.
For CAN Audit:All children presenting to Emergency Department
under two years of age for any reason
All DHBs to submit two PDSAs focused on improving
assessment rates in two services.
Phase 1. PLAN (Objectives, changes to be tested),
questions to be answered, prediction, data required, tasks to be completed for
test).
Feedback
Phase 2. DO, STUDY ACT(Undertake PDSA cycles
until changes are adopted, adapted or abandoned)
NATIONAL REPORT
PDSA results submitted
Feedback
Figure5. 2015EvaluationPlan
METHODS
2015VIPEvaluation
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DHBswereinvitedtosubmitselfauditdataby28October2015,fortheaudit period 1 July 2014 to 30June 2015. The 2015 auditwas the tenth auditmeasuring system developmentsince2003.Requesteddocumentationincluded:
1. PartnerAbuseAuditTool(seefollowingsection)2. ChildAbuseandNeglectAuditTool(seefollowingsection)3. Self-AuditReport2015(includingVIPImplementationstatus,selfauditfindingsandobservations(e.g.
mostsignificantVIPachievements,programmestrengths,areasforimprovement.
Quantitative self auditdatawerecollectedapplyingthePartnerAbuse (PA) Programme Evaluation Tooland Child Abuse and Neglect (CAN) Programme Evaluation Tool. ThesetoolsreflectmodificationsoftheDelphiInstrumentforHospital-BasedDomesticViolenceProgramme33,39,40for the bicultural Aotearoa NewZealand context. The audit tools assess programmesagainstcriteriaforanidealprogramme.
The PartnerAbuse (PA) Toolhas beenusedwithout change across all audit periods. In 2007, a DelphiprocesswithaNewZealandexpertpanelwasconductedtorevisetheChildAbuseand Neglect(CAN)Tooltoimproveitscontentvalidity.31ThisRevisedCANToolhasbeenusedsince the48monthfollow-upaudit.41The audit tools are available (open access at www.aut.ac.nz/vipevaluation) as interactive Excel files,allowingusers to see measurementnotes,entertheirindicatordataandbeprovidedscoreresults.
The64performancemeasuresintheRevisedCANTooland127performancemeasuresinthe PAToolarecategorized intodomains reflectingcomponentsconsistentwithasystemsmodelapproach(seeFigure6).Eachdomainscoreisstandardisedresultinginapossiblescorefrom0to100,withhigherscoresindicatinggreater levelsofprogrammedevelopment.Anoverall score isgeneratedusing aweighting scheme (seeAppendixE).TheMinistry’sminimalachievementthreshold(targetscore)wasraisedfrom70to80forthe2015audit.
Figure6.AuditToolDomains
SYSTEMINFRASTRUCTURE(DELPHIAUDIT)
PA&CANProgrammeEvaluationAuditTools
• Policies and procedures outline assessment and treatment of victims: mandate identifcation training; and direct sustainability
• Children and young people are assessed for safety, safety risks are identified and securities plans implemented [CAN tool only]
• Posters and brochures let patients and visitors know it is OK to talk about and seek help for family violence
• Family violence is recognised as an important issue for the health organisation
• Staff receive core and refresher training to identify and respond to family violence based on a training plan
• Standardised screening and safety assessments are performed [PA tool only]
• Standardised family violence documentation forms are available
• Checklists guide intervention and access to advocacy services
• Activities monitor programme efficiency and whether goals are achieved
• Internal and independent collaborators are involved across programme processes
Policies and Procedures
Safety and Security
Physical Environment
Institutional Culture
Training of Providers
Screening & Safety Assessment
Documentation
Intervention Services
Evaluation Activities
Collaboration
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Recognisingthatculturallyresponsivehealthsystemscontributetoreducinghealthinequalities, indicatorsaddressingMāori, Non-Māori non-Pakeha (e.g. Pacific Island, Asian,migrant and refugee)andgeneralculturalissuesforplanningandimplementingafamilyviolenceresponse inthehealthsectorhavebeenintegratedwithinthePartnerAbuse(n=30items)andChildAbuseand Neglect (n=28items) audit tools.These items contribute to aC ultural R esponsiveness score, standardisedtorangefrom0to100.
All(n=20)DHBsundertookselfauditsinthe2015programmeevaluation.TheMinistryadvisedallDHBson29August2015thattheauditwastocommenceandon1September2015auditdocumentation(includingevaluationresources)wasdistributedbytheAUTEvaluationTeam.DHBssubmittedtheircompletedelectronicDelphifilestotheindependentevaluationteam.Followingreviewofdataanddocumentation,theevaluationteamprovidedfeedbacktotheDHBCEO,copiedtotheDHBVIPportfoliomanager,FVICsandtheMinistry.
Self audit data were exported from Excel audit tools into an SPSS Statistics (Version22)file. ScorecalculationswereconfirmedbetweenExcelandSPSSfiles.InthisreportwepresentoverallDelphianddomainscorescovering10auditsfrom2004to2015.Boxplotsandleaguetablesareusedtoexaminethe distributionofscoresovertime(seeAppendixF:HowtoInterpretBoxPlots).Theunitofanalysisfortheinfrastructure(DelphiTool)analysiswashospitaluntil2011.From2012onwardstheunitofanalysishasbeenDHB.ThechangetoanalysisbyDHBwasimplementedduetoa lackofinfrastructurevariationwithinDHBsandrecognisingthatprogrammemanagement(andreportingtotheMinistry)occursbyDHB.Asindividualextremescoresinfluencemeanscores,wefavourreportingmedians(andboxplots).
VIPprogrammeinformationiscollectedaspartoftheDHBselfauditprocess(AppendixD).ItallowsDHBsto summarise their programme progress since the previous audit and to identify VIP serviceimplementation,programme strengthsandchallenges.ProgrammeinformationassiststhenationalVIPmanagement team to monitor programme implementation. Services are considered to haveimplementedVIPwhenservicelevelprotocolsandtraininghavebeeninstitutedwithintheservice.
TheSelfAuditReportalsoincludessupplementaryinformationaboutculturalresponsivenesstoMāori,Elder Abuse andNeglect policies, disability initiatives, Shaken Baby Programme implementation andinternalclinicalauditsummariesbasedontheVIPQualityImprovementToolkit.In2015wefocusedondocumentationstandardswhenareferral ismadetoChild,YouthandFamily.ThisincludedreviewofclinicalrecordsandReportsofConcern(ROC).QuantitativeprogrammeinformationwasenteredintoanSPSS file for descriptive analysis. Data on training is also included. Training is a necessary, thoughinsufficient,pre-requisitetosupportasensitive,qualityresponsetofamilyviolence.DHBswereaskedtoreporttheproportionofstaff(e.g.doctors,nurses,midwives,socialworkers)indesignatedserviceswhohavereceivedthenationalVIPtraining.
Procedure
Analysis
PROGRAMMEINFORMATION
Cultural Responsiveness
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TheSnapshotclinicalauditsaimtocollect“accountabilitydatathatmattertoexternalparties”13anduse a nationally standardised reporting process tomonitor service delivery and inform performanceimprovements.42
Snapshotauditsprovideestimatesof:(a)VIPoutputs–womenandchildrenassessedforviolenceandabuse, and (b) VIP outcomes –women and childrenwith a violence concernwho received specialistassistance. The inaugural VIP Snapshots occurred in 2014with twonew services added for the 2015Evaluation.
Snapshotauditsprovideassessmentofcomparabilityandaprocesstofostertheimplementationofbestpractice.
• Systemreliabilityisachievedwhenastandardactionoccursatleast80%ofthetime.14Therefore,theVIPaimstoachieveIPVandCANassessmentrates≥80%.
• The quality of IPV screening (routine inquiry) influenceswomen’s decisionwhether or not todisclose IPV to a health worker.15,16 The estimated New Zealand population past year IPVprevalencerateamongwomenis≈5%.17,18TheprevalenceofIPVreportedbywomenreceivinghealth care services is higher than the population prevalence in both international and NewZealandresearch.19-23ThisisnotsurprisinggiventhenegativeimpactofIPVonhealth.24TheVIPexpectsIPVdisclosureratesamongwomenseekinghealthcaretobe≥5%.
• Basedon theprevalenceof CAN indicators (such asCANalerts), VIP expects the rateof childprotectionconcernidentificationtobe≥5%.
Forthe2015Snapshotaudit,fiveserviceswereaudited.IntimatePartnerViolenceClinicalAudit:
• PostnatalMaternityinpatient• ChildHealthinpatient(Femaleguardians,parentsorcaregiversassessedfor partner
abuse)• SexualHealth(inauguralaudit)• EmergencyDepartment[adult](inauguralaudit)
ChildAbuse&NeglectClinicalAudit:
• EmergencyDepartment[children]childrenundertwoyearsofagepresentingforanyreason
WithineachDHB, foreachselectedservice,a randomsampleof25eligible recordsduringthethreemonth audit period (1 April – 30 June 2015) were retrospectively reviewed by DHB VIP staff ordelegates.Therefore,theSnapshotinvolvedeachDHBreviewingatotalof125 clinicalrecords.
DHBssampledmainsites(e.g.,secondaryortertiaryhospitals,orcommunity).DHBswereinstructedtoseek assistance with selecting a random sample from their Quality Manager, Clinical Records orinformation specialists. TheVIP Tool Kit also includes a document entitled “How to select an auditsample”.
SNAPSHOT
Benchmarking
SelectedServices
SamplingandEligibility
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Eligibilitycriteriawere(seealsoAppendixC):• PostnatalMaternity–anywomanwhohasgivenlivebirthandbeenadmittedtopostnatalmaternitywardduringtheauditperiod
• ChildHealthInpatient–thefemalecaregiver(guardian,parentorcaregiver)ofanychildaged16andunderadmittedtoageneralpaediatricinpatientward(notaspecialtysetting)duringtheauditperiod
• SexualHealthServices–allwomenaged16yearsandoverwhopresenttosexualhealthservicesduringtheauditperiod
• EmergencyDepartment [adult]– allwomenaged16 years andoverwhopresent to an emergencydepartmentduringtheauditperiod
• EmergencyDepartment[children]-allchildrenundertheageoftwoyearswhopresenttoanemergencydepartment(foranyreason)duringtheauditperiod
Thefollowingvariableswerecollectedforeachrandomlyselectedcase(seedefinitionsin AppendixC):• DHB,site,andservice• Totalnumberofeligiblepatients(women,orchild–dependingonservice)inthe designated
serviceduringthethreemonthauditperiod1April2015to30June2015.• Ethnicityofpatient.Uptothreeethnicitiesperpatientwereabletoberecorded.• Child’sAge(rangingbetween0–16years)forchildhealthinpatientserviceonly.• PartnerAbusevariables:
o IPVscreen(yesorno)o IPVdisclosure(yesorno)o IPVreferral(active(onsite),passive(offsite)ornone).
• ChildAbuseandNeglectvariables:o ChildProtection/RiskAssessment(yesorno)o ChildProtectionConcernidentified(yesorno)o ChildProtectionconsultation(yesorno).
Snapshotdatawereexportedfromthesecureweb-basedserverinanexcelfileandimportedinto SPSSStatistics(Version22).Descriptiveanalysiswasconductedforeachdataelement(seepriorsection).Forreportingethnicity,consistentwithMinistryofHealthstandard,43wheremorethanoneethnicgroupisrecorded,thepersonwascountedineachapplicablegroup.
For each service, anationalmeanscreening rate and 95% confidence intervals were derived fromindividualDHBscreeningratesweightedbythenumberofclientsseenperDHBduringtheperiod. Datawerethenextrapolatedtoprovidenationalestimatesofthenumberofhealthclientsseeking carewithinthedesignatedservicesduringtheauditperiodwhoreceivedVIPservices.Thedisclosureandreferralrateswerecalculatedsimilarly.
TheelectronicVIPSnapshotreportingsystemprovidesserviceresultsandagraphoncompletionoftheinputforeachservice.TheVIPNationalteamreceivedtheresultsoftheVIPSnapshotauditsinFebruary2016.IndividualauditresultswereprovidedtotheDHBPortfolioManager,copiedtotheLineManager,FVICoordinatorandtheMinistryinJuly2016.
DataElements
Analysis
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The Model for Improvement Plan-Do-Study-Act (PDSA) cycle was introduced into the quality andevaluationactivitiesoftheVIPProgrammein2015.TheModelforImprovement25isasimpleframeworktoguidespecificimprovementsinpersonalwork,teams or natural work groups. Themodel comprises three basic questions:What are we trying toaccomplish;Howwillweknowthatachangeisanimprovement;andWhatChangecanwemakethatwillresultinanimprovement.ThefourthelementofthemodelusesthePlan-Do-Study-Actcyclefortestingthechangeorinnovationonasmallscaletoseeifitwillresultinanimprovement.AnessentialcomponentofdevelopingaPDSAisthemakingofapredictionaboutwhatwillhappenduringthePDSAcycle.Predictioncombinedwiththelearningcyclerevealsgapsinknowledgeandprovidesastartingplaceforgrowth.Withoutitlearningisaccidentalatbest,butwithit,effortscanbedirectedtowardbuildingamorecompletepictureofhowthingsworkinthesystem.TwoPDSAPlanswererequestedtobesubmittedforapprovalbytheAUTEvaluationTeampriortoimplementation(i.e.writingupthePLANphasebeforeundertakingtheDO,STUDY,andACTphasesofthe PDSA cycle). They were directed to be aimed at improving service delivery using their 2014Snapshotresultsasabaseline.PDSAcycleswereto improveratesof familyviolenceassessmentorspecialised consultation, or cultural responsiveness forMāori. A PDSApack (including a template,resourceandinstructions)wasdistributedandongoingsupport,coachingandfeedbackwasprovidedbytheEvaluationTeam.DHBsthatachievedimprovementsin2015wereinvitedtooutlinekeyfactorsthatcontributedtotheirachievementsforsystemlearning.Theirstoriesareincludedinthisreport(withinBoxes).
QUALITYIMPROVEMENT–PLAN-DO-STUDY-ACTCYCLES
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With current resources, theoverall partner abuseprogrammemedian infrastructure scoreshavebeenconsistentlyhighoverfourauditperiods(Figure7andAppendixI).
Ø The2015medianpartnerabuseprogrammescorewas92.
Ø Partnerabuseprogrammescores>80wereachievedby95%(n=19)ofDHBs.
Figure7.PartnerAbuseViolenceInterventionProgrammeScores2004-2015
Figurenote:TheMinistryofHealthminimalachievementthreshold(targetscore)wasraisedfrom70to80forthe2015audit.
VariabilityinscoresovertimeisshowninFigure8. Since the84month followupaudit, scores have been consistently atthehigherrangeofthescale.In2015thepartner abuse score ranged from76 to99;thestandarddeviationwas5.79.
20
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84
9391
10092 9592
10092 95
0
20
40
60
80
100
MedianOverallProgrammeScores AchievedTargetScore(%)
2004 2005 2007 2008 2009 2011 2012 2013 2014 2015
FINDINGS:SYSTEMINFRASTRUCTURE
PARTNERABUSEPROGRAMME
Figure8.Overallpartnerabusescoredistributionovertime.
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Manyindicatorsofasystemsapproachforrespondingtopartnerabuseareinplaceacross all20DHBs. Selected partner abuse programme indicators are highlighted below. Frequencies forindividualpartnerabuseprogrammetoolindicatorsareprovidedinAppendixI.
Ø Allninepartnerabuseprogrammedomainmedianscoresexceededthetargetscoreof80(Table3).
Ø OnlyhalfofNewZealandDHBs(n=10)achievedthetargetscore(≥80)acrossallninedomains.
Ø Twenty-fivepercent(n=5)ofDHBsscoredlessthan80intheEvaluationActivitiesdomain.
Table3.2015PartnerAbuseDomainresults(N=20DHBs)
DomainMedianScore
Minimumscore
Maximumscore
No.DHBsbelowtarget
(<80)
Policies&Procedures 90 76 100 2
PhysicalEnvironment 100 70 100 3
CulturalEnvironment 94 67 100 3
TrainingofProviders 100 78 100 1
Screening&SafetyAssessment 93 66 100 1
Documentation 95 62 100 4
InterventionServices 97 76 100 1
EvaluationActivities 92 14 100 5
Collaboration 100 92 100 0
PartnerAbuseProgrammeIndicators
PartnerAbuseProgrammeDomains
100%(n=20)ofDHBshadoneormorededicatedFVIcoordinatorpositionatthetimeoftheaudit.However,55%(n=11)ofDHBshadatleastonechangeintheirVIP
teamintheoneyearauditperiod.
On-sitevictimadvocacyservicesareprovided:
• Atalltimesby80%(n=16)ofDHBs• Duringcertaintimesby20%(n=4)
ofDHBs
80%(n=16)ofDHBshaveanEmployeeAssistanceProgramme(orsimilar)that
maintainsspecificpoliciesandproceduresforrespondingtoemployeesexperiencing
partnerabuse.
75%(n=15)ofDHBsmeasurecommunitysatisfactionwiththepartnerabuseprogramme,suchasbyRefugeserviceandPolice.FewDHBs,however,includegatheringclientsatisfactiondata,
necessarytoadvancingclient40andwhānau-centredcare.22
65%(n=13)ofDHBsroutinelyofferpatientswithinjuriesanoptiontohavetheirinjuriesphotographed;65%(n=13)alsoprovidestafftraininginforensic
photography.
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TheDHBleaguetableforthe2015partnerabuseinterventionprogrammescoreispresentedin Table4 . The amount of change since the last audit (absolute score difference) ranged from a decreaseof17toanincreaseof17.
Scores in the league table reflect infrastructure development rather than diffusion across or withinservices.ThereremainsvariationinindividualDHBscoresovertime.Anecdotally, explanationsforscoreimprovements include increased political will by senior DHB executive, consistencyinVIPmanagersandcoordinators,programmereviewsandserviceinnovations.
Table4.DHBPartnerabuseprogrammescores:LeagueTable(2014–2015)
Rank DHB 2015 2014 Changefrom2014
1 Northland 99 96 3
2 BayofPlenty 99 99 0
3 Waikato 99 98 1
4 CountiesManukau 98 98 0
5 MidCentral 98 95 3
6 Lakes 96 92 4
7 Taranaki 94 92 2
8 Canterbury 93 93 0
9 Capital&Coast 92 75 17
10 Southern 92 95 -3
11 HuttValley 92 87 5
12 WestCoast 91 90 1
13 SouthCanterbury 90 90 0
14 Whanganui 89 89 0
15 Wairarapa 89 91 -2
16 NelsonMarlborough 88 84 4
17 Tairawhiti 86 92 -6
18 Auckland 86 88 -2
19 HawkesBay 85 85 0
20 Waitemata 76 93 -17
DHBMedian 92 92 0
PartnerAbuseProgrammeLeagueTables
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Withcurrentresources,theoverallchildabuseandneglectprogrammemedianinfrastructurescoreshavebeenconsistentlyhighoverfourauditperiods(Figure9andAppendixJ).
Ø The2015medianchildabuseandneglectscorewas94.
Ø Childabuseandneglectprogrammescores>80wereachievedbyallDHBs.
Figure9.ChildAbuseandNeglectProgrammeScores(2004-2015)
Accompanyinghigherscoresovertimehasseenlessscorevariation(Figure10).The2015childabuseandneglectscorerangedfrom76to99;thestandarddeviationwas4.88.
Figure10. DHBOverallChildAbuseandNeglectScoreDistributionsoverTime.
37
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MedianOverallProgrammeScores AchievedTargetScore(%)2004 2005 2007 2008 2009 2011 2012 2013 2014 2015
CHILDABUSEANDNEGLECTPROGRAMME
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Mostindicatorsofasystemsapproachforrespondingtochildabuseandneglectare inplaceacross allDHBs.Selectedchildabuseandneglectprogrammeindicatorsarehighlightedbelow.Frequencies forallchildabuseandneglectprogrammeindicatorsareprovidedinAppendixK.
Ø Allninechildabuseandneglectprogrammedomainmedianscoresexceededthetargetscoreof80(Table5).
Ø Sixtypercent(n=12)ofNewZealandDHBsachievedthetargetscore(≥80)acrossallninedomains.
Ø Oneinthree(35%,n=7)DHBsscoredlessthan80intheEvaluationActivitiesdomain.
Ø Oneinthree(35%,n=7)DHBsachievedscoresgreaterthan80acrossallpartnerabuseandchildabuseandneglectdomains.
Table5.2015ChildAbuseandNeglectDomainresults(N=20DHBs)
Domain MedianScore
MinimumScore
MaximumScore
No.DHBsbelow
target(<80)
PoliciesandProcedures 96 80 100 0
SafetyandSecurity 100 80 100 0
Collaboration 100 83 100 0
InstitutionalCulture 96 77 100 1
TrainingofProviders 99 90 100 0
InterventionServices 91 82 100 0
Documentation 100 67 100 2
EvaluationActivities 82 26 100 7
PhysicalEnvironment 96 79 100 2
ChildAbuseandNeglectProgrammeIndicators
ChildAbuse&NeglectProgrammeDomains
AllDHBshaveaclinicalassessmentpolicyforidentifyingsignsand
symptomsofchildabuseandneglectandforidentifyingchildrenatrisk.
AllDHBscollaboratewithChild,YouthandFamilyandthePoliceinprogramme
planningandsafetyplanningforchildrenatrisk.
95%(n=19)ofDHBshadbeenapprovedfortheNationalChildProtectionAlert
Systems(NCPAS) 50%(n=10)ofDHBshavesocialworkersavailable24/7(eitheronsiteoroncall).
80%(n=16)ofDHBsrecord,collateandreportondatarelatedtochildabuse&neglectassessments,identifications,referralsandalertstatustoseniormanagement;75%(n=15)ofDHBs
monitordemographics,riskfactorsandtypesofabusetrends.
55%(n=11)ofDHBshaveafulltime(≥1FTE)childprotectioncoordinator
resource.
Page13……Table5.2015ChildAbuseandNeglectDomainresults(N=20DHBs)
Domain MedianScore
MinimumScore
MaximumScore
No.DHBsbelowtarget
(<80)
PoliciesandProcedures 96 80 100 0SafetyandSecurity 100 80 100 0Collaboration 100 83 100 0InstitutionalCulture 96 77 100 1TrainingofProviders 99 90 100 0InterventionServices 91 82 100 0Documentation 100 67 100 2EvaluationActivities 82 26 100 7PhysicalEnvironment 96 79 100 2
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The DHB league table for the 2015 child abuse and neglect intervention programme scores ispresented inTable6. Theamountofchangesincethelastaudit(absolutescoredifference)rangedfromadecrease of17toanincreaseof6.
Scores in the league table reflect infrastructure development rather thandiffusion acrossorwithin services. While most DHBs are maintaining high scores over time, there remainsvariation. Anecdotally, explanations for score improvements include increased political willby senior DHB executive, consistency in VIP managers and child protection coordinators,programmereviewsand serviceinnovations.
Table6. ChildAbuseandNeglectprogrammescores:DHBLeagueTable(2014-2015)
Rank DHB 2015 2014 Change
from2014
1 Northland 99 96 3
2 BayofPlenty 99 99 0
3 Waikato 99 98 1
4 CountiesManukau 98 98 0
5 MidCentral 98 95 3
6 Lakes 96 92 4
7 Taranaki 94 92 2
8 Canterbury 93 93 0
9 Capital&Coast 92 75 17
10 Southern 92 95 -3
11 HuttValley 92 87 5
12 WestCoast 91 90 1
13 SouthCanterbury 90 90 0
14 Whanganui 89 89 0
15 Wairarapa 89 91 -2
16 NelsonMarlborough 88 84 4
17 Tairawhiti 86 92 -6
18 Auckland 86 88 -2
19 HawkesBay 85 85 0
20 Waitemata 76 93 -17
DHBMedian 92 92 0
ChildAbuseandNeglectProgrammeLeagueTables
Page14….Table6. ChildAbuseandNeglectprogrammescores:DHBLeagueTable(2014-2015)
Rank DHB 2015 2014 Change
from2014
1 BayofPlenty 100 100 02 CountiesManukau 99 99 13 Northland 98 96 24 Canterbury 97 97 05 Taranaki 96 92 46 Lakes 96 93 47 MidCentral 96 95 18 Auckland 95 98 -29 Waikato 95 94 110 SouthCanterbury 95 94 011 Capital&Coast 94 88 612 NelsonMarlborough 93 90 313 WestCoast 92 88 414 Wairarapa 92 93 -115 HuttValley 90 88 216 Southern 90 89 017 Whanganui 88 90 -118 HawkesBay 86 86 019 Tairawhiti 84 92 -720 Waitemata 82 99 -17
DHBMedian 94 93 1
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VIPrecognisesculturallyresponsivehealthsystemscontributetoreducinghealthinequalities.ThefollowingFigure(Figure11)summarisesthesub-setofaudittoolindicators(30indicatorsforpartnerabuseand28forchildabuseandneglect)evaluatingculturalresponsivenesswithinVIPprogrammesacrossthenineevaluation periods.
Ø Thetypical(median)overallCultural Responsivenessscoreshavebeenmaintainedatorabove90forthreeauditperiods.
Figure11.MedianVIPCulturalResponsivenessScores2004-2015
Despite overall high median cultural responsiveness scores and many achieved culturalindicators,somekeyindicatorsremainabsentinmanyDHBs(Figure12).Forinstance:
Ø 55%(n=11)ofDHBsuseaquality framework toevaluatewhetherpartnerabuseservicesareeffectiveforMāori.
