HEALTH RESPONSE TO FAMILY VIOLENCE€¦ · Snapshot clinical audit benchmarks have been identified: • System reliability is achieved when a standard action occurs at least 80% of

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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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

4

28

8

49

19

67

48

74

56

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

4

51

12

59

15

75

65

81 78

879391

10092 9593

10094

100

0

20

40

60

80

100

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

40

60

80

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

1715

14

11

16

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)


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)


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.

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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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Follow-upAuditReport

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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:onsite: Onsitefamilyviolencespecialist(suchasasocialworker,Women’sRefuge

advocate)whoestablishessafety,addressesidentifiedrisks,andprovidessupportandaccesstocommunityservices.

SEXUALHEALTHEntertotalnumberofallwomenaged16yearsandoverwhopresentedtoSexualHealthServicesduringtheauditperiod.IPVScreen:Wasthewomanscreened?NO: Thereisnodocumentationthatthewomanwasscreened.Ifthereis

documentationregardingareasonfornotscreening(suchas‘with’partner),thisisstilla‘NO’.


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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.




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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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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

Page 63



Page60

• 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

Page 64



Page60

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)[email protected]

ChristineMcLean ProfessorJaneKoziol-McLain,PhD,RNResearchProjectManager PrincipalInvestigatorCentreforInterdisciplinaryTraumaResearch CentreforInterdisciplinaryTraumaResearch SchoolofClinicalSciences SchoolofClinicalSciencesAucklandUniversityofTechnology AucklandUniversityofTechnology(09)9219999x7114 (09)[email protected] [email protected]

Page 65



Page60

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


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%

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(7

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24

(89%

) 18

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19

(95%

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Phys

ical

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viro

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t7

15

23

75

79

91

100

100

100

100

0 (0%

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(15%

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(5

9%)

16

(59%

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(8

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(93%

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17

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)

Inst

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re

22

31

59

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(30%

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(5

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(59%

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(8

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(93%

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(9

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19

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17

(85%

)

Trai

ning

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ider

s 11

32

59

78

88

89

10

010

010

010

01 (4%

)5

(20%

)8

(30%

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(5

6%)

18

(67%

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(9

6%)

26

(96%

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(9

5%)

20

(100

%)

19

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)

Scre

enin

g&

Sa

fety

As

sess

men

t

00

43

65

73

80

80

854

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88

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%)

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0%)

8(3

0%)

15

(56%

)18

(6

7%)

26

(96%

)26

(9

6%)

19

(95%

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(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%

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(8

2%)

24

(89%

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(9

0%)

18

(90%

)

17

(85%

)

Inte

rven

tion

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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


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

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ficia

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ritte

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icies

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era

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?If

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dop

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es:

19(9

5%)

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00%

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20

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20

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(100

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(100

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j)ad

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?19

(95%

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(95%

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(90%

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2Is

ther

eev

iden

ceo

fah

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ased

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oest

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:20

(100

%)

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11(5

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8(4

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b)in

clude

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men

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00%

)19

(95%

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(100

%)

c)in

clude

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from

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15(7

5%)

16(8

0%)

16(8

0%)

d)in

clude

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sicia

n(s)

from

the

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icals

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17

(85%

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(85%

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(85%

)e)

inclu

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izatio

n(e

.g.W

omen

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fuge

)?

18(9

0%)

19(9

5%)

19(9

5%)

f)in

clude

repr

esen

tativ

e(s)

from

hos

pita

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inist

ratio

n?

20(1

00%

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(95%

)20

(100

%)

g)in

clude

Māo

rire

pres

enta

tive(

s)?

20(1

00%

)19

(95%

)20

(100

%)

1.3

Does

the

hosp

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irect

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ncia

lsup

port

fort

hep

artn

era

buse

pro

gram

me

(bey

ond

VIP

fund

ing)

?17

(85%

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(85%

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(100

%)

1.3 a

Is

fund

ing

seta

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ifica

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?13

(65%

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(60%

)11

(55%

)1.

4Is

ther

ea

man

dato

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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


Page 68


“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

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resi

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ing?

19

(95%

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(100

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(80%

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(95%

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(95%

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18(9

0%

18(9

0%)

18(9

0%)

1.6

Are

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fors

ecur

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rest

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take

nw

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tal?

17

(85%

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(80%

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(90%

)%

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rest

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17

(85%

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(90%

)18

(90%

)d)

do

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āori?

