Family violence is a major global public health issue (United Nations, 2022). New Zealand has high rates of family violence, with one-in-three women experiencing family violence in their lifetime (Organisation for Economic Co-Operation and Development, 2019; Fanslow et al, 2021). Family violence takes many forms including intimate partner violence, child abuse and elder abuse (Family Violence Act 2018). Although not officially listed as a form of family violence, pets or animals can also be abused. International research over the last 40 years recognises that the abuse of animals is linked with violence in families (Ascione et al, 2007; Krienert et al, 2012; Newberry, 2017). New Zealand research identifies the coexistence of family violence and the abuse of animals, and recognises complexity of the problem (Roguski, 2012; Jury et al, 2018). Family violence is a multi-factorial issue that intersects with gender, race, financial status and has its basis in power, coercion and control (Lloyd, 2013). From a veterinary perspective, coercion and control within families can result in the abuse of animals (Roguski, 2012). The effects of family violence are far-reaching and multi-generational, affecting the educational and healthcare systems, the families of victims, communities and the welfare of both companion animals and rural animals (Hassall and Fanslow, 2006; Are You OK, 2017; McEwen, 2017).
The association between animal abuse and family violence presents an opportunity to address family violence within animal healthcare services (Arkow, 2015; Monsalve et al, 2017). Veterinary professionals are well-placed to recognise signs of family violence, which can manifest as animal abuse and neglect (Newland et al, 2019). In response, a human healthcare model of offering support for victims can be adapted for application in veterinary practice (Arkow, 2015).
To be able to respond to victims of violence in a meaningful way, veterinary professionals need to feel comfortable discussing concerns about animal abuse and potential family violence with tact and respect (Newland et al, 2019). Ideally, veterinary professionals would be educated regarding the complexities of the links between animal abuse and family violence and therefore have the skills to respond. Appropriate responses include offering victims support and referral to specialist family violence agencies (Arkow, 2015). Veterinary professionals need confidence to broach the subject with clients as a first step. This article reports on the results of a survey of New Zealand veterinary professionals which aimed to identify the barriers they faced when working with suspected cases of animal abuse and family violence. The purpose of the study and subsequent data analysis was to inform the development of an educational workshop for veterinary professionals.
Methods
This study used a mixed method cross-sectional design on a convenience sample of veterinary nurses and veterinarians recruited through the New Zealand Veterinary Nursing Association and the New Zealand Veterinary Association. Participants were invited to complete a survey sent as a link in membership email bulletins. The survey was adapted with permission from Baird et al's (2015) domestic violence knowledge survey used with Australian midwives. At the time of the study, there were approximately 2500 members of the New Zealand Veterinary Association, and 1300 New Zealand Veterinary Nursing Association members. The survey was open from 8 May to 5 June 2020. The link opened with an information sheet and electronic consent page. To maximise reach, the survey was also distributed via veterinary interest groups on social media (New Zealand Veterinary Association and New Zealand Veterinary Nursing Association Facebook pages). Ethical approval was obtained from Otago Polytechnic Research Ethics Committee (Application No: 52).
Demographics
The online survey included questions about demographic details, experience, and practice-based knowledge of the links between animal abuse and family violence. Participants indicated their level of confidence in discussing family violence on 4-point Likert scales (1 = ‘I don't feel confident’ to 4 = ‘very confident’). Simple descriptive statistics report on quantitative data. When a lack of confidence was indicated, participants were asked to comment on barriers to discussing family violence. Comments were thematically analysed using Braun and Clarke's (2006) six phase process explained as ‘a method for identifying, analysing, and reporting patterns (themes) within data’ (Braun and Clarke, 2006). The systematic process involves data familiarization, development of codes, construction of themes from the coding, reviewing themes, finalizing, and naming themes and reporting on themes. The demographics of survey respondents is shown in Table 1.
