Domestic and family violence: screening, safety planning, and the GP role

Why DFV belongs in every GP consult

Domestic and family violence (DFV) is a pattern of abusive behaviour within a relationship — current or former intimate partner, parent, child, sibling, kinship, or carer arrangement — used to gain or maintain power and control. It encompasses physical assault, sexual assault and reproductive coercion, psychological abuse (humiliation, threats, gaslighting, isolation), financial and economic abuse, spiritual abuse, and technology-facilitated abuse. It also includes coercive control — a sustained pattern of behaviour that strips another person of their autonomy, regardless of whether each individual act would be criminal in isolation (RACGP White Book, 5th ed 2022).

In Australia, approximately 27% of women and 12% of men have experienced violence by an intimate partner since the age of 15, and around one woman is killed by a current or former partner every nine days (AIHW Family, Domestic and Sexual Violence 2024; ABS Personal Safety Survey 2021–22). Aboriginal and Torres Strait Islander women are hospitalised for family violence at approximately 32 times the rate of non-Indigenous women, with much higher rates of homicide — an appalling disparity demanding targeted clinical response.

GPs are the most common point of first professional contact for people experiencing DFV — consulted well before disclosure to police, friends, or specialist services. The health consequences span every system: depression, anxiety, PTSD, suicidality, substance use, chronic pelvic pain, somatic disorder, recurrent STIs, unwanted pregnancy, traumatic brain injury from repeated strangulation or head impacts, and perinatal complications with generational consequences. Detecting DFV in general practice and responding effectively is not optional clinical work.

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A. Core clinical — the AU general-practice framework

Recognising DFV — what to look for

DFV rarely announces itself. Clinical presentations that should heighten suspicion include:

• A partner who refuses to leave the room, answers questions on the patient’s behalf, or controls what is said
• Multiple injuries of varying ages — particularly on the head, neck, chest, abdomen, genitals, or forearms (defensive injuries); bilateral bruising or bruises in the shape of a hand or implement
• Inconsistent or implausible injury mechanism — delayed presentation for care
• Frequent attendances or missed appointments (DNAs) with no clear clinical explanation
• Chronic pelvic pain, IBS-spectrum somatic disorder, recurrent STIs, or recurrent unwanted pregnancies — all recognised sequelae of DFV
• Escalating anxiety, depression, suicidality, or substance use disproportionate to apparent stressors
• Antenatal injuries — pregnancy and early postpartum are peak periods for onset and escalation of DFV, and antenatal screening is routine per the Pregnancy Care Guidelines 2020
• In children: behavioural regression, school problems, somatic symptoms, hypervigilance, sexualised behaviour

Universal vs selective screening

Current Australian practice occupies a deliberate middle ground. The RACGP White Book and the USPSTF 2018 recommend selective inquiry (case-finding) in general adult practice — ask when red flags or risk markers are present — because universal screening alone has not been shown to reduce violence or improve health outcomes in unselected populations (Feder et al., Lancet 2009). However, universal antenatal screening is recommended at booking, mid-pregnancy, and the postnatal review — the elevated risk, the access window, and the better evidence base all support this (RANZCOG Family Violence statement).

In practice, the most effective approach is a universal framing applied selectively: “Because relationships and safety at home affect everyone’s health, I ask all my patients about this.” This reduces stigma without demanding a protocol-level screen of every patient regardless of context.

Validated screening tools

Choose one tool and learn it well:

• HARK — Humiliation, Afraid, Rape, Kick — 4 questions; any positive response constitutes a positive screen (Sohal et al., BMC Fam Pract 2007)
• HITS — Hurt, Insult, Threaten, Scream — 4 questions, scored 1–5 each; ≥10 out of 20 is positive
• AAS — Abuse Assessment Screen — 5 questions, validated specifically in pregnancy
• WAST — Woman Abuse Screening Tool — 8 questions with a validated 2-item short form

These tools guide the inquiry but should not replace a genuinely curious, open-ended conversation.

