"Psychological Injuries Are Not Visible": Experiences and Perceptions of Midwives and Nurses about Domestic Violence during Pregnancy.

This study aimed to describe perceptions and experiences of nurses and midwives working in primary care about domestic violence (DV) in pregnancy. Data were collected by conducting in-depth face-to-face interviews with 10 midwives and 7 nurses working in seven family health centers between July 17 and August 28, 2020. Five main themes emerged: "The causes of domestic violence," "Difficulty recognizing domestic violence," "Obstacles to revealing domestic violence," "Obstacles to Assisting/Supporting domestic violence in pregnant women," and "Solutions to prevent domestic violence in pregnancy." Midwives/nurses feel inadequate and unprepared to recognize the symptoms of DV and to guide and support women and they are willing to take an active role in managing DV. It is recommended that they should be trained on DV, a monitoring system should be established including primary healthcare services and a measurement tool should be developed.

How CARE Tools Are Being Used to Address Brain Injury and Mental Health Struggles With Survivors of Domestic Violence.

INTRODUCTION: CARE (Connect, Acknowledge, Respond, and Evaluate) is an advocacy framework developed for domestic violence service organization (DVSO) providers to address and accommodate domestic violence (DV) survivors with brain injury and mental health struggles. The CARE tools were designed for use by advocates and include the Just Breathe booklet, the Head Injury education card, and the Invisible Injuries booklet. OBJECTIVE: The purpose of this study was to report findings on how CARE tools are being used by DVSO providers as well as their impact on DVSO advocacy practice. METHODS: Post-CARE retrospective process evaluation online surveys (n = 60) and focus groups (n = 10 groups; 57 advocates) were conducted with consenting staff at 5 DVSOs in Ohio who partnered with the state coalition to develop and evaluate CARE, overseen by a university research partner. Rigorous, iterative coding qualitative analysis methods, endorsed by the Centers for Disease Control and Prevention, were used (Cohen's κ = 0.903 [stage 1] and 0.810 [stage 2]). RESULTS: The use of CARE tools has been integral to DVSO providers' implementation of the CARE advocacy framework. DVSO advocates are using CARE tools to Connect with self, survivors, and other systems; to Acknowledge that head trauma and mental health struggles are common among survivors and that ongoing education and self-care are necessary for advocates. Advocates have been able to provide a more holistic Response through accommodation within DVSOs and referral to other providers, often by using the CARE tools, including the Head Injury education card. CONCLUSION: CARE tools were designed for lay use to address head trauma, strangulation, and mental health struggles with DV survivors and are free for download at the Center on Partner Inflicted Brain Injury website: https://www.odvn.org/brain-injury. More widespread use of these tools by advocates has the potential to improve services for DV survivors and address what have historically been invisible injuries and mental health struggles in the population.

A atuação da Atenção Hospitalar como ponto da Rede de Enfrentamento à Violência contra a Criança / The role of hospital care as a point of the Network to Combat Violence against Children

