KEY POINTS:
Plunket will keep its rule that all mothers be questioned about family violence despite a finding that many nurses are too scared to ask such questions in some poorer households.
The Plunket Society, which cares for 90 per cent of babies, has pioneered questions about family violence in advance of an $11 million national programme to cover all women and caregivers of children attending public hospitals, which was launched at Parliament yesterday.
Plunket has required nurses to question mothers on the issue since 2003. Some 29,000 mothers have been asked such questions, with the result that 600 of them have been referred to women's refuges or other agencies.
But an evaluation by the Auckland University of Technology has found:
* Documented evidence of family violence screening in baby records varied widely between 30 per cent and 80 per cent in different regions, with an average of 64 per cent. Only 6 per cent of mothers disclosed family violence.
* Two out of four mothers did not realise they had been asked about family violence "indicating that some staff may not be asking the screening question in an effective, direct manner".
* Plunket nurses in the three poorest areas felt "scared for their own safety and the safety of their clients" if they asked the question.
* Some nurses did not ask because they felt they did not have time to help if the mother admitted being abused.
One nurse in a poorer area said the hardest part was telling a mother that if she disclosed abuse the nurse might have to talk to someone about it.
"You're scared to tell them because that is the end of your relationship with them and I find it hard and scary," she said. "Luckily, you get out of the house before something happens to you."
However, another nurse who took part in yesterday's launch at Parliament, Charlotte Leslie, said she had now asked hundreds of mothers about violence without any bad effects.
Five or six mothers had told her they were being abused. In most cases, they were already in touch with support agencies but, in one case, the mother did not know anyone could help and Ms Leslie was able to give her contacts.
She asked mothers a direct question such as: "Do you feel safe in your home?"
Usually she asked the question on her first home visit when the baby was four to five weeks old, along with other standard questions such as the name of the family doctor.
"Sometimes, it might be a couple of visits before you can ask the question if there is another adult or children present," she said. "So there is the odd case where you never ask it because there is always someone else there."
Plunket's national clinical adviser, Brenda Hynes, said asking about violence was "a huge culture change for the nurses" and the evaluation showed there was still "work to do around things like safety plans".
But Plunket would keep asking the question because simply talking about violence could help mothers to recognise what was happening and do something about it.
"We've had instances where the mother went back to the nurse the next day and said, 'You know you asked me ... '," she said.
"What we have done, no matter what deprivation area it's in, is that we have opened the door so when they are ready to do something they can."
Twins' death shifts attitudes
The deaths of 3-month-old Mangere twins Chris and Cru Kahui last year has made it easier for Plunket nurses to ask mothers about family violence.
An Auckland University of Technology evaluation of Plunket's family violence screening says nurses felt the media focus on the case and subsequent coverage of family violence "enhanced their ability to discuss family violence with clients".
"When it's just happened in the media, that high profile is a good opportunity to revisit it again with your clients because they are thinking about it," one nurse said.
Another said: "After the Kahui twins it was real easy to talk to people."
But a nurse in one location had a different experience, saying: "After the Kahui twins, it's a little bit hard. They look at us as pokey noses."
