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Disclosure and non-disclosure

How the provider responds to both disclosure and suspected but non-disclosed DVA is vital.
© Coventry University. CC BY-NC 4.0

Here we are talking specifically about two situations: where DVA has been disclosed, and where DVA has not been disclosed but is suspected.

The women/birthing persons discloses an experience of DVA

Based on a review of the literature on what women want after disclosing DVA, Tarzia et al., 2020 developed the CARE model:

The care model stands for Choice and control, Action and advocacy, Recognition and understanding, and Emotional connection
Select the image to expand it.
(Adapted from Tarzia et al., 2020)

It recommends emotional connection, practical support through action and advocacy, and an approach that emphasises the person’s autonomy and individualised needs.

Woman- or person-centred care is about employing good listening skills, showing compassion and paying attention to non-verbal behaviours and cues. Ensuring privacy and confidentiality (and explaining about the limits of confidentiality) is also essential as part of a frontline response and will encourage the person to elaborate and discuss their concerns and experiences with you.

We will look at appropriate responses in further detail later in the course, starting with Validate the person’s experiences.

DVA is suspected but the person does not disclose

Follow the LIVES approach and avoid pressuring the person in any way.

They should be offered resources and information, and ideally, a follow-up appointment. Supporters can experience a sense of disappointment when people choose not to disclose the abuse or disclose it but then decline to take any action.

Offering compassion and support over time can assist a person to move through different stages of readiness (Reisenhofer & Taft, 2013). These stages include the victim/survivor acknowledging the abuse (‘naming’ it as such), recognising links between mental/physical health problems and the abuse; understanding the risks they and their baby/other children face; preparing for change and taking action (for example making a safety plan, leaving the partner).

A prerequisite for a person to accept help is their awareness or recognition that what is experienced is abuse. Inquiry and validation of experiences and feelings can assist the disclosure process over time. Empowering people to make even small changes can increase their self-efficacy with regard to addressing the abuse.

You can assist a person to make links between their health status and the abuse by asking: ‘Can we explore how your partner’s behaviours may be affecting your health/your pregnancy/your baby/your children? Have you had any thoughts on this?’

Often, this interaction sows the seeds; arranging a follow-up may allow further exploration of the person’s experiences in their relationship.

After abuse starts, it continues and affects health. At this stage the abuse is not named and there is a strong belief that the abuse is own fault. In response, suggest possibility of connection between symptoms and behaviours from partner. After the turning point, the person endures the abuse but questions it. At this stage the abuse is names and they engage in trying to minimise harm. In response, discuss the abuse is not acceptable, encourage possibilities for action. Praise whatever is done. After a catalyst for change, the person considers disclosing further, seeking help, or ending the relationship. At this stage they are preparing/planning and weighing up their options, there is decisional balance. In response, explore actions and possible referral but respect their decision about what they want to change. There may be back and forth between enduring the abuse but questioning and considering disclosing further. If the person chooses to stay in the relationship, work with them to promote safety and wellbeing. The response might be you, them or together, plan for safety, promote wellbeing, talk to family, explore protection orders, or partner seeks help. Needs ongoing support for women and children. There is likely to be an increase in self efficacy at this stage which may lead to a safer relationship or to the person leaving the relationship. If this occurs, action should be focused on staying safe and enhancing health and wellbeing of the family. The response might be you, them or together, ensure all services and safety planning are in place. Ongoing support for women and children. If the abuse ends or continues with harassment after leaving or taking action, focus should be on maintenance; staying safe, achieving wellbeing of family. The person may return to the abusive partner, be at the stage of having named the abuse, if they feel unsupported or after negative life events.
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(Adapted from García-Moreno et. al., 2015)

The figure above from García-Moreno et. al., 2015 is a helpful representation covering appropriate responses for the different stages of readiness for change experienced by those exposed to DVA.

Research and references

García-Moreno, C., Hegarty, K., d’Oliveira, A. F. L., Koziol-McLain, J., Colombini, M., & Feder, G. (2015). The health-systems response to violence against women. The Lancet, 385(9977), 1567-1579. DOI link.

Mauri, E. M., Nespoli, A., Persico, G., & Zobbi, V. F. (2015). Domestic violence during pregnancy: Midwives׳ experiences. Midwifery, 31(5), 498-504. DOI link

Reisenhofer, S., & Taft, A. (2013). Women’s journey to safety—the Transtheoretical model in clinical practice when working with women experiencing intimate partner violence: A scientific review and clinical guidance. Patient Education and Counseling, 93(3), 536-548. DOI link

Tarzia, L., Bohren, M. A., Cameron, J., Garcia-Moreno, C., O’Doherty, L., Fiolet, R., Hooker, L., Wellington, M., Parker, R., Koziol-McLain, J., Feder, G., & Hegarty. K. (2020). Women’s experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis. BMJ Open, 1011, Article e041339. DOI link

Taylor, J., Bradbury‐Jones, C., Kroll, T., & Duncan, F. (2013). Health professionals’ beliefs about domestic abuse and the issue of disclosure: A critical incident technique study. Health & Social Care in the Community, 21(5), 489-499. DOI link

World Health Organization. (2019). Caring for women subjected to violence: A WHO curriculum for training health-care providers. Web link

© Coventry University. CC BY-NC 4.0
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Identifying and Responding to Domestic Violence and Abuse (DVA) in Pregnancy

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