The consistent failure of initiatives aimed at addressing discrepancies between Australia's Aboriginal and non Aboriginal citizens point to a need to address responses to Aboriginal people by mainstream service providers. This practice paper draws on the experience of Aboriginal and non Aboriginal practitioners in the trauma field to consider the limitations and potential of “cultural competence” as a construct for working with Aboriginal and Torres Strait Islander peoples. Key limitations are the lack of accounting for the trauma and ongoing racism experienced by Aboriginal people, which result in isolation of communities, protection of abusers, and under-use of mainstream services by Aboriginal people. When trauma and racism are addressed, successful and respectful engagement with Aboriginal individuals and communities becomes possible and the potential of cultural competency initiatives can be realised. A three-step process for achieving this at the personal, practice, and agency levels, which has been developed in a collaboration by Aboriginal and non Aboriginal practitioners, is outlined.

Sexual violence is highly prevalent in armed conflict and other humanitarian crises and attracting increasing policy and practice attention. This systematic review aimed to canvas the extent and impact of initiatives to reduce incidence, risk and harm from sexual violence in conflict, post-conflict and other humanitarian crises, in low and middle income countries. Twenty three bibliographic databases and 26 websites were searched, covering publications from 1990 to September 2011 using database-specific keywords for sexual violence and conflict or humanitarian crisis . The 40 included studies reported on seven strategy types: i) survivor care; ii) livelihood initiatives; iii) community mobilisation; iv) personnel initiatives; v) systems and security responses; vi) legal interventions and vii) multiple component interventions. Conducted in 26 countries, the majority of interventions were offered in African countries. Despite the extensive literature on sexual violence by combatants, most interventions addressed opportunistic forms of sexual violence committed in post-conflict settings. Only one study specifically addressed the disaster setting. Actual implementation of initiatives appeared to be limited as was the quality of outcome studies. No studies prospectively measured incidence of sexual violence, although three studies provided some evidence of reductions in association with firewood distribution to reduce women's exposure, as did one program to prevent sexual exploitation and abuse by peacekeeping forces. Apparent increases to risk resulted from lack of protection, stigma and retaliation associated with interventions. Multiple-component interventions and sensitive community engagement appeared to contribute to positive outcomes. Significant obstacles prevent women seeking help following sexual violence, pointing to the need to protect anonymity and preventive strategies. This review contributes a conceptual framework for understanding the forms, settings, and interventions for conflict and crisis-related sexual violence. It points to the need for thorough implementation of initiatives that build on local capacity, while avoiding increased risk and re-traumatisation to survivors of sexual violence.

Background In conflict-affected settings, women and girls are vulnerable to gender-based violence (GBV). GBV is associated with poor long-term mental health such as anxiety, depression and post-traumatic stress disorder (PTSD). Understanding the interaction between current violence and past conflict-related violence with ongoing mental health is essential for improving mental health service provision in refugee camps. Methods Using data collected from 209 women attending GBV case management centres in the Dadaab refugee camps, Kenya, we grouped women by recent experience of GBV using latent class analysis and modelled the relationship between the groups and symptomatic scores for anxiety, depression and PTSD using linear regression. Results Women with past-year experience of intimate partner violence alone may have a higher risk of depression than women with past-year experience of non-partner violence alone (Coef. 1.68, 95% CI 0.25 to 3.11). Conflict-related violence was an important risk factor for poor mental health among women who accessed GBV services, despite time since occurrence (average time in camp was 11.5 years) and even for those with a past-year experience of GBV (Anxiety: 3.48, 1.85–5.10; Depression: 2.26, 0.51–4.02; PTSD: 6.83, 4.21–9.44). Conclusion Refugee women who experienced past-year intimate partner violence or conflict-related violence may be at increased risk of depression, anxiety or PTSD. Service providers should be aware that compared to the general refugee population, women who have experienced violence may require additional psychological support and recognise the enduring impact of violence that occurred before, during and after periods of conflict and tailor outreach and treatment services accordingly.

Routine screening for intimate partner violence (IPV) has been introduced in many health settings to improve identification and responsiveness to IPV. The debate about the level of evidence required to warrant routine screening continues. Three assumptions have impeded progress in measuring the impact of screening. The first is that routine screening is a test only which does not of itself have an impact on patients. The second is that it can be assessed by evaluating interventions provided to women after abuse is identified through screening. The third is that there can be an agreed appropriate intervention for IPV. Each of these assumptions is problematic. In addition, there are significant impediments to evaluating screening as an intervention through a randomized control trial. These include identification of the study group, isolating the control group from the intervention, ethics, lack of baseline data, and recall bias. A range of study designs is required and a rethink of assumptions is needed in researching this area.