title: General practice clinicians' perspectives on involving and supporting children and adult perpetrators in families experiencing domestic violence and abuse.
abstract: BACKGROUND
  Government and professional guidance encourages general practice clinicians to identify and refer children who experience domestic violence and abuse (DVA) but there is scant understanding of how general practice clinicians currently work with DVA in families.
  
  
  OBJECTIVE
  The study explored general practice clinicians' practice with children and their parents experiencing DVA and reflected on the findings in the light of current research and policy guidelines.
  
  
  METHODS
  Semi-structured interviews with 54 clinicians (42 GPs and 12 practice nurses/nurse practitioners) were conducted across six sites in England. Data were analysed using current literature and emerging themes. Data presented here concern clinicians' perspectives on engaging with family members when a parent discloses that she is experiencing DVA.
  
  
  RESULTS
  When a parent disclosed DVA, clinicians were more likely to consider talking to abusive fathers than talking to children about the abuse. Perspectives varied according to whether consultation opportunities arose, risks, consent and confidentiality. Perceptions of 'patienthood', relationships and competence shaped clinicians' engagement. Perpetrators were seen as competent informers and active service users, with potential for accepting advice and support. Clinicians were more hesitant in talking with children. Where this was considered, children tended to be seen as passive informants, only two GPs described direct and ongoing consultations with children and providing them with access to support.
  
  
  CONCLUSIONS
  Clinicians appear more inclined to engage directly with abusive fathers than children experiencing DVA. Clinician skills and confidence to talk directly with children experiencing DVA, in child sensitive ways, should be developed through appropriate training.
authors.affiliation: School of Social Work, Care and Community, University of Central Lancashire, Preston, CLarkins@uclan.ac.uk.
authors.forename: Cath
authors.initials: C
authors.lastname: Larkins
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds.
authors.forename: Jessica
authors.initials: J
authors.lastname: Drinkwater
authors.affiliation: School for Social Policy, University of Bristol, Bristol and.
authors.forename: Marianne
authors.initials: M
authors.lastname: Hester
authors.affiliation: School of Social Work, Care and Community, University of Central Lancashire, Preston.
authors.forename: Nicky
authors.initials: N
authors.lastname: Stanley
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Eszter
authors.initials: E
authors.lastname: Szilassy
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Gene
authors.initials: G
authors.lastname: Feder
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002983:Clinical Competence / Q000592:standards; D017579:Domestic Violence / Q000517:prevention & control* / Q000523:psychology; D004739:England; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D036301:Qualitative Research; D055815:Young Adult
keywords: Child neglect; child support; domestic violence; general practice; patient participation.