General Practice and Primary Care - Theses

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    Safety and resiliency at home: voices of children from a primary care population
    MORRIS, ANITA ( 2015)
    Almost one quarter of Australian children experience family violence perpetrated by their father or step father which has significant health outcomes across the lifespan. However, some children who experience family violence are thought to be resilient. Children lack opportunities to have their voices heard, therefore children’s own understandings of their safety and resilience are often missing. As a site of early intervention, primary care is well placed to respond to these children. The aim of the research was to hear children’s voices about their safety and resilience in the context of family violence, and to determine an appropriate primary care response. Qualitative methodologies underpinned the research which involved semi-structured interviews and focus groups with 23 children and 18 mothers from primary care settings, all of whom had experienced family violence. I developed a child-centred approach utilising ethical and safe methods. A theoretical framework of ethics of care and dialogical ethics informed the research. Hermeneutic phenomenological analysis revealed that children and mothers understood children’s safety in the context of: awareness of family violence; whether the violence was named and by whom; who provided care and protection; and children’s sense of trust in relationships. Resilience was understood differently by children and mothers. Children understood their resilience according to social recognition of their achievements and talents. The children’s meaning was independent of adversity and aligned with the concept of relational self-worth. Mothers however, only understood children’s resilience with reference to the adversity their child had experienced. This was underpinned by the mother’s sense of responsibility for the adversity and the child’s apparent resilience despite this adversity. Understandings of safety and resiliency were further analysed to reveal the key finding that children required agency to negotiate their safety in the context of family violence and post-separation. A ‘model of children’s agency’ was developed to reflect the four factors that facilitated children’s agency: physical and emotional distance from the perpetrator; awareness of disruption or danger in the parental relationship; modelling of safety in relationships by non-violent adults; and the child’s sense of co-constructing family resiliency. To inform an appropriate primary care response, I also sought children’s and mothers’ understandings of primary care. Their insights focused on: questioning the role of primary care to respond to children experiencing family violence; the importance of knowing and modelling within the child-mother-health practitioner relationship; and the expectation that the health practitioner would facilitate communication about family violence. Using these insights, I proposed an approach based on collaboration, relationship and shared language, an ‘informed trialogue’ within the child-mother-health practitioner triad to foster children’s agency in the primary care consultation. The ‘informed trialogue’ guides the health practitioner to encourage and impart the ‘model of children’s agency’ by advocating physical and emotional distance from the perpetrator; building child awareness of family violence; supporting the modelling of safety in trusted relationships and demystifying family resiliency. The ‘model of children’s agency’ and the ‘informed trialogue’ bring children’s voices to the fore to inform primary care and those that work with children experiencing family violence.