Table 1. Demographics of survey respondents
| Veterinary nurse | Veterinarian | |||
|---|---|---|---|---|
| n | % | n | % | |
| Gender | ||||
| Female | 114 | 82 | 19 | 14 |
| Male | 3 | 2 | 2 | 1 |
| Age | ||||
| 20–29 | 49 | 41 | 3 | 14 |
| 30–39 | 23 | 24 | 7 | 33 |
| 40–49 | 28 | 23 | 6 | 29 |
| 50–59 | 14 | 12 | 4 | 19 |
| 70+ | 0 | 0 | 1 | 5 |
| Years in practice | ||||
| 0–4 | 41 | 35 | 4 | 19 |
| 5–9 | 35 | 30 | 1 | 5 |
| 10–14 | 17 | 15 | 9 | 43 |
| 15–19 | 16 | 14 | 1 | 5 |
| 20 + | 7 | 6 | 6 | 28 |
| Current area of practice | ||||
| Companion animal | 67 | 57 | 16 | 76 |
| Mixed | 47 | 40 | 5 | 24 |
| Production animal | 2 | 2 | 0 | 0 |
| Animal shelter | 2 | 2 | 0 | 0 |
| Equine | 1 | 1 | 0 | 0 |
Results
The results demonstrated low levels of confidence in discussing family violence with clients across both groups. Three quarters of veterinary nurse respondents and 64% of veterinarians said they ‘don't feel confident’ broaching the topic with clients (Figure 1). Participants then described the barriers to discussing family violence.
Barriers to discussing family violence with clients
Thematic analysis identified five themes related to barriers to discussing family violence with clients. Participant comments are embedded to show the findings with the participants professional status identified as VN – veterinary nurse or Vet – veterinarian, in parentheses.
1. Lack of knowledge
The first theme highlighted that the veterinary professionals recognised that they had lack of knowledge on how to approach the situation (VN). Participants felt that broaching the subject of family violence with a client would be difficult because they had very little education on the topic (VN). Participants identified ‘lack of training’ about the links between animal abuse and family violence as a barrier to discussion with one respondent saying:
‘I haven't had any training with it, so I don't feel I have the skills to approach the subject with clients.’
(VN)
Some participants felt they did not know ‘how to help’ in terms of not knowing the support they can offer or agencies that can assist and provide help (VN). Participants felt that without the tools to adequately tackle the issue (VN), discussing family violence with an at-risk client would be out of the realms of their training and expertise (VN).
The survey respondents identified significant ‘barriers to approach’ with a lack of knowledge on how to approach the situation (VN) expressed. They had concerns about talking to clients about this sensitive topic (VN). Their recognition of the complexity of the subject was clear, ‘it's a very complicated and delicate matter and I have no training’. Participants comments along the line of ‘I don't feel I have the skills to manage that conversation’ (Vet) were common.
2. Professional boundaries
Theme two highlighted the lack of clarity regarding the veterinary professional's legal and professional standing in managing links cases. When discussing boundaries and responsibilities many indicated discomfort. Quotes included, ‘it almost seems a leap too far to feel like you can professionally extend your scope of practice to target family violence’ (VN), and, ‘I'm unsure that it's my jurisdiction’ (Vet).
The concerns related to ‘not my place’ centered around scope of practice. The participants felt their responsibilities regarding intervention in family violence related to animal abuse were ambiguous. Participants felt they would be crossing a line with clients (VN) or overstepping professional boundaries (VN). They recognised that the roles of animal health and welfare professionals, and of human health and welfare professionals are distinct, ‘I am not a social worker’ (Vet), and that the two realms are separate – clients come seeking help for their pet, not their personal affairs (VN).
Worry about overstepping boundaries in practice and upsetting veterinary clinic management, dragging my workplace into something (VN), was evident, particularly in the VN group:
‘You could get into a lot of trouble by going about things the wrong way. I feel my clinic would not want to get involved.’
