Domestic and Family Violence: Ask, Document, Refer Safely
1‑Minute Clinician Summary
Domestic and family violence (DFV) is common, under‑recognised and has profound health consequences. The RACGP’s White Book (5th ed., 2022) emphasises that interpersonal abuse encompasses physical, emotional, sexual, financial and social abuse and that it is prevalent across all populations [1]. One in six Australian women and one in 16 men have experienced physical or sexual violence from a current or previous co‑habiting partner [2]; on average one woman per week is killed by her partner [3]. DFV often starts or escalates during pregnancy (4–8 % of pregnant women are affected [4]) and rarely presents with obvious signs. GPs are often the first trusted professionals to whom survivors disclose violence [5], yet only about one in 10 women are ever asked about DFV [6]. Routine screening of all patients is not recommended; instead, ask sensitively when there are clinical indicators (depression, anxiety, vague somatic complaints) and always ask in pregnancy [7]. Immediate safety and warm referrals take precedence over detailed history‑taking.
Key Points
Safety first. Prioritise physical and emotional safety and assess risk; document concerns and activate urgent pathways if there is immediate danger, child risk or escalating coercive control [8]. Use non‑judgemental language and respect cultural and gender diversity.
DFV is common and hidden. Up to one in three women experience intimate partner abuse in their lifetime [9], yet survivors rarely disclose spontaneously. Monitor for subtle cues such as depression, anxiety, chronic pain, sleep problems or repeated injuries.
Ask, document, refer. Ask about DFV when red flags are present or during antenatal care [7]. Use brief, trauma‑informed questions (e.g., “Do you ever feel afraid of your partner?”). Document verbatim disclosures, injuries and risk assessment in the clinical record; avoid subjective labels. Provide first‑line support using the LIVES approach (Listen, Inquire about needs, Validate, Enhance safety, Support) and refer appropriately.
Referral thresholds. Refer to clinical psychology when there is immediate safety risk or children are at risk, pregnancy, or escalating coercive control. Also refer when psychological distress, PTSD, depression, anxiety, sleep disturbance or substance misuse interferes with daily functioning.
Evidence and training. The RACGP White Book (5th ed., 2022) provides evidence‑based guidance [10]. The Australian Department of Health funds the Readiness Program and Pathways to Safety training for primary care, which runs until February 2026 and offers trauma‑informed, accredited DFV training [11].
When to Refer to Clinical Psychology
Immediate safety risk / children at risk. Any disclosure of current violence, threat of harm, strangulation, stalking, or children witnessing violence warrants urgent referral and safety planning. Activate emergency services or child protection as needed.
Pregnancy. Refer if DFV is disclosed during pregnancy or the postpartum period, or if there is concern that violence will start or has escalated [4].
Escalating coercive control. Patterns of controlling behaviour, isolation, surveillance or financial abuse should prompt referral even when there is no physical violence [12].
Clinical Problem at a Glance
Definition and scope. DFV encompasses violent, threatening or controlling behaviour within intimate, familial or caregiving relationships, including physical, sexual, emotional, economic and technology‑facilitated abuse [1]. Coercive control is a pattern of intimidation and isolation that deprives the person of autonomy [12]. In Australia, DFV is a major contributor to poor health in women of childbearing age [13].
Why doctors care. Patients affected by DFV present with diverse health issues—chronic pain, sleep disturbance, depression, anxiety, substance misuse, pregnancy complications and trauma‑related symptoms. It can undermine adherence to medical treatment and compromise parenting and employment. Properly documenting disclosures protects both the patient and clinician from medico‑legal risk and facilitates continuity of care. Effective inquiry improves safety and enables warm referrals to trauma‑informed services.