O fenômeno da violência coloca para os níveis de saúde a necessidade do desenvolvimento de ações intrassetoriais, intersetoriais e o fortalecimento das ferramentas disponíveis para o cuidado de crianças e famílias em situação de violência. A Atenção Hospitalar possui portas de entrada que atendem casos de crianças violentadas, porém ainda não reconhece-se como um ponto de atenção capaz de atuar sob forma de rede para o enfrentamento da violência. OBJETIVOS: Identificar e compreender as estratégias de intervenção e atuação das instituições hospitalares como ponto de atenção da Rede de enfrentamento à violência contra criança nas últimas duas décadas no Brasil. OBJETIVOS ESPECÍFICOS:Identificar as normativas implementadas pelo governo brasileiro no período de 2000 até 2020 sobre a caracterização dos serviços que compõem a rede de enfrentamento às violências intrafamiliar contra criança; Analisar as estratégias de intervenção e atuação das instituições hospitalares como ponto de atenção da Rede de enfrentamento à violência contra criança; Identificar o perfil das unidades hospitalares no manejo dos casos de violência contra crianças METODOLOGIA: Foi estudo exploratório e descritivo realizado através de revisão bibliográfica do tipo integrativa, para a coleta dos dados foi realizada pesquisa bibliográfica nas bases de dados Biblioteca Virtual da Saúde (BVS) e Scientific Eletronic Library Online. O critério de seleção das fontes foi a disponibilidade via web, na base de dados da área, dentro do período de tempo delimitado do estudo - 2000 - 2020. RESULTADOS: Foram selecionados 17 artigos, 03 teses, 01 capítulo de livro e 01 protocolo de rede de proteção municipal e com análise do material foram construídas cinco categorias de análises: I) Políticas Públicas Brasileiras e o enfrentamento da Violência contra Criança na Atenção Hospitalar; II) Percepção dos profissionais de saúde acerca do atendimento da criança violentada/maltratada no serviços hospitalares que tratou dos significados e sentimentos desencadeados nos profissionais de saúde no cuidado de crianças violentadas; III) Elementos da Rede de Proteção/Prevenção à violência contra criança na perspectiva dos profissionais (ou elementos que apontem para isso) como a formação de equipes multidisciplinares e multiprofissionais na discussão dos casos suspeitos ou confirmados de violência; criação de protocolos, diretrizes e normatizações que orientem a conduta dos profissionais no acolhimento, atendimento, registro e encaminhamento dos casos; fomento de práticas intersetoriais para o cuidado integral de crianças e famílias em situação de violências; capacitação e educação permamente para as equipes profissionais que atuam no serviço hospitalar; IV) Programa de Proteção à Criança - a experiência institucional do Hospital das Clínicas de Porto Alegre no enfrentamento da violência contra criança; e V) Rede de Proteção à Criança e ao Adolescente em Situação de Risco para a violência - protocolo do município de Curitiba. CONCLUSÃO: As Redes de Atenção são concepções de trabalho que coloca para os pontos de atenção os desafios da integração, da conectividade, da reorganização das normativas de trabalho, da criação de espaços de gestão compartilhada e o direcionamento para um único objetivo a todos os serviços da rede.

The phenomenon of violence places the need to develop intrasectoral and intersectoral actions and the strengthening of available tools for the care of children and families in situations of violence at the health levels. Hospital care has gateways that assist cases of violent children, but it is not yet recognized as a point of care capable of acting in the form of a network to face violence. OBJECTIVES: To identify and understand how hospital institutions' intervention and performance strategies have been a point of attention in the network to combat violence against children in the last two decades in Brazil. SPECIFIC OBJECTIVES: Identify the norms against children by the Brazilian government 2000 of 2020 family period services on the characterization of coping with family violence; To analyze the intervention and performance strategies of hospital institutions as a point of attention of the network to combat violence against children; Identify the profile of hospital units in the management of cases of violence against children METHODOLOGY: It was an exploratory and descriptive study carried out through an integrative literature review. For data collection, a literature search was carried out in the Virtual Health Library (BVS) and Scientific Electronic Library Online databases. The source selection criterion was availability via the web, in the area's database, within the delimited period of time of the study - 2000 - 2020. RESULTS: 17 articles, 03 theses, 01 book chapter and 01 research protocol were selected. municipal protection network and with analysis of the material, five categories of analysis were constructed: I) Brazilian Public Policies and the confrontation of Violence against Children in Hospital Care; II) Perception of health professionals about the care of abused/abused children in hospital services that dealt with the meanings and feelings triggered in health professionals in the care of abused children; III) Elements of the Protection/Prevention Network against violence against children from the perspective of professionals (or elements that point to it) such as the formation of multidisciplinary and multiprofessional teams in the discussion of suspected or confirmed cases of violence; creation of protocols, guidelines and norms that guide the conduct of professionals in the reception, care, registration and referral of cases; fostering intersectoral practices for the comprehensive care of children and families in situations of violence; permanent training and education for the professional teams that work in the hospital service; IV) Child Protection Program - the institutional experience of Hospital das Clínicas de Porto Alegre in dealing with violence against children; and V) Network for the Protection of Children and Adolescents at Risk for Violence - protocol of the city of Curitiba. CONCLUSION: The Care Networks are works concept that places the challenges of integration, connectivity, reorganization of work regulations, the creation of shared management spaces and the direction towards a single objective for all the services.

A cross-sectional survey of pregnant women's perceptions of routine domestic and family violence screening and responses by midwives: Testing of three new tools.