(VN)
‘Legal concerns’ related to professional boundaries highlighted specific worries about confidentiality. These were general in the VN group, for example, ‘I don't know my legal rights to intervene’ (VN). The veterinarians, with their professional obligation to abide by the Veterinary Council of New Zealand's code of professional conduct were explicit in their concerns regarding confidentiality and privacy. Their barriers to discussing concerns about family violence with clients included being:
Unsure of making the situation worse, of legal requirements and limits with regards to privacy.
(Vet)
Another participant had concerns regarding client confidentiality (Vet).
As evidenced in the participants words, there was concern regarding the understanding of, and application of, professional boundaries regarding suspected animal abuse and family violence.
The Veterinary Council of New Zealand provides clarity for veterinary professionals in their pamphlet (2013). However, this study found that awareness of the guidance was limited, with more than half of veterinarian respondents, and 85% of veterinary nurses, reporting never having heard of the publication (Figure 2).
3. Uncertainty
The third theme identified as a barrier to family violence communications centered around uncertainty (VN). Participants were concerned about misinterpreting signs (Vet) and making the assumption that there is family violence is happening in their household (VN). Some participants expressed uncertainty about their ability to identify where discussing family violence with clients would be appropriate, with one stating ‘it's very personal and a huge assumption has to be made’ (VN).
With reservations about making assumptions evident, the participants were ‘Not wanting to cause offence’, expressed as the fear of making a mistake and offending a client (Vet). This emerged as a significant barrier, with doubts centered around the possibility of getting it wrong and offending someone (VN) in both groups.
4. Fear of harm
Theme four drew attention to the fear that the veterinary professionals felt where there is abuse and potential for violence in practice. Participants were worried about causing the victim further harm or distress, essentially ‘making matters worse’. They were aware of their limitations in the situation disclosing the following concerns:
‘Actually causing an escalation in the violence and putting the family at more risk by becoming involved without the skills/knowledge to be effective.’
(VN)
The veterinary professionals were mindful of the risk of violence in general with one participant concerned:
‘That the client thinks I'm interfering or is afraid of repercussions if he/she talks to someone about the violence.’
(VN)
‘Fear of violence’ was apparent in the comments, and concerns regarding personal safety (Vet) and for the risk to staff (VN) (their colleagues in the practice), were notable. Some participants were frightened of threats and violence as evident in the following quotes: ‘Retaliation/violence against self, other staff on premises from person committing the violence’ (VN), and another of ‘aggressive clients threatening me’ (Vet).
5. Practice logistics
The fifth and final theme that emerged related to logistical matters. The veterinary clinic is a busy environment and the comments revealed that time pressure was a barrier. The length of consultations (VN) was identified as a particular issue. One participant admitted to time constraints by stating ‘not having time during a busy day to address it properly’ (Vet).
Lack of privacy was also highlighted, with multiple respondents mentioning privacy. Lack of appropriate facilities (VN) was identified, along with more than one family member being present in veterinary consultations. This caused concerns around identifying the abuser with participants stating: ‘Multiple family members present (abuser may be present), nowhere private to discuss this’ (VN), and recognition that it is difficult to try to get suspected victim away from suspected perpetrator: ‘Hard to get clients on their own away from the potential person causing abuse’ (VN).
Discussion
The findings confirm the results of previous studies that responding to family violence where it presents as animal abuse is a difficult issue for veterinary professionals (Williams et al, 2008; Arkow, 2015; Newland et al, 2019). Arkow (2015) detailed five steps undertaken in human healthcare towards building a helpful response and recommended a similar course of action for the veterinary profession. The themes identified in the survey respondents' comments align with Arkow's (2015) recommendations, confirming their relevance. By advancing these steps; building awareness, assisting professionals to resolve ethical dilemmas, providing guarantees of legal protection, training veterinary professionals in identification of clinical indicators of abuse and developing protocols for responses, the veterinary profession can improve its response to abuse and violence presenting in practice.