Rapid Triage & Stepped Care
| Presentation (not exhaustive) | What to do in General Practice now | Threshold to Refer to Clinical Psychology | Escalate/Urgent |
|---|---|---|---|
| Patient hints at tension or unhappiness in relationship; mild anxiety/depression; vague somatic complaints. |
Ask non‑judgemental DFV questions (see cheat sheet); explore supports; provide psychoeducation about healthy relationships; assess for coercive control; offer information about services. Document any concerns and patient’s language verbatim. |
Refer if distress persists for >4 weeks or impacts work, sleep or parenting, or if screening reveals coercive control. Suggest early referral for culturally and linguistically diverse (CALD) patients or LGBTIQA+ survivors who may face additional barriers. |
Not applicable—routine care. |
| Disclosure of past DFV; patient reports nightmares, flashbacks, insomnia or hypervigilance. |
Validate the experience; provide brief counselling using trauma‑informed techniques; normalise emotional responses; encourage basic self‑care (sleep hygiene, nutrition, exercise); consider mental health plan and prescribe short‑term medication if indicated. | Refer when symptoms suggest PTSD, major depression, generalised anxiety or substance misuse, or when functioning is significantly impaired. Early therapy improves outcomes. | If patient expresses current suicidal ideation or intent to harm others, initiate urgent mental health assessment. |
| Pregnant or postpartum patient with signs of DFV (e.g., bruising, frequent “accidents”, missed antenatal visits). |
Routinely inquire about DFV at antenatal visits. Assess risk to mother and fetus; discuss safety planning; liaise with obstetric services; provide information about shelters and legal protection. |
Immediate referral to clinical psychology and specialist DFV services. Collaborate with midwives and child health nurses. | Urgent: if injuries or threats are present, call emergency services and child protection. |
| Escalating coercive control (e.g., stalking, threats, financial deprivation, digital monitoring) without physical violence. |
Recognise coercive control as a serious form of DFV. Offer support; create a safety plan; involve social workers or DFV advocates; document control tactics. |
Refer for therapy focusing on trauma recovery, self‑esteem and boundaries. Consider legal advice or advocacy. | If threats to kill, strangulation, or threats to harm children are disclosed, treat as immediate safety risk—activate emergency pathway. |
| Acute crises: severe violence, psychosis, suicide risk or child endangerment. |
Prioritise safety: contact emergency services (000) or state‑wide DFV helplines; ensure safe transport to hospital; consult on‑call psychiatry if needed. Provide non‑collusive documentation and avoid confrontation with perpetrator. | Referral deferred until safety assured; involve DFV specialist services and mental health crisis teams. | Immediate escalation—call emergency services and mandated reporting to child protection if children are at risk. |
What Works (Practical Management in General Practice)
First‑line brief interventions. Apply the LIVES approach endorsed by the WHO and the RACGP White Book[7]:
Listen non‑judgementally and with empathy; allow silence.
Inquire about needs and concerns (safety, medical care, legal options).
Validate by acknowledging the courage to disclose and affirming that violence is unacceptable.
Enhance safety by assessing risk, developing a safety plan (e.g., safe code word, emergency bag), and discussing child protection.
Support through information on DFV services, legal rights and psychosocial resources. Offer follow‑up appointments.
Use trauma‑informed phrasing: “Sometimes people in relationships are scared or hurt by their partners. Has this ever happened to you?” Provide educational materials and refer to reputable websites. Encourage basic self‑care (sleep hygiene, regular meals, gentle exercise) and link with community supports.
Pitfalls to avoid. Avoid making assumptions or asking “Why don’t you leave?”. Do not confront or contact the perpetrator without consent or safe context. Do not document in a way that blames the patient; record the patient’s words verbatim and note objective findings (injuries, affect). Do not screen for DFV in the presence of a partner or family member. Avoid providing couple’s counselling when violence or coercive control is present.
How We Help (Clinical Psychology at Delta Psychology)
Service overview. Delta Psychology offers trauma‑informed assessment and therapy for DFV survivors. Our clinicians use evidence‑based modalities including trauma‑focused cognitive behaviour therapy (TF‑CBT), acceptance and commitment therapy (ACT), eye‑movement desensitisation and reprocessing (EMDR) and skills‑based approaches (e.g., grounding, distress tolerance). Treatment is tailored to individual goals and typically ranges from 6–12 sessions, with options to extend. We provide individual therapy, and family sessions where safe.
Collaboration with referrers. We work closely with GPs, obstetricians, psychiatrists and paediatricians to coordinate care. Feedback (with patient consent) is provided after initial assessment, mid‑treatment and on discharge, or sooner if risk escalates. We welcome shared case conferences and offer telehealth to improve access.
What to include in the referral.