The AVDR consultation

Ask — the consultation must happen with the patient alone. No partner, no family members (even well-meaning ones), no children older than about two years who can understand and repeat what they hear. Create the conditions: a practice-nurse-led parallel intake, an in-room ECG, a urine sample — any legitimate reason to have the room to yourself with the patient. Use a normalising frame. Ask conversationally.

Validate — “I believe you. This is not your fault. You do not deserve this. I am concerned about your safety.” Believing is the most therapeutic clinical act at a first disclosure. Do not move to problem-solving or safety planning in the same breath as the disclosure; let the validation land first.

Document — factual, contemporaneous, time-stamped clinical notes. Use the patient’s own words in direct quotation marks. Complete a body diagram for injuries. Obtain consent to photograph injuries with a date-stamp and an object for scale, stored securely. Avoid editorialising language such as “alleged” or “claims” — document what the patient says happened. Record who else was present. Documentation may be subpoenaed and may form the basis for an apprehended violence order.

Refer — active warm referral to specialist services. 1800RESPECT (1800 737 732) is the 24/7 national crisis and counselling line. Additional pathways are covered in section D.

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B. Risk assessment and lethality — the elements that cannot be skipped

Strangulation

The single most important risk factor for intimate-partner homicide is a history of non-fatal strangulation. Prior strangulation increases homicide risk approximately 6–8-fold (Glass et al., J Emerg Med 2008; Campbell et al., AJPH 2003). Strangulation often leaves no visible external marks — the history must be directly asked: “Has anyone ever grabbed you by the throat or choked you?” Physical examination should look for petechiae on the conjunctivae or face, voice changes, dysphagia, and neurological symptoms. Treat a positive strangulation history as a sentinel event requiring escalated response.

Lethality clusters

The combination of multiple high-risk features identifies situations requiring immediate escalation. Lethality indicators include: recent separation (statistically the highest-risk period for homicide); threats with weapons; perpetrator access to firearms; threats to kill; escalating frequency or severity of violence; perpetrator unemployment or financial stress; jealous surveillance; pregnancy; a child (particularly a stepchild) in the home; perpetrator substance use or untreated mental illness; and coercive control as the overarching pattern.

Structured risk assessment tools should be used where possible — the DVSAT (Domestic Violence Safety Assessment Tool) in NSW, or ODARA (Ontario Domestic Assault Risk Assessment) — and the outcome documented.

Safety planning

Safety planning is co-produced with the patient and is not a script. Components depend on what is feasible and safe in the specific situation:

• A named safe place to go
• Emergency cash, hidden or accessible
• Copies of ID, Medicare card, scripts, immunisation records, bank cards, and passports stored with a trusted person
• A packed bag at a trusted person’s home
• A code word with a trusted contact
• A plan for children, including their school
• Technology safety — a separate phone, location services disabled, new passwords on a clean device, checking keys and car for tracking devices; detailed guidance at the eSafety Commissioner domestic violence hub

Leaving is statistically the highest-risk period — never pressure on timing. Honour that the patient knows their situation and their safety better than the clinician does.

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C. Coercive control and the changing legal landscape

What coercive control means clinically

Coercive control is not a single dramatic incident — it is a pattern. The pattern typically includes surveillance (location tracking, reading messages, controlling access to social contacts), financial control (withholding money, sabotaging employment, running up debt in the victim’s name), social isolation (controlling contact with family and friends), reproductive coercion (sabotaging contraception, pressuring pregnancy or termination), emotional abuse (humiliation, threats, gaslighting, intimidation), and spiritual or cultural abuse (shaming, weaponising religious or cultural practices). Each individual act may seem minor in isolation; the cumulative effect is profound loss of autonomy.