Ø 40%(n=8)ofDHBsuseaqualityframeworktoevaluatewhetherchildabuseandneglectservicesareeffectiveforMāori.
17
3330
4347 50
67 68
8075
87 8690 8995 9193 9190 93
0
20
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100
PartnerAbuse ChildAbuse&Neglect
2004 2005 2007 2008 2009 2011 2012 2013 2014 2015
CULTURALRESPONSIVENESS
All(n=20)DHBshaveaprotocolforcollaborativesafetyplanningfor
childrenathighriskwithMāoriandPacificHealthproviders.
95%ofDHBscollaboratewithMāoricommunityorganisationsandproviderstodeliverpreventiveoutreachand
publiceducationactivities.
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Figure12.SelectedCulturalResponsivenessIndicators(n=20DHBs)
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VIPIMPLEMENTATIONWITHINSERVICESVIP continued to be rolled out in Ministry of Health targeted services in 2015 (Figure 13).Nineteen of twenty DHBs have implemented VIP in child health inpatient, emergencydepartmentandpostnatalmaternityinpatientservices.Thirteenoffifteensexualhealthservices(offered regionally in some locations) have implemented VIP. Some DHBs have reportedimplementingVIPinservicesbeyondtheMinistrytargetedservices(suchasin medicalwardsandprimaryhealthcareservices).
Figure13.VIPImplementationbyService(numberofDHBs)
FigureNotes: inpt=inpatientservice;com=communityservice; thereare15SexualHealthServicesand17Alcohol&DrugServicesnationally.Some Alcohol&DrugserviceshavebeenamalgamatedwithinCommunityMentalHealth.
CAPACITYDEVELOPMENT(TRAINING)
OnlyeightDHBs(anincreasefromfourDHBsin2014)wereabletoprovidetrainingdataforallimplementingservices(thoughnotnecessarilyforallprofessions).AmongreportingDHBs,trainingvaried widely among health provider profession and among services (Table 9). The lowerparticipationofphysiciansinVIPtraining(withtheexceptionofsexualhealthservices)evidencesacapacitygapintheinterprofessionalhealthdeliveryteam.
1817
14 14
1011
1311
10
1918
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14
11
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1311
19 19 1918
17 1716
1413
02468101214161820
2013 2014 2015
FINDINGS:PROGRAMMEINFORMATION
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Table9:DHBsreportingproportionofstaffwhohadreceivednationalVIPtrainingEmergencyDepartment Doctors SocialWorkers Nurses MidwivesNo.DHBreporting 8 8 9 N/A%trained 0%-60% 0%-100% 10%-100% Median 0% 100% 85% PostnatalMaternityNo.DHBreporting 5 8 5 9%trained 0%-60% 100% 90%-100% 30-100%Median 0% 100% 100% 81%ChildHealthInpatientsNo.DHBreporting 7 7 10 N/A%trained 0-100% 30%-100% 5%-100% Median 10% 100% 93% SexualHealthNo.DHBreporting 7 5 9 N/A%trained 0%-100% 0%-100% 7%-100% Median 90% 100% 100% EmergencyDepartment[Childrenunder2]No.DHBreporting 6 9 9 N/A%trained 0%-90% 30%-100% 49%-100% Median 0% 100% 90% Notes:ThenumberofDHBsreportingemergencydepartmenttrainingisvariableforadultandchildrenastherearesomechildspecificemergencyservices(e.g.,KidzFirst,Starship).
New initiatives linked toVIP included the ShakenBabyprogramme,ElderAbuse Interventionpoliciesandimplementation,andthedevelopmentofpoliciestoaddressissuesforpersonswithdisabilitieswhoareabused.
SixteenDHBs(80%)providedinternalauditdataforReportsofConcerntoChild,YouthandFamilyandtheiraccompanyingclinicalrecords.TheperiodofreviewvariedacrossthereportingDHBs,from1to12months.Thenumberofcasesreviewedrangedfrom3to303,representingbetween10%and100%ofeligiblecasesduringthereviewperiod. AmongreportingDHBs:
ASSOCIATEDVIPINITIATIVES
INTERNALAUDITOFCHILD, YOUTH& FAMILYREFERRALS
All20(100%)DHBshadimplementedShakenBaby
Programme.
70%(n=14)ofDHBshadapprovedand
implementedElderAbusepolicies.
75%(n=15)ofDHBshadpoliciestoaddress
issuesforpersonswithdisabilities.
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Ø Partnerabusewasassessed27%ofthetime (range20%-100%)
Ø Childmaltreatmentwasincludedinthemedicaldiagnoses44%ofthetime (range0%-100%)
Ø ChildprotectionconcernswereincludedintheDischargeSummary15%ofthetime(range0%-100%)
These dataindicateaneedforimprovementinservicedeliveryanddocumentationofchildprotection concernswhenareferraltoChild,YouthandFamilyisinitiated.
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PARTNERABUSEASSESSMENTANDINTERVENTION
Nationalestimatesindicatethatmostwomenwhoreceivedspecialistfamilyviolenceservicesduringthethreemonthauditperiodin2015werereferredthroughtheemergencydepartment(n=982)orsexualhealth(n=446)VIPservices.Bothemergencyandsexualhealthserviceshadpartnerabusedisclosureratesgreaterthan5%;inaddition,theemergencydepartmenthashighpatientvolumes(Table10).
Ø Approximatelyoneineverytwowomen(48%)presentingtosexualhealthservicesareassessedforpartnerabuse.
Ø Approximatelyoneineverytwo(48%)womenadmittedtopostnatalmaternityservicesareassessedforpartnerabuse(asignificantincreasefrom33%in2014.)
Ø Forchildrenadmittedtochildhealthinpatientservices,approximatelyoneofeverythree(35%)oftheirfemalecaregiversareassessedforpartnerabuse.
Ø Approximately one in every fourwomen (23%) presenting to emergency departmentservicesareassessedforpartnerabuse.
Ø Thepartnerabusedisclosurerateamongwomen insexualhealthservices (20%) isatleastthreetimeshigherthanthedisclosurerateforwomeninpostnatalmaternity(4%),childhealth(4%)andemergency(6%)services.
Table10:Populationestimatesofwomenwhoreceivedpartnerabuseassessmentandspecialistpartnerabuseservice(April-June2014and2015)
Womenscreened Disclosures ReferralsService 2014 2015 2014 2015 2014 2015PostnatalMaternityInpatientPopulationestimate 2935 4,637 257 197 193 197
WeightedMean 33% 48% 9% 4% 75% 100%95%CI 26%,39% 42%,55% 3%,14% 2%,6% * *
ChildHealthInpatientPopulationestimate 4869 4513 259 160 181 160
WeightedMean 39% 35% 6% 4% 70% 100%95%CI 31%,48% 33%,38% 4%,9% 2%,5% * *
SexualHealthPopulationestimate 2703 537 446
WeightedMean 48% 20% 83%95%CI 42%,55% 13%,27% *
EmergencyDepartmentPopulationestimate 21,924 1310 982
WeightedMean 23% 6% 75%95%CI 20%,26% 4%,8% *
Notes:ProportionofIPVdisclosuresisamongthosewhowereassessedforIPV;proportionofIPVreferralsisamongthosewhodisclosedIPV;confidenceintervalsnotcalculatedforreferralsduetosmallnumberswithinindividualDHBs.Sexualhealthandemergencydepartmentservicesnotauditedin2014.
FINDINGS:SNAPSHOT
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As stated earlier in this report, apartner abuse screening rate of80% or greater is indicative ofsystem reliability; and given thepopulationprevalence, adisclosurerateof5%orgreaterisexpectedasan indicator of screening quality.2015 Snapshot average scores didnot meet the benchmark (targetzone, see Figure 14) for anyof thefourservices.Average scores, however, maskvariability in service delivery. In2015, there were seven servicelocations (included postnatalmaternityor sexualhealth serviceswithin six DHBs) that achievedscreening rates ≥ 80% anddisclosures rates ≥ 5% (within thetargetzone).Servicespecificdataisprovidedinthefollowingsections.
Acrossthe20DHBs,9,574 women were admitted topostnatalmaternityservicesduring thethree monthSnapshot audit period (1 April – 30 June 2015). Randomsamplingfromthe22locations (two DHBs reported on two locations) resulted in 576 cases audited for the 2015Snapshot.
The IPVpostnatalmaternity snapshot screening rates ranged from0% to 100%acrossDHBs(Figure15).FourDHBsachievedthetargetscreeningrateof≥80%:Northland,BayofPlenty,Auckland, andWairarapa. An additional three DHBs (Southern,MidCentral andWest Coast)achieved screening rates between 75% and 80%. The DHB with 0% screening rate had notimplementedVIPinthepostnatalmaternityserviceatthetimeoftheaudit.
PostnatalMaternity
Figure14.2015nationalaverage(weighted)partnerabuseSnapshotscreeninganddisclosurerates.
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Figure15.DistributionofPartnerAbuseScreeningRatesAcrossDHBPostnatalMaternity Services(N=20)
Amongwomenwhowere screened, IPV disclosure rates ranged from 0% to 33% (Figure 16).NineDHBsmettheexpectationthatatleast oneofeverytwentywomenscreenedwoulddiscloseabuse. TheDHBswere: Lakes, Taranaki, Bay of Plenty, South Canterbury, Northland, Waitemata,MidCentral,NelsonMarlboroughandWairarapa.
Figure16.DistributionofPartnerAbuseDisclosureRatesAcrossDHBPostnatalMaternityServices(n=20)
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Inpostnatalmaternityservices,three DHBs achieved thebenchmark (≥ 80% screeningwith ≥ 5% disclosure rate;Figure 17): Bay of Plenty,NorthlandandWairarapa.NorthlandDHBhassharedtheirexperience in making servicedeliveryimprovements(Box1).Their experiencedemonstrateswhatcanbeachieved.
Figure17. PlotofDHBpartnerabusescreeninganddisclosureratesforpostnatalmaternityservices(N=20)
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Box1.ImprovingResponsetoPartnerAbuseresultsinNorthlandDHBPostnatalMaternityContext:Allwomen16yearsandolder,andteenagemumsagedbetween12and15,areroutinelyscreenedforfamilyviolence.Inthe2014Snapshotaudit(April-June),WhangareiHospital’sPostnatalMaternityscreeningratestoodat60%anddisclosurerateat0%,bothbelowthenationaltarget.In2015,PostnatalMaternityservicedeliveryachievedthenationaltarget,with≥80%screeningand≥5%disclosureratesacrossthreequarterlyaudits.Progress:ThePDSAcycleframeworkenabledFVICstoplan,monitorandevaluatetheeffectivenessofinterventions.• Actionsincluded:weeklyvisitstokeyareas,‘levelofcomfort’surveys,regularin-service
sessionsforstaff,quarterlyauditofscreeninganddisclosurerates;• ResultsmonitoredanddisseminatedtoClinicalNurseManagertosharewithstaff;• SoundworkingrelationshipbetweenClinicalNurseManager,SocialWorkerandFVIC
haveenabledacollaborativeprocesstoidentifytheVIPchampionanddeveloptherole.Challenges:• Sustainingcoreandrefreshertrainingattendancetomaintaincompetenceinscreening
andmanagementofdisclosures.• Maintenanceandfutureproofingthechampionrolewithintheclinicalareatoensure
thatannualleaveorresignationwillhaveminimalimpactontheVIPprogramme.• Developmentofpathwaystoenablescreeningoftransientandshortstaywomenonthe
postnatalmaternityward.• EngagingLeadMaternityCarers(LMCs)whoworkwithintheenvironmentbutwhoare
notemployedbyDHB.
• Provisionofaprivateandsafescreeningenvironmentawayfromwoman’spartnersandvisitors.
LessonsLearnt• CollaborationensuredcommitmenttotheVIPprocessandconsistencyinitsdelivery.• Sustainability,visibilityandconsistencyareparamounttosuccess.• WorkingwithinthePDSAframeworkguidesinformedimprovementopportunities.• ImplementationoftheVIPchampionrolewithintheclinicalareaensuresongoing
supportamongstclinicalcolleagues.• EnablingtheVIPchampiontoimplementanddriveareaappropriateinitiativesto
encourageandstreamlinescreening(e.g.avisualcueinthenurses’stationshowingwomenscreened/notscreened)helpstoensureandmaintainrobustprocesses.
• ConsistentVIPcoordinatorvisitstotheclinicalareaarehighlyvaluedandensurevisibility.
• StaffVIPtrainingsupportsincreasedlevelofcomfortamongcolleaguesandsustainabilityofscreening.
• Perseveranceisnecessarytoachievescreeningrates.Attimesitisdifficulttospeaktoawomanaloneonthewardandsoscreenersmayhavetotryseveraltimesbeforesucceedinginscreeningtheirpatients.
• Celebratesuccesseswithallinvolved.
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BasedontheSnapshotweightedmeanforIPVscreening(48%;95%CI42%,55%),weestimatethat 4,637women admitted to postnatalmaternity services during the threemonth auditperiod(April-June2015)receivedaVIPintimatepartnerabusescreen(SeeTable11).
BasedontheSnapshotweightedmeanforIPVdisclosure(4%,95%CI2%,6%),weestimatethat197womendisclosed intimate partner violence to a health care provider,with 197 (100%)women receiving a referral for special services. Importantly, we estimate that 99 womenreceivedanactivespecialistconsultationduringherhealthcareadmission.Table 11. Postnatal maternity services inpatient population estimates of women whoreceivedintimatepartnerviolence(IPV)screeningintervention(April-June2015)
PartnerAbuseScreening,DisclosureandReferralRates Number 95%CI
Eligiblewomenadmittedtoservice 9,558
EstimatednumberofwomenwhowerescreenedforIPV 4,637 4033,5241
EstimatednumberofwomenwhodisclosedIPV 197 114,280
Estimatednumberofwomenwhoreceivedreferrals:
Toactive(onsite)specialistservices: 99Topassive(offsite)specialistservices: 98
197
Tablenotes:CI=ConfidenceIntervals;CIsnotcomputedforreferralsascellsizessmall.
Nationally,20DHBsprovideddatafrom22childhealthinpatientlocations.Theyreportedthatatotalof12,746childrenwereadmittedduringthethreemonthauditperiod(1April–30June2015). Random sampling from the 22 locations resulted in 550 cases audited for the 2015Snapshot.
TheIPVchildhealthinpatientsnapshotscreeningrateoffemaleparents,guardiansorcaregivers,ranged from12% to92% (Figure 18).West CoastDHBachieved the target screening rate ofgreaterthan80%.TheoneDHBwhohadnotfullyimplementedVIPinchild healthinpatientservicesachievedascreeningrateof12%.
ChildHealthInpatient
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Figure18.DistributionofIPVScreeningRatesAcrossDHBChildHealth(n=20)
Amongwomenwhowerescreened,disclosureratesrangedfrom6%to33%acrossthe7DHBswithanon-zeroscreeningrate(Figure19).SevenDHBsmettheexpectationthatatleast oneofeverytwentywomenscreenedwoulddiscloseabuse.TheDHBswere:Auckland,Wairarapa,Whanganui,HuttValley,Tairawhiti,TaranakiandBayofPlenty.
Figure19.DistributionofIPVDisclosureRatesAcrossDHBChildHealth(n=20).
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Inchildhealthservices,noDHBsachievedthebenchmark(≥80%screeningwith≥5%disclosurerate;Figure20).Thatsaid,twoDHBs(BayofPlentyandTaranaki)achieveda60%orgreaterscreeningratewithadisclosurerate≥5%.
Based on the Snapshotweighted mean for IPVscreening (35%; 95% CI33%, 38%), we estimatethat 4,513 femalecaregivers of childrenadmitted to generalpaediatricwardsduringthesecond quarter of 2015received a VIP intimatepartner violence screen (seeTable12).Based on the Snapshot data weightedmean forIPVdisclosure (4%; 95% CI 2%, 5%), we alsoestimatethat160womendisclosedIPVtoahealthcareprovider,with160women(100%ofthosewhodisclosedabuse)receivingareferralforspecialistservices.Importantly,weestimatethat107womenreceivedanonsite(active)specialistconsultationduringheradmission.Table12.Childhealthinpatientpopulationestimatesofwomenwhoreceivedintimatepartnerabuse(IPV)screeningandservice(April-June2015)
PartnerAbuseScreening,DisclosureandReferralRates Number 95%CI
Childrenadmittedtoservice 12,746
EstimatednumberoffemalecaregiversscreenedforIPV 4,513 4180,4847
EstimatednumberoffemalecaregiverswhodisclosedIPV 160 83,237
Estimatednumberofwomenwhoreceivedreferrals:
Toactive(onsite)specialistservices:107Topassive(offsite)specialistservices:53
160
Notes:CI=ConfidenceIntervals;CIsnotcomputedforreferralsascellsizessmall.
Nationally, 20DHBsprovideddata from22 emergencydepartments. They reported that 95,668womenpresentedtotheemergencydepartmentsduringthethreemonthauditperiod(1April–30June 2015). Random sampling from the 22 locations resulted in 551 cases audited for the 2015Snapshot.
EmergencyDepartment[adult]
Figure20.PlotofDHBIPVScreeningandDisclosureratesforChildHealthInpatientServices.
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TheIPVemergencydepartmentsnapshotscreeningrateofwomenaged16yearsandoverrangedfrom0%to68%(Figure21).OneofthefourDHBswitha0%screeningratehadnotimplementedVIPintheirservice.
Figure21.DistributionofIPVscreeningratesacrossDHBemergencydepartments(n=20)
Amongwomenwhowerescreened,inthe16DHBswithanonzeroscreeningrate,IPVdisclosureratesrangedfrom0%to100%(Figure22).SixDHBs(MidCentral,Tairawhiti,Taranaki,Waitemata,SouthCanterburyandBayofPlenty)mettheexpectationthatatleastoneineverytwentywomenscreenedwoulddiscloseabuse.
Figure22.DistributionofIPVdisclosureratesacrossDHBemergencydepartments(n=20)
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Inemergencydepartmentservices,noDHBsachievedthebenchmark(≥80%screeningwith≥5%disclosure rate; Figure 23). Two DHBS achieved a screening rate between 50% and 80% withdisclosurerates≥5%(MidCentralandTaranaki).TwoDHBsreportedhighdisclosurerateswithminimalpartnerabusescreening,consistentwithdisclosure-relatedidentification(level1identification1)ratherthanroutinescreening. Based on the Snapshotweighted mean for IPVscreening (23%;95%CI 20%,26%)weestimatethat21,924womenwhopresentedtotheadultemergencydepartmentduring thesecondquarterof2015 receivedaVIP intimatepartner violence screen (seeTable13).Based on the Snapshot dataweighted mean for IPVdisclosure (6%; 95% CI 4%,8%) we estimate that 1,310women disclosed intimatepartner violence to a healthcare provider, with 983women receiving a referralfor specialist services. Weestimate that 492 womenreceivedanactive(onsite)specialistconsultationduringtheiradmission.Table13.EmergencydepartmentpopulationestimatesofwomenwhoreceivedIntimatePartnerViolence(IPV)screening andservice(April-June2015)
PartnerAbuseScreening,DisclosureandReferralRates Number 95%CI
EligibleWomenpresentingtoservice95,668
EstimatednumberofeligiblewomenscreenedforIPV21,924 18819,25029
EstimatednumberofeligiblewomenwhodisclosedIPV1310 917,1702
Estimatednumberofwomenwhoreceivedreferrals:Toactive(onsite)specialistservices:492Topassive(offsite)specialistservices:491
983
Tablenotes:CI=ConfidenceIntervals;CIsnotcomputedforreferralsascellsizessmall.
Figure23.PlotofDHBIPVScreeningandDisclosureRatesforadultDHBemergencydepartment
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Nationally,14ofthe15DHBsprovidingsexualhealthservicessubmittedSnapshotdatain2015.Theyreported that5,590womenpresented to thesexualhealth serviceduring the threemonthauditperiod(1April–30June2015).Randomsamplingfromthe14locationsresultedin403casesauditedfor the 2015 Snapshot. One DHB did not submit any data for 2015 audit period due toimplementationofnewITsystemsthatdidnotfacilitatetheauditprocess.The IPVsexualhealthserviceSnapshotscreeningrate forwomenaged16yearsandover rangedfrom0%to93%(Figure24).FiveDHBs(NelsonMarlborough,Tairawhiti,Waikato,BayofPlenty,andSouthern)achievedthetargetscreeningrateofgreaterthan80%.TheDHBwitha0%screeningratehadnotyetimplementedVIPintotheservice.
Figure24.DistributionofIPVscreeningratesacrossDHBsexualhealthservices(n=14)
IPVdisclosureratesrangedfrom0%to100%(Figure25).NineDHBsmettheexpectationthatatleastoneineverytwentywomenscreenedwoulddiscloseabuse(Auckland,HawkesBay,MidCentral,Taranaki,WestCoast,NelsonMarlborough,Southern,WaikatoandBayofPlenty).
SexualHealthServices
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Figure25.DistributionofIPVdisclosureratesacrossDHBsexualhealthservices(n=14)
In sexual health services,four DHBs (NelsonMarlborough, Bay ofPlenty, Southern andWaikato) achieved the VIPSnapshot benchmark (≥80% screening with ≥ 5%disclosurerate;Figure26).Sexualhealthserviceshavea long standingpracticeofassessingforbothhistoricaland current partner andsexual violence. WaikatoDHB describes adaptingtheir sexual health serviceabuse assessment routineto the ViolenceInterventionProgrammeinBox2.BasedontheSnapshotweightedmeanforIPVscreening(48%;95%CI42%,55%),weestimatethat2,703womenpresentingtothesexualhealthservicesduringthesecondquarterof2015receivedaVIPpartnerabusescreen(seeTable14).Based on the Snapshot data weighted mean for IPV disclosure (20%: 95% CI 13%, 27%), weestimate that 537womendisclosedpartner abuse to a health careprovider,with 448womenreceivingareferralforspecialistservices.Weestimatethat75womenreceivedanactivespecialist
Figure26.PlotofDHBIPVScreeningandDisclosureRatesforSexualHealthServices
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consultation.Table14.Sexualhealthservicespopulationestimatesofwomenwhoreceivedintimatepartnerviolencescreeningandservice(April-June2015)
PartnerAbuseScreening,DisclosureandReferralRates Number
95%CI
EligibleWomenadmittedtoservice 5,590
EstimatednumberofwomenwhowerescreenedforPA 2,703 2330,3076
EstimatednumberofwomenwhodisclosedPA 537 349,725
Estimatednumberofwomenwhoreceivedreferrals: Toactive(onsite)specialistservices:90Topassive(offsite)specialistservices:358
448
Notes:CI=ConfidenceIntervals;CIsnotcomputedforreferralsascellsizessmall.
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Box2ImprovedresultsinWaikatoDHBsexualhealthservice(2015)ContextSexualhealthservices(SHS)atWaikatoDHBhavealwaysprioritisedquestioningaroundabuse,particularlysexualabuse(historicalandcurrent).RelevantquestionshavebeenincludedontheSexualHistorySheetusedforassessmentwithintheservice.Thesestandardquestionsfocusonwhethersexualabuseordomesticviolencehasoccurredandwhethercounsellingiscurrentlybeing(orhasbeen)accessed.Progress:Overthepast12monthsprogresshasbeenmadeintransitioningfromthequestionsaroundsexualabuse/domesticviolencealreadyembeddedinSHSpracticetoincorporatingquestionsaskedroutinelyaspartofthenationalfamilyviolencescreeningprocess.Challenges:• Gainingsupportfromstafffornewscreeningformat,particularlyfromthosewhoare
experiencedaroundquestioningaroundsexualabuse(historicalandcurrent).• Introducingthescreeningformatwhilemaintainingandpreservingthegatheringof
historicalinformationimportanttothenatureoftheSexualHealthServiceassessmentprocess.
• Incorporatingnewscreeninginformationintoexistingdocumentationwhilststillprovidingacleardocumentationprocess.
• Creatingaclearunderstandingbetweenthedistinctionbetweenhistoricalandcurrentdisclosuresofabuseandpursuingtheappropriatepathways.
• CreatingasystemforsubmittingregularmonthlyauditdatafortheDHBintranetalongsideotherreportingservices.
LessonsLearnt:Theimportanceof:• Valuingideasandinputfromstaffinregardtoprocessesofchange,whilstsupporting
thereasonsbehindthechange.• Establishingadequatesupportandreferralpathways(e.g.socialwork,community
agencies)toassistthosewhohavemadeacurrentorhistoricaldisclosureofabuse.
“If you want to go fast, go alone. If you want to go far, go together”.
African proverb.
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Nationalestimatesindicatethat374(95%CI251,497)childrenpresentingforemergencyserviceswereassessedtohaveachildprotectionconcernduringthethreemonthauditperiodin2015(Table15).Inallcases,specialistconsultationoccurred.
Ø Clinical assessment of children under two years of age presenting to an emergencydepartmentincludesachildprotectionscreenforapproximatelyoneofeveryfour(26%).
Ø Specialistchildabuseandneglectconsultationoccursconsistently(100%)whenachildprotectionconcernisidentified.