BACKGROUND: Implementing Domestic and Family Violence (DFV) screening, support, and prevention within maternity services is becoming common practice but women's experiences of screening are not routinely evaluated. AIMS: (1) Explore pregnant women's experiences of routine DFV screening and perceptions of responses by midwives; and (2) undertake preliminary testing of three new tools. METHODS: Using a cross-sectional design, pregnant women (n = 210) attending an antenatal service were surveyed. Three new measures: beliefs about DFV screening; non-disclosure of DFV; and midwifery support were tested. RESULTS: Most women (92.3% n = 194) recalled being screened. Twelve (5.8%) respondents had/were experiencing DFV. A quarter (24.1% n = 49) had experienced or witnessed violence in the home as a child. The scales were reliable and factor analysis established validity. Women reported positive beliefs (mean 35.38, SD 3.63 range 19-40) and views about midwifery support (mean 24.88, SD 3.08 range 18-30). There was less agreement about why some women do not disclose DFV (mean 21.97, SD 4.27, range 8-30). Women who experienced or witnessed violence as a child, or were experiencing violence now were less comfortable with screening. Comments (n = 75) revealed support for routine enquiry that was confidential, explained, and occurred in a trusting relationship. DISCUSSION: Women were supportive of screening, but actual rates of disclosure were low. Women acknowledged the importance of screening but did not want their information shared. CONCLUSIONS: Women value screening, even if DFV is not disclosed. Exploring women's experiences is central to ensuring quality care.

Violence against the elderly: the conceptions of nursing professionals regarding detection and prevention. / Violência contra idosos: concepções dos profissionais de enfermagem acerca da detecção e prevenção.

OBJECTIVE: To analyze the conceptions of the nursing professionals working in Basic Health Units regarding the detection and prevention of violence against the elderly. METHODS: Descriptive, exploratory, qualitative study. Performed in two BHUs in Mossoró/RN, using a semi-structured interview script, from March to August of 2013. Sample composed of four nurses and six nursing technicians. The content analysis, pre-analysis, material exploration, and treatment of results were performed. RESULTS: Four categories were identified: Strategies used to identify violence against the elderly; Types of violence against the elderly; Conduct used after finding a suspicion of violence; SUS and the problem of violence against the elderly. Many professionals recognize/distrust possible cases, however, they do not know how to proceed. The dimension of the problem requires that pragmatic interventions be performed in the clinical setting and in the social context. FINAL CONSIDERATIONS: There is a need for continuing education for professionals and greater communication between the bodies responsible for reporting and embracement.

[Psychopathology of intrafamily violence]. / Psychopathologie des violences intrafamiliales.

Intrafamily violence is a major public health problem, due to its frequency and the severity of its consequences. The aim is to establish links between violence and psychopathology, for the perpetrators as well as the victims. Data reveal a higher frequency of certain mental health disorders and history of abuse in the perpetrators, without it being systematic. It is important to adopt a global and multidisciplinary approach, and a holistic perspective faced with the people concerned by these acts. Health professionals, from the social sector and associations must therefore work together in a network to manage and attempt to prevent crisis situations.

Longitudinal evaluation of a training program to promote routine antenatal enquiry for domestic violence by midwives.

BACKGROUND: Routine enquiry about domestic violence during pregnancy is accepted best practice. Training is essential to improve knowledge and practice. Few studies have undertaken a comprehensive evaluation of training impact over time. AIM: To evaluate the longitudinal impact of a domestic violence training and support program to promote midwives' routine antenatal enquiry for domestic violence using a mixed methods design. METHOD: Data sources included (1) surveys of midwives at 6 months post-training, (2) interviews with key stakeholders at 12 months, (3) chart audit data of screening, risk, and disclosure rates (for 16 months). Measures included midwives' knowledge, preparation for routine enquiry, knowledge of domestic violence and perceptions of impact of the training and support for practice change. FINDINGS: Forty (out of 83) participant surveys could be matched and responses compared to baseline and post-training scores. Wilcoxon signed-rank test identified that all 6-month follow-up scores were significantly higher than those at baseline. Level of preparedness increased from 42.3 to 51.05 (Z=4.88, p<.001); and knowledge scores increased from a mean of 21.15 to 24.65 (Z=4.9, p<.001). Most participants (>90%) reported improved confidence to undertake routine inquiry. A chart audit of screening rates revealed that of the 6671 women presenting for antenatal care, nearly 90% were screened. Disclosure of domestic violence was low (<2%) with most women at risk or experiencing violence declining referral. CONCLUSIONS: Training, support processes, and referral pathways, contributed to midwives' sustained preparedness and knowledge to conduct routine enquiry and support women disclosing domestic violence.

