Health Staff Responses to Domestic and Family Violence: The Case for Training to Build Confidence and Skills

ABSTRACT

Domestic and family violence (DFV) is a serious, worldwide public health concern and the literature suggests that women who have experienced violence identify health care providers as the professionals they would most trust with disclosure of abuse. Social work is well positioned to respond to women presenting in hospitals after experiencing DFV and in advocating for systems and policy initiatives to support health staff in becoming adequately trained and supported to detect and respond appropriately. This paper reports on research that surveyed health staff in two hospitals in Queensland, Australia, to identify what DFV training they had received, whether this training increased their knowledge, skills and confidence to address DFV and what services they would access to support women presenting with DFV. The results showed that the respondents were an experienced staff group who had worked in the health sector for 10–20 years but despite having access to State-based training, the majority of them had not completed any in-house training and only 12% had received face-to-face training, and when they did undertake training, it was usually only a two-hour session. Seventy-five per cent of respondents would refer to their hospital-based social worker and 40% would make referrals to other support services, primarily social work.

IMPLICATIONS

• Hospitals need to prioritise, commit to, and resource appropriate and regular training to better equip health staff to identify and respond to DFV.

• Training needs to build the knowledge and skills of staff members to address their confidence to intervene and offer support.

• Social work can provide an important role in advocating and developing training and procedures to sustain health staff members’ capacity to respond appropriately to DFV.

     

Index insurance and climate risk management: Addressing social equity

Fair distribution of benefits from index insurance matters. Lack of attention to social equity can reinforce inequalities and undermine the potential index insurance holds as a tool for climate risk management that is also pro‐poor. The aims of this article are to: (a) examine social equity concerns raised by index insurance in the context of climate risk management, (b) consider how greater attention can be paid to social equity in index insurance initiatives, and (c) reflect on the policy challenges raised by taking social equity into account as a mechanism for climate risk reduction. The article draws on learning from the CGIAR's Research Program on Climate Change, Agriculture and Food Security (CCAFS) and presents the cases of the Index Based Livelihoods Insurance (IBLI) and Agriculture and Climate Risk Enterprise Ltd. (ACRE) in East Africa. It proposes a framework for unpacking social equity related to equitable access, procedures, representation and distribution within index insurance schemes. The framework facilitates identification of opportunities for building outcomes that are more equitable, with greater potential for inclusion and fairer distribution of benefits related to index insurance. The article argues that systematically addressing social equity raises hard policy choices for index insurance initiatives without straightforward solutions. Attention to how benefits and burdens of index insurance are distributed, suggests the unpalatable truth for development policy that the poorest members of rural society can be excluded. Nevertheless, a focus on social equity—facilitated by the framework—opens up opportunities to ensure index insurance is linked to more socially just climate risk management. At the very least, it may prevent index insurance from generating greater inequality. Taking social equity into account, thus, shifts the focus from agricultural systems in transition per se to systems with potential to incorporate societal transformation through distributive justice.     

The ableism elephant in the academy: a study examining academia as informed by Australian scholars with lived experience

Abstract

The academy should be a welcoming environment for people with disability. Across Australia, however, there is a current shortage of programmes supporting people with disability to develop their careers as researchers. This article critically investigates current practice and experiences concerning universities and the employment and career development of people with disability as advised by the literature, and how this practice aligns with the lived experiences of several of our authors. Our review of the literature utilising Scopus, PsycINFO and ProQuest databases found a deficiency of research attention on this topic, with only 16 relevant articles identified. This paucity of literary evidence has been augmented in the article by personal stories shared by four of its authors. By focusing on evidence-based measures with potential to support disability employment and career pathways throughout universities in Australia and elsewhere, this article challenges leaders to address ableism and to advance a more inclusive academy.     