Table15.Emergencydepartmentpopulationestimatesofchildrenundertwoyearsofagewhoreceivedchildabuseandneglect(CAN)assessmentandservice(April-June2014and2015) Childrenassessedfor
CANindicatorsCPConcern(≥1positive
indicator)SpecialistConsultation
2014 2015 2014 2015 2014 2015Populationestimate 4163 4242 549 374 489 374Weightedmean 27% 26% 13% 9% 89% 100%95%CI 20%,34% 21%,32% 8%,18% 6%,12% * *Notes:proportionofchildprotection(CP)concernisamongthosewhoreceivedaCANassessment;proportionofspecialistconsultationisamongthosewithanidentifiedCPconcern;confidenceintervalsnotcalculatedforspecialistconsultationduetosmallnumberswithinindividualDHBs.
Nationally, 20 DHBs (100%) provided data from 22 emergency department locations. Theyreported that a total of 16,135 children under two years presented for any reason to theemergencydepartmentduringthethreemonthauditperiod(1 April–30June2015). Randomsamplingfromthe22locationsresultedin575casesauditedfor the2015CANSnapshot.
The CAN snapshot child protection assessment rate, for children under two presenting toemergencyservicesfor anyreason,rangedfrom0%to76%acrosstheDHBs(Figure27).
CHILDABUSE&NEGLECTASSESSMENT&INTERVENTION
EmergencyDepartment
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Figure 27.Distributionofchildabuse&neglectassessmentrateacross
DHBemergency departments
Amongthe17DHBsthathadachildabuseandneglectassessmentrategreaterthanzero,sixidentifiedaCANconcern(oneormorepositiveindicators) inoneormorechildren(Figure28).
Figure28.DistributionofCANConcernRatesacrossDHBChildren’s/EmergencyDepartments
One DHB (MidCentral) achieved a CAN assessment rate between 75% and 80% with a CANconcernrateof5%orabove(Figure29).
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Based on the Snapshotweighted mean for CANassessment (26%; 95% CI21%, 32%), weestimatethat4,424childrenundertwoyearsof age seen in an acutehospital emergencydepartmentwereassessedforabuseduringthethreemonthauditperiod(seeTable16).
Based on the Snapshot dataweighted mean for CANidentification of risk factors(9%; 95% CI 6%, 12%), weestimatethat374childrenhadaCANconcern identified. All374 children (100%) with aCAN concern identified werereviewed for child abuse andneglectbyaspecialist.
Table16.EmergencyDepartmentpopulationestimatesofchildrenundertwoyearsofagewho receivedCANassessmentandservice(April-June2015)ReportedAssessment,IdentificationofConcernandSpecialist Consultation
Number 95%CI
ChildrenpresentingtoEDunder2yearsforanyreason 16,135
EstimatednumberofchildrenassessedforCANindicators 4242 3387,5096
EstimatednumberofchildrenwithoneormorepositiveCAN indicators
374 251,497
EstimatednumberofchildrenwhosecaseswerereviewedforCANwithspecialist
374
Note:CI=ConfidenceIntervals;Cisnotcomputedforconsultationsascellsizessmallwithmany‘0’cells.
Figure29.PlotofDHBChildAbuseandNeglectAssessmentandConcernRatesforChildrenundertwoyearsofagepresentingtotheEmergencyDepartment.
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2014and2015assessmentratesforchildabuseandneglectindicatorsamongchildrenunder2yearspresentingtoanemergencydepartmentwereexaminedforMāoriandnon-Māori(Table17).Therelativeunder-assessmentforchildabuseandneglectindicatorsofnon-MāorichildrencomparedtoMāorichildrenresolvedin2015.Allgroups,however,arenotconsistentlyassessed(ratebelowtargetof80%).Table17.CANAssessmentsbyEthnicityintheEmergencyDepartment
2014and2015assessmentratesforpartnerabusewereexaminedforMāoriandnon-Māori(Table18).ThedifferenceinassessmentratesbetweenMāoriandnon-Māoriin2015wasthelargestinsexualhealthservices(absolutedifferenceof10%;non-Māoriunder-assessed),followedbypostnatalmaternity(absolutedifference7%;Māoriunder-assessed).Thisraisesthequestionas towhyMāoriandnon-Māoriarebeingtreateddifferently, thoughbothareunderserved(less than 80% assessment rates). We will continue to examine the pattern of VIPimplementationacrossethnicityinfutureSnapshotaudits.Table18.IPVAssessmentsbyEthnicity
CANAssessment 2014 2015 NonMāori Māori NonMāori MāoriCANAssessment/Reviewed(95%confidenceinterval)
72/39118%
50/17529%
107/39227%
(23%,32%)
45/18325%
(18%,31%)Note:ThesearecruderatesoverallDHBreporteddataandnotadjustedfortheethnicvariationacrossDHBs.
IPVScreening
2014 2015
NonMāori Māori NonMāori MāoriPostnatalMaternity
160/42937%
53/12044%
229/43952%
(47%,57%)
60/13744%
(35%,52%)ChildHealthInpatient
266/42937%
110/33633%
142/37438%
(33%,43%)
73/16943%
(36%,51%)EmergencyDepartment
NA NA 118/44726%
(22%,31%)
26/10425%
(17%,33%)SexualHealth
NA NA 164/27759%
(53%,65%)
69/10168%
(59%,78%)Notes:ThesearecruderatesoverallDHBreporteddataandnotadjustedfortheethnicvariationacrossDHBs;Childhealthinpatientin2015excludes7caseswheretherewasdocumentationofnofemalecaregiver;2015(,)=95%confidenceinterval
ETHNICITY
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VNAPSHOTETHNICITYDATAIn2015,DHBswereaskedtofirstlysubmittheirPDSAPlantotheevaluationteambyNovember2015.ThirtyninePDSAcycleplansweresubmittedbyeighteenDHBs(2DHBsdidnotsubmitanyPDSAplans).AllDHBshadtheopportunitytorevisetheirPDSAsbasedonevaluatorfeedback.Secondly,DHBswereaskedtosubmittheircompletedPDSAstoevaluatorsinApril2016.Twenty-twocompletedPDSAsweresubmitted.2014Snapshot resultsprovidedbaselinedata to focus2015programme improvementchangeefforts. EightPDSAsinvolvedachievingclinicalcompliancewiththeuseofEDchildinjuryflowcharts; fifteenPDSAs focusedon improving IPV screening rates in those services thatwereorwouldbesubjecttoVIPsnapshotclinicalauditsin2015or2016.TwoPDSAswereabandonedduetoaninabilitytoincreaseratesbeyondthebasemeasure.Othersachievedimprovementsinitiallybutthendroppedoff.Changes implemented includedtheeliminationofqualityproblems, improvingqualitywithoutadditionalresources,expandingstaffandmanagementexpectationstofocusoncoreprocessesand purpose, and to change the clinical work environment by introducing training, access toinformation,andfacilitatingclarityaboutexpectations.InconductingPDSAs,severalissuesemerged.Theseincluded:• Identifyingaimsandobjectivesinvolvedbuildingrelationshipsandengagementwithservice
managementandclinicalstaffbeforetheactualPDSAcouldbeimplemented.• Relationshipbuilding,collaborationandplanningalwaystooklongerthanexpectedinthe
busyDHBenvironmentandsupportwasnotnecessarilyalwaysforthcominginthetimeframesexpected.
• Submittedcycletimeframesweresubstantiallylonger(e.g.,6months)thanwouldnormallybeassociatedwithPDSAs(e.g.twoweeks).
• Submittedplanswereoftentoocomplex.
SeveralDHBssuccessfullyappliedthePDSAcycletoenhanceperformanceandto improvetheconsistencyandqualityoftheirfamilyviolenceservicedeliveryresponse.SeveraloftheseDHBswereinvitedtosharewhathascontributedtotheirachievement.NorthlandandWaikatoDHBjourneys were outlined above under Postnatal Maternity (Box 1) and Sexual Health (Box 2)services.BayofPlenty’scontributionfollows(Box3).AnexampleofaPDSAimprovementcyclefromLakesDHBisprovidedinBox4.
FINDINGS:QUALITYIMPROVEMENTandPDSACYCLES
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Box3.BayofPlentyDHB’sVIPProgramme(2015)Context:• VIPimplementedinalltargetedservices.• TheVIPstrategicplanandtheVIPgovernancegrouparekeyelementsofthesuccessfulVIP
ProgrammewithintheDHB.• VIPtrainingiswelldeliveredandwellreceived.• PDSAswereusedinSexualHealthfortheIntroductionandadoptionofanewcomputer
systemthatincludedthefamilyviolencescreeningquestions.• BayofPlentyVIPIPVscreeningresultsareinthetargetzoneforPostnatalMaternityand
SexualHealth.
Progress:• Regularauditsareundertakenandthegoodandnotsogoodresultsgobacktothemanager
andteamfirst.• HaveestablishedaFamilyViolencescreeningmonthintheEmergencyDepartmentwitha
majorpushtoundertakemorescreening.• Theimportanceoffamilyviolenceinmentalhealthcannotbeunderstated.Iftheservices
areworkingholisticallywithmentallyunwellpeople,theyneedtoknowwhethertherearechildreninthefamily.“Howcanyouhelpthemifyoudon’tknowabouttheirstressors?”VIPTeamisworkingwithMentalHealthtoseehowVIPcanfitintotheircorebusiness.VIPtakestheanglethattheyarealreadydoingsomeofit.
• InternalsocialworkersarepartoftheVIPteam.It’stheservicesfirstportofcall,it’stheirrole.FVICsworkwithMaternitysocialworkerstodeveloporassistwithplansfornew-bornbabies.
• Mantra–“it’sreallyimportanttoscreenforfamilyviolence.Yes,otherthingsarecompulsory,butreductionoffamilyviolenceissoimportant.”
• Maternitypatientshaveaspecialrelationshipwithstaff;theyarethereforalongertime,arevulnerableandtrustthestaff.Screeningunderwayinallareas–SCUBU,wards,postandantenatalmaternity.
Challenges:• Achievingconsistencyacrosstwosites,urbanandrural.• Timepressures• FindingtruechampionswhoarecommittedtoVIP(andnotjustgoingthroughthemotions)• EthicalbalancebetweenawomanandachildLessonsLearnt:• Goslow.Don’trush.Gentlyandslowly.Don’tforce.Don’tpowerover!Gowith!• Relationshipsareveryvaluable• Getstafftounderstandtheimportanceofscreening.Allstaffwanttomakeadifferenceto
patients’livesandVIPisjustanotherservice(likeheartoperations)thatmakesahugedifferencetowomenandchildren’slives.
• Undertakeregularwalkarounds“howareyougoing?”• Giveregularacknowledgementtostaff,servicesandmanagers–highlightwhattheyare
doingwellandbuildonwhattheyaredoingright(andnotwhattheyaredoingwrong).Keepthemomentumgoingandsupportstaff.
• FVICtellspeoplethatshetotallybelievesintheVIPprogramme.Sheemphasisesthatthepositiveimpactofscreeningandinterventionmaynotbeevidentataninitialassessment.Awomanmayreturn6monthslatersayingshewantshelp.Nexttimeitmightbetherighttime.
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Box4.LakesDHBPDSAExample
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TheViolenceInterventionProgrammeevaluationin2015aimedto(a)measureservicedeliveryconsistency and quality in Ministry of Health targeted services and (b) foster systemimprovements.Thehealthresponseto familyviolence isdirectedbynationalassessmentandinterventionguidelines1,2,44andsupportedbyahealthsystemsapproach.Abuseassessmentratesprovideameasureofserviceconsistency.Among95locationsproviding2015 clinical Snapshot data across the 20DHBs and 5 services,a 10% (n=10) achieved an IPVassessmentrateof80%orhigher.ThiswasanimprovementfromtheinauguralSnapshotauditin 2014, where 3% of locations (2/60 locations involving 20 DHBs and 3 services) met theassessmenttarget.NoDHBmetthistargetforchildabuseandneglectassessmentforchildrenundertwoyearsofagepresentingtoanemergencyservice.The2015evaluationdataindicatesthattheassessmentoffamilyviolencewithinhealthservicesiscurrentlyinconsistent.Significantvariationexistsinfamilyviolenceassessmentratesbyservice,from23%forwomenpresentingtoemergencydepartments, to48%forwomen inpostnatalmaternityandwomencaregiversforchildrenadmittedtothehospital.Ofthethreeservicesinvolvedinthe2014VIPSnapshotclinicalaudits,postnatalmaternityservicesincreasedtheirmeanscreeningrate(from33%in2014to48%in2015).VariationacrossserviceswasalsoevidentintheNewSouthWales2014 domestic violence Snapshot, ranging from 46% in mental health to 93% in women’shealth.45,bAbuse identification rates provide a measure of service quality as well as the underlyingprevalencerateamongserviceusers.Among95 locationsprovidingclinicalSnapshotdata, forwomenwhowereassessedforIPVinthepast12monthsandchildrenundertwoyearsofageassessed forchildabuseandneglect,34%(n=37)achievedthe target identification/disclosurerate of 5% or higher. The identification of IPV was highest in sexual health services (20%),comparedtoinemergency(6%),childhealth(4%)andpostnatalmaternity(4%)services.The6%identification of IPV among women presenting to the emergency department is significantlylowerthanthe18%22and21%1912monthprevalenceidentifiedintwoNewZealandstudies.Theidentificationrateofachildprotectionconcerninchildrenundertwoyearsofagepresentingtoanemergencydepartmentwas9%.ThereareseveralDHBswhohavenotimplementedVIPinalltargetedservicesandotherswhohave implemented VIP, but achieved zero or very low rates of family violence assessment,identificationandintervention.Thereareavarietyofexplanationsthathavebeenoffered,suchasinsufficientnursingand/orsocialworkstafftoprovideanappropriateinterventionforthosewho disclose abuse or inwhom there is a concern, lack of seniormanagement support andpractical physical structural issues (e.g. curtained cubicles are not sufficient for confidentialconversations).Suchbarriersarelimitationsthatthehealthsystemcanovercomeifthereisthewilltodoso.LackofachievementisnotacceptablegiventhehighprevalenceoffamilyviolenceinNewZealand17,46andthesignificantimpactoffamilyviolenceonhealthandwell-being.24,47ItisrecommendedthatahealthresponsetofamilyviolencebemadeaNewZealandhealthtarget.A health target would signal that the assessment for family violence and accompanyinginterventions are mandatory. This would be supported by designating family violence coretrainingasaKeyPerformanceIndicator.Overtime, DHBs have achieved significant infrastructure to support a systems approach forrespondingtointimatepartnerviolenceandchildabuseandneglect.Ongoingimprovementsare
aSexualhealthservicesprovidedby15DHBsbTheNewSouthWalesSnapshotprogrammestargetsmaternity,alcoholanddrugs,childandfamilyhealthandmentalhealthservices.
DISCUSSION
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occurring at the national level. These include the revised family violence guideline,2 implementation of the National Child Protection Alert System and Children’s Teamsc. Therevised New Zealand Family Violence Assessment and Intervention Guideline (2016),2 whichincludesaChildProtectionChecklisttooltosupportclinicaljudgement,providesapolicydirectionfornormalisingclinicalassessmentforchildabuseandneglect.Wealsoacknowledgetheworkprogramme of the Ministerial Group on Family Violence and Sexual Violence3 including theIntegratedSafetyResponsebeingpilotedinChristchurchandWaikato.
Thereisworkbeingdoneatalllevelstoimprovethehealthresponsetofamilyviolence.However,thedatainthisreportidentifyagapbetweenpolicyandpractice.Programmesustainabilityisaconcern. Turnover of key VIP staff including DHB VIP portfolio managers, family violenceintervention coordinators and service level champions impact on VIP service deliverywithinindividualDHBs.ThereisinsufficientfocusontheeffectivenessofservicesforMāori.Ongoingworkforce development, strong management support, and more capability in applying theModelforImprovementarestillneeded.Thelackofelectronicrecordsforfamilyviolenceresultsinasignificantburdenofmanualchartreview.
Having data is only a first step in improving quality. Understanding the “causes underlying thedifferencesanddeterminingwhatactionsmaybeappropriatetotaketoimprovehealthoutcomes”48remains our challenge. The response to family violence is not a tick box affair. It demands asupportivesystemwithaskilledworkforcesensitivetothedynamicsoffamilyviolence, includingtheentanglementbetween intimatepartnerviolenceandchildabuseandneglectandthefamilyharmcausedbyapatternofcoerciveandcontrollingbehaviours.49,50Thisisanessentialifwearetomeetourobligationtopreventandreducetheharmoffamilyviolence.51
Strengths of this evaluation project include using established family violence programmeevaluation instruments and following standard quality improvement processes inauditing.25,52The project promotes a comprehensive systems approach to addressing familyviolence,akeycharacteristicfordeliveringeffectiveservices.10
TheVIPSnapshotauditsprovidestandardiseddatathatcanbeaggregatedacrossallDHBsandutilisedforaccountabilitypurposesandperformancemeasurement.DHBswillbesupportedtoimprove their internal systemsover time tomeet the standardised requirementsof theVIPSnapshot clinical audits. Thiswill result inmore efficient and effectiveVIP Clinical SnapshotauditsinDHBsinthefuture.
Our processes of audit planning and reporting have facilitated DHB VIP programmedevelopment over time. Theevaluationproject is also integrated into theVIPmanagementprogramme,providingtheMinistrytheabilitytotargetremedialactionsinthecontextoflimitedresources.
The audit rounds foster a sense of urgency,53supporting timely policy revisions, procedureendorsementsandtimelyfillingofunfilledvacanciesofFVICoordinatorpositions.Finally,andperhapsmostimportantly,thelongitudinalnatureoftheevaluationhasallowedmonitoringofchangeovertime(2004to2015).
Limitationsareimportanttoconsiderininterpretingthefindingsandmakingrecommendationsbasedonthisevaluationwork.Theseinclude:
• Bydesign,thisstudyislimitedtoDHBsprovidingacutehospitalandcommunityservicesat
chttp://childrensactionplan.govt.nz/childrens-teams/
EVALUATIONSTRENGTHSANDLIMITATIONS
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secondaryandtertiarypublichospitals.TheVIPdoesnotincludeservicesprovidedbyprivatehospitalswhichmayalsoprovidepublicly funded services,orprimary carewhere familyviolence prevention programmes are being introduced opportunistically in DHB regions.
• Infrastructureaudittoolscoresrangefrom0to100.Thismeansthatasprogrammesmature
theyapproachthetopendofthescaleandhavelittleroomforscoreimprovement,creatinga‘ceilingeffect’.Inaddition,someinfrastructureindicatorshavebecome‘outofdate’,suchasthepartnerabuseprogrammetoolrequiringmonthly(ratherthanquarterly)governance(steeringgroup)meetings.Theinfrastructuretoolsareunderreviewtoguide programmemaintenanceandsustainability.
• The2015VIPDelphiauditdoesnotincludeindicatorsassociatedwithchangesintherevised(2016)FamilyViolenceAssessmentandIntervention Guideline:ChildAbuseAndIntimatePartnerViolence,2 theFamilyViolenceInterventionGuidelines:ElderAbuseandNeglect44ortheShakenBabyPreventionProgramme.
• TheSnapshotauditdoesnotcaptureallrecommendedfamilyviolencescreening,suchasfor
malepatientspresentingwithsignsorsymptomsindicativeofabuseorintheprimarycaresetting.
• TheSnapshotsamplesizeforindividualDHBswassmall(n=25).Forexample,aDHBmayhave
assessedforabusein10outof25eligiblecases,withonlyasingledisclosure/identification.
• VIPtobefullyimplementedinallMinistryofHealthtargetedservicesinallDHBs• DHBs to focuson improving the consistencyandqualityof identification, assessment, and
interventionforchildren,women,theirfamilies/whānauexperiencingfamilyviolence.• ADelphistudyisbeingconductedtoupdatethecurrentVIPDelphiPartnerAbuseandChild
Abuse andNeglect audit tools. The aim is to identify best practice elements of a healthresponse to family violence informedby current literature, the refreshed FamilyViolenceAssessmentandInterventionGuideline:ChildAbuseandIntimatePartnerViolence2016,theNew Zealand health context, and programme innovations (e.g. Elder Abuse, ShakenBabyProgramme).
• StandardisednationalITsolutionstoenableelectronicmonitoringofVIPbyDHBandservices.
• VIPwillcontinuetocontributetoandsupportallgovernmentinitiativesandinterventionsto
reducechildabuseandneglectandfamilyviolence.
VIPPRIORITIESFOR2016–2018
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1. FanslowJ.FamilyViolenceInterventionGuidelines:ChildandPartnerAbuse.Wellington,
NewZealand:MinistryofHealth;2002.2. FanslowJ,KellyP.Familyviolenceassessmentandinterventionguideline:Childabuse
andintimatepartnerviolence.2nded.Wellington:MinistryofHealth;2016.3. AdamsA,TolleyA.ProgressontheworkprogrammefortheMinisterialGrouponFamily
ViolenceandSexualViolence:CabinetpaperWellington,NZ:OfficeoftheMinisterofJusticeandOfficeoftheMinisterforSocialDevelopment;2015.
4. NewZealandGovernment.DeliveringBetterPublicServices:SupportingVulnerableChildrenResultActionPlan.2012.http://www.msd.govt.nz/documents/about-msd-and-our-work/work-programmes/better-public-services/supporting-vulerable-children/supporting-vulnerable-children-result-action-plan.pdf.Accessed18.12.2013.
5. MinistryofHealth.StatementofIntent2014-2018:MinistryofHealth.Wellington:MinistryofHealth;2014.
6. Young-WolffKC,KotzK,McCawB.Transformingthehealthcareresponsetointimatepartnerviolence:Addressing“wickedproblems”.JAMA.2016;315(23):2517-2518.
7. DeckerMR,FrattaroliS,McCawB,etal.Transformingthehealthcareresponsetointimatepartnerviolenceandtakingbestpracticestoscale.Journalofwomen'shealth(2002).2012;21(12):1222-1229.
8. BellE,ButcherK.DFIDGuidanceNoteonAddressingViolenceAgainstWomenandGirlsinHealthProgrammes-PartB.London:VAWGHelpdesk,DepartmentforInternationalDevelopment;2015.
9. WorldHealthOrganization.Monitoringthebuildingblocksofhealthsystems:ahandbookofindicatorsandtheirmeasurementstrategies.Geneva:WorldHealthOrganization;2010:http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf.
10. García-MorenoC,HegartyK,d'OliveiraAFL,Koziol-McLainJ,ColombiniM,FederG.Thehealth-systemsresponsetoviolenceagainstwomen.TheLancet.2014;385(9977):1567-1579.
11. O'CampoP,KirstM,TsamisC,ChambersC,AhmadF.Implementingsuccessfulintimatepartnerviolencescreeningprogramsinhealthcaresettings:Evidencegeneratedfromarealist-informedsystematicreview.SocSciMed.2011;72(6):855-866.
12. WillsR,RitchieM,WilsonM.Improvingdetectionandqualityofassessmentofchildabuseandpartnerabuseisachievablewithaformalorganisationalchangeapproach.JPaediatrChildHealth.2008;44(3):92-98.
13. SolbergLI,MosserG,McDonaldS.Thethreefacesofperformancemeasurement:improvement,accountability,andresearch.JtCommJQualImprov.1997;23(3):135-147.
14. NolanT,ResarR,HaradenC,GriffinFA.ImprovingtheReliabilityofHealthCare.Cambridge,MA:InstituteforHealthcareImprovement;2004.
15. SpangaroJ,Koziol-McLainJ,ZwiA,RutherfordA,FrailMA,RuaneJ.Decidingtotell:Qualitativeconfigurationalanalysisofdecisionstodiscloseexperienceofintimatepartnerviolenceinantenatalcare.SocSciMed.2016;154:45-53.
16. FederG,HutsonM,RamsayJ,TaketAR.Womenexposedtointimatepartnerviolence:expectationsandexperienceswhentheyencounterhealthcareprofessionals:ameta-analysisofqualitativestudies.ArchInternMed.2006;166(1):22-37.
17. FanslowJ,RobinsonE.ViolenceagainstwomeninNewZealand:prevalenceandhealthconsequences.NZMedJ.2004;117(1206):U1173.
18. MinistryofJustice.2014NewZealandCrimeandSafetySurveyMainFindings.WellingtonNewZealand:MinistryofJustice;2015.
19. Koziol-McLainJ,GardinerJ,BattyP,RamekaM,FyfeE,GiddingsL.Prevalenceofintimatepartnerviolenceamongwomenpresentingtoanurbanadultandpaediatricemergencycaredepartment.NZMedJ.2004;117(1206):U1174.
20. WhiteheadA,FanslowJ.PrevalenceoffamilyviolenceamongstwomenattendinganabortionclinicinNewZealand.AustNZJObstetGynaecol.2005;45(4):321-324.
REFERENCES
Page 45
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21. Koziol-McLainJ,RamekaM,GiddingsL,FyfeE,GardinerJ.PartnerviolenceprevalenceamongwomenattendingaMāorihealthproviderclinic.AustNZJPublicHealth.2007;31(2):143-148.
22. Koziol-McLainJ,GarrettN,FanslowJ,etal.ARandomizedControlledTrialofaBriefEmergencyDepartmentIntimatePartnerViolenceScreeningIntervention.AnnEmergMed.2010;56(4):413-423.
23. AnsaraDL,HindinMJ.Formalandinformalhelp-seekingassociatedwithwomen'sandmen'sexperiencesofintimatepartnerviolenceinCanada.SocSciMed.2010;70(7):1011-1018.