Violência contra idosos: concepções dos profissionais de enfermagem acerca da detecção e prevenção / Violencia contra ancianos: conceptos de profesionales de enfermería sobre la detección y prevención / Violence against the elderly: the conceptions of nursing professionals regarding detection and prevention

Resumo OBJETIVO Analisar as concepções dos profissionais de enfermagem atuantes em Unidades Básicas de Saúde quanto à detecção e prevenção de idosos violentados. MÉTODOS Estudo descritivo, exploratório, qualitativo. Realizado em duas UBS, Mossoró/RN, utilizando roteiro de entrevista semiestruturada, em março a agosto de 2013. Amostra composta por quatro enfermeiros e seis técnicos de enfermagem. Realizada análise de conteúdo. RESULTADOS Identificaram-se 4 categorias: Estratégias utilizadas para identificar a violência contra o idoso; Tipos de violências contra o idoso; Conduta utilizada após constatação de uma suspeita de violência; SUS e a problemática da violência contra o idoso. Muitos profissionais reconhecem/desconfiam dos possíveis casos, entretanto, não sabem como proceder. A dimensão do problema exige que sejam realizadas intervenções pragmáticas no meio clínico e no contexto social. CONCLUSÕES Há necessidade de educação permanente para profissionais e maior comunicação entre as instâncias responsáveis pela denúncia e acolhimento.

Resumen OBJETIVO Analizar los conceptos de enfermeros activos en unidades básicas de la salud sobre la detección y prevención del maltrato hacia personas ancianas. MÉTODOS Estudio exploratorio, descriptivo y cualitativo, realizado en dos UBS, en Mossoro/RN, por medio de entrevistas semiestructuradas entre marzo y agosto de 2013. Se realizó el estudio con cuatro enfermeros y seis técnicos de enfermería. Se llevó a cabo el análisis de contenido. RESULTADOS El análisis se divide en 4 categorías: Estrategias utilizadas para identificar la violencia contra ancianos; Tipos de violencia contra personas mayores; Acción utilizada luego de detectarse la violencia; y SUS y el tema de la violencia contra ancianos. Muchos profesionales reconocen/desconfían de los posibles casos, sin embargo, no saben cómo proceder. La magnitud del problema requiere de intervenciones pragmáticas que se lleven a cabo en el ámbito clínico y en el contexto social. CONSIDERACIONES FINALES Existe la necesidad de una educación continua para profesionales y una mayor comunicación entre los organismos responsables de la queja y acogida.

Abstract OBJECTIVE To analyze the conceptions of the nursing professionals working in Basic Health Units regarding the detection and prevention of violence against the elderly. METHODS Descriptive, exploratory, qualitative study. Performed in two BHUs in Mossoró/RN, using a semi-structured interview script, from March to August of 2013. Sample composed of four nurses and six nursing technicians. The content analysis, pre-analysis, material exploration, and treatment of results were performed. RESULTS Four categories were identified: Strategies used to identify violence against the elderly; Types of violence against the elderly; Conduct used after finding a suspicion of violence; SUS and the problem of violence against the elderly. Many professionals recognize/distrust possible cases, however, they do not know how to proceed. The dimension of the problem requires that pragmatic interventions be performed in the clinical setting and in the social context. FINAL CONSIDERATIONS There is a need for continuing education for professionals and greater communication between the bodies responsible for reporting and embracement.

Protocolo de atención en salud integral de niñas y niños en situación de maltrato infantil / Comprehensive health care protocol for girls and boys in situations of child abuse

