Family and domestic violence — structured SAQ (15 marks)

(a) Seeing her alone and the LIVES response (4 marks)

The mark is for knowing that the partner cannot be present for any enquiry, plus four LIVES elements. ^[1]

• Why alone: disclosure is impossible with the partner present; build a routine that always separates the partner for at least part of the visit. The doorway is the first intervention.^[5]
• L — Listen: listen closely, with empathy and without judgement; move to her eye level, use her name.
• I — Inquire: inquire about her needs and concerns — her safety, her child, her housing, her health.
• V — Validate: say explicitly "I believe you. This is not your fault. You are not alone." Validation is the act, not an implication.^[1]
• E — Enhance safety: conduct a risk assessment and help build a safety plan (see part c and d).
• S — Support: connect her to specialist advocacy and support services, offer follow-up.

(b) Documentation standard (3 marks)

One mark per element. Marks are lost for "counseled re FDV" with no detail. ^[1]

• Verbatim quotes in quotation marks — the woman's own words, e.g. "he put his hands around my neck until I couldn't breathe", recorded contemporaneously.
• Body map documenting the location, size, type and approximate age of every injury (the patterned bruise on the upper inner arm); offer forensic photography with explicit written consent and record the consent.
• Date, time, sign and identify yourself; flag the record confidential so discharge summaries, posted letters and patient-portal messages do not reach the partner.^[5]

(c) Risk and lethality assessment (4 marks)

One mark for naming the instrument, one for the strangulation evidence, two for the other risk markers. ^[2][3]

• Named instrument: the Campbell Danger Assessment — a validated, weighted lethality-risk instrument (area under the ROC curve 0.90 in an independent attempted-femicide sample).^[2]
• The single most elevating factor in this case is non-fatal strangulation. In the Glass case-control study, a prior history of non-fatal strangulation was associated with over seven-fold odds of a completed intimate-partner homicide (OR 7.48, 95% CI 4.53–12.35); strangulation was reported in 43% of completed homicides versus 10% of abused controls.^[3]
• Other high-risk markers: escalation in frequency or severity, recent or planned separation, pregnancy, partner access to a firearm, partner substance misuse, threats to kill, threats to harm the children.^[2]
• This woman is therefore in a high-risk category and needs urgent, specialist, safety-led input.

(d) Safety planning, referral and mandatory reporting (4 marks)

One mark each for safety plan elements, referral, the leaving-is-dangerous principle, and the child-protection obligation. ^[4][5]

• Safety plan: an emergency bag (identification, money, keys, medications, documents) packed and hidden; an identified safe destination; emergency contacts stored where he cannot find them; an agreed code word with a trusted person; a plan for the toddler.
• Referral pathway: social work; specialist domestic violence service (1800RESPECT in Australia, Women's Refuge in Aotearoa New Zealand); perinatal mental health. The Cochrane review found advocacy may reduce abuse, particularly in pregnant women, which is the evidence base for the referral.^[4]
• Leaving is the most dangerous time: respect her autonomy not to leave now; the safety plan and the timing of separation determine the outcome, not the clinician's directive. Re-offer help at every contact.^[1]
• Mandatory reporting — the toddler: child abuse and neglect is mandatorily reportable in every Australian state and territory and in New Zealand; a child exposed to family violence in the household may meet the child-protection threshold even without direct injury. This is a separate obligation from the competent adult woman's confidentiality.^[5]