24. WorldHealthOrganization.Globalandregionalestimatesofviolenceagainstwomen:Prevalenceandhealtheffectsofintimatepartnerviolenceandnon-partnersexualviolence.Geneva:WorldHealthOrganizationPress;2013.ISBN9789241564625.
25. LangleyGJ,MoenRD,NolanKM,NolanTW,NormanCL,ProvostLP.TheImprovementGuide:APracticalApproachtoEnhancingOrganizationalPerformance.2nded.SanFrancisco:Jossey-Bass;2009.
26. GuedesA,BottS,Garcia-MorenoC,ColombiniM.Bridgingthegaps:aglobalreviewofintersectionsofviolenceagainstwomenandviolenceagainstchildren.GlobHealthAction.2016;9:31516.
27. DobbsT,ErueraM.KaupapaMāoriwellbeingframework:ThebasisforwhānauviolencepreventionandinterventionAuckland,NewZealand:NewZealandFamilyViolenceClearinghouse;2014.
28. WorldHealthOrganisation.Preventingchildmaltreatment:aguidetotakingactionandgeneratingevidence.Geneva,Switzerland:WHO;2006.
29. UnitedNationsChildren'sFund.HiddeninPlainSight:Astatisticalanalysisofviolenceagainstchildren.NewYork:UNICEF;2014.
30. WorldHealthOrganization.Respondingtointimatepartnerviolenceandsexualviolenceagainstwomen:WHOclinicalandpolicyguidelines.Geneva,Switzerland:WorldHealthOrganization;2013.
31. WilsonD,Koziol-McLainJ,GarrettN,SharmaP.Ahospital-basedchildprotectionprogrammeevaluationinstrument:AmodifiedDelphistudy.IntJQualHealthCare.2010;22(4):283-293.
32. Koziol-McLainJ,AdamsJ,NeitzertE,etal.HospitalResponsivenesstoFamilyViolence:BaselineAuditFindings.Auckland:AucklandUniversityofTechnology;2004.CommissionedbytheNewZealandMinistryofHealth.
33. CobenJ.Measuringthequalityofhospital-baseddomesticviolenceprograms.AcadEmergMed.2002;9(11):1176-1183.
34. Jigsaw,MinistryofHealth.IncreasingVIPProgrammes'ResponsivenesstoMāori:Awhānau-centredapproachfortheVIPprogramme.Wellington,NZ:MinistryofHealth;2014.
35. NewSouthWalesHealth.DomesticViolenceRoutineScreeningSnapshotReport11(2013).SydneyAustralia:NSWKidsandFamilies;2014.
36. NewZealandGovernment.VulnerableChildren'sAct,No.40.2014.37. DurieM,CooperR,GrennellD,SnivelyS,TuaineN.WhānauOra:ReportoftheTaskforce
onWhānau-CentredInitiatives.Wellington:MinistryofSocialDevelopment;2010.38. MassoudMR,DonohueKL,McCannonCJ.OptionsforLarge-scaleSpreadofSimple,
HighimpactInterventions.TechnicalReport.Bethesda,MD:UniversityResearchCo;2010.39. AgencyforHealthcareResearchandQuality.EvaluatingDomesticViolencePrograms.
2002;http://www.ahrq.gov/research/domesticviol/.Accessed02.01.2013.40. CobenJH,FisherEJ.Evaluatingtheimplementationofhospital-baseddomesticviolence
programs.FamilyViolencePreventionandHealthPractice.2005;1(2):1-11.41. Koziol-McLainJ,GarrettN,GearC.Hospitalresponsivenesstofamilyviolence:48month
follow-upevaluationAuckland,NZ:InterdisciplinaryTraumaResearchUnit,AucklandUniversityofTechnology;2009.ISSN1177-4347ReportNo8.
42. Ettorchi-TardyA,LevifM,MichelP.Benchmarking:AMethodforContinuousQualityImprovementinHealth.HealthcarePolicy.2012;7(4):e101-e119.
43. MInistryofHealth.EthnicityDataProtocolsfortheHealthandDisabilitySector.Wellington,NZ:MinistryofHealth;2004.
Page 46
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44. GlasgowK,FanslowJ.FamilyViolenceInterventionGuidelines:ElderAbuseandNeglect.Wellington:MinistryofHealth;2007.
45. NewSouthWalesMinistryofHealth.DomesticViolenceRoutineScreeningNovember2014Snapshot12.NorthSydney,NSW:OfficeofKidsandFamilies,NSWMinistryofHealth;2016.
46. UNICEF.Aleaguetableofchildmaltreatmentdeathsinrichnations.Florence:UNICEFInnocentiResearchCentre;2003.
47. UNICEF.BehindClosedDoorsTheImpactofDomesticViolenceonChildren.UNICEF;2006.48. NolteE.Internationalbenchmarkingofhealthcarequality:Areviewoftheliterature.
Cambridge,UK:RANDEuropeandLondonSchoolofHygieneandTropicalMedicine;2010.
49. FamilyViolenceDeathReviewCommittee.FifthReport:January2014toDecember2015.Wellington:NewZealandHealthQuality&SafetyCommission;2016.
50. WilsonD,SmithR,TolmieJ,deHaanI.Becomingbetterhelpers:Rethinkinglanguagetomovebeyondsimplisticresponsestowomenexperiencingintimatepartnerviolence.PolicyQuarterly.2015;11(1):25-31.
51. UnitedNationsEntityforGenderEqualityandtheEmpowermentofWomen,WorldHealthOrganization,UnitedNationsPopulationFund,UnitedNationsDevelopmentProgramme,UnitedNationsOfficeonDrugsandCrime.EssentialServicesPackageforWomenandGirlsSubjecttoViolence.NewYork2015.
52. KarapetrovicS,WillbornW.Auditsystem:Conceptsandpractices.TotalQualityManagement.2001;12(1):13-28.
53. KotterJP.LeadingChange.Boston:HarvardBusinessSchoolPress;1996.
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APPENDICESAPPENDIXA:FamilyViolenceProgrammeLogica
Culturally Appropriate
a MOH Advisory Committee; modified from Duignan, Version 4, 16-10-02
Better outcomes
Appropriate services
Women feel more empowered & have referral
options
Appropriate referrals for
children
Appropriate Intervention
Screening questions asked
of women
Clinical assessment and questioning about child abuse & neglect
Better trained and supported health professionals
Institutional support to sustain and implement
practice guidelines
Development of practice guidelines
Provision of
training
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DistrictHealthBoard Hospital LevelofcareNorthland Kaitaia S
Whangarei SWaitemata NorthShore S
Waitakere SAuckland AucklandCity TCountiesManukau Middlemore TWaikato Waikato T
Thames SBayof Plenty Tauranga S
Whakatane SLakes Rotorua STairawhiti Gisborne STaranaki NewPlymouth SHawkesBay HawkesBay SWhanganui Whanganui SMidCentral PalmerstonNorth SCapitalandCoast Wellington TWairarapa Wairarapa SHuttValley Hutt SNelson-Marlborough Nelson S
Wairau SCanterbury Christchurch T
Ashburton SWestCoast GreyBase SSouthCanterbury Timaru SSouthern Otago T Southland S S=secondaryservice,T=tertiary
LinkstoDHBMaps: http://www.moh.govt.nz/dhbmaps
APPENDIXB:DistrictHealthBoardHospitals
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(Letterheadremoved)
VIPSnapshotInformation1. IntroductionTheVIPSnapshotclinicalauditsystemhasbeenredevelopedtoprovideamoreefficientanduser-friendlyaudittool.
2. OverviewTheVIPSnapshot’sprimarypurposeistoprovidemeasurementdataofDHBVIPIntimatePartnerViolence(IPV)routineenquiry(screening)inselectedservicesandChildAbuseandNeglect(CAN)riskassessmentsdataforaccountabilitypurposes.VIPsnapshotclinicalauditsindicateashiftinnationalVIPevaluationfocusfromDHBinfrastructuredevelopmenttoaccountabilityandimprovementsinthedeliveryofservicestovulnerablechildren,women,theirwhānauandfamilies.
3. TimeframeTheduedateis7November2015.
4. 2015VIPSnapshotClinicalauditThefollowingserviceshavebeenselectedforthe2015VIPsnapshotaudit.
A.IntimatePartnerViolence(IPV):
• PostnatalMaternityAdmissions• AdultEmergencyDepartment• ChildHealthinpatient(aged0-16years)-Femaleguardians,parentsorcaregivers
assessedforIPV• SexualHealthservices
B.ChildAbuseandNeglectRiskAssessment:
• AllchildrenagedundertwopresentingtoEmergencyDepartmentforanyreason
5. Sites:• Mainsitesonlyshouldbereportedoniftherearesatellitesitesandmanyservices.
6. AuditPeriod:The3monthauditperiodisfrom1Aprilto30June2015.
7. UsernamesandPasswordsTheVIPSnapshotsystemwillbeemailingyouwithusernamesandatemporarypassword.Youwillberequiredtocreateanewpasswordforthesystem.AccesstheVIPSnapshotsystemathttps://vipsnapshot.aut.ac.nz
8. RandomSampleRandomsamplesof25patienthealthrecordsaretoberetrospectivelyselectedfromalleligiblepersonsduringthereviewperiod(1April–30June)foreachofthefiveserviceslistedabove.TheQualityManager,ClinicalRecordsorITHelpshouldassistintherandomselectionprocess.RefertotheVIPToolKitdocument“Howtoselectanauditsample”.
APPENDIXC:VIPSnapshotAuditInformationSheet
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9. DefinitionsDefinitionsareprovidedinAppendix1.TheyarealsoavailableintheSnapshotsystemdropdownmenu.
10. AdhocandOfficialAuditsThenewsystemwasdevelopedfortheofficialSnapshotAuditdatacollection(1April–30June).YouwillalsobeabletousethesystemtoenterDHBVIPdatafromAdhocaudits.Pleasetickthecorrectcategory.
11. StartaNewAudit1. Clickonthe+NewAuditbutton2. ClickwhethertheOfficial(requiredSnapshotAudit)oranAdhoc(voluntary)audit3. SelectyourDHBfromthedropdownlist(DHBsorderednorthtosouth)4. EnterthepercentofcurrentstaffwhohavecompletedVIPcoretrainingbyprofession
(e.g.doctor,nurse,midwife,socialworker).5. Enterthetotalnumberofeligiblewomen/childrenwhowereadmittedduring
theauditperiod(Itisfromthisnumberthat25patientsshouldberandomlyselected)
6. Click‘save’toadvancetopatientdataentry
12. Enterpatientdata1. ClickEthnicity/iesasrecordedinthepatientfile2. IPVScreen/ChildProtectionScreen–Yes/No
a. IftickNo,saveandmoveontonextpatientfile.b. Iftickyes,gotoIPVDisclosed/ChildProtectionConcern
i. Iftickno,saveandmoveontonextpatientfileii. Iftickyes,gotoIPVReferral/CANConsultation
1. TickYesorNo,saveandmoveontonextpatient.3. Thenumberoffilesenteredandsavedappearsontherightsideofthescreen.4. 25patientfilestobeenteredforeachservice.5. Thesystemwillautomaticallyswitchovertoauditstatus“DONE”forOfficial
(requiredSnapshotAudit)wheninputiscomplete.(Adhoc(voluntary)auditsneedtobemanuallyswitchedoverbyclicking“InProgress”to“DONE”).
6. Youmayenterthedatainoneormoresittings.Thesystemwillkeeptrackofhowmanypatientsyouhaveentered.
7. Ifyouareenteringasmallernumberofcasesforanadhocaudityoumayclickthe“InProgress”buttontochangeto“DONE”.
13. YourResultsThesystemwillprovidetheDHBresults(screeninganddisclosure/concernandreferral/consultation).DocumentyourresultsforeachserviceinyourSelfAuditReportandincludeinyourJanuary2016reporttotheMinistryofHealth.
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APPENDIX1.DEFINITIONSGenericQuestions:VIPCoreTraining:EnterthepercentofcurrentstaffwhohavecompletedVIPCoreTrainingindesignatedservice:Ethnicity: SelectEthnicity/iesasindicatedinpatientfile.
INTIMATEPARTNERVIOLENCE
POSTNATALMATERNITYTotalnumberofwomenwhohavegivenlivebirthandwhohavebeenadmittedtopostnatalmaternitywardduringauditperiod.IPVScreen:Wasthewomanscreened?NO: Thereisnodocumentationthatthewomanwasscreened.Ifthereisdocumentation
regardingareasonfornotscreening(suchas‘with’partner),thisisstilla‘NO’.
YES: Thereisdocumentationthatthewomanwasscreenedforpartnerabuseinthepast12monthsaccordingtothenationalVIPGuidelines.Thiswouldincludeaskingthewomanthreeormorescreeningquestions.
IPVDisclosed:DidthewomandiscloseIPV?NO: WomandidnotdiscloseIPV.Ifawomanwasscreened,butthereisno
documentationregardingdisclosure,thisisa‘NO’.
YES: WomandisclosedabuseinresponsetoIPVscreen(abuseinthepast12monthsorcurrentlyafraid).Ifwomandisclosedabusebeforescreening,wouldstillbea‘YES’.
IPVReferrals:Wereappropriatereferralsmade?
NO: Noidentificationinnotesthatreferralswerediscussed,ornotesindicatereferrals
weremade,butdonotspecifytowhom,orappearincomplete.Ifdocumentedthatawomanrefusedareferral,thisisalsoaNO.
YES:offsite: Clearevidenceinnotesofappropriatereferralstooffsitespecialisedfamily
violencesupport.Thiswouldinclude,forexample,providingthewomanwithabrochurewithcontactorwebsiteinformationtooffsiteservices(e.g.Women’sRefuge,communityservices).
YES:onsite: Immediateaccesstoonsitefamilyviolencespecialist(suchasasocialworker,Women’sRefugeadvocate)whoestablishessafety,addressesidentifiedrisks,andprovidessupportandaccesstocommunityservices.
ADULTEMERGENCYDEPARTMENT
Informationrequestedincluded:Entertotalnumberofallwomenaged16yearsandoverwhopresentedtoEDduring
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theauditperiod.Age: EnterageofwomanTriage–1,2,3,4,or5(ClickTriagestatus)Admittedtointensivecare,coronarycare,orhighdependencyunit:YES/NOIPVScreen:Wasthewomanscreened?NO: Thereisnodocumentationthatthewomanwasscreened.Ifthereis
documentationregardingareasonfornotscreening(suchas‘with’partner),thisisstilla‘NO’.
YES: Thereisdocumentationthatthewomanwasscreenedforpartnerabuseinthepast12monthsaccordingtothenationalVIPGuidelines.Thiswouldincludeaskingthewomanthreeormorescreeningquestions.
IPVDisclosed:DidthewomandiscloseIPV?NO: WomandidnotdiscloseIPV.Ifawomanwasscreened,butthereisno
documentationregardingdisclosure,thisisa‘NO’.
YES: WomandisclosedabuseinresponsetoIPVscreen(abuseinthepast12monthsorcurrentlyafraid).Ifwomandisclosedabusebeforescreening,wouldstillbea‘YES’.
IPVReferrals:Wereappropriatereferralsmade?
NO: Noidentificationinnotesthatreferralswerediscussed,ornotesindicatereferrals
weremade,butdonotspecifytowhom,orappearincomplete.Ifdocumentedthatawomanrefusedareferral,thisisalsoaNO.
YES:offsite: Clearevidenceinnotesofappropriatereferralstooffsitespecialisedfamily
violencesupport.Thiswouldinclude,forexample,providingthewomanwithabrochurewithcontactorwebsiteinformationtooffsiteservices(e.g.Women’sRefuge,communityservices).
YES:onsite: Onsitefamilyviolencespecialist(suchasasocialworker,Women’sRefuge
advocate)whoestablishessafety,addressesidentifiedrisks,andprovidessupportandaccesstocommunityservices.
SEXUALHEALTHEntertotalnumberofallwomenaged16yearsandoverwhopresentedtoSexualHealthServicesduringtheauditperiod.IPVScreen:Wasthewomanscreened?NO: Thereisnodocumentationthatthewomanwasscreened.Ifthereis
documentationregardingareasonfornotscreening(suchas‘with’partner),thisisstilla‘NO’.
YES: Thereisdocumentationthatthewomanwasscreenedforpartnerabuseinthepast12monthsaccordingtothenationalVIPGuidelines.Thiswouldincludeaskingthewomanthreeormorescreeningquestions.
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IPVDisclosed:DidthewomandiscloseIPV?NO: WomandidnotdiscloseIPV.Ifawomanwasscreened,butthereisno
documentationregardingdisclosure,thisisa‘NO’.
YES: WomandisclosedabuseinresponsetoIPVscreen(abuseinthepast12monthsorcurrentlyafraid).Ifwomandisclosedabusebeforescreening,wouldstillbea‘YES’.
IPVReferrals:Wereappropriatereferralsmade?
NO: Noidentificationinnotesthatreferralswerediscussed,ornotesindicatereferrals
weremade,butdonotspecifytowhom,orappearincomplete.Ifdocumentedthatawomanrefusedareferral,thisisalsoaNO.
YES:offsite: Clearevidenceinnotesofappropriatereferralstooffsitespecialisedfamily
violencesupport.Thiswouldinclude,forexample,providingthewomanwithabrochurewithcontactorwebsiteinformationtooffsiteservices(e.g.Women’sRefuge,communityservices).
YES:onsite: Onsitefamilyviolencespecialist(suchasasocialworker,Women’sRefuge
advocate)whoestablishessafety,addressesidentifiedrisks,andprovidessupportandaccesstocommunityservices.
CHILDHEALTHINPATIENTEntertotalnumberofchildhealthadmissionsaged16yearsandunder,admittedtoageneralpaediatricinpatientward(notaspecialtysetting)duringtheauditperiodAgeofChild: Enterchild’sageatlastbirthday.Pleaseenter‘0’forchildrenunder1year.Ethnicity: Selectethnicity/iesasindicatedinchild’sfileIPVScreen: Wasthefemalecaregiver(guardian,parentorcaregiver)screened?NO: Thereisnodocumentationthatthewomanwasscreened.Ifthereis
documentationofareasonfornotscreening(suchas‘withpartner’thisisstillaNO.
NO,femalecaregiver Documentationstatesthereisnofemalecaregiverinthe
household.YES: ThereisdocumentationthatthewomanwasscreenedforIPVinthepast12
monthsaccordingtothenationalVIPGuidelines.Thiswouldincludeaskingthewomanthreeormorescreeningquestions.
IPVDisclosed:DidthewomandiscloseIPV?NO: WomandidnotdiscloseIPV.Ifawomanwasscreened,butthereisno
documentationregardingdisclosure,thisisa‘NO’.
YES: WomandisclosedabuseinresponsetoIPVscreen(abuseinthepast12monthsorcurrentlyafraid).Ifwomandisclosedabusebeforescreening,wouldstillbea‘YES’.
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IPVReferrals:Wereappropriatereferralsmade?
NO: Noidentificationinnotesthatreferralswerediscussed,ornotesindicatereferrals
weremade,butdonotspecifytowhom,orappearincomplete.Ifdocumentedthatawomanrefusedareferral,thisisalsoaNO.
YES:offsite: Clearevidenceinnotesofappropriatereferralstooffsitespecialisedfamily
violencesupport.Thiswouldinclude,forexample,providingthewomanwithabrochurewithcontactorwebsiteinformationtooffsiteservices(e.g.Women’sRefuge,communityservices).
YES:onsite: Onsitefamilyviolencespecialist(suchasasocialworker,Women’sRefuge
advocate)whoestablishessafety,addressesidentifiedrisks,andprovidessupportandaccesstocommunityservices.
CHILDABUSE&NEGLECTEthnicity: Selectethnicity/iesasindicatedinchild’sfileThoroughChildProtectionScreen/RiskAssessment-WasathoroughChildProtectionScreenorAssessmentdone?NO: NoevidenceofathoroughChildProtectionscreen,checklistorflowchart(i.e.no
childinjuryflowchart,checklistorequivalentinthenotes,ordocumentationispresentbutisblank,orispartiallycompleted).
YES: EvidenceofathoroughChildProtectionScreen/RiskAssessment(i.e.ChildInjuryFlowchart,checklistorequivalentfullycompletedincludinglegiblesignature.
CANConcern–WasaChildProtectionConcernidentified?NO: Nochildprotectionconcernsorriskfactorsofchildabuseandneglectwere
documented;ordocumentationwasnotcomplete.YES: AChildProtectionConcern(i.e.oneormoreriskfactors)isidentifiedinthenotes.
IfdocumentationofaReportofConcern,suspectedchildmaltreatmentorchildprotectionconcernisincludedinthenotes,thiswouldbeaYES.
CANConsultation:WereidentifiedChildProtectionconcernsdiscussed?NO: NoindicationofdiscussioninthenotesaboutChildProtectionriskfactorsand
assessment,ortheplanappearsinappropriate,unclearormisleading,ornotesindicateclearplanbutdonotindicatewhothecasewasdiscussedwith.IfnoCANconcern,thisisa‘NO’.
YES: EvidencethatChildProtectionconsultationoccurredisinthenoteswithnameanddesignationofpersonconsulted.ChildProtectionConsultationmaybewithaSeniorConsultantED,Paediatrician,specialistsocialworker,CYF,orothermemberofthemultidisciplinarychildprotectionteam.DiscussionoftheChildProtectionriskfactors,assessmentofthelevelofriskandplanisrecorded.
APPENDIX2. SCREENINGQUESTIONSTheVIPPartnerAbuseInterventionTraining(2014)suggeststhefollowingScreeningQuestionsandframingbeusedtoscreenwomenpatients:(Fanslow(2002)FVIGp43(2.1.4))
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“Thestaffofthisserviceareconcernedaboutfamilyviolence,andtheimpactithasonwomenandchildren,thereforeweroutinelyaskallwomenaboutviolenceintheirhome.”
• ‘Haveyoubeenhit,kicked,punchedorhurtinanywaybysomeoneinthelastyear?’• ‘Doyoufeelsafeinyourcurrentrelationship?’• ‘Isthereapartnerfromapreviousrelationshipwhoismakingyoufeelunsafenow?’• ‘Withinthelastyearhasanyoneforcedyoutohavesexinawayyoudidn’twantto?’
ORaskhowthepartnerisfindingbeingaparentandwhetheranythinghaschangedinthewoman’srelationship.
• “Howarethingsbetweenyou?”ORyoumighthavetorefertomarksonthewoman’sbodyorbehaviourandsay
• “I’venoticedthat……….Issomeonehurtingyou?”or• I’mworriedthatyoumightbebeinghitoryelledat.”
APPENDIX3. REFERENCES• Fanslow,J.L.(2002).FamilyViolenceInterventionGuidelines.Wellington:MinistryofHealth.• Langley,G.J.,Moen,R.D.,Nolan,K.M.,Nolan,T.W.,Norman,C.L.&Provost,L.P.
(2009).Theimprovementguide:ApracticalapproachtoenhancingOrganisationalPerformance.SanFrancisco,CA:Jossey-Bass.
• O’Campo,P.,Kirst,M.,Tsamis,C.,Chambers,C.,Ahmad,F.(2011)Implementingsuccessfulintimatepartnerviolencescreeningprogramsinhealthcaresettings:Evidencegeneratedfromarealist-informedsystematicreview.SocialScience&Medicine,72,855-866.Doi:10.1016/j.socscimed.2010.12.019
• Perla,R.J.,Bradford,D.A.(2011)BalancingCostandPrecisioninHospitalAccountabilitySampling.JHealthcQual,May-Jun;33(3),5-9.doi:10.1111/j.1945-1474.2010.00106.x.Epub2010Jul23.
• Solberg,L.I.,Mosser,G.,&McDonald,S.(1997).Thethreefacesofperformancemeasurement:Improvement,accountabilityandresearch.TheJointCommissiononQualityImprovement,23,135-147.
• Wilson,D.,Smith,R.,Tolmie,J.,deHaan,I.(2015).BecomingBetterHelpers.Rethinkinglanguagetomovebeyondsimplisticresponsestowomenexperiencingintimatepartnerviolence.
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Violence Intervention Programme (VIP) Evaluation SelfAuditReport:2015(fortheperiod1July2014–30June2015)
**DistrictHealthBoard**Hospital(s)
****2015ChiefExecutiveOfficerVIPSponsor/PortfolioManagerFVICChildProtectionCoordinator
VIPImplementation(Rolloutofintegratedpartnerabuseandchildabuseandneglect)
Service
VIPImplemented(PleasetickYESorNO) Comment
YES NO
1. EmergencyDepartment
2a.ChildHealth–Inpatient
2b.ChildHealth–Community
3a.Maternity–Inpatient
3b.Maternity–Community
4.SexualHealth–Community
5a.MentalHealth–Inpatient
5b.MentalHealth–Community
6.Alcohol&Drug–Community
DHBViolenceInterventionProgrammeSelfAuditSummary
Thisreportprovidesananalysisbasedonreviewofthefollowing(tickallthatapply):____CurrentVIPstrategicplanand2014-15actionplan____PartnerAbuseProgrammeOverallandCategoryScores(usingDelphitool)____ChildAbuseandNeglectProgrammeOverallandCategoryScores(usingDelphitool)____VIPSnapshotClinicalAuditresults(usingonlineSnapshotfindings)____Internalclinicalauditresults(usingVIPQIToolkit)____2014-2015completedPDSAcycles____CompletedSupplementaryInformation(seepage4)
APPENDIXD:DHBSelfAuditReport:2015Follow-upForm
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SelfAuditFindingsandObservations
MostsignificantVIPachievementssincethelastaudit:
ProgrammeStrengths
AreasforImprovement:
OverallAuditConclusions:
Consider:• Evaluationscores• VIPSnapshotresults• MaoriResponsiveness• Progresssincepreviousaudit• ProposedActionsfor2015
TitlesforSelected2015-2016ModelforImprovementPDSAs(Plan-Do-Study-Act):
1.2.