2024–2026 legislative changes

Coercive control is now criminalised or in the process of being criminalised across most Australian states:

• New South Wales — Crimes Legislation Amendment (Coercive Control) Act 2022, commenced 1 July 2024
• Queensland — Criminal Law (Coercive Control) and Affirmative Consent Amendment Act 2024, staged commencement from 2024
• Western Australia — legislation passed 2025
• Victoria — Royal Commission framework, planned commencement 2026

The clinical implication: documenting the pattern matters as much as documenting individual incidents. A single contemporaneous note about one controlling behaviour is limited evidence. A longitudinal record — noting frequency, escalation over time, specific behaviours, and the patient’s reported impact — can be used by prosecutors, courts, and family-violence risk assessment panels. GPs who see the same patient repeatedly are in a unique position to build this record.

State information-sharing schemes

Most states have established frameworks permitting defined entities (including health services) to share information about DFV risk without patient consent when there is a serious threat to life. These are distinct from mandatory child-protection reporting and are used sparingly, with documented rationale, and with notification to the patient where safe to do so: VIC Family Violence Information Sharing Scheme (FVISS), NSW Domestic Violence Information Sharing Scheme (DVISS), QLD Information Sharing, WA Family and Domestic Violence Risk Assessment and Management Framework (FDVRT).

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D. Australian operations

MBS items

DFV presentations are time-intensive and billing should reflect this. Item 44 (Level D consultation, ≥40 minutes) is appropriate for a first disclosure combined with risk assessment, safety planning, and documentation. Item 36 (Level C, ≥20 minutes) covers most follow-up encounters. Telehealth equivalents (video 91801/91802; phone 91891/91892) apply with standard eligibility rules. After-hours items (5000–5067) where relevant. ATSI-specific Health Assessment item 715 plus follow-up item 10987 (practice nurse / Aboriginal Health Worker).

Mental Health Care Plans (items 2715 or 2717) provide up to 10 subsidised psychology sessions per year via the Better Access initiative — appropriate for depression, anxiety, PTSD, and adjustment disorder resulting from DFV. The Chronic Disease Management Plan items (965/967) cover complex chronic comorbidities. Antenatal items (16407/16500) where relevant.

PBS prescribing for DFV sequelae

There is no DFV-specific pharmacotherapy. Sequelae are treated using PBS-listed agents: SSRIs or SNRIs (sertraline, escitalopram, venlafaxine) for depression, anxiety, and PTSD; prazosin off-label for PTSD nightmares (private or authority); short-course zopiclone for acute sleep disturbance (private). Avoid maintaining benzodiazepines — sedation impairs the safety response and complicates protective parenting. Emergency contraception (levonorgestrel, ulipristal) is pharmacist-supply without prescription. HIV PEP is Section 100 specialist via a sexual health service or emergency department — refer the same day if within 72 hours.

Mandatory reporting

Child at risk is mandatory for healthcare workers in every Australian state and territory — thresholds and age cut-offs vary by jurisdiction; the AIFS mandatory reporting resource 2023 provides a jurisdiction-by-jurisdiction summary. Exposure to DFV meets the threshold for mandatory child-protection reporting in most states — the children are victims, not witnesses. Adult IPV is not mandatorily reportable in most jurisdictions; patient autonomy governs disclosure for adults with capacity. Exception: the NT has partial provisions for life-threatening DFV.

Referral pathways

Pathway	Contact
National 24/7 DFV crisis line	1800RESPECT 1800 737 732
ATSI patients	AFVPLS / NFVPLS 13 92 76 · 13YARN 13 92 76
CALD patients	InTouch Multicultural Centre Against Family Violence
Technology safety	eSafety Commissioner
Financial abuse	National Debt Helpline 1800 007 007
Women’s legal services	Women’s Legal Services Australia
Men seeking to change behaviour	No to Violence 1300 766 491 · Mensline 1300 78 99 78
Emergency	000

Paid family and domestic violence leave

Since 1 February 2023, all employees are entitled to 10 days paid family and domestic violence leave per year under the Fair Work Act. A supportive, factual GP letter (avoiding phrases that presuppose legal findings) is often the catalyst for a patient to access this entitlement.