Brief summary of presenting issues and any DFV disclosures or risk factors.
Key symptoms (e.g., depression, anxiety, PTSD, sleep problems) and duration.
Functional impact (work, parenting, relationships), protective factors and coping strategies.
Treatments tried (counselling, medications) and current medications, including dosage.
Cultural or language considerations; need for interpreter; preferences for therapist gender.
Accessibility needs (telehealth, disability, carer involvement).
Referrals can be made under a GP Mental Health Treatment Plan (Better Access) or through local PHN programs. Please state if immediate risk or pregnancy is involved to prioritise triage.
Evidence Snapshot
RACGP White Book (5th ed., 2022). Developed by GPs and experts, this comprehensive guideline emphasises that interpersonal abuse encompasses physical, emotional, sexual, economic and social abuse; it provides updated chapters on trauma‑informed care and specific populations [10]. It advises GPs to ask about DFV when clinical indicators are present and to routinely screen pregnant women [7]. The guideline underscores that one woman per week is killed by a partner [3] and that the incidence of DFV during pregnancy is 4–8 % [4]. It also highlights the gendered prevalence (1 in 6 women vs 1 in 16 men) [15].
Australian Bureau of Statistics Personal Safety Survey (2016). The White Book cites this survey: an estimated 2.2 million Australians have experienced physical or sexual violence from a partner; 17 % of women and 6 % of men are affected [2]. Most disclosures occur to health practitioners rather than police [5].
Australian Government Department of Health – Training and Resources for Health Professionals (updated 29 May 2025). This resource outlines federally funded training for primary care, including the Readiness Program and Pathways to Safety training, which provide trauma‑informed, accredited DFV courses for the whole practice team and continue until February 2026 [11]. It emphasises that training is free for eligible health professionals, delivered online or face‑to‑face, and includes whole‑of‑practice onsite modules [16]. These programs underscore the importance of early identification and appropriate referral.
FAQ:
“What are safe DFV questions I can ask?” Use open, non‑judgemental questions that normalise disclosure: “How are things at home?”, “Do you ever feel afraid of your partner or family member?”, “Have you been hurt or threatened by someone close to you?” Always ensure privacy and do not ask when a partner or other family members are present. If the patient discloses abuse, thank them, acknowledge their courage, assess safety and offer support and referrals. Avoid asking why they stay or implying blame.
“How should I document DFV in the notes? ”Document verbatim statements from the patient and objective findings (e.g., bruises, injuries, tearfulness). Record the date, time, and context of disclosures; note who was present, any children involved and whether safety planning was discussed. Use neutral language (“Patient reports being hit by partner”) and avoid pejorative terms. Include risk assessment outcomes (e.g., immediate danger, access to weapons, strangulation) and any referrals made. Keep the record secure and consider separate, protected notes if there is concern that the perpetrator may access the file.
Local & Administrative Notes (Australia)
Consider Medicare Benefits Schedule (MBS) mental health items and local Primary Health Network (PHN) programs to fund psychology sessions. Some PHNs offer FDSV training and link worker programs [11]; contact your local PHN for details.
Cultural safety matters. Use accredited interpreters rather than family members; be aware of the heightened risk faced by Aboriginal and Torres Strait Islander women and women from CALD communities [14]. Offer telehealth consultations where travel, disability or childcare are barriers. Involve support people or carers with the patient’s consent.
Maintain confidentiality but understand mandatory reporting obligations for child abuse, elder abuse or threats to kill. If uncertain, consult state DFV helplines or medico‑legal services.
Referring to Delta Psychology
To refer a patient to Delta Psychology:
Prepare the referral: Complete a GP Mental Health Treatment Plan if appropriate and include the checklist items listed above. Highlight any immediate risk, pregnancy or escalating coercive control.
Contact us: Send the referral via fax (08 9463 7891). Telephone (08 9403 4777) for urgent triage or to discuss a complex case. Alternatively, email a de‑identified referral to referrals@deltapsychology.com.au (encrypted attachments preferred). Expect acknowledgement within 1 business days and an appointment offer within 1 week for urgent cases.
Advise the patient: Provide the patient with our contact details and encourage them to call if safe. Remind them of DFV helplines (1800 RESPECT) and emergency services.