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SelfAuditReportApproval:DHBViolenceInterventionProgrammeAuditTeamLeader_______________________ ___________________________ _______________Name Signature ReviewDateDHBViolenceInterventionProgrammeSponsor_______________________ ___________________________ _______________Name Signature ReviewDate
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SUPPLEMENTARYINFORMATION
(Pleasecompleteandsubmitwithselfauditreport)
1. CulturalresponsivenesstoMāoriandcontributiontowhānauoraworkforcedevelopment
DoesyourVIPstrategicplanidentifyactionstoimproveculturalresponsivenesstoMāoriandtocontributetowhānauoraworkforcedevelopment? YES/NO(Deleteone)
PleaseelaborateonWhānauOrainitiativeprogressandplans:
2. ElderAbuseandNeglectinterventionandviolencepreventionpolicies
HaveElderAbuseandNeglect(EAN)policiesbeenapproved? YES/NO(deleteone)Arethepoliciesbeingimplemented? YES/NO(deleteone)
Pleaseelaborate:
3. Disabilityinitiatives
Hasyourprogrammeaddressedissuesforpersonswithdisabilities? YES/NO(Deleteone)
Pleaseelaborate:
4. ShakenBabyProgrammeImplementation
IstheimplementationoftheShakenBabyProgrammeunderway? YES/NO(Deleteone)
Pleaseelaborate:
5. ClinicalAudit:DocumentationauditofreferralsmadebyDHBtoChildYouthandFamily(refertoVIPQIToolkit)
ReviewPeriodStart(dd/mm/yy)
ReviewPeriodEnd(dd/mm/yy)
No.ReportofConcernsmadebyDHBtoCYFduringperiod
No.ReportofConcernsandaccompanyinghealthrecordsReviewed
No.includeassessmentforco-occurrenceofpartnerabuse
No.childmaltreatmentconfirmedorsuspectedincludedinhealthdiagnosis
No.childprotectionconcernsincludedindischargesummary
Comments:
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2015 Violence Intervention Programme Evaluation Follow-upAuditReport
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10.SafetyandSecurity 1.20
ThereaderisreferredtotheoriginalDelphiscoringguidelinesavailableat:http://www.ahcpr.gov/research/domesticviol/.
Theweightingsusedforthisstudyareprovidedbelow.
1. PoliciesandProcedures 1.16 1.16 1.21
2.PhysicalEnvironment
0.86
0.86
.95
3.InstitutionalCulture
1.19
1.19
1.16
4.Trainingofstaff
1.15
1.15
1.16
5.ScreeningandSafetyAssessment
1.22
N/A
N/A
6.Documentation
0.95
0.95
1.05
7.InterventionServices
1.29
1.29
1.09
8.EvaluationActivities
1.14
1.14
1.01
9.Collaboration
1.04
1.04
1.17
Total score forPartnerAbuse= sumacrossdomains (domain raw score *weight)/10Total score for Child Abuse & Neglect = sum across domains (domain rawscore*weight)/8.78
APPENDIXE:DelphiScoringWeights
Domain PartnerAbuse
ChildAbuse&Neglect
RevisedChildAbuse&Neglect
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VIPAUDITPREPARATIONINFORMATION2015Evaluation
IntroductionThe VIP evaluation provides the opportunity for DHBs to build competence in family violenceservicedeliveryaswellasmeasureprogressovertime.Processesareguidedbyaphilosophyofsupporting programme leaders in building a culture of improvement. The evaluation project isapproved by the Multi-region Ethics Committee (AKY/03/09/218) with current approval toDecember2015.Itisrecommendedthatrequirementsofthe2015VIPauditarecompletedinthefollowingorder.
The2015VIPauditcoverstheoneyearperiod1July2014to30June2015(nottobeconfusedwiththeSnapshotauditthreemonthperiodfrom1Aprilto30June2015).
VIPDelphilnfrastructureSelfAuditinPartnerAbuse&
ChildAbuse&Neglect
VIPSnapshotclinicalauditsforIntimatePartnerViolencein:PostnatalMaternity
ChildHealthInpatientsAdultEmergencyDepartment
SexualHealthServices
andforChildAbuseandNeglectin
ChildrenundertheageoftwoyearspresentingtotheEmergencyDepartmentforanyreason
SelfAuditReport
TwoModelforImprovementPlan-Do-Study-Act(PDSA)Worksheetsfor2015/2016
APPENDIXF: 2015AuditRoundProcess
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DueDates 28October VIPDelphiAuditsdue7November VIPSnapshotAudits–dataentrytobecompleted7November SelfAuditReportdue7November TwoPDSA–PLANSonly–dueforevaluationteamreview7April2016 TwocompletedPDSAworksheets(withDO,STUDYandACT)duePreliminary2015VIPAuditnationalresultswillbesharedattheNNVIPMeeting(23NovemberinWellington)AuditPreparationWeencouragethedevelopmentofanAuditPlantoguideyourevaluationprocesses.TheplanisideallydevelopedincollaborationwiththeDHBVIPportfoliomanager,steeringgroup(includingQuality & Risk, Māori Health) and Family Violence Intervention Coordinator(s). The followingresourcemayassistyouineffectiveselfauditplanning:MakinganAuditPlan2015(MakingaSelfAuditPlan2015.pdf).
VIPDelphiInfrastructureSelf-Audits
Ø PreparationfortheDelphiexceltoolauditsshouldbuildonpreviousaudit
documentation,updatingandimprovingevidencecollation.Ø Ifrequired,blankpartnerabuseandchildabuseandneglectauditfilesare
availabletodownloadatwww.aut.ac.nz/vipevaluationorfromtheVIPHIIRCwebsite.
Ø APhysicalEnvironmentWalkThroughFormisalsoavailable(VIPPhysicalenvironmentwalkthrough.pdf)
Ø PleasesubmityourPAandCANDelphiauditstoChristineMcLeanby28October.
VIPSnapshotClinicalAudits
TheSnapshotauditsarenationallystandardisedtomeasureservicedeliverytovulnerablechildrenandwomen,whānauandfamilies.In2015theVIPSnapshotsystemhasbeenupgraded.Userswillbeabletosaveandeditdataandreceivetheirauditresultsinrealtime.
Ø Samplesize:Retrospectiverandomsamplesof25patienthealthrecordsaretobe
selectedfromthe3monthreviewperiod–1Aprilto30June2015from5services:
IPV:• PostnatalMaternity
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• ChildHealthInpatient• SexualHealthServices• AdultEmergencyDepartment
CAN:• Children’s/EmergencyDepartment–Allchildrenundertheageoftwo
admittedtoEDforanyreason.Ø TheVIPSnapshotsystemwillemailallFVICswithusernameandatemporary
password.Youwillberequiredtocreateapasswordforthesystem.Ø AccesstheVIPSnapshotsystemathttps://vipsnapshot.aut.ac.nzØ MedicalRecordsshouldbeadvisedassoonaspossibleoftheauditrequirements
foreachserviceØ SnapshotauditsaretobeundertakeninallserviceswhetherornotVIPis
implementedØ PleaseenteryourVIPSnapshotdataby7November2015
SelfAuditReport
Ø TheSelfAuditReportcoverstheoneyearperiod1July2014to30June2015.Ø PleaseprovidethenamesofthekeyDHBVIPstakeholdersonthecoversheet,and
completetheSelfAuditFindingsandEvaluations,andtheSupplementaryInformationsectionsasrequested.
Ø Pleasedouble-checkthatallitemshavebeencompleted.
ModelforImprovementPlan-Do-Study-Act(PDSA)Worksheets
Ø TwoPDSAPlansaretobesubmittedby7NovemberforapprovalbytheAUT
EvaluationTeampriortoimplementationØ TheObjectivesshouldfocusonimprovingyourSnapshotresults.Ø PDSApackwithresourcesandinstructionswillbeforwardedseparately.Ø CompletedPSDAworksheets(withDO,STUDYandACT)submittedby7April2016.
AdditionalInformationIndependentAuditThe criteria for an independent audit (outlined in the 2015-2018 Ministry of HealthContractfortheNationalEvaluationofDistrictHealthBoardResponsestoVictimsofFamilyViolence)iswhentheDHB’sDelphioverallordomain(category)scoreislessthan80.IfanIndependentAuditistriggered,indicatorevidence(aspreparedfortheself-audit)willneed
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2015 Violence Intervention Programme Evaluation
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tobeavailabletobeviewedbytheindependentevaluator.National Report. A national report and summary documenting VIP programmedevelopmentacrosstheauditperiodwillbemadeavailableinApril2016.AuditdiscussionsandindividualDHBreportsprovidedbyauditorswillbekeptconfidentialbetweentheDHBandMOHVIPteam.NationalreportsofoverallprogrammeandculturalresponsivenessscoreswillidentifyDHBsinleaguetables.DHBsachievinghighscoresintheVIPSnapshotauditswillbenamedintheNationalReport.AuditSupportAuditsupportisavailablethroughvariousmeans.RegionalFVICsshouldbeyourfirstpointofcontact.Pleasefeelfreetogethelpfromtheauditteam,ChrisMcLean–inthefirstinstance,andJaneKoziol-McLain,toansweranyoutstandingquestions.Concerns:ForconcernsregardingtheprocessorconductoftheauditpleasecontactJaneKoziol-McLainortheMinistryofHealthcontactperson,HelenFraser(07)9293647orHelen_Fraser@moh.govt.nz
ChristineMcLean ProfessorJaneKoziol-McLain,PhD,RNResearchProjectManager PrincipalInvestigatorCentreforInterdisciplinaryTraumaResearch CentreforInterdisciplinaryTraumaResearch SchoolofClinicalSciences SchoolofClinicalSciencesAucklandUniversityofTechnology AucklandUniversityofTechnology(09)9219999x7114 (09)9219670cmclean@aut.ac.nz jkoziolm@aut.ac.nz
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Ø The length of the box is important.The lower boundaryofthebox
representsthe25thpercentileandtheupperboundary of the box the 75th
percentile.Thismeansthattheboxincludesthemiddlehalfofall scores.So,
25%ofscoreswillfallbelowtheboxand25%abovethebox.
Ø Thethickblack line indicatesthemiddlescore(medianor50thpercentile).This
sometimesdiffers from the mean, which is thearithmeticaveragescore.
Ø Acircleindicatesan‘outlier’,avalue that is outside thegeneral range of
scores (1.5 box-lengths fromtheedgeofabox).
Ø Astarindicatesan‘extreme’ score (3 box-lengths from theedgeofabox).
Ø The whiskers or needles extending from the box indicate thescore range, the
highestand lowestscoresthatarenotoutliers (orextremevalues).
SPSS
APPENDIXG:HowtoInterpretBoxPlots
Page 66
2015 Violence Intervention Programme Evaluation
APPE
NDIX
H.
Part
nerA
buse
Bas
elin
ean
dFo
llow
-Up
Scor
es
Median
AchievingTargetScore≥70
≥80
2004
20
05
2007
20
08
2009
20
11
2012
20
13
2014
20
15
2004
20
05
2007
20
08
2009
20
11
2012
20
13
2014
20
15
Ove
rall
Scor
e
20
28
49
67
74
84
91
92
92
92
1 (4%
)2 (8%
)5
(19%
)13
a
(48%
15
(5
6%)
25
(93%
)27
(1
00%
)19
(9
5%)
20
(100
%)
19
95%
DomainScores
Polic
ies&
Pr
oced
ures
19
30
49
62
75
82
87
89
87
87
1 (4%
) 2 (8%
)7
(26%
) 11
(4
1%)
16
(59%
) 20
(7
4%)
24
(89%
) 18
(9
0%)
19
(95%
) 18
(9
0%)
Phys
ical
En
viro
nmen
t7
15
23
75
79
91
100
100
100
100
0 (0%
)1 (4%
)4
(15%
)16
(5
9%)
16
(59%
)23
(8
5%)
25
(93%
)18
(9
0%)
19
(95%
)
17
(85%
)
Inst
itutio
nal
Cultu
re
22
31
59
72
83
89
94
97
94
92
2 (8%
)5
(20%
)8
(30%
)15
(5
6%)
16
(59%
)23
(8
5%)
25
(93%
)18
(9
0%)
19
(95%
)
17
(85%
)
Trai
ning
of
Prov
ider
s 11
32
59
78
88
89
10
010
010
010
01 (4%
)5
(20%
)8
(30%
)15
(5
6%)
18
(67%
)26
(9
6%)
26
(96%
)19
(9
5%)
20
(100
%)
19
(95%
)
Scre
enin
g&
Sa
fety
As
sess
men
t
00
43
65
73
80
80
854
87
88
1(4
%)
5(2
0%)
8(3
0%)
15
(56%
)18
(6
7%)
26
(96%
)26
(9
6%)
19
(95%
)20
(1
00%
)
19
(95%
)
Docu
men
tatio
n0
19
29
67
76
90
91
90
100
95
0 (0%
)0 (0%
)2 (7%
)12
(4
4%)
14
(52%
)22
(8
2%)
24
(89%
)18
(9
0%)
18
(90%
)
17
(85%
)
Inte
rven
tion
Serv
ices
26
46
62
65
79
93
10
010
097
99
4
(16%
)6
(24%
)9
(33%
)11
(4
1%)
17
(63%
)24
(8
9%)
27
(100
%)
20
(100
%)
20
(100
%)
19
(95%
)
Eval
uatio
nAc
tiviti
es
00
20
34
63
66
80
80
90
82
1 (4%
)1 (4%
)4
(15%
)6
(22%
)11
(4
1%)
13
(48%
)23
(8
5%)
14
(70%
)15
(7
5%)
15
(75%
)
Colla
bora
tion
38
77
79
93
92
100
100
100
100
100
1 (4%
)15
(6
0%)
19
(70%
)23
(8
5%)
25
(93%
)27
(1
00%
)27
(1
00%
)20
(1
00%
)20
(1
00%)
20
(100
%)
Note
:Th
eun
itof
ana
lysis
chan
ged
from
hos
pita
ls(n
=27)
toD
HBs(
n=20
)for
the
2013
follo
w-u
pau
dit.
The
sele
cted
ben
chm
ark
scor
ew
asra
ised
from
70
to8
0fo
rthe
201
5fo
llow
-up
audi
t.T
he2
012
follo
w-u
psc
ores
inclu
dein
depe
nden
tsco
res(
n=13
hos
pita
ls)a
ndse
lfau
dits
core
s(n=
14h
ospi
tals)
.Th
e20
13a
nd2
014
follo
w-u
psc
ores
inclu
dese
lfau
dits
core
s(n=
16)
and
inde
pend
enta
udit
scor
es(n
=4).
The
201
5fo
llow
-up
scor
esa
rea
ll(n
=20)
from
self
audi
ts.
_____ Follow-upAudit _____
Page 67
2015 Violence Intervention Programme Evaluation
Note
:120
mon
thfo
llow
-up
scor
esin
clude
self
audi
tsco
res(
n=16
DHB
s)a
ndin
depe
nden
taud
itsc
ores
(n=4
DHB
s).N
ote:
The
96
mon
thfo
llow
-up
scor
esw
ere
hosp
italb
ased
in
cludi
ngse
lfau
dits
core
s(n=
14h
ospi
tals)
and
inde
pend
enta
udit
scor
es(n
=13
DHBs
).
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs
(%)
CATE
GORY
1.P
OLI
CIES
AN
DPR
OCE
DURE
S
1.1
Are
ther
eof
ficia
l,w
ritte
nho
spita
lpol
icies
rega
rdin
gth
eas
sess
men
tand
trea
tmen
tofv
ictim
sofp
artn
era
buse
?If
yes,
dop
olici
es:
19(9
5%)
20(1
00%
)20
(100
%)
a)d
efin
epa
rtne
rabu
se?
20(1
00%
)20
(100
%)
20(1
00%
)b)
man
date
trai
ning
on
part
nera
buse
fora
nyst
aff?
20
(100
%)
19(9
5%)
19(9
5%)
c)a
dvoc
ate
univ
ersa
lscr
eeni
ngfo
rwom
ena
nyw
here
inth
eho
spita
l?
20(1
00%
)20
(100
%)
20(1
00%
)d)
def
ine
who
isre
spon
sible
fors
cree
ning
?20
(100
%)
20(1
00%
)20
(100
%)
e)ad
dres
sdoc
umen
tatio
n?
19(9
5%)
20(1
00%
)19
(95%
)f)
addr
essr
efer
ralo
fvict
ims?
20
(100
%)
20(1
00%
)20
(100
%)
g)a
ddre
ssle
galr
epor
tingr
equi
rem
ents
?19
(95%
)20
(100
%)
20(1
00%
)h)
add
ress
the
resp
onsib
ilitie
sto,
and
nee
dso
f,M
āori?
20
(100
%)
20(1
00%
)20
(100
%)
i)ad
dres
sthe
nee
dso
foth
er(n
on-M
āori/
non-
Pake
ha)c
ultu
rala
nd/o
reth
nicg
roup
s?
19(9
5%)
20(1
00%
)20
(100
%)
j)ad
dres
sthe
nee
dso
fLGB
Tcli
ents
?19
(95%
)19
(95%
)18
(90%
)1.
2Is
ther
eev
iden
ceo
fah
ospi
tal-b
ased
par
tner
abu
sew
orki
ngg
roup
?Ify
es,d
oest
heg
roup
:20
(100
%)
19(9
5%)
19(9
5%)
a)m
eeta
tlea
ste
very
mon
th?
11(5
5%)
13(6
5%)
8(4
0%)
b)in
clude
repr
esen
tativ
e(s)
from
mor
eth
antw
ode
part
men
ts?
20(1
00%
)19
(95%
)20
(100
%)
c)in
clude
repr
esen
tativ
e(s)
from
the
secu
rityd
epar
tmen
t?
15(7
5%)
16(8
0%)
16(8
0%)
d)in
clude
phy
sicia
n(s)
from
the
med
icals
taff?
17
(85%
)17
(85%
)17
(85%
)e)
inclu
dere
pres
enta
tive(
s)fr
oma
par
tner
abu
sea
dvoc
acyo
rgan
izatio
n(e
.g.W
omen
’sRe
fuge
)?
18(9
0%)
19(9
5%)
19(9
5%)
f)in
clude
repr
esen
tativ
e(s)
from
hos
pita
ladm
inist
ratio
n?
20(1
00%
)19
(95%
)20
(100
%)
g)in
clude
Māo
rire
pres
enta
tive(
s)?
20(1
00%
)19
(95%
)20
(100
%)
1.3
Does
the
hosp
italp
rovi
ded
irect
fina
ncia
lsup
port
fort
hep
artn
era
buse
pro
gram
me
(bey
ond
VIP
fund
ing)
?17
(85%
)17
(85%
)20
(100
%)
1.3 a
Is
fund
ing
seta
side
spec
ifica
llyfo
rMāo
ripr
ogra
mm
esa
ndin
itiat
ives
?13
(65%
)12
(60%
)11
(55%
)1.
4Is
ther
ea
man
dato
ryu
nive
rsal
scre
enin
gpo
licyi
npl
ace?
20
(100
%)
20(1
00%
)20
(100
%)
APPE
NDIX
I:P
artn
erA
buse
Del
phiI
tem
Ana
lysis
_____ Follow-upAudit _____
Page 68
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
108
mo
FU
DHBs
(%)
120
mo
FU
DHBs
(%)
2015
FU
DHBs
1.
5Ar
eth
ere
qual
itya
ssur
ance
pro
cedu
resi
npl
ace
toe
nsur
epa
rtne
rabu
sesc
reen
ing?
19
(95%
)20
(100
%)
20(1
00%
)a)
regu
larc
hart
aud
itsto
ass
esss
cree
ning
?18
(90%
)20
(100
%)
20(1
00%
)b)
pos
itive
rein
forc
erst
opr
omot
esc
reen
ing?
16
(80%
)19
(95%
)19
(95%
)c)
isth
ere
regu
lars
uper
visio
n?
18(9
0%
18(9
0%)
18(9
0%)
1.6
Are
ther
epr
oced
ures
fors
ecur
itym
easu
rest
obe
take
nw
hen
vict
imso
fpar
tner
abu
sea
reid
entif
ied?
Ify
es,
a)
writ
ten
proc
edur
esth
ato
utlin
eth
ese
curit
ydep
artm
ent's
role
inw
orki
ngw
ithvi
ctim
sand
per
petr
ator
s?
17(8
5%)
19(9
5%)
20(1
00%
)b)
pro
cedu
rest
hati
nclu
den
ame/
phon
ebl
ockf
orv
ictim
sadm
itted
toh
ospi
tal?
17
(85%
)16
(80%
)18
(90%
)%
%%
c)
pro
cedu
rest
hati
nclu
dep
rovi
sions
fors
afe
tran
spor
tfro
mth
eho
spita
lto
shel
ter?
17
(85%
)18
(90%
)18
(90%
)d)
do
thes
epr
oced
ures
take
into
acc
ount
the
need
sofM
āori?
15
(75%
)18
(90%
)19
(95%
)1.
7Is
ther
ean
iden
tifia
ble
part
nera
buse
coor
dina
tora
tthe
hos
pita
l?If
yesi
sita
:(choo
seone
)20
(100
%)
20(1
00%
)20
(100
%)
a)p
artt
ime
posit
ion
orin
clude
dw
itho
ther
resp
onsib
ilitie
s?
6(3
0%)
6(3
0%)
8(4
0%)
b)fu
ll-tim
epo
sitio
nw
ithn
oot
herr
espo
nsib
ilitie
s?
14(7
0%)
14(7
0%)
12(6
0%)
CATE
GORY
2.P
HYSI
CALE
NVI
RON
MEN
T
2.1
Inh
owm
anyl
ocat
ions
are
pos
ters
/bro
chur
esre
late
dto
par
tner
abu
seo
ndi
spla
yin
the
hosp
ital?
(up
to3
5):
11-2
021
-35
2
(10%
)18
(90%
)
0
(0%
)20
(100
%)
1(5
%)
19(9
5%)
Inh
owm
any
loca
tions
are
ther
eM
āori
imag
esre
late
dto
par
tner
abu
seo
ndi
spla
y?(u
pto
17)
:1-
10
11-1
7
0
(0%
)20
(100
%)
0
(0%
)20
%(1
00%
1
(5%
)19
(95%
)2.
2In
how
man
yloc
atio
nsis
ther
ere
ferr
alin
form
atio
nre
late
dto
par
tner
abu
sese
rvice
son
disp
layi
nth
eho
spita
l?
(Can
be
inclu
ded
onth
epo
ster
s/br
ochu
ren
oted
abo
ve)(u
pto
35)
:11
-20
21-3
5
2
(10%
)18
(90%
)
2
(10%
)18
(90%
)
2(1
0%)
18(9
0%)
Inh
owm
anyl
ocat
ions
isth
ere
refe
rral
info
rmat
ion
rela
ted
toM
āori
prov
ider
sofp
artn
era
buse
serv
iceso
npu
blic
disp
layi
nth
eho
spita
l?(u
pto
17)
:0-
10
11-1
7
3
(15%
)17
(85%
)
4
(20%
)16
(80%
)
2
(10%
)18
(90%
)In
how
man
ylo
catio
nsis
ther
ere
ferr
alin
form
atio
nre
non
-Māo
rino
n-Pa
keha
on
publ
icdi
spla
y?(u
pto
17)
0-
67-
17
4(2
0%)
16(8
0%)
5
(25%
)15
(75%
)
2(1
0%)
18(9
0%)
_____ 2015Follow-upAudit _____
Page 69
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)2.
3Do
esth
eho
spita
lpro
vide
tem
pora
ry(<
24h
ours
)saf
esh
elte
rfor
vict
imso
fpar
tner
abu
sew
hoca
nnot
go
hom
eor
ca
nnot
be
plac
edin
aco
mm
unity
-bas
edsh
elte
r?I
fyes
:20
(100
%)
20(1
00%
)20
(100
%)
a)D
oest
hed
esig
nan
dus
eof
the
safe
shel
ters
uppo
rtM
āori
cultu
ralb
elie
fsa
ndp
ract
ices?
19
(95%
)19
(95%
)18
(90%
)CA
TEGO
RY3
.IN
STIT
UTIO
NAL
CUL
TURE
3.1
Inth
ela
st3
year
s,ha
sthe
reb
een
afo
rmal
(writ
ten)
ass
essm
ento
fthe
hos
pita
lsta
ff'sk
now
ledg
ean
dat
titud
eab
outp
artn
era
buse
?If
yes,
whi
chg
roup
shav
ebe
ena
sses
sed?
a)n
ursin
gst
aff
20(1
00%
)19
(95%
)18
(90%
)b)
med
icals
taff
16(8
0%)
15(7
5%)
15(7
5%)
c)ad
min
istra
tion
16(8
0%)
16(8
0%)
12(6
0%)
d)o
ther
staf
f/em
ploy
ees
18(9
0%)
17(8
5%)
17(8
5%)
Ifye
s,di
dth
eas
sess
men
tadd
ress
staf
fkno
wle
dge
and
attit
ude
abou
tMāo
rian
dpa
rtne
rabu
se?
