GPs need better training to
help children affected by domestic violence
ALTHOUGH doctors and nurses are
becoming more aware of patients experiencing domestic violence, the needs of
children are often ignored, according to new research published today that
reveals a lack of training about how to identify and support children exposed to
Experts from the universities of Bristol and Central Lancashire say better
training, coupled with improved information sharing between agencies, could
greatly improve outcomes for these children.
About 1 in 5 children in the UK are exposed to domestic violence, according to
the NSPCC. Although there is considerable research based evidence associating
domestic violence with poor physical health, mental health, behavioural and
educational outcomes for exposed children, GPs and nurses are not confident
about how to respond to the needs of these children, the authors say.
Writing in the journal Health and Social Care in the Community today, they
highlight a lack of cohesion and coordination in the approach to domestic
violence and child safeguarding. Their study draws attention to general practice
clinicians' insufficient understanding of multi agency work, a limited
competence in gauging thresholds for child protection referral to children's
services and little understanding of outcomes for children. While prioritising
children's safety, GP clinicians are more inclined to engage directly with
abusive parents than with affected children.
Lead author Dr Eszter Szilassy, from the University of Bristol's Centre for
Academic Primary Care, in the School of Social and Community Medicine said:-
"Our research found that, while GPs are fully aware of their child
safeguarding responsibilities, they are uncertain about best practice at the
interface between child safeguarding and domestic violence. The lack of relevant
training contributes to failures to translate child safeguarding knowledge into
safe and effective domestic violence related practice strategies."
The paper highlights that "the poor engagement of general practice
clinicians with domestic violence training and the lack of relevant training
content within child safeguarding training, is currently a major gap for general
practice, leading to uncertainty and resulting in missed opportunities to
support victims and their children".
The authors describe the development of an evidence based training intervention
on domestic violence and child safeguarding for general practice teams, called:-
RESPONDS (Researching Education to Strengthen Primary care ON Domestic violence
and Safeguarding). This training was developed to encourage general practice
clinicians to overcome barriers and engage more extensively with adults
experiencing abuse, as well as responding directly to the needs of children.
The mixed method paper reports key research findings and their implications for
practice and policy. If adopted, the authors' recommendations could lead to
greater support for children via more relevant training and support for the GPs
and nurses assigned to them.
Nicky Stanley, Professor of Social Work at the University of Central Lancashire,
noted:- "The research found that GPs were more ready to engage with
victims and perpetrators of domestic violence than to talk directly to children
or young people about this issue. They need to improve their confidence and
skills in relation to this, since children are also their patients."
Dr Szilassy and colleagues argue that clinicians need more focused training to
equip them with the skills and confidence to respond safely and effectively to
adult victims and perpetrators, and vitally, in talking directly with children
experiencing domestic violence. They recommend that such training is reinforced
by supportive practice environments, improved systems of interagency
collaboration, appropriate and effective documenting and improved
information sharing systems and policies.
The authors hope that the development and piloting of their evidence based
training will be a crucial first step towards strengthening the response to all
family members experiencing or perpetrating domestic violence and their
The paper:- 'Making the links between domestic violence and child safeguarding'
An evidencebased pilot training for general practice. Health and Social Care in
the Community, by Eszter Szilassy et al is available at