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E. Special populations

Aboriginal and Torres Strait Islander patients

The 32-fold hospitalisation disparity and substantially elevated homicide rate demand an uncompromising response. Clinical requirements: never use a community member or family member as an interpreter; involve an Aboriginal Health Worker or cultural liaison; partner with the ACCHO and AFVPLS / NFVPLS; recognise the Bringing Them Home legacy when considering any child-protection referral, and understand the amplified fear many First Nations families have of statutory systems. 13YARN (13 92 76) provides culturally safe crisis support.

Culturally and linguistically diverse (CALD) patients

Always use a professional interpreter via TIS National (131 450) — never a family member or community interpreter. Be aware of immigration implications: partner-visa family-violence provisions under the Migration Act allow visa holders experiencing DFV to remain in Australia; connect with InTouch for specific advocacy.

LGBTIQ+ patients

DFV occurs across all relationship types. Same-sex relationship violence is often under-recognised and under-reported. Honour chosen family; be aware of historical trauma and distrust of institutions among LGBTIQ+ patients; Switchboard (1800 184 527) provides LGBTIQ+-specific support.

Pregnancy and the postnatal period

Antenatal and early postnatal periods are peak onset and escalation windows. Routine inquiry at every antenatal visit is recommended per the Pregnancy Care Guidelines 2020. Antenatal injuries, particularly to the abdomen, are a sentinel event. The perinatal period also increases isolation, financial dependency, and sleep deprivation — factors that may escalate perpetrator behaviour.

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When to escalate

Call 000 immediately if:

• There is immediate physical danger to the patient or children
• The patient discloses threat to kill or a weapon
• Strangulation is recent or has caused neurological symptoms
• A child is at immediate risk of harm

Contact police with consent (or without consent if there is imminent danger and the patient lacks capacity to decide) when:

• Criminal assault has occurred
• Threats with weapons have been made
• Strangulation has been disclosed

Refer to emergency domestic violence accommodation services (Safe Steps VIC 1800 015 188 or state equivalent) when:

• The patient cannot safely return home
• Safety plan requires immediate alternative accommodation

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What this article is and is not

This is general health information based on current Australian guidelines — the RACGP White Book 5th ed 2022, the Pregnancy Care Guidelines 2020, and peer-reviewed evidence. It is not personal medical advice and does not create a doctor–patient relationship. Decisions about individual patient care, mandatory reporting, and referral are made with the treating clinician in the specific clinical context.

For immediate support: 1800RESPECT 1800 737 732 · Lifeline 13 11 14 · Beyond Blue 1300 22 4636 · 000 for immediate danger.

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Sources cited

1. RACGP — Abuse and Violence: Working with Our Patients in General Practice (The White Book), 5th ed 2022
2. Australian Department of Health — Pregnancy Care Guidelines 2020
3. RANZCOG — Family Violence statement
4. Our Watch — Change the Story 2nd ed 2021
5. AIHW — Family, Domestic and Sexual Violence in Australia 2024
6. ABS — Personal Safety Survey 2021–22
7. 1800RESPECT — 1800 737 732
8. Hegarty K et al. — WEAVE trial. Lancet 2013
9. Feder G et al. — IRIS trial. Lancet 2011
10. Feder L et al. — IPV screening in clinical settings. Lancet 2009
11. Glass N et al. — non-fatal strangulation and homicide risk. J Emerg Med 2008
12. Campbell J et al. — risk factors for femicide. Am J Public Health 2003
13. USPSTF 2018 — Intimate Partner Violence Screening
14. Sohal H et al. — HARK questionnaire. BMC Fam Pract 2007
15. Fair Work Ombudsman — Family and Domestic Violence Leave
16. AIFS — Mandatory Reporting of Child Abuse and Neglect 2023
17. eSafety Commissioner — Domestic and Family Violence Hub
18. NFVPLS / AFVPLS
19. InTouch Multicultural Centre Against Family Violence
20. Women’s Legal Services Australia
21. Mensline Australia
22. No to Violence
23. Lifeline 13 11 14
24. Beyond Blue 1300 22 4636