16(8
0%)
19(9
5%)
15(7
5%)
3.2
How
long
has
the
hosp
ital's
par
tner
abu
sep
rogr
amm
ebe
enin
exis
tenc
e?
1-
24m
onth
s0
(0%
)0
(0%
)0
(0%
)24
-48
mon
ths
0(0
%)
0(0
%)
0(0
%)
>48
mon
ths
20(1
00%
)20
(100
%)
20(1
00%
)3.
3Do
esth
eho
spita
ladd
ress
the
follo
win
gin
resp
ondi
ngto
em
ploy
eese
xper
ienc
ing
part
nera
buse
?
a)Is
ther
ea
hosp
italp
olicy
cove
ring
the
topi
cofp
artn
era
buse
inth
ew
orkp
lace
?17
(85%
)18
(90%
)18
(90%
)b)
Doe
sthe
Em
ploy
eeA
ssist
ance
pro
gram
me
(ore
quiv
alen
t)m
aint
ain
spec
ificp
olici
esa
ndp
roce
dure
sfor
dea
ling
with
em
ploy
eese
xper
ienc
ing
part
nera
buse
?15
(75%
)16
(80%
)16
(80%
)
c)Is
the
topi
cofp
artn
era
buse
am
ong
empl
oyee
scov
ered
inth
eho
spita
ltra
inin
gse
ssio
nsa
nd/o
rorie
ntat
ion?
20
(100
%)
20(1
00%
)20
(100
%)
3.4
Does
the
hosp
ital's
par
tner
abu
sep
rogr
amm
ead
dres
scul
tura
lcom
pete
ncyi
ssue
s?If
yes:
a)D
oest
heh
ospi
tal's
pol
icysp
ecifi
cally
reco
mm
end
univ
ersa
lscr
eeni
ngre
gard
less
oft
hep
atie
nt's
cultu
ral
back
grou
nd?
20(1
00%
)20
(100
%)
20(1
00%
)
b)A
recu
ltura
lissu
esd
iscus
sed
inth
eho
spita
l'sp
artn
era
buse
trai
ning
pro
gram
me?
19
(95%
)20
(100
%)
20(1
00%
)c)
Are
tran
slato
rs/in
terp
rete
rsa
vaila
ble
forw
orki
ngw
ithvi
ctim
sifE
nglis
his
nott
hevi
ctim
'sfir
stla
ngua
ge?
19(9
5%)
20(1
00%
)20
(100
%)
d)A
rere
ferr
alin
form
atio
nan
dbr
ochu
resr
elat
edto
par
tner
abu
sea
vaila
ble
inla
ngua
geso
ther
than
Eng
lish?
20
(100
%)
20(1
00%
)20
(100
%)
3.5
Does
the
hosp
italp
artic
ipat
ein
pre
vent
ive
outr
each
and
pub
lice
duca
tion
activ
ities
on
the
topi
cofp
artn
era
buse
?If
yes,
isth
ere
docu
men
tatio
nof
:(aorband
answerc)
19
(95%
)19
(95%
)19
(95%
)
a)1
pro
gram
me
inth
ela
st1
2m
onth
s?
2(1
0%)
3(1
5%)
1(5
%)
b)>
1pr
ogra
mm
ein
the
last
12
mon
ths?
17
(85%
)16
(80%
)19
(95%
)c)
Doe
sthe
hos
pita
lcol
labo
rate
with
Māo
rico
mm
unity
org
aniza
tions
and
pro
vide
rsto
del
iver
pre
vent
ive
outr
each
an
dpu
blic
educ
atio
nac
tiviti
es?
18(9
0%)
16(8
0%)
19(9
5%)
_____ Follow-upAudit _____
Page 70
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)CA
TEGO
RY4
.TRA
ININ
GO
FPRO
VIDE
RS
4.
1Ha
safo
rmal
trai
ning
pla
nbe
end
evel
oped
fort
hein
stitu
tion?
Ifye
s:
19(9
5%)
20(1
00%
)19
(95%
)a)
Doe
sthe
pla
nin
clude
the
prov
ision
ofr
egul
ar,o
ngoi
nge
duca
tion
forc
linica
lsta
ff?
19(9
5%)
20(1
00%
)20
(100
%)
b)D
oest
hep
lan
inclu
deth
epr
ovisi
ono
freg
ular
,ong
oing
edu
catio
nfo
rnon
-clin
icals
taff?
18
(90%
)17
(85%
)18
(90%
)4.
2Du
ring
the
past
12
mon
ths,
hast
heh
ospi
talp
rovi
ded
trai
ning
on
part
nera
buse
:
a)a
spar
toft
hem
anda
tory
orie
ntat
ion
forn
ewst
aff?
20
(100
%)
19(1
00%
)20
(100
%)
b)to
mem
bers
oft
hecl
inica
lsta
ffvi
aco
lloqu
iao
roth
erse
ssio
ns?
20(1
00%
)20
(100
%)
20(1
00%
)4.
3Do
esth
eho
spita
l'str
aini
ng/e
duca
tion
onp
artn
era
buse
inclu
dein
form
atio
nab
out:
a)
def
initi
onso
fpar
tner
abu
se?
19(9
5%)
20(1
00%
)20
(100
%)
b)d
ynam
icso
fpar
tner
abu
se?
19(9
5%)
20(1
00%
)20
(100
%)
c)ep
idem
iolo
gy?
19(9
5%)
20(1
00%
)20
(100
%)
d)h
ealth
cons
eque
nces
?20
(100
%)
20(1
00%
)20
(100
%)
e)st
rate
gies
fors
cree
ning
?20
(100
%)
20(1
00%
)20
(100
%)
f)ris
kass
essm
ent?
20
(100
%)
20(1
00%
)20
(100
%)
g)d
ocum
enta
tion?
19
(95%
)20
(100
%)
20(1
00%
)h)
inte
rven
tion?
20
(100
%)
20(1
00%
)20
(100
%)
i)sa
fety
pla
nnin
g?
20(1
00%
)20
(100
%)
20(1
00%
)j)
com
mun
ityre
sour
ces?
20
(100
%)
20(1
00%
)20
(100
%)
k)re
port
ingr
equi
rem
ents
?19
(95%
)20
(100
%)
20(1
00%
)l)
lega
lissu
es?
20(1
00%
)20
(100
%)
20(1
00%
)m
)con
fiden
tialit
y?
19(9
5%)
20(1
00%
)20
(100
%)
n)cu
ltura
lcom
pete
ncy?
19
(95%
)20
(100
%)
20(1
00%
)o)
clin
icals
igns
/sym
ptom
s?
19(9
5%)
20(1
00%
)20
(100
%)
p)M
āori
mod
elso
fhea
lth?
19(9
5%)
20(1
00%
)20
(100
%)
q)ri
ska
sses
smen
tfor
child
ren
ofvi
ctim
s?
20(1
00%
)20
(100
%)
20(1
00%
)r)
socia
l,cu
ltura
l,hi
stor
ic,a
nde
cono
mic
cont
exti
nw
hich
Māo
rifa
mily
viol
ence
occ
urs?
19
(95%
)20
(100
%)
18(9
0%)
s)te
Tiri
tio
Wai
tang
i?
19(9
5%)
20(1
00%
)20
(100
%)
t)M
āori
serv
icep
rovi
ders
and
com
mun
ityre
sour
ces?
19
(95%
)20
(100
%)
20(1
00%
)u)
serv
icep
rovi
ders
and
com
mun
ityre
sour
cesf
ore
thni
cand
cultu
ralg
roup
soth
erth
anP
akeh
aan
dM
āori?
19
(95%
)20
(100
%)
20(1
00%
)v)
par
tner
abu
sein
sam
e-se
xrel
atio
nshi
ps?
18(9
0%)
20(1
00%
)20
(100
%)
w)s
ervi
cep
rovi
ders
and
com
mun
ityre
sour
cesf
orv
ictim
sofp
artn
era
buse
who
are
insa
me-
sexr
elat
ions
hips
?18
(90%
)20
(100
%)
20(1
00%
)
_____ 2015Follow-upAudit _____
Page 71
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)4.
4Is
the
part
nera
buse
trai
ning
pro
vide
dby
:(choo
seonea-cand
answerd-e
)
a)a
sing
lein
divi
dual
?1
(5%
)0
(0%
)0
(0%
)b)
ate
amo
fhos
pita
lem
ploy
eeso
nly?
0
(0%
)0
(0%
)0
(0%
)c)
ate
am,i
nclu
ding
com
mun
itye
xper
t(s)?
19
(95%
)20
(100
%)
20(1
00%
)If
prov
ided
by
ate
am,d
oesi
tinc
lude
:
d)a
Māo
rire
pres
enta
tive?
19
(95%
)19
(95%
)19
(95%
)e)
are
pres
enta
tive(
s)o
foth
ere
thni
c/cu
ltura
lgro
ups?
16
(80%
)14
(70%
)15
(75%
)CA
TEGO
RY5
.SCR
EEN
ING
AND
SAFE
TYA
SSES
SMEN
T
5.1
Does
the
hosp
italu
sea
stan
dard
ized
inst
rum
ent,
with
atl
east
3q
uest
ions
,to
scre
enp
atie
ntsf
orp
artn
era
buse
?If
19(9
5%)
20(1
00%
20
(100
%)
a)in
clude
d,a
sase
para
tefo
rm,i
nth
ecli
nica
lrec
ord?
0
(0%
)0
(0%
)0
(0%
)b)
inco
rpor
ated
asq
uest
ions
inth
ecli
nica
lrec
ord
fora
llch
arts
inE
Dor
oth
ero
ut-p
atie
nta
rea?
0
(0%
)0
(0%
)0
(0%
)c)
inco
rpor
ated
asq
uest
ions
inth
ecli
nica
lrec
ord
fora
llch
arts
intw
oor
mor
eou
t-pat
ient
are
as?
7(3
5%)
7(3
5%)
8(4
0%)
d)in
corp
orat
eda
sque
stio
nsin
clin
icalr
ecor
dfo
rall
char
tsin
out
-pat
ient
and
in-p
atie
nta
reas
?12
(60%
)13
(65%
)12
(60%
)5.
2W
hatp
erce
ntag
eof
elig
ible
pat
ient
shav
edo
cum
enta
tion
ofp
artn
era
buse
scre
enin
g(b
ased
upo
nra
ndom
sam
ple
ofch
arts
ina
nycl
inica
lare
a)?
Notd
one
orn
ota
pplic
able
0%
-10
%
11%
-25
%
26%
-50
%
51%
-75
%
76%
-10
0%
1(5
%)
0(0
%)
1(5
%)
4(2
0%)
0(0
%)
0(0
%)
1(5
%)
2((1
0%)
0(0
%)
5(2
5%)
8(4
0%)
5(2
5%)
5(2
5%)
8(4
0%)
10(5
0%)
4(2
0%)
2(1
0%)
4(2
0%)
5.3
Isa
stan
dard
ized
safe
tya
sses
smen
tper
form
eda
ndd
iscus
sed
with
vict
imsw
hosc
reen
pos
itive
forp
artn
era
buse
?If
yes,
does
this:
18
(90%
)20
(100
%)
20(1
00%
)
a)a
lsoa
sses
sthe
safe
tyo
fany
child
ren
inth
evi
ctim
’sca
re?
18(9
0%)
20(1
00%
)20
(100
%)
CATE
GORY
6.D
OCU
MEN
TATI
ON
6.1
Does
the
hosp
italu
sea
stan
dard
ized
docu
men
tatio
nin
stru
men
tto
reco
rdkn
own
orsu
spec
ted
case
sofp
artn
er
abus
e?If
yes,
does
the
form
inclu
de:
19(9
5%)
20(1
00%
)20
(100
%)
a)in
form
atio
non
the
resu
ltso
fpar
tner
abu
sesc
reen
ing?
19
(95%
)20
(100
%)
20(1
00%
)b)
the
vict
im's
desc
riptio
nof
curr
enta
nd/o
rpas
tabu
se?
19(9
5%)
19(9
5%)
20(1
00%
)c)
the
nam
eof
the
alle
ged
perp
etra
tora
ndre
latio
nshi
pto
the
vict
im?
19(9
5%)
20(1
00%
)20
(100
%)
d)a
bod
ym
apto
doc
umen
tinj
urie
s?
18(9
0%)
19(9
5%)
19(9
5%)
e)in
form
atio
ndo
cum
entin
gth
ere
ferr
alsp
rovi
ded
toth
evi
ctim
?19
(95%
)20
(100
%)
20(1
00%
)f)
inth
eca
seo
fMāo
ri,in
form
atio
ndo
cum
entin
gw
heth
erth
ein
divi
dual
was
offe
red
aM
āori
advo
cate
?19
(95%
)20
(100
%)
20(1
00%
)
_____ Follow-upAudit _____
Page 72
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)6.
2Is
fore
nsic
phot
ogra
phyi
ncor
pora
ted
inth
edo
cum
enta
tion
proc
edur
e?If
yes:
a)Is
afu
llyo
pera
tiona
lcam
era
with
ade
quat
efil
ma
vaila
ble
inth
etr
eatm
enta
rea?
19
(90%
)20
(100
%)
20(1
00%
)b)
Do
hosp
itals
taff
rece
ive
on-g
oing
trai
ning
on
the
use
ofth
eca
mer
a?
13(6
5%)
16(8
0%)
15(7
5%)
c)D
oho
spita
lsta
ffro
utin
elyo
ffert
oph
otog
raph
alla
buse
dpa
tient
swith
inju
ries?
13
(65%
)16
(80%
)13
(65%
)d)
Isa
spec
ific,
uni
que
cons
ent-t
o-ph
otog
raph
form
obt
aine
dpr
iort
oph
otog
raph
ing
anyi
njur
ies?
16
(80%
)15
(75%
)15
(75%
)e)
Do
med
icalo
rnur
sing
staf
f(no
tsoc
ialw
ork
ora
par
tner
abu
sea
dvoc
ate)
pho
togr
aph
allin
jurie
sfor
med
ical
docu
men
tatio
npu
rpos
es,e
ven
ifpo
lice
obta
inth
eiro
wn
phot
ogra
phsf
ore
vide
nce
purp
oses
?16
(80%
)16
(80%
)17
(85%
)
CATE
GORY
7.I
NTER
VENT
ION
SER
VICE
S
7.1
Isth
ere
ast
anda
rdin
terv
entio
nch
eckl
istfo
rsta
ffto
use
/ref
erto
whe
nvi
ctim
sare
iden
tifie
d?
19(1
00%
)20
(100
%)
20(1
00%
)7.
2Ar
eon
-site
vict
ima
dvoc
acys
ervi
cesp
rovi
ded?
Ifye
s,choo
seonea-band
answerc-d)
:20
(100
%
20(1
00%
)20
(100
%)
a)A
trai
ned
vict
ima
dvoc
ate
prov
ides
serv
icesd
urin
gce
rtai
nho
urs.
2(1
0%)
2(1
0%)
4(2
0%)
b)A
trai
ned
vict
ima
dvoc
ate
prov
ides
serv
icea
tall
times
.18
(90%
)18
(95%
16
(80%
)c)
isa
Māo
riad
voca
teis
ava
ilabl
eon
-site
forM
āori
vict
ims?
20
(100
%)
19(1
00%
)19
(95%
)d)
isa
nad
voca
te(s
)ofe
thni
cand
cultu
ralb
ackg
roun
dot
hert
han
Pake
haa
ndM
āori
avai
labl
eon
site?
19
(95%
)18
(90%
)18
(90%
)7.
3Ar
em
enta
lhea
lth/p
sych
olog
icala
sses
smen
tsp
erfo
rmed
with
inth
eco
ntex
toft
hep
rogr
amm
e?If
yes,
are
they
:20
(100
%)
20(1
00%
)
a)a
vaila
ble,
whe
nin
dica
ted?
8
(40%
)7
(35%
)9
(45%
)b)
per
form
edro
utin
ely?
12
(60%
)13
(65%
)11
(55%
)7.
4Is
tran
spor
tatio
npr
ovid
edfo
rvict
ims,
ifne
eded
?20
(100
%)
19(9
5%)
20(1
00%
)7.
5Do
esth
eho
spita
lpar
tner
abu
sep
rogr
amm
ein
clude
follo
w-u
pco
ntac
tand
coun
selli
ngw
ithvi
ctim
safte
rthe
initi
al
asse
ssm
ent?
19
(95%
)18
(90%
)20
(100
%)
7.6
Does
the
hosp
italp
artn
era
buse
pro
gram
me
offe
rand
pro
vide
on-
site
lega
lopt
ions
coun
selli
ngfo
rvict
ims?
20
(100
%)
19(9
5%)
20(1
00%
)7.
7Do
esth
eho
spita
lpar
tner
abu
sep
rogr
amm
eof
fera
ndp
rovi
dep
artn
era
buse
serv
icesf
orth
ech
ildre
nof
vict
ims?
20
(100
%)
20(1
00%
)20
(100
%)
7.8
Isth
ere
evid
ence
ofc
oord
inat
ion
betw
een
the
hosp
italp
artn
era
buse
pro
gram
me
and
sexu
ala
ssau
lt,m
enta
lhea
lth
and
subs
tanc
eab
use
scre
enin
gan
dtr
eatm
ent?
20
(100
%)
20(1
00%
)20
(100
%)
CATE
GORY
8.E
VALU
ATIO
NAC
TIVI
TIES
8.1
Are
anyf
orm
ale
valu
atio
npr
oced
ures
inp
lace
tom
onito
rthe
qua
lity
ofth
epa
rtne
rabu
sep
rogr
amm
e?If
yes:
19
(95%
)20
(100
%)
19(9
5%)
a)D
oev
alua
tion
activ
ities
inclu
dep
erio
dicm
onito
ring
ofch
arts
toa
udit
forp
artn
era
buse
scre
enin
g?
18(9
0%)
20(1
00%
)2
0(1
00%
)b)
Do
eval
uatio
nac
tiviti
esin
clude
pee
r-to-
peer
case
revi
ewsa
roun
dpa
rtne
rabu
se?
18(9
0%)
20(1
00%
)18
(90%
)8.
2Do
hea
lthca
rep
rovi
ders
rece
ive
stan
dard
ized
feed
back
on
thei
rper
form
ance
and
on
patie
nts?
15
(75%
)18
(90%
)19
(95%
)8.
3Is
ther
ean
ymea
sure
men
tofc
lient
satis
fact
ion
and/
orco
mm
unity
satis
fact
ion
with
the
part
nera
buse
pro
gram
me?
16
(80%
)15
(75%
)15
(75%
)8.
4Is
aqu
ality
fram
ewor
k(s
uch
asW
hāna
uO
ra)u
sed
toe
valu
ate
whe
ther
serv
icesa
ree
ffect
ive
forM
āori?
9
(45%
)10
(50%
)11
(55%
)
_____ Follow-upAudit _____
Page 73
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
U
DHBs
(%)
CATE
GORY
9.C
OLL
ABO
RATI
ON
9.1
Does
the
hosp
italc
olla
bora
tew
ithlo
calp
artn
era
buse
pro
gram
mes
?Ify
es,
20(1
00%
)20
(100
%)
20(1
00%
)a
i)co
llabo
ratio
nw
ithtr
aini
ng?
19(9
5%)
20(1
00%
)20
(100
%)
ii)co
llabo
ratio
non
pol
icya
ndp
roce
dure
dev
elop
men
t?
20(1
00%
)20
(100
%)
20(1
00%
)iii
)col
labo
ratio
non
par
tner
abu
sew
orki
ngg
roup
?19
(95%
)20
(100
%)
20(1
00%
)iv
)col
labo
ratio
non
site
serv
icep
rovi
sion?
20
(100
%)
20(1
00%
)20
(100
%)
b)is
colla
bora
tion
with
i)M
āori
prov
ider
(s)o
rrep
rese
ntat
ive(
s)?
20(1
00%
)20
(100
%)
20(1
00%
ii)
Pro
vide
r(s)o
rrep
rese
ntat
ive(
s)fo
reth
nico
rcul
tura
lgro
upso
ther
than
Pak
eha
orM
āori?
18
(90%
)19
(95%
)18
(90%
)9.
2Do
esth
ehos
pita
lcol
labo
rate
with
loca
lpol
icean
dco
urts
inco
njun
ctio
nw
ithth
eirp
artn
erab
usep
rogr
amm
e?If
yes:
20(1
00%
)20
(100
%
20(1
00%
)a)
colla
bora
tion
with
trai
ning
?19
(95%
)20
(100
%)
20(1
00%
)b)
colla
bora
tion
onp
olicy
and
pro
cedu
red
evel
opm
ent?
20
(100
%)
20(1
00%
)20
(100
%)
c)co
llabo
ratio
non
par
tner
abu
sew
orki
ngg
roup
?19
(95%
)20
(100
%)
20(1
00%
)9.
3Is
ther
eco
llabo
ratio
nw
ithth
epa
rtne
rabu
sep
rogr
amm
eof
oth
erh
ealth
care
facil
ities
?If
yes,
whi
chty
peso
fcol
labo
ratio
nap
ply:
20
(100
%)
20(1
00%
)20
(100
%)
a)w
ithin
the
sam
ehe
alth
care
syst
em?
20(1
00%
)20
(100
%)
20(1
00%
)If
yes,
with
aM
āori
heal
thu
nit?
20
(100
%)
19(1
00%
)18
(90%
)b)
with
oth
ersy
stem
sin
the
regi
on?
20(1
00%
)20
(100
%)
20(1
00%
)If
yes,
with
aM
āori
heal
thp
rovi
der?
19
(95%
)18
(90%
)18
(90%
)
_____ MonthFollow-upAudit _____
Page 74
2015 Violence Intervention Programme Evaluation
APPE
NDIX
J.C
hild
Abu
sea
ndN
egle
ctB
asel
ine
and
Follo
w-U
pSc
ores
Median
AchievingTargetScore≥70
≥80
20
04
2005
20
07
2008
a 20
09
2011
20
12
2013
20
14
2015
20
04
2005
20
07b
2008
20
09
2011
20
12
2013
20
14
2015
OverallScore
37
51
59
75
81
87
91
92
93
93
2(8
%)
3(1
2%)
4(1
5%)
17
(65%
)21
(7
8%)
25
(93%
)27
(1
00%
)19
95
%)
20
(100
%)
20
(100
%)
Dom
ain
Scor
es
Policiesa
nd
Proced
ures
43
50
60
81
84
92
95
95
96
94
3(1
2%)
5(2
0%)
8(2
9%)
23
(89%
)19
(7
0%)
26
(96%
)27
(1
00%
)20
(1
00%
)20
(1
00%
)20
(1
00%
Safetyand
Security
--
-77
72
82
90
92
96
10
0-
--
17
(65%
)17
(6
3%)
23
(85%
)27
(1
00%
)19
(9
5%)
20
(100
%)
20
(100
%)
Colla
boratio
n47
71
85
83
91
94
97
98
10
010
05
(20%
)15
(6
0%)
20
(74%
)21
(8
1%)
25
(93%
)26
(9
6%)
27
(100
%)
20
(100
%)
20
(100
%)
20
(100
%)
Institu
tiona
lCu
lture
42
43
57
80
82
86
90
94
96
96
3(1
2%)
5 20%
6 22%
18
69
%
20
74%
25
93
%
27
(100
%)
20
(100
%)
20
(100
%)
19
(95%
)Training
of
Providers
40
49
67
93
96
98
100
100
100
99
2(8
%)
9(3
6%)
14
(52%
)19
(7
3%)
22
(82%
)26
(9
6%)
27
(100
%)
20
(100
%)
20
(100
%)
20
(100
%)
Interven
tion
Service
s65
70
73
82
84
89
92
89
89
91
12
(4
8%)
13
(52%
)15
(5
6%)
21
(81%
)22
(8
2%)
27
(100
%)
27
(100
%)
20
(100
%)
20
(100
%)
20
(100
%)
Documentatio
n19
29
58
84
83
87
93
96
97
10
05
(20%
)5
(20%
)8
(29%
)22
(8
5%)
19
70%
)22
(8
2%)
24
(89%
)19
(9
5%)
19
(95%
)18
(9
0%)
Evalua
tion
Activ
ities
35
37
37
30
59
72
76
73
80
82
1(4
%)
1(4
%)
5(2
0%)
3(1
2%)
7(2
6%)
14
(52%
)18
(6
7%)
11
(55%
)15
(7
5%)
13
(65%
)Ph
ysica
lEn
vironm
ent
23
28
35.6
68
91
10
010
010
010
091
1
(4%
)2
(5%
)2
(7%
)12
(4
6%)
26
(96%
)27
(1
00%
)27
(1
00%
)19
(9
5%)
20
(100
%)
18
(18%
)
Note
s:T
heu
nito
fana
lysis
chan
ged
from
hos
pita
ls(n
=27)
toD
HBs(
n=20
)for
the
2013
follo
w-u
pau
dit:
The
sele
cted
ben
chm
ark
scor
ew
asra
ised
from
70
to8
0fo
rthe
201
5fo
llow
-up
audi
t.
