CALD family violence case studies to reflect on

After going through this resource we leave you with some case studies so that you can think about how you would handle similar situations in your own practice.

Scenario 1: Shireen

Shireen is a migrant from Pakistan. She is 18 years old and in the second trimester of her pregnancy. She has an appointment at the ante-natal clinic because she is experiencing some light bleeding. Shireen’s sister-in-law accompanies her to the appointment and serves as an interpreter during the examination. Shireen is very quiet, and the midwife conducts a routine partner abuse screen. (Refer to DHB Partner Abuse Screening policy for maternity services).

Scenario 2: Fahima

Fahima’s husband accompanies her to a busy emergency department where she is diagnosed with a broken rib. Her medical record and stored digital photographs indicate that she came to ED with a broken nose three months ago which she claimed was the result of a fall. Her husband is very attentive and does not leave her side. Fahima has recently moved to New Zealand from Afghanistan and does not speak English. She believes that her community will shun her if she discloses the abuse. She fears her family will abandon her and that her husband will force her to return to Afghanistan. Her husband interprets for her. The doctor diagnoses her broken rib and prescribes an analgesic.

Scenario 3: Noi

Noi, a woman from Thailand looks sad and reports insomnia, a lack of appetite and a loss of interest in most areas of her life. A clinical examination reveals significant bruising on her inner thighs. The nurse identifies these injuries as possibly being caused by sexual assault and partner abuse, and promptly proceeds to screen the patient for partner abuse. Noi refuses to answer the questions. The nurse feels frustrated and gives Noi the number for the Family violence hotline. Noi does not want to take the number with her and leaves it behind in the clinical room.

Scenario 4: Safia

Safia is Fijian Indian. She is 16 years old and has been married for about six months. Her family arranged her marriage to a man in his 30’s. Safia is three months pregnant but seems to be unhappy about the prospect of being a mother. She tells the midwife that her husband screams at her and embarrasses her in front of the family. The midwife screens for partner abuse, and Safia acknowledges that her husband has hit her on two occasions. She tells the midwife that they live in the same house as her in-laws, and that her mother-in-law accuses her of being a poor wife and a bad daughter-in-law. Her mother-in-law told Safia that she deserves to be hit. Safia has not discussed the abuse with anyone from her community because she does not want to bring shame to her family.

Scenario 5: South Asian Woman - Asal

Background

Asal is a 30 year old pregnant woman who presents to hospital during her 3rd trimester seeking midwifery care. She and her husband have four other female children aged between two and 12 years old. Asal, her husband and their eldest daughter are migrants from a South Asian country who settled in New Zealand eight years ago. Asal’s husband is currently unemployed and the family struggles financially. English is their second language. This is Asal’s fourth pregnancy since arriving in New Zealand.

Current Pregnancy

Asal presented to the hospital for an ante-natal assessment during which she was screened [with an interpreter] for partner abuse and answered no to all the screening questions.

She received a pregnancy ultrasound scan and was advised that she was having a girl. Asal responded on hearing this news that she did not want another girl.

Asal did not attend any further follow-up antenatal appointments and was admitted when she went into premature labour. Her baby was born 5 weeks early.

Upon delivery, Asal refused to have contact with her baby and she discharged herself without the baby. The baby needed to remain in hospital for 5 weeks. During this time Asal did not want any contact with her baby telling nurses that this was because the baby was a girl and “she did not like her baby”. Other members of her family did not visit.

Nurses recorded in the patient’s medical record that they were concerned about the lack of emotional care that the baby was receiving from her mother and other family members.

Staff found Asal and her family difficult to engage with and to assess when they made attempts to meet the family. The staff made provision for the availability of interpreters. Ante-natal staff made the assessment that Asal was tired and overwhelmed by the birth of a fifth child and was possibly suffering from post-natal depression. A referral was made to mental health services. Mental health services had the same difficulties engaging with Asal and her family. Follow-up postnatal visits by the midwife were also difficult.

Discharge of Baby

After 5 weeks the baby was well enough to be discharged home with her parents and siblings. A discharge meeting was held with parents, an interpreter, mental health services and a well-child provider. It was felt at this meeting that there were no child protection concerns and that there were enough services involved to support the family in the community.

Re-admission of baby into hospital

After two weeks post discharge, the baby was re-admitted to hospital in a seriously malnourished and neglected state.

Child Protection Indicators and Red Flags:

During pregnancy

1. Once the baby had been identified as a girl – it appeared that this was an unwanted baby.
2. Asal did not attend follow-up antenatal appointments.

Postnatal

1. Asal did not want to hold or care for her baby directly after birth.
2. Asal discharged herself as soon as possible post delivery.
3. Asal refused to have any further contact with her baby and stated she did not like her baby.
4. The baby did not receive any skin to skin contact, nurturing, emotional connection/attachment or family involvement.
5. Health professionals were concerned about the mother’s lack of emotional attachment to her baby.
6. Asal was deemed to be suffering from postnatal depression, to be shut down and was not responsive to her baby.
7. Asal had other stressors, 4 other children to care for at home, no extended family support, financial difficulties.