A partir de la premisa, que el maltrato infantil se está convirtiendo en un problema cada vez más serio a nivel nacional, situación que es avalada por la Organización Panamericana de la Salud (OPS) que considera que la violencia y sus diferentes manifestaciones son un problema que afectan a la salud y al desarrollo social y económico de amplios sectores de la población. Este protocolo considera que es importante que los proveedores de salud desarrollen habilidades y competencias que ayuden a detectar los casos de niños maltratados, así como conocer las mejores estrategias de intervención. El objetivo de este protocolo es proponer una herramienta que proporcione los elementos básicos a proveedores y proveedoras de salud para brindar atención de calidad en salud integral y realizar la notificación oportuna de los casos de maltrato infantil. Para ello han seleccionado un modelo basado en el triage del AIEPI (Atención Integral a las Enfermedades Prevalentes de la Infancia). Es una estrategia elaborada por la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (Unicef) presentada en 1996 como principal método para mejorar la salud en la niñez. La metodología del modelo se lleva a cabo por medio de tres componentes. El primero está dirigido a mejorar el desempeño del personal de salud para la prevención de enfermedades en la niñez y su tratamiento. El segundo se dirige a mejorar la organización y funcionamiento de los servicios de salud para que brinden atención de calidad apropiada; y el tercer componente está dirigido a mejorar las prácticas familiares y comunitarias de cuidado y atención de la niñez. Contiene un marco teórico, marco legal, así como una serie de anexos dirigidos a apoyar tanto el diagnóstico, como el seguimiento dado a las víctimas.

Contemplative Activities in Undergraduate Nursing Courses.

BACKGROUND: Affective learning is valued in nursing, but it is often difficult to plan and evaluate learning activities in this domain. Contemplative activities can promote learning and are relatively easy to implement. These activities can promote deep, reflective thinking. METHOD: A variety of contemplative activities were used in undergraduate nursing courses. Students participated in and reflected on a vigil promoting domestic violence awareness. They attended two different art exhibits and related these exhibits to nursing. The students used journals and eportfolios to reflect on the entire nursing program. They participated in breathing exercises and guided imagery meditations. RESULTS: Students evaluated the activities positively, and their reflections were thoughtful. CONCLUSION: Contemplative activities can be useful to develop affective competencies. [J Nurs Educ. 2017;56(6):378-382.].

Knowledge gap in domestic abuse care.

More than one quarter of nursing staff say they lack confidence in supporting people who face domestic abuse, an RCNi survey reveals.

Midwives' experiences of routine enquiry for intimate partner violence in pregnancy.

BACKGROUND: Reducing violence against women is a national public health priority in Australia. Routine antenatal intimate partner violence screening by a skilled midwife is essential for assessment, support and appropriate referral, but can be challenging to implement. AIM: To explore midwives' experiences of routine enquiry, perceptions of facilitators and barriers, and suggested strategies to improve practice. METHOD: A qualitative descriptive design was used. Participants were recruited from an e-mail bulletin by the Australian College of Midwives. In-depth telephone interviews were conducted with 21 midwives. Data were analysed using an inductive thematic analysis approach. FINDINGS: Three themes were identified: The first theme; Asking the Question incorporated the belief that whilst asking women about intimate partner violence were within the role of the midwife, participants felt unsupported and unprepared. The second theme; The big fear factor represented concerns around positive disclosures of intimate partner violence, including a sense of responsibility, worries about encouraging women to disclose without clear processes and resources to support them. The third theme; Building a relationship incorporated the importance of continuity of care, trust and rapport-building. Continuity of care was identified as a positive enabler for routine enquiry. A perceived lack of support, time pressures, and presence of a partner at appointments were all considered barriers to routine enquiry. CONCLUSION: Routine enquiry about IPV is a valuable and important midwifery role. Midwives described frustration and fear when women disclosed violence. The perceived level of support from health services varied according to practice contexts and needs to be improved.

Domestic violence in pregnancy: midwives and routine questioning.

The Confidential enquiry into maternal and child health (CEMACH) (2004) set the standard for maternity care to protect women from domestic violence. Twelve women who were murdered by their partner and 43 further deaths from disclosure with no appropriate referrals prompted the routine enquiry for domestic violence to be initiated in 2000. The death rate from domestic violence had marginally decreased slightly in the latest report from The Centre for Maternal and Child Enquiries (CMACE) (2011) with 11 women murdered by their partner and 34 further deaths from disclosure with no referrals. The aim of this article is to review the current literature in order to explore evidence that questions the confidence of midwives when asking about domestic violence in pregnancy. The article aims to highlight the concerns that midwives face when confronted with a positive disclosure of domestic violence, and to provide a flow chart to aid in referral.

"It Gave Me My Life Back": An Evaluation of a Specialist Legal Domestic Abuse Service.