The survey results show that members of the veterinary profession in New Zealand are broadly aware of the links between animal abuse and family violence (Williams et al, 2008); however, despite recognition of the role of veterinarians in the intervention of the cycle of violence, there is limited education for them on responding to cases in practice (Newland et al, 2019). The Veterinary Council of New Zealand guidance (2013) addresses the concerns raised by survey participants and fits with Arkow's (2015) recommendations. With limited awareness of the pamphlet demonstrated in the survey results, bringing this publication out into the light is a priority in improving veterinary professionals' confidence in responding to victims of violence, and their animals.
Guidance for veterinarians dealing with cases of suspected or actual abuse and family violence
The guidance, and the agencies it promotes, provide advice with ethical questions. Within its pages, the Veterinary Council provide clarity for veterinarians on their legal standing with regards to sharing client information with agencies such as New Zealand Police and Oranga Tamariki (child protection services). The guidance contains flow charts to follow in cases of animal abuse, and where there are suspected, or actual, links to family violence. With a clear protocol for responding to cases of abuse published by the New Zealand veterinary profession's regulatory council, veterinary professionals can be confident that by following the guidance they will be legally protected when responding to cases in practice.
The document outlines specific indicators of abuse, both animal and human. It addresses signs of abuse in children, adults and elders. The provision of training in identifying clinical indicators of abuse would further equip New Zealand's veterinary professionals to respond to victims of violence where they present in veterinary practice.
The New Zealand government's family violence management framework calls for a coordinated, multiagency approach to screening, assessing and managing risk (New Zealand Ministry of Justice, 2017). Training practitioners in the community is a key aspect of this initiative. In a recent review of the literature, Newland et al (2019) identified a need for ‘improved veterinary education programmes addressing the link between pet abuse and family violence’. This survey identifies the key aspects to focus training of veterinary professionals. As the first phase of a study, it provided valuable information to guide the development of phase two – an educational workshop for veterinary professionals on responding to cases in practice.
Table 2 provides further information on support for veterinary professionals.
Table 2. Further information and support for veterinary workers
| United Kingdom | The Links Group works to raise awareness of the connection between the abuse of people and animals by providing support, training, and promoting collaboration among different agencies. |
| New Zealand | The Veterinary Council of New Zealand has published specific guidance for dealing with cases of suspected or actual animal abuse and family violence. |
| Australia | The Animal Welfare League Australia provides resources and support for professionals involved in animal welfare. Members of the Veterinary Nurses Council of Australia can contact them for information about the support available to them, which varies between states. |
| USA | The National Link Coalition offers resources, research and training for veterinary professionals. |
Limitations
There are some limitations to this study. Although the results refer to veterinary professionals, many more veterinary nurses completed the survey than veterinarians. However, 138 participants completed the survey overall and given it appears to be the first investigation of veterinary professionals' experience of responding to suspected family violence (in New Zealand), it provides a good starting point on which to base further research and training. Discussions regarding pet abuse and family violence are emotive topics and as such the research may have benefitted from a more personal approach through semi-structured interviews. This may be something that can be followed up in future research on the topic.
Conclusions
Overall, the results show there is work to be done to enable veterinary professionals to overcome the barriers to responding to victims of abuse where there are links to family violence in practice. Specific knowledge gaps in the topic identified by the survey respondents provided valuable information for the development and subsequent delivery of educational workshops for veterinary professionals across New Zealand. The links between animal abuse and family violence mean that an informed and helpful response to victims of family violence from veterinary professionals is required. With awareness and training, the veterinary nurse and veterinarian can become part of a multidisciplinary approach to supporting victims of family violence, and their animals, to escape abuse and live their lives fee from violence.
KEY POINTS
- Family violence is a major global public health issue and international research over the last 40 years recognises that the abuse of animals is linked with violence in families.
- Veterinary professionals are well-placed to recognise signs of family violence, which can manifest as animal abuse and neglect.
- This study found low levels of confidence in discussing family violence with clients.
- There are five main themes covering barriers to discussing family violence with clients: lack of knowledge; professional boundaries; uncertainty; fear of harm and practice logistics.