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(75%

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(90%

)19

(95%

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7Is

ther

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:(choo

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(100

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(100

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a)p

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b)fu

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14(7

0%)

14(7

0%)

12(6

0%)

CATE

GORY

2.P

HYSI

CALE

NVI

RON

MEN

T

2.1

Inh

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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

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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%

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(90%

)

2

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(90%

)

2(1

0%)

18(9

0%)

Inh

owm

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ocat

ions

isth

ere

refe

rral

info

rmat

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ted

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āori

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ider

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era

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iceso

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blic

disp

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nth

eho

spita

l?(u

pto

17)

:0-

10

11-1

7

3

(15%

)17

(85%

)

4

(20%

)16

(80%

)

2

(10%

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(90%

)In

how

man

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catio

nsis

ther

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ferr

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form

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nre

non

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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


“Y

ES”r

espo

nses

10

8m

oFU

DH

Bs(%

)12

0m

oFU

DH

Bs(%

)20

15F

UDH

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)2.

3Do

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vide

tem

pora

ry(<

24h

ours

)saf

esh

elte

rfor

vict

imso

fpar

tner

abu

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hoca

nnot

go

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eor

ca

nnot

be

plac

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aco

mm

unity

-bas

edsh

elte

r?I

fyes

:20

(100

%)

20(1

00%

)20

(100

%)

a)D

oest

hed

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eof

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rtM

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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%)


Page 70


“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


“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%

)


Page 72


“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

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rand

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on-

site

lega

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20

(100

%)

19(9

5%)

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)7.

7Do

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spita

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tner

abu

sep

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dep

artn

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buse

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ech

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20

(100

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20(1

00%

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(100

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7.8

Isth

ere

evid

ence

ofc

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inat

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een

the

hosp

italp

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buse

pro

gram

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and

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ssau

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and

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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

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buse

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g?

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0%)

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Do

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(90%

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2Do

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15

(75%

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(90%

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(95%

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3Is

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men

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ality

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9

(45%

)10

(50%

)11

(55%

)


Page 73


“Y

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9.C

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9.1

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buse

pro

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mes

?Ify

es,

20(1

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(100

%)

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(100

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non

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18

(90%

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(95%

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(90%

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2Do

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lpol

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nw

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usep

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amm

e?If

yes:

20(1

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(100

%

20(1

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)a)

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with

trai

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?19

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ealth

care

facil

ities

?If

yes,

whi

chty

peso

fcol

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ratio

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ply:

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(100

%)

20(1

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a)w

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)If

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(100

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(90%

)b)

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(100

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19

(95%

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(90%

)18

(90%

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_____ MonthFollow-upAudit _____

Page 74


APPE

NDIX

J.C

hild

Abu

sea

ndN

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and

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pSc

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Median

AchievingTargetScore≥70

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20

04

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20

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20

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2015

20

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20

14

2015

OverallScore

37

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91

92

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--

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Colla

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(93%

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42

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40

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Documentatio

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Evalua

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Activ

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35

37

37

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76

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(18%

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Note

s:T

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;

_____2015Follow-upAudit _____

Page 75


Note

:96

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thfo

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Ifso

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APPE

NDIX

K.R

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Page 76


“Y

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Ar

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%)

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%

)


Page 77


“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%

)


Page 78


“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%

)


Page 79


“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%

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(85%

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the

Child

Pro

tect

ion

Coor

dina

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ssup

port

edto

att

end

the

VIP

Coor

dina

torM

eetin

gs?

20(1

00%

)20

(100

%)

19(9

5%)


Page 80


“Y

ES”r

espo

nses

10

8m

oFU

DH

Bs(%

)12

0m

oFU

DH

Bs(%

)20

15F

UDH

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)4.

2In

the

last

3ye

ars,

hast

here

bee

na

form

al(w

ritte

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sses

smen

toft

heD

HBst

aff's

know

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ean

dat

titud

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out

child

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sea

ndn

egle

ct?

20(1

00%

19

(95%

)17

(85%

)

a)n

ursin

gst

aff

20(1

00%

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med

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taff

18(9

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16(8

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14(7

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c)ad

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istra

tion

15(7

5%)

14(7

0%)

12(6

0%)

d)o

ther

staf

f/em

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ees

18(9

0%)

19(9

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17(8

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Ifye

s,di

dth

eas

sess

men

tadd

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staf

fkno

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dge

and

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abou

tMāo

rian

dch

ilda

buse

and

neg

lect

?17

(85%

)19

(95%

)16

(80%

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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

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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

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rote

ctio

nco

ordi

nato

rand

the

stee

ring

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pw

ork

with

the

Māo

rihe

alth

uni

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er

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eDH

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raph

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20(1

00%

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(100

%)

19(9

5%)

c)A

recu

ltura

lissu

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sed

inth

eho

spita

l'sch

ilda

buse

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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

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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

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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%

)


Page 81


“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

%)


Page 82


“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%

)


Page 83


“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

%)


Page 84


“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

%)


Page 85


“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%)


Page 86


“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%)


Documents

HEALTH RESPONSE TO FAMILY VIOLENCE€¦ · Snapshot clinical audit benchmarks have been identified: • System reliability is achieved when a standard action occurs at least 80% of