The
2012
follo
wu
psc
ores
inclu
dein
depe
nden
tsco
res(
n=13
hos
pita
ls)a
ndse
lfau
dits
core
s(n=
14h
ospi
tals)
.T
he2
013
and
2014
follo
w-u
psc
ores
inclu
dese
lfau
dits
core
s(n=
16)a
ndin
depe
nden
taud
itsc
ores
(n=4
).T
he2
015
follo
w-u
psc
ores
are
all
(n=2
0)fr
omse
lfau
dits
.a C
hang
eto
Rev
ised
Delp
hito
ol;
b 200
7fo
llow
-up
perc
enta
gesc
orre
cted
;
_____2015Follow-upAudit _____
Page 75
2015 Violence Intervention Programme Evaluation
Note
:96
mon
thfo
llow
-up
scor
esin
clude
inde
pend
ents
core
s(n=
13h
ospi
tals)
and
self
audi
tsco
res(
n=14
hos
pita
ls).
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)CA
TEGO
RY1
.PO
LICI
ESA
NDP
ROCE
DURE
S
1.1
Are
ther
eof
ficia
l,w
ritte
nDH
Bpo
licie
sreg
ardi
ngth
ecli
nica
lass
essm
ent,
appr
opria
teq
uest
ioni
ng,a
ndtr
eatm
ento
fsu
spec
ted
abus
eda
ndn
egle
cted
child
ren?
Ifso
,do
the
polic
ies:
20
(100
%)
20
(100
%)
20(1
00%
)
a)D
efin
ech
ilda
buse
and
neg
lect
?20
(100
%)
20(1
00%
)20
(100
%)
b)M
anda
tetr
aini
ngo
nch
ilda
buse
and
neg
lect
fors
taff?
20
(100
%)
20(1
00%
)20
(100
%)
c)O
utlin
eag
e-ap
prop
riate
pro
toco
lsfo
rrisk
ass
essm
ent?
18
(90%
)19
(95%
)19
(95%
)d)
Def
ine
who
isre
spon
sible
forr
iska
sses
smen
t?
19(9
5%)
20(1
00%
)20
(100
%
e)A
ddre
ssth
eiss
ueo
fcon
tam
inat
ion
durin
gin
terv
iew
ing?
19
(95%
)20
(100
%)
20(1
00%
)f)
Addr
essd
ocum
enta
tion?
19
(95%
)20
(100
%)
20(1
00%
)g)
Add
ress
refe
rral
sfor
child
ren
and
thei
rfam
ilies
?19
(95%
)20
(100
%)
20(1
00%
)h)
Add
ress
child
pro
tect
ion
repo
rtin
greq
uire
men
ts?
18(9
0%)
20(1
00%
)20
(100
%)
i)Ad
dres
sthe
resp
onsib
ilitie
sto,
and
nee
dso
f,M
āori?
20
(100
%)
20(1
00%
)20
(100
%)
j)Ad
dres
soth
ercu
ltura
land
/ore
thni
cgro
ups?
20
(100
%)
20(1
00%
)20
(100
%)
1.2
Who
isco
nsul
ted
rega
rdin
gch
ildp
rote
ctio
npo
licie
sand
pro
cedu
res?
Māo
rian
dPa
cific?
20
(100
%)
20(1
00%
)20
(100
%)
CYF?
19
(95%
)20
(100
%)
20(1
00%
)
Polic
e?
18(9
0%)
20(1
00%
)20
(100
%)
Child
abu
sea
ndn
egle
ctp
rogr
amm
ean
dVi
olen
ceIn
terv
entio
nPr
ogra
mm
est
aff?
20
(100
%)
20(1
00%
)20
(100
%)
Plus
Oth
erA
genc
ies:
suc
has
Ref
uge;
Nat
iona
lNet
wor
kofS
topp
ing
Viol
ence
Serv
ices(
NNSV
S);O
ffice
oft
he
Child
ren’
sCom
miss
ione
r(O
CC);
Com
mun
ityA
lcoho
l&D
rug
Serv
ice(C
ADS)
18
(90%
)19
(95%
)20
(100
%)
1.3
Isth
ere
evid
ence
ofa
DHB
-bas
edch
ilda
buse
and
neg
lect
stee
ring
grou
p?If
yes,
does
the:
a)St
eerin
ggr
oup
mee
tatl
east
eve
ryth
ree
(3)m
onth
s?
19(9
5%)
19(9
5%)
15(7
5%)
b)In
clude
repr
esen
tativ
esfr
omm
ore
than
two
depa
rtm
ents
?19
(95%
)19
(95%
)17
(85%
)
APPE
NDIX
K.R
evise
dCh
ildA
buse
and
Neg
lect
Del
phiT
oolI
tem
Ana
lysis
_____ Follow-upAudit _____
Page 76
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)1.
4Do
esth
eDH
Bpr
ovid
edi
rect
fina
ncia
lsup
port
fort
hech
ilda
buse
and
neg
lect
pro
gram
me
(bey
ond
VIP
fund
ing)
?20
(100
%)
20(1
00%
)20
(100
%)
a)Is
fund
ing
seta
side
spec
ifica
llyfo
rMāo
ripr
ogra
mm
esa
ndin
itiat
ives
?15
(75%
)11
(55%
)13
(65%
)1.
5Is
ther
ea
polic
yfor
iden
tifyi
ngsi
gnsa
ndsy
mpt
omso
fchi
lda
buse
and
neg
lect
and
fori
dent
ifyin
gch
ildre
nat
hig
hris
k?
a)in
bot
hin
patie
nta
ndo
utpa
tient
are
as?
20
(100
%)
20
(100
%)
20(1
00%
)1.
6Ar
eth
ere
proc
edur
esfo
rsec
urity
mea
sure
sto
beta
ken
whe
nsu
spec
ted
case
sofc
hild
abu
sea
ndn
egle
cta
re
iden
tifie
dan
dth
ech
ildis
per
ceiv
edto
be
atim
med
iate
risk
?If
yes,
are
the
proc
edur
es:
a)w
ritte
n?
19(9
5%)
20(1
00%
)20
(100
%
b)in
clude
nam
e/ph
one
bloc
k?
16(8
0%)
18(9
0%)
19(9
5%)
c)p
rovi
defo
rsaf
etr
ansp
orta
tion?
16
(80%
)19
(95%
)20
(100
%)
d)a
ccou
ntfo
rthe
nee
dso
fMāo
ri?
17(8
5%)
19(9
5%)
19(1
00%
)1.
7Is
ther
ean
iden
tifia
ble
child
pro
tect
ion
coor
dina
tora
tthe
DHB
?If
yes,
isth
eco
ordi
nato
rpos
ition
(cho
ose
one)
:20
(100
%)
20(1
00%
)20
(100
%)
a)p
art-t
ime
<0.5
FTE
2
(10%
)1
(5%
)2
(10%
)b)
par
t-tim
e≥0
.5F
TE?
4(2
0%)
6(3
0%)
7(3
5%)
c)fu
ll-tim
e?
14(7
0%)
13(6
5%)
11(5
5%)
1.8
Are
ther
epo
licie
stha
tout
line
the
min
imum
exp
ecta
tion
fora
llsta
ff:
a)
toa
tten
dm
anda
tory
trai
ning
?20
(100
%)
20(1
00%
)20
(20%
)b)
toid
entif
icatio
nan
dre
ferr
alch
ildre
nat
risk
?20
(100
%)
20(1
00%
)20
(100
%)
c)to
repo
rtin
gch
ildp
rote
ctio
nco
ncer
ns?
19(9
5%)
20(1
00%
)20
(100
%)
1.9
Doth
ech
ilda
buse
and
neg
lect
pol
icies
and
pro
cedu
resi
ndica
teco
llabo
ratio
nw
ithg
over
nmen
tage
ncie
sand
oth
er
rele
vant
gro
ups,
such
ast
heP
olice
,CYF
,ref
uge,
and
NNS
VS('
men
'spr
ogra
mm
epr
ovid
er')?
a)go
vern
men
tage
ncie
s?
20(1
00%
)20
(100
%)
20(1
00%
)b)
com
mun
itygr
oups
?20
(100
%)
20(1
00%
)20
(100
%)
1.10
Ar
eth
eDH
Bpo
licie
sand
pro
cedu
rese
asily
acc
essib
lea
ndu
ser-f
riend
ly?
Ifye
s,ar
e20
(100
%)
a)th
eya
vaila
ble
onth
eDH
Bin
tran
et?
20(1
00%
)19
(95%
)19
(95%
)b)
ther
esu
ppor
ting
and
refe
renc
edo
cum
ents
app
ende
dto
the
appr
opria
tep
olici
esa
ndp
roce
dure
s?
20(1
00%
)20
(100
%)
18(9
0%)
c)th
ere
tran
slatio
nm
ater
ials
tofa
cilita
teth
eap
plica
tion
ofp
olicy
and
pro
cedu
res,
such
asf
low
char
tsa
nda
lgor
ithm
s?
19(9
5%)
20(1
00%
)19
(95%
)1.
11
Are
the
DHB
polic
iesa
ndp
roce
dure
scro
ss-re
fere
nced
too
ther
form
soff
amily
viol
ence
,suc
has
par
tner
abu
sea
nd
elde
rabu
se?
20(1
00%
)20
(100
%)
20(1
00%
)
_____ Follow-upAudit _____
Page 77
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)CA
TEGO
RY2
.SAF
ETY
&S
ECUR
ITY
2.
1Do
esth
eDH
Bha
vea
pol
icyin
pla
ceth
ata
llch
ildre
nar
eas
sess
edw
hen
signs
and
sym
ptom
sare
sugg
estiv
eof
abu
se
and/
orn
egle
ct?
20(1
00%
)20
(100
%)
20(1
00%
)
2.2
Does
the
DHB
have
ap
roto
colf
orco
llabo
rativ
esa
fety
pla
nnin
gfo
rchi
ldre
nat
hig
hris
k?
a)
are
safe
typ
lans
ava
ilabl
eor
use
dfo
rchi
ldre
nid
entif
ied
atri
sk?
Whi
chty
peso
fcol
labo
ratio
nap
ply:
19
(95%
)19
(95%
)20
(100
%)
b)w
ithin
the
DHB?
20
(100
%)
20(1
00%
)20
(100
%)
c)w
itho
ther
gro
upsa
nda
genc
iesi
nth
ere
gion
?19
(95%
)20
(100
%)
20(1
00%
)d)
with
Māo
rian
dPa
cific
heal
thp
rovi
ders
?20
(100
%)
20(1
00%
)20
(100
%)
e)w
itho
ther
rele
vant
eth
nic/
cultu
ralg
roup
s?
17(8
5%)
18(9
0%)
19(9
5%)
f)w
ithth
epr
imar
yhea
lthse
ctor
?19
(95%
)18
(90%
)20
(100
%)
2.3
Does
the
DHB
have
ap
roto
colt
opr
omot
eth
esa
fety
ofc
hild
ren
iden
tifie
dat
risk
ofa
buse
orn
egle
ct?
a)
with
inth
eDH
B?
20(1
00%
)20
(100
%)
20(1
00%
)b)
with
rele
vant
prim
aryh
ealth
care
pro
vide
rsa
spar
tofd
ischa
rge
plan
ning
?19
(95%
)20
(100
%)
20(1
00%
)c)
bya
cces
sing
nece
ssar
ysup
port
serv
icesf
orth
ech
ilda
ndfa
mily
top
rom
ote
ongo
ing
safe
tyo
fthe
child
?20
(100
%)
20(1
00%
)20
(100
%)
2.4
Doin
patie
ntfa
ciliti
esh
ave
ase
curit
ypl
anw
here
peo
ple
atri
sko
fper
petr
atin
gab
use,
orw
hoh
ave
apr
otec
tion
orde
rag
ains
tthe
m,c
anb
ede
nied
ent
ry?
19(9
5%)
20(1
00%
)20
(100
%)
2.5
Doth
eDH
Bse
rvice
shav
ean
ale
rtsy
stem
ora
cent
rald
atab
ase
reco
rdin
gan
yco
ncer
nsa
bout
child
ren
atri
sko
fabu
se
and
negl
ecti
npl
ace?
b)a
loca
lale
rtsy
stem
ina
cute
care
sett
ing
19(9
5%)
18(9
0%)
19(9
5%)
c)a
loca
lale
rtsy
stem
inco
mm
unity
sett
ing,
inclu
ding
PHO
9
(45%
)15
(75%
)15
(75%
)d)
ap
roce
ssfo
rnot
ifica
tion
ofa
lert
pla
cem
ents
tore
leva
ntp
rovi
ders
14
(70%
)18
(90%
)18
(90%
)e)
par
ticip
atio
nin
an
atio
nala
lert
syst
em(1
08M
o.n
ote
8NC
PAS
appr
oved
+3
sel
f-rep
ortin
gth
atin
pro
cess
)11
(55%
)15
(75%
)18
(90%
)f)
clear
crite
riafo
ride
ntify
ing
leve
lsof
risk
,and
pro
cess
that
gui
dest
heu
seo
fthe
ale
rtsy
stem
13
(65%
)17
(85%
)19
(95%
)2.
6Is
ther
eev
iden
cein
pro
toco
lsof
pro
cess
esto
ass
esso
rref
erto
CYF
and/
oro
ther
appr
opria
teag
encie
sallc
hild
ren
livin
gin
the
hous
ew
hen
child
abu
sea
ndn
egle
cto
rpar
tner
viol
ence
has
bee
nid
entif
ied?
a)p
roce
ssth
atin
clude
sthe
safe
tyo
foth
erch
ildre
nin
the
hom
ear
eco
nsid
ered
?19
(95%
)20
(100
%)
20(1
00%
)b)
pro
cess
forn
otify
ing
CYFa
nd/o
roth
era
genc
ies?
19
(95%
)20
(100
%)
20(1
00%
)c)
refe
rral
form
that
requ
irest
hed
ocum
enta
tion
ofth
eris
kas
sess
edfo
rthe
sech
ildre
n?
18(9
0%)
20(1
00%
)2
0(1
00%
)
_____ Follow-upAudit _____
Page 78
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)
CATE
GORY
3.C
OLL
ABO
RATI
ON
3.
1Do
esth
eDH
Bco
llabo
rate
with
CYF
and
NGO
child
adv
ocac
yand
pro
tect
ion?
20
(100
%)
20(1
00%
)20
(100
%)
a)
whi
chty
peso
fcol
labo
ratio
nap
ply:
i)co
llabo
ratio
nw
ithtr
aini
ng?
20(1
00%
)20
(100
%)
20(1
00%
)ii)
colla
bora
tion
onp
olicy
and
pro
cedu
red
evel
opm
ent?
20
(100
%)
20(1
00%
)20
(100
%)
iii)c
olla
bora
tion
onch
ilda
buse
and
neg
lect
task
forc
e?
19(9
5%)
20(1
00%
)20
(100
%)
iv)c
olla
bora
tion
onsi
tese
rvice
pro
visio
n?
19(9
5%)
20(1
00%
)20
(100
%)
v)co
llabo
ratio
nis
two-
way
?20
(100
%)
20(1
00%
)20
(100
%)
b)is
colla
bora
tion
with
:
i)CY
F?
20(1
00%
)20
(100
%)
20(1
00%
)ii)
NGO
sand
oth
era
genc
iess
uch
asW
omen
’sRe
fuge
?20
(100
%)
20(1
00%
)19
(95%
)iii
)Māo
ripr
ovid
er(s
)orr
epre
sent
ativ
e(s)
?20
(100
%)
20(1
00%
)20
(100
%)
iv)P
rovi
der(s
)orr
epre
sent
ativ
e(s)
fore
thni
corc
ultu
ralg
roup
soth
erth
anP
akeh
aor
Māo
ri?
18(9
0%)
18(9
0%)
19(9
5%)
c)se
rvice
s,de
part
men
tsa
ndb
etw
een
rele
vant
staf
fwith
inth
eDH
Bev
iden
t?
20(1
00%
)20
(100
%)
20(1
00%
)3.
2Do
esth
eDH
Bco
llabo
rate
with
pol
icea
ndp
rose
cutio
nag
encie
sin
conj
unct
ion
with
thei
rchi
lda
buse
and
neg
lect
pr
ogra
mm
e?If
yes,
whi
chty
peso
fcol
labo
ratio
nap
ply:
20
(100
%)
20(1
00%
)20
(100
%)
a)co
llabo
ratio
nw
ithtr
aini
ng?
20(1
00%
)20
(100
%)
20(1
00%
)b)
colla
bora
tion
onp
olicy
and
pro
cedu
red
evel
opm
ent?
20
(100
%)
20(1
00%
)20
(100
%)
c)co
llabo
ratio
non
child
abu
sea
ndn
egle
ctta
skfo
rce?
19
(95%
)19
(95%
)18
(90%
)3.
3Is
ther
eco
llabo
ratio
nof
the
child
abu
sea
ndn
egle
ctp
rogr
amm
ew
itho
ther
hea
lthca
refa
ciliti
es?
Ifye
s,w
hich
type
sofc
olla
bora
tion
appl
y:
20(1
00%
)20
(100
%)
20(1
00%
)
a)w
ithin
the
DHB?
20
(100
%)
20(1
00%
)20
(100
%)
b)w
itha
Māo
riun
it?
20(1
00%
)20
(100
%)
20(1
00%
)c)
with
oth
erg
roup
sand
age
ncie
sin
the
regi
on?
20(1
00%
)20
(100
%)
20(1
00%
)d)
with
aM
āori
heal
thp
rovi
der?
19
(95%
)20
(100
%)
20(1
00%
)e)
with
the
prim
aryh
ealth
care
sect
or?
20(1
00%
)19
(95%
)19
(95%
)f)
with
nat
iona
lnet
wor
kofc
hild
pro
tect
ion
and
fam
ilyvi
olen
ceco
ordi
nato
rs?
20(1
00%
)20
(100
%)
20(1
00%
)
_____ Follow-upAudit _____
Page 79
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)3.
4Do
rele
vant
staf
fhav
em
embe
rshi
pon
,ora
tten
d:
a)
the
inte
rdisc
iplin
aryc
hild
pro
tect
ion
team
?20
(100
%)
20(1
00%
)20
(100
%)
b)C
hild
abu
sete
amm
eetin
gs?
20(1
00%
)20
(100
%)
19(9
5%)
c)Se
xual
abu
sete
amm
eetin
gs?
18(9
0%)
17(8
5%)
16(8
0%)
d)C
YFC
are
and
Prot
ectio
nRe
sour
ceP
anel
?17
(85%
)18
(90%
)15
(75%
)e)
Nat
iona
lNet
wor
kofF
amily
Vio
lenc
eIn
terv
entio
nCo
ordi
nato
rs?
20(1
00%
)20
(100
%)
19(9
5%)
3.5
Does
the
DHB
have
aM
emor
andu
mo
fUnd
erst
andi
ngth
ate
nabl
esth
esh
arin
gof
det
ails
ofch
ildre
nat
risk
fore
ntry
on
thei
rdat
abas
ew
ithth
ePo
lice
and/
orC
YF?
a)C
YF?
20(1
00%
)20
(100
%)
20(1
00%
)b)
the
Polic
e?
20(1
00%
)20
(100
%)
20(1
00%
)3.
6Do
esth
eDH
Bha
vea
Mem
oran
dum
ofU
nder
stan
ding
ors
ervi
cea
gree
men
ttha
tena
bles
tim
elym
edica
lexa
min
atio
ns
tosu
ppor
t:
a)C
YF?
18(9
0%)
19(9
5%)
20(1
00%
)b)
Pol
ice?
18(9
0%)
19(9
5%)
20(1
00%
)c)
DSA
C?
17(8
5%)
17(8
5%)
18(9
0%)
CATE
GORY
4.I
NSTI
TUTI
ONA
LCUL
TURE
4.1
Does
the
DHB
seni
orm
anag
emen
tsup
port
and
pro
mot
eth
ech
ilda
buse
and
neg
lect
pro
gram
me?
a)ch
ildp
rote
ctio
nis
inth
eDH
BSt
rate
gicP
lan?
15
(75%
)18
(90%
)19
(95%
)b)
child
pro
tect
ion
isin
the
DHB
Annu
alP
lan?
16
(80%
)20
(100
%)
20(1
00%
)c)
the
child
pro
tect
ion
prog
ram
me
isad
equa
tely
reso
urce
d,in
cludi
ngd
edica
ted
prog
ram
me
staf
f?
16(8
0%)
18(9
0%)
18(9
0%)
d)a
wor
king
gro
upo
fski
lled
and
trai
ned
peop
lew
hoo
pera
tiona
lises
pol
icies
and
pro
cedu
res,
ina
dditi
onto
the
child
pr
otec
tion
coor
dina
tor?
20
(100
%)
20(1
00%
)20
(100
%)
e)a
tten
danc
eat
trai
ning
asa
keyp
erfo
rman
cein
dica
tor(
KPI)
fors
taff?
13
(65%
)13
(65%
)15
(75%
)f)
role
soft
hose
inth
ech
ilda
buse
and
neg
lect
wor
king
team
are
inclu
ded
inp
ositi
ond
escr
iptio
ns?
15(7
5%)
18(9
0%)
18(9
0%)
g)D
HBre
pres
enta
tion
onth
eCY
FCa
rea
ndP
rote
ctio
nRe
sour
ceP
anel
?17
(85%
)19
(95%
)17
(85%
)h)
the
Child
Pro
tect
ion
Coor
dina
tori
ssup
port
edto
att
end
the
VIP
Coor
dina
torM
eetin
gs?
20(1
00%
)20
(100
%)
19(9
5%)
_____ Follow-upAudit _____
Page 80
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)4.
2In
the
last
3ye
ars,
hast
here
bee
na
form
al(w
ritte
n)a
sses
smen
toft
heD
HBst
aff's
know
ledg
ean
dat
titud
eab
out
child
abu
sea
ndn
egle
ct?
20(1
00%
19
(95%
)17
(85%
)
a)n
ursin
gst
aff
20(1
00%
)19
(95%
)17
(85%
)b)
med
icals
taff
18(9
0%)
16(8
0%)
14(7
0%)
c)ad
min
istra
tion
15(7
5%)
14(7
0%)
12(6
0%)
d)o
ther
staf
f/em
ploy
ees
18(9
0%)
19(9
5%)
17(8
5%)
Ifye
s,di
dth
eas
sess
men
tadd
ress
staf
fkno
wle
dge
and
attit
ude
abou
tMāo
rian
dch
ilda
buse
and
neg
lect
?17
(85%
)19
(95%
)16
(80%
)4.
3Ho
wlo
ngh
asth
eho
spita
l'sch
ilda
buse
and
neg
lect
pro
gram
me
been
ine
xist
ence
?
a)2
4-48
mon
ths
b)
>48
mon
ths
20(1
00%
)20
(100
%)
20(1
00%
)4.
4Do
esth
eDH
B’sc
hild
abu
sea
ndn
egle
ctp
rogr
amm
ead
dres
scul
tura
lissu
es?
a)
doe
sthe
DHB
spol
icies
spec
ifica
llyre
quire
impl
emen
tatio
nof
the
child
abu
sea
ndn
egle
ctcl
inica
lass
essm
entp
olicy
re
gard
less
oft
hech
ild's
cultu
ralb
ackg
roun
d?
20(1
00%
)20
(100
%)
20(1
00%
)
b)d
oest
hech
ildp
rote
ctio
nco
ordi
nato
rand
the
stee
ring
grou
pw
ork
with
the
Māo
rihe
alth
uni
tand
oth
er
cultu
ral/e
thni
cgro
upsr
elev
antt
oth
eDH
Bsd
emog
raph
ics?
20(1
00%
)20
(100
%)
19(9
5%)
c)A
recu
ltura
lissu
esd
iscus
sed
inth
eho
spita
l'sch
ilda
buse
and
neg
lect
trai
ning
pro
gram
me?
20
(100
%)
20(1
00%
)20
(100
%)
d)a
retr
ansla
tors
/inte
rpre
ters
ava
ilabl
efo
rwor
king
with
vict
imsi
fEng
lish
isno
tthe
vict
im's
first
lang
uage
?20
(100
%)
20(1
00%
)20
(100
%)
e)A
rere
ferr
alin
form
atio
nan
dbr
ochu
resr
elat
edto
child
abus
ean
dne
glec
tava
ilabl
ein
lang
uage
soth
erth
anE
nglis
h?
16(8
0%)
17(8
5%)
19(9
5%)
4.5
Does
the
DHB
part
icipa
tein
pre
vent
ion
outr
each
/pub
lice
duca
tion
activ
ities
on
the
topi
cofc
hild
abu
sea
ndn
egle
ct?
20(1
00%
)20
(100
%)
19(9
5%)
a)1
pro
gram
me
inth
ela
st1
2m
onth
s?
2(1
0%)
3(1
5%)
3(1
5%)
b)>
1pr
ogra
mm
ein
the
last
12
mon
ths?
18
(90%
)17
(85%
)16
(80%
)c)
Doe
sthe
DHB
colla
bora
tew
ithM
āori
com
mun
ityo
rgan
isatio
nsa
ndp
rovi
ders
tod
eliv
erp
reve
ntiv
eou
trea
cha
nd
publ
iced
ucat
ion
activ
ities
?17
(85%
)18
(90%
)19
(95%
)
4.6
Dop
olici
esa
ndp
roce
dure
sind
icate
the
avai
labi
lity
ofsu
ppor
tive
inte
rven
tions
fors
taff
who
hav
eex
perie
nced
abu
se
and
negl
ect,
orw
hoa
rep
erpe
trat
orso
fabu
sea
ndn
egle
ct?