Community-based advocacy services are important in enabling victims to escape domestic abuse and rebuild their lives. This study evaluated a domestic abuse service. Two phases of research were conducted following case-file analysis (n = 86): surveys (n = 22) and interviews (n = 12) with victims, and interviews with key individuals (n = 12) based in related statutory and community organizations. The findings revealed the holistic model of legal, practical, mental health-related, and advocacy components resulted in a range of benefits to victims and enhanced interagency partnership working. Core elements of a successful needs-led, victim-centered service could be distilled.

Addressing domestic violence through antenatal care in Sri Lanka's plantation estates: Contributions of public health midwives.

Domestic violence in pregnancy is a significant health concern for women around the world. Globally, much has been written about how the health sector can respond effectively and comprehensively to domestic violence during pregnancy via antenatal services. The evidence from low-income settings is, however, limited. Sri Lanka is internationally acknowledged as a model amongst low-income countries for its maternal and child health statistics. Yet, very little research has considered the perspectives and experiences of the key front line health providers for pregnant women in Sri Lanka, public health midwives (PHMs). We address this gap by consulting PHMs about their experiences identifying and responding to pregnant women affected by domestic violence in an underserved area: the tea estate sector of Badulla district. Over two months in late 2014, our interdisciplinary team of social scientists and medical doctors met with 31 estate PHMs for group interviews and a participatory workshop at health clinics across Badulla district. In the paper, we propose a modified livelihoods model to conceptualise the physical, social and symbolic assets, strategies and constraints that simultaneously enable and limit the effectiveness of community-based health care responses to domestic violence. Our findings also highlight conceptual and practical strategies identified by PHMs to ensure improvements in this complex landscape of care. Such strategies include estate-based counselling services; basic training in family counselling and mediation for PHMs; greater surveillance of abusive men's behaviours by male community leaders; and performance evaluation and incentives for work undertaken to respond to domestic violence. The study contributes to international discussions on the meanings, frameworks, and identities constructed at the local levels of health care delivery in the global challenge to end domestic violence. In turn, such knowledge adds to international debates on the roles and responsibilities of health care professionals in responding to and preventing domestic violence.

STAND BY ME. NURSES AND MIDWIVES PUTTING A STOP TO DOMESTIC VIOLENCE.

The scale and atrocity of domestic and family violence in Australia has come under the spotlight in 2015 largely due to the voice of Australian of the Year and family violence campaigner Rosie Batty. The implications of family violence are far reaching for many nurses and midwives, professionally and personally. Natalie Dragon reports.

Protocol for a randomised controlled trial of a web-based healthy relationship tool and safety decision aid for women experiencing domestic violence (I-DECIDE).

BACKGROUND: Domestic violence is a serious problem affecting the health and wellbeing of women globally. Interventions in health care settings have primarily focused on screening and referral, however, women often may not disclose abuse to health practitioners. The internet offers a confidential space in which women can assess the health of their relationships and make a plan for safety and wellbeing for themselves and their children. This randomised controlled trial is testing the effectiveness of a web-based healthy relationship tool and safety decision aid (I-DECIDE). Based broadly on the IRIS trial in the United States, it has been adapted for the Australian context where it is conducted entirely online and uses the Psychosocial Readiness Model as the basis for the intervention. METHODS/DESIGN: In this two arm, pragmatic randomised controlled trial, women who have experienced abuse or fear of a partner in the previous 6 months will be computer randomised to receive either the I-DECIDE website or a comparator website (basic relationship and safety advice). The intervention includes self-directed reflection exercises on their relationship, danger level, priority setting, and results in an individualised, tailored action plan. Primary self-reported outcomes are: self-efficacy (General Self-Efficacy Scale) immediately after completion, 6 and 12 months post-baseline; and depressive symptoms (Centre for Epidemiologic Studies Depression Scale, Revised, 6 and 12 months post-baseline). Secondary outcomes include mean number of helpful actions for safety and wellbeing, mean level of fear of partner and cost-effectiveness. DISCUSSION: This fully-automated trial will evaluate a web-based self-information, self-reflection and self-management tool for domestic violence. We hypothesise that the improvement in self-efficacy and mental health will be mediated by increased perceived support and awareness encouraging positive change. If shown to be effective, I-DECIDE could be easily incorporated into the community sector and health care settings, providing an alternative to formal services for women not ready or able to acknowledge abuse and access specialised services. TRIAL REGISTRATION: Trial registered on 15(th) December 2014 with the Australian New Zealand Clinical Trials Registry ACTRN12614001306606.