The role of evidence in nutrition policy‐making in Ethiopia: Institutional structures and issue framing

Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with most cases arising in low‐ and middle‐income countries. However, the multi‐sectoral nature of nutrition policy‐making adds considerable complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change can come about within different country settings. This article examines multi‐sectoral nutrition policy‐making from the health sector perspective, specifically focusing on different sectoral perspectives and the role and use of evidence within this. Ethiopia provides a unique example of the challenging nature of multi‐sectoral nutrition policy‐making, even with a strong co‐ordinating infrastructure. In December 2014 we undertook 23 in‐depth semi‐structured interviews with stakeholders from key health sector organizations, along with a related documentary analysis. Participants represented a diverse range of perspectives, including government representatives, policy stakeholders, aid providers from multi‐lateral organizations and academic researchers. Our respondents described how nutrition framing in Ethiopia is changing, with greater consideration of overweight, obesity and non‐communicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight‐ and obesity‐related concerns are still less evident in key documents. Some health actors described the challenge of enacting structural policy changes when doing so requires engagement from the agriculture sector. While multi‐sectoral plans and infrastructure to address malnutrition are in place, respondents suggested that the mandate for addressing nutrition resting with the health sector was reinforced by the nature of evidence collected. This study of nutrition policy‐making in Ethiopia highlights the complex interaction of evidence within different conceptualisations of policy problems and responses. Despite Ethiopia's strategic framework and its progress in achieving terms of nutrition targets, it shares the challenge of countries elsewhere in addressing nutrition as a multi‐sectoral issue.     

The Nature of Social Responsibility: Exploring Emancipatory Ends

Social responsibility (SR) initiatives within a corporate environment (CSR) continue to be met with deep scepticism. My concern is with exploring this scepticism, which I argue is due to there being more to the underlying objectives of SR than has previously been investigated. I begin by outlining and substantiating my project as a social ontological enquiry, one in which I unpack key concepts to reveal the nature of SR. These ontological findings then underpin my argument that SR is problematically grounded in liberalist thinking, and CSR is in fact just one manifestation of SR. I advance the thesis that SR has emancipatory ends, of meeting human needs and flourishing, and that it is best explicated using feminist care ethics. The argument is then focussed on both shoring up and advancing the emancipatory project of SR. The scepticism of interest is revealed to be the incongruity between care and business; that businesses are deemed as being incompatible with SR, at least in their present capacity. Any claims to the contrary by the business community are branded inauthentic and the aforementioned scepticism ensues. The paper concludes with a brief discussion concerning implications for CSR initiatives and future changes and developments are considered.     

Mainstream and Marginal Newspaper Coverage of the 1995 Quebec Referendum: An Inquiry into the Functioning of the Canadian Public Sphere*

Cet article applique le concept habermassien de la sphère publique à l'examen des relations entre les journaux ethniques et grand public présents à Toronto. En particulier, cette étude analyse les éditoriaux parus au cours de l'année précédant le référendum de 1995 sur la souveraineté du Québec et en explique la couverture médiatique sur la base d'entretiens avec les rédacteurs en chef des journaux concernés. Pendant cette période, tous les journaux, sauf un, étaient antiséparatistes. Cependant, contrairement aux journaux grand public, les journaux ethniques se sont particulièrement attachés à des questions de survivance culturelle. Les approches des éditeurs sur la question de la souveraineté suggèrent qu'on ne peut ni parler de sphère publique unifiée ni de publics multiples et atomisés. Il y a plutôt des sphères publiques multiples - inscrites dans des tempo-ralités socio-économiques spécifiques - qui se recouvrent et se complètent. This article employs Habermas's concept of the public sphere in examining the relationship between ethnic and mainstream Toronto newspapers. In particular, the study analyses editorials in the year leading up to the 1995 Quebec referendum on sovereignty, and draws upon interviews with the newspaper editors in explaining the patterns of coverage. During the specified time period, all but one newspaper was anti-separatist. Unlike the mainstream papers, however, the ethnic presses stressed issues of cultural survival. The editors' approaches to the sovereignty question suggests that there is neither a single unified public sphere nor multiple discrete publics. Instead, there are multiple overlapping public spheres—embedded in particular socio-economic historical moments—that complement one another.     

The multistate life table method: An application to contraceptive switching behavior

In many demographic behaviors (e.g., those relating to marriage, contraception, migration, and health), people change among multiple statuses through time, sometimes leaving and then returning to the same status. Data on such behaviors are often collected in surveys as censored event histories. The multistate life table (MSLT) can be used to properly describe, in a single analysis, these complex transitions among multiple states measured in such data, but MSLT is rarely applied in the demographic literature because practical guidance is lacking on how to compute MSLTs with such data. We provide methods for computing MSLT quantities using censored event-history data: namely, transition intensities and probabilities, "state occupancy" probabilities and standard errors, average time spent in specified states, and average number of visits to specified states. Applying these methods to contraceptive use, we find high levels of switching back and forth, particularly between barrier methods and non-use, resulting in high rates of unintended pregnancy.