20(1
00%
)19
(95%
)20
(100
%)
a)is
alis
tofs
uppo
rtiv
ein
terv
entio
nsa
vaila
ble?
20
(100
%)
20(1
00%
)20
(100
%)
b)a
rest
affa
war
eof
how
toa
cces
ssup
port
and
inte
rven
tions
ava
ilabl
e?
20(1
00%
)20
(100
%)
20(1
00%
)
_____ Follow-upAudit _____
Page 81
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)4.
7Is
ther
eev
iden
ceo
fcoo
rdin
atio
nbe
twee
nth
eDH
Bch
ilda
buse
and
neg
lect
pro
gram
me
inc
olla
bora
tion
with
oth
er
viol
ence
inte
rven
tion
prog
ram
mes
?19
(95%
)20
(100
%)
20(1
00
%)
a)is
ther
eis
are
ferr
alm
echa
nism
?20
(100
%)
20(1
00%
)19
(100
%)
4.8
Does
the
child
pro
tect
ion
polic
yreq
uire
man
dato
ryu
seo
fDHB
app
rove
dtr
ansla
tors
whe
nEn
glish
isn
otth
evi
ctim
'sor
ca
regi
ver's
firs
tlan
guag
e?
a)D
HBa
ppro
ved
tran
slato
rsb
eing
use
d?
20(1
00%
)20
(100
%)
20(1
00%
)b)
alis
toft
rans
lato
rsis
acc
essib
le?
20(1
00%
)20
(100
%)
20(1
00%
)c)
tran
slato
rsu
sed
that
are
gen
dera
nda
gea
ppro
pria
te?
15(7
5%)
16(8
0%)
16(8
0%)
4.9
Does
the
DHB
supp
orta
ndp
rom
ote
child
pro
tect
ion
and
inte
rven
tion
with
inth
epr
imar
ysec
tor.
a)
invo
lvem
ento
fprim
aryh
ealth
care
pro
vide
rsin
the
plan
ning
and
dev
elop
men
tofc
hild
abu
sea
ndn
egle
cta
ndch
ild
prot
ectio
npr
ogra
mm
es?
20(1
00%
)18
(90%
)19
(95%
)
b)a
cces
sto
child
abu
sea
ndn
egle
cttr
aini
ng?
19(9
5%)
19(9
5%)
20(1
00%
)c)
coor
dina
tion
ofre
ferr
alp
roce
sses
bet
wee
nth
eDH
Ban
dpr
imar
yhea
lthca
rese
ctor
s?
17(8
5%)
18(9
0%)
19(9
5%)
d)o
ngoi
ngre
latio
nshi
psa
nda
ctiv
ities
that
focu
son
prev
entio
nan
dpr
omot
ing
child
pro
tect
ion?
20
(100
%)
19(9
5%)
20(1
00%
)CA
TEGO
RY5
.TRA
ININ
GO
FPR
OVI
DERS
5.1
Isth
ere
evid
ence
ofa
form
altr
aini
ngp
lan
that
issp
ecifi
cto
child
abu
sea
ndn
egle
ctfo
rclin
icals
taff
and
non-
clini
cal
staf
f?
a)a
stra
tegi
cpla
nfo
rtra
inin
g?
19(9
5%)
20(1
00%
)20
(100
%)
b)a
nop
erat
iona
lpla
nth
ato
utlin
esth
esp
ecifi
cso
fthe
pro
gram
me
oftr
aini
ng?
19(9
5%)
20(1
00%
)20
(100
%)
c)D
oest
hep
lan
inclu
deth
epr
ovisi
ono
freg
ular
,ong
oing
edu
catio
nfo
rclin
icals
taff?
19
(95%
)20
(100
%)
20(1
00%
)d)
Doe
sthe
pla
nin
clude
the
prov
ision
ofr
egul
ar,o
ngoi
nge
duca
tion
forn
on-c
linica
lsta
ff?
19(9
5%)
20(1
00%
)20
(100
%)
5.2
Durin
gth
epa
st1
2m
onth
s,ha
sthe
DHB
pro
vide
dtr
aini
ngo
nch
ilda
buse
and
neg
lect
?
a)a
spar
toft
hem
anda
tory
orie
ntat
ion
forn
ewst
aff?
19
(95%
)19
(95%
)20
(100
%)
b)to
mem
bers
oft
hecl
inica
lsta
ffvi
aco
lloqu
iao
roth
erse
ssio
ns?
20(1
00%
)20
(100
%)
20(1
00%
)5.
3Do
esth
etr
aini
ng/e
duca
tion
onch
ilda
buse
and
neg
lect
inclu
dein
form
atio
nab
out:
a)
def
initi
onso
fchi
lda
buse
and
neg
lect
?20
(100
%)
20(1
00%
)20
(100
%)
b)d
ynam
icso
fchi
lda
buse
and
neg
lect
?20
(100
%)
20(1
00%
)20
(100
%)
c)ch
ilda
dvoc
acy?
20
(100
%)
20(1
00%
)20
(100
%)
d)ap
prop
riate
child
-cen
tred
inte
rvie
win
g?
20(1
00%
)20
(100
%)
20(1
00%
)e)
issu
eso
fcon
tam
inat
ion?
20
(100
%)
20(1
00%
)19
(95%
)f)
ethi
cald
ilem
mas
?20
(100
%)
20(1
00%
)20
(100
%)
_____ Follow-upAudit _____
Page 82
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)
g)co
nflic
tofi
nter
est?
20
(100
%)
20(1
00%
)20
(100
%)
h)ep
idem
iolo
gy?
20(1
00%
)20
(100
%)
20(1
00%
)i)
heal
thco
nseq
uenc
es?
20(1
00%
)20
(100
%)
20(1
00%
)j)
iden
tifyi
ngh
igh
riski
ndica
tors
?20
(100
%)
20(1
00%
)20
(100
%)
k)p
hysic
alsi
gnsa
ndsy
mpt
oms?
20
(100
%)
20(1
00%
)20
(100
%)
l)du
ala
sses
smen
twith
par
tner
viol
ence
?19
(100
%)
20(1
00%
)20
(100
%)
m)d
ocum
enta
tion?
20
(100
%)
20(1
00%
)20
(100
%)
n)in
terv
entio
n?
20(1
00%
)20
(100
%)
20(1
00%
)o)
safe
typ
lann
ing?
20
(100
%)
20(1
00%
)20
(100
%)
p)co
mm
unity
reso
urce
s?
20(1
00%
)20
(100
%)
20(1
00%
)q)
child
pro
tect
ion
repo
rtin
greq
uire
men
ts?
20(1
00%
)20
(100
%)
20(1
00%
)r)
linki
ngw
ithth
epo
lice
and
child
you
tha
ndfa
mily
?20
(100
%)
20(1
00%
)20
(100
%)
s)lim
itso
fcon
fiden
tialit
y?
20(1
00%
)20
(100
%)
20(1
00%
)t)
age
appr
opria
tea
sses
smen
tand
inte
rven
tion?
19
(95%
)20
(100
%)
20(1
00%
)u)
cultu
ralis
sues
?20
(100
%)
20(1
00%
)20
(100
%)
v)lin
kbet
wee
npa
rtne
rvio
lenc
ean
dch
ilda
buse
and
neg
lect
?20
(100
%)
20(1
00%
)20
(100
%)
w)M
āori
mod
elso
fhea
lth?
19(9
5%))
19(9
5%)
19(9
5%)
x)th
eso
cial,
cultu
ral,
hist
oric,
and
eco
nom
icco
ntex
tin
whi
chM
āori
fam
ilyvi
olen
ceo
ccur
s?
18(9
0%)
19(9
5%)
20(1
00%
)y)
Te
Tirit
ioW
aita
ngi?
20
(100
%)
20(1
00%
)20
(100
%)
z)M
āori
serv
icep
rovi
ders
and
com
mun
ityre
sour
ces?
20
(100
%)
20(1
00%
)2
0(1
00%
)aa
)ser
vice
pro
vide
rsa
ndco
mm
unity
reso
urce
sfor
eth
ican
dcu
ltura
lgro
upso
ther
than
Pak
eha
and
Māo
ri?
19(1
00%
)18
(90%
)1
9(9
5%)
ab)I
falls
ub-it
emsa
ree
vide
nt,b
onus
1.5
16
(80%
)18
(90%
)19
(95%
)5.
4Is
the
child
abu
sea
ndn
egle
cttr
aini
ngp
rovi
ded
by:(choo
seoneofa
-dand
answere-f)
c)a
team
ofD
HBe
mpl
oyee
sonl
y?
1(5
%)
0(0
%)
1(5
%)
d)a
team
,inc
ludi
ngco
mm
unity
exp
ert(s
)?
19(9
5%)
20(1
00%
)1
9(9
5%)
e)a
Chi
ldY
outh
and
Fam
ilyst
atut
orys
ocia
lwor
ker?
19
(95%
)20
(100
%)
20
(100
%)
f)a
Māo
rire
pres
enta
tive?
19
(95%
)18
(90%
)18
(90%
)g)
are
pres
enta
tive(
s)o
foth
ere
thni
c/cu
ltura
lgro
ups?
13
(65%
)12
(60%
)12
(60%
)
_____ Follow-upAudit _____
Page 83
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)5.
5Is
the
trai
ning
del
iver
edin
colla
bora
tion
with
vario
usd
iscip
lines
,and
pro
vide
rso
fchi
ldp
rote
ctio
nse
rvice
s,su
chas
CYF
,Po
lice
and
com
mun
itya
genc
ies?
20
(100
%)
20(1
00%
)20
(100
%)
5.6
Does
the
plan
inclu
dea
rang
eof
teac
hing
and
lear
ning
app
roac
hesu
sed
tod
eliv
ertr
aini
ngo
nch
ilda
buse
and
neg
lect
?20
(100
%)
20(1
00%
)20
(100
%)
CATE
GORY
6.I
NTER
VENT
ION
SERV
ICES
6.1
Isth
ere
ast
anda
rdin
terv
entio
nch
eckl
istfo
rsta
ffto
use
/ref
erto
whe
nsu
spec
ted
case
sofc
hild
abu
sea
ndn
egle
cta
re
iden
tifie
d?
20(1
00%
)20
(100
%)
20(1
00%
)
6.2
Are
child
pro
tect
ion
serv
icesa
vaila
ble
"on-
site"
?If
yes,choo
seoneofa
-band
answerc-d:
20
(100
%)
a)A
mem
bero
fthe
child
pro
tect
ion
team
ors
ocia
lwor
kerp
rovi
dess
ervi
cesd
urin
gce
rtai
nho
urs.
5(2
5%)
8(4
0%)
5(2
5%)
b)A
mem
bero
fthe
child
pro
tect
ion
team
ors
ocia
lwor
kerp
rovi
dess
ervi
cea
tall
times
.15
(75%
)12
(60%
)15
(75%
)c)
AM
āori
advo
cate
ors
ocia
lwor
keri
sava
ilabl
e“o
n-sit
e”fo
rMāo
rivi
ctim
s.19
(95%
)19
(95%
)19
(95%
)d)
An
advo
cate
ofe
thni
cand
cultu
ralb
ackg
roun
dot
herP
akeh
aan
dM
āori
isav
aila
ble
onsit
e.
16(8
0%)
15(7
5%)
15(7
5%)
6.3
Are
men
talh
ealth
/psy
chol
ogica
lass
essm
ents
per
form
edw
ithin
the
cont
exto
fthe
pro
gram
me?
If
yes,
are
they
:(choo
seaorb
and
answerc)
20
(100
%)
20(1
00%
)
a)a
vaila
ble,
whe
nin
dica
ted?
12
(60%
)11
(55%
)13
(65%
)b)
per
form
edro
utin
ely?
8
(40%
)9
(45%
)7
(35%
)c)
age-
appr
opria
te?
20(1
00%
)20
(100
%)
20(1
00%
)6.
4Do
the
inte
rven
tion
serv
icesi
nclu
de:
a)
acc
esst
oph
ysica
land
sexu
ale
xam
inat
ion?
20
(100
%)
20(1
00%
)20
(100
%)
b)a
cces
sto
spec
ialis
edse
xual
abu
sese
rvice
s?
20(1
00%
)20
(100
%)
20(1
00%
)c)
fam
ilyfo
cuse
din
terv
entio
ns?
19(1
00%
)20
(100
%)
19(9
5%)
d)su
ppor
tser
vice
stha
tinc
lude
rele
vant
NGO
s,or
acu
tecr
isisc
ouns
ello
rs/s
uppo
rt?
19(9
5%)
20(1
00%
)20
(100
%)
e)cu
ltura
llya
ppro
pria
tea
dvoc
acya
ndsu
ppor
t?
19(9
5%)
20(1
00%
)20
(100
%)
6.5
Are
Socia
lWor
kers
ava
ilabl
e?
a)
Mon
day
toF
riday
8a
mto
4p
mse
rvice
,with
refe
rral
sout
side
ofth
ese
hour
s?
12(6
0%)
11(5
5%)
10(5
0%)
b)0
n-ca
llaf
ter4
pm
and
atw
eeke
nds?
3
(15%
)2
(10%
)4
(20%
)c)
asa
24
hour
serv
ice?
5(2
5%)
7(3
5%)
6(3
0%)
6.6
Isth
ere
acu
rren
tlist
ofr
elev
ants
ervi
cesa
vaila
ble
tosu
ppor
tchi
lda
ndfa
mily
safe
ty?
20(1
00%
)20
(100
%)
20(1
00%
)6.
7Is
prov
ision
mad
efo
rtra
nspo
rtfo
rvict
imsa
ndth
eirf
amili
es,i
fnee
ded?
20
(100
%)
20(1
00%
)20
(100
%)
6.8
Does
the
DHB
child
abu
sea
ndn
egle
ctp
rogr
amm
ein
clude
follo
w-u
pco
ntac
tand
coun
selli
ngw
ithvi
ctim
safte
rthe
in
itial
asse
ssm
ent?
20
(100
%)
20(1
00%
)20
(100
%)
_____ Follow-upAudit _____
Page 84
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)6.
9Do
esth
ech
ilda
buse
and
neg
lect
pro
gram
me
asse
ssa
ndp
rovi
defa
mily
viol
ence
inte
rven
tion
serv
icesa
nd
appr
opria
tere
ferr
alfo
r:
a)th
em
othe
r20
(100
%)
20(1
00%
)20
(100
%)
b)si
blin
gs
19(9
5%)
20(1
00%
)20
(100
%)
6.10
Is
ther
eev
iden
ceo
fcoo
rdin
atio
nw
ithC
YFa
ndth
ePo
lice
forc
hild
ren
iden
tifie
dat
risk
ofc
hild
abu
sea
ndn
egle
ct?
20(1
00%
)20
(100
%)
20(1
00%
)CA
TEGO
RY7
.DO
CUM
ENTA
TIO
N
7.1
Isth
ere
evid
ence
ofu
seo
fast
anda
rdise
ddo
cum
enta
tion
form
tore
cord
know
nor
susp
ecte
dca
seso
fchi
lda
buse
and
ne
glec
t,an
dsa
fety
ass
essm
ents
?If
yes,
does
the
form
inclu
de:
20(1
00%
) 20
(100
%)
a)R
easo
nfo
rpre
sent
atio
n?
19(9
5%)
20(1
00%
)20
(100
%)
b)in
form
atio
nge
nera
ted
byri
ska
sses
smen
t?
18(9
0%)
19(9
5%)
19(9
5%)
c)th
evi
ctim
orc
areg
iver
’sde
scrip
tion
ofcu
rren
tand
/orp
asta
buse
?19
(95%
)20
(100
%)
20(1
00%
)d)
the
nam
eof
the
alle
ged
perp
etra
tora
ndre
latio
nshi
pto
the
vict
im?
16(8
0%)
18(9
0%)
19(9
5%)
e)a
bod
ymap
tod
ocum
enti
njur
ies?
19
(95%
)20
(100
%)
20(1
00%
)f)
Past
med
icalh
istor
y?
18(9
0%)
20(1
00%
)20
(100
%)
g)A
socia
lhist
ory,
inclu
ding
livin
gcir
cum
stan
ces?
18
(90%
)20
(100
%)
20(1
00%
)h)
An
inju
rya
sses
smen
t,in
cludi
ngp
hoto
grap
hice
vide
nce
(ifa
ppro
pria
te)?
17
(85%
)20
(100
%)
20(1
00%
)i)
The
inte
rven
tions
und
erta
ken?
18
(90%
)19
(95%
)20
(100
%)
j)in
form
atio
ndo
cum
entin
gth
ere
ferr
alsp
rovi
ded
toth
evi
ctim
and
thei
rfam
ily?
19(9
5%)
20(1
00%
)20
(100
%)
k)in
the
case
ofM
āori,
info
rmat
ion
docu
men
ting
whe
ther
the
vict
ima
ndth
eirf
amily
wer
eof
fere
da
Māo
riad
voca
te?
14(7
0%)
16(8
0%)
18(9
0%)
7.2
Does
the
DHB
have
sexu
ala
buse
spec
ificf
orm
stha
tinc
lude
:
a)a
gen
itald
iagr
am?
19(9
5%)
18(9
0%)
16(8
0%)
b)a
cons
entf
orm
?17
(85%
)17
(85%
)17
(85%
)7.
3Is
ther
eev
iden
ceo
fuse
ofa
sta
ndar
dise
dre
ferr
alfo
rma
ndp
roce
ssfo
rCY
Fan
d/or
Pol
icen
otifi
catio
n?I
fyes
,is
are
ferr
alfo
rma
ndp
roce
ssa
vaila
ble
for:
20(1
00%
)
a)C
YFn
otifi
catio
n?
20(1
00%
)20
(100
%)
20(1
00%
)b)
Pol
icen
otifi
catio
n?
15(7
5%)
14(7
0%)
14(7
0%)
7.4
Are
staf
fpro
vide
dtr
aini
ngo
ndo
cum
enta
tion
forc
hild
ren
rega
rdin
gab
use
and
negl
ect?
20
(100
%)
20(1
00%
)20
(100
%)
_____ Follow-upAudit _____
Page 85
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)CA
TEGO
RY8
.EVA
LUAT
ION
ACTI
VITI
ES
8.
1Ar
eany
form
alev
alua
tion
proc
edur
esin
pla
ceto
mon
itort
heq
ualit
yoft
hech
ildab
usea
ndn
egle
ctp
rogr
amm
e?If
yes:
a)
Do
eval
uatio
nac
tiviti
esin
clude
per
iodi
cmon
itorin
gof
impl
emen
tatio
nof
child
abu
sea
ndn
egle
ctcl
inica
las
sess
men
tpol
icy?
20(1
00%
)20
(100
%)
19(9
5%)
b)Is
the
eval
uatio
npr
oces
ssta
ndar
dise
d?
17(8
5%)
17(8
5%)
17(8
5%)
c)D
oev
alua
tion
activ
ities
mea
sure
out
com
es,e
ither
fore
ntire
pro
gram
me
orco
mpo
nent
sthe
reof
?18
(90%
)19
(95%
)18
(90%
)d)
Doe
sthe
eva
luat
ion
ofth
epr
ogra
mm
ein
clude
rele
vant
revi
ew/a
udit
ofth
efo
llow
ing
activ
ities
:
Iden
tifica
tion,
risk
ass
essm
ent,
adm
issio
nsan
dre
ferr
ala
ctiv
ities
?18
(90%
)18
(90%
)17
(85%
)M
onito
ring
tren
dsre
dem
ogra
phics
,risk
fact
ors,
and
type
sofa
buse
?15
(75%
)15
(75%
)15
(75%
)Do
cum
enta
tion?
17
(85%
)18
(90%
)17
(85%
)Re
ferr
alst
oCY
Fand
the
Polic
e?
18(9
0%)
19(9
5%)
18(9
0%)
Case
revi
ews?
17
(85%
)17
(85%
)19
(95%
)Cr
itica
lincid
ents
?19
(95%
)18
(90%
)19
(95%
)M
orta
litym
orbi
dity
revi
ew?
19(9
5%)
18(9
0%)
17(8
5%)
Polic
yand
pro
cedu
rere
view
s?
20(1
00%
)19
(95%
)20
(100
%)
e)D
oth
eev
alua
tion
activ
ities
inclu
de:
M
ultid
iscip
linar
ytea
mm
embe
rs?
20(1
00%
)20
(100
%)
20(1
00%
)Po
lice?
19
(95%
)18
(90%
)17
(85%
)CY
F?
19(9
5%)
20(1
00%
)20
(100
%)
Com
mun
ityag
encie
s?
19(9
5%)
17(8
5%)
16(8
0%)
8.2
Isth
ere
evid
ence
off
eedb
ack
onth
ech
ilda
buse
and
neg
lect
pro
gram
me
from
com
mun
itya
genc
iesa
ndg
over
nmen
tse
rvice
spro
vide
rs,s
uch
asC
YF,t
heP
olice
,ref
uge,
and
wel
lchi
ldp
rovi
ders
?16
(80%
)18
(90%
)17
(85%
)
8.3
Doh
ealth
care
pro
vide
rsre
ceiv
est
anda
rdize
dfe
edba
cko
nth
eirp
erfo
rman
cea
ndo
npa
tient
sfro
mC
YF?
14(7
0%)
14(7
0%)
14(7
0%)
8.4
Isth
ere
anym
easu
rem
ento
fclie
ntsa
tisfa
ctio
nan
dco
mm
unity
satis
fact
ion
with
the
child
abu
sea
ndn
egle
ct
prog
ram
me?
a)cl
ient
satis
fact
ion?
10
(50%
)6
(30%
)8
(40%
)b)
com
mun
itysa
tisfa
ctio
n?
14(7
0%)
18(9
0%)
17(8
5%)
_____ Follow-upAudit _____
Page 86
2015 Violence Intervention Programme Evaluation
“Y
ES”r
espo
nses
10
8m
oFU
DH
Bs(%
)12
0m
oFU
DH
Bs(%
)20
15F
UDH
Bs(%
)8.
5Is
aqu
ality
fram
ewor
kuse
dto
eva
luat
ew
heth
erse
rvice
sare
effe
ctiv
efo
rMāo
ri?
9(4
5%)
8(4
0%)
8(4
0%)
8.6
Are
data
rela
ted
toc
hild
abu
sea
ndn
egle
cta
sses
smen
ts,i
dent
ifica
tions
,ref
erra
lsan
dal
erts
tatu
srec
orde
d,c
olla
ted
and
repo
rted
on
toth
eDH
B?
14(7
0%)
18(9
0%)
16(8
0%)
8.7
Isth
ech
ilda
buse
and
neg
lect
pro
gram
me
evid
enti
nth
eDH
Bqu
ality
and
risk
pro
gram
me?
19
(95%
)17
(85%
)1
9(9
5%)
8.8
Isth
ere
spon
sibili
tyfo
ract
ing
one
valu
atio
nre
com
men
datio
nssp
ecifi
edin
the
polic
iesa
ndp
roce
dure
s?
11(5
5%)
14(7
0%)
17(8
5%)
CATE
GORY
9.P
HYSI
CALE
NVIR
ONM
ENT
9.
1Ho
wm
any
loca
tions
with
pos
ters
/imag
esre
leva
ntto
child
ren
and
youn
gpe
ople
whi
cha
reth
eych
ild-fr
iend
ly,c
onta
in
mes
sage
sabo
utch
ildri
ghts
and
safe
ty,a
ndco
ntai
nM
āori
and
othe
rrel
evan
tcul
tura
lore
thni
cim
ages
?
a)<
10p
oste
rso
rim
ages
1
(5%
)0
(0%
)0
(0%
)b)
10-
20p
oste
rso
rim
ages
3
(15%
)3
(15%
)2
(10%
)c)
>20
pos
ters
ori
mag
es
16(8
0%)
17(8
5%)
16
(80%
)9.
2Is
ther
ere
ferr
alin
form
atio
n(lo
calo
rnat
iona
lpho
nen
umbe
rs)r
elat
edto
child
adv
ocac
yand
rele
vant
serv
iceso
npu
blic
disp
layi
nth
eDH
B?(C
anb
ein
clude
don
the
post
ers/
broc
hure
not
eda
bove
).
a)<
10lo
catio
ns
1(5
%)
1(5
%)
1(5
%)
b)1
0-20
loca
tions
4
(20%
)4
(20%
)4
(20%
)c)
>20
loca
tions
15
(75%
)15
(75%
)1
5(7
5%)
9.3
Are
ther
ede
signa
ted
priv
ate
spac
esa
vaila
ble
fori
nter
view
ing?
a)>
4lo
catio
ns?
20(1
00%
)20
(100
%)
19
(100
%)
9.4
Does
the
DHB
prov
ide
tem
pora
ry(<
24h
ours
)saf
esh
elte
rfor
vict
imso
fchi
lda
buse
and
neg
lect
and
thei
rfam
ilies
who
ca
nnot
go
hom
eor
cann
otb
epl
aced
ina
com
mun
ity-b
ased
shel
teru
ntil
CYFo
rare
fuge
inte
rven
e?
a)'S
ocia
ladm
issio
ns"m
entio
ned
inch
ilda
buse
and
neg
lect
pol
icies
?17
(85%
)18
(90%
)17
(85%
)b)
Tem
pora
rysa
fesh
elte
risa
vaila
ble?
18
(90%
)19
(95%
)1
9(9
5%)
_____ Follow-upAudit _____
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