HARMONY - A randomised controlled trial of a GP systems intervention for family violence experienced by South Asian migrant and refugee women and children in Melbourne, Australia..

Intervention: Practices in the intervention arm of the study will undergo specialised family violence training co-facilitated by a GP trainer and a bilingual/bicultural South Asian family violence caseworker/advocate, based with and managed by an immigrant women's domestic violence service. The training, developed with University of Melbourne Department of General Practice, will all be delivered online by a GP educator and the caseworker/advocate, for which we have RACGP accreditation, will include 3 sessions of 90 minute training (altered because of COVID) (comprising short lectures, role play simulation and discussions, delivered ~four to eight weeks apart), plus resources (including online modules, information pages and videos accessible during training and after as required), reinforced by 3 opportunities over the intervention year for a teleconference/webinar case discussion. As part of accreditation, training must be delivered in different formats for which self-access resources will be made available on the RACGP website, University of Melbourne and HARMONY websites. This RACGP site requires login to access online resources. The training will teach clinicians cultural competency to: identify family violence symptoms; ask and respond to women with indicators of family violence sensitively; develop women-centred goals appropriate to women's readiness to make changes; motivational interviewing; trauma-informed care; discuss strategies to improve safety; document both ethnicity and family violence accurately on common GP routine software (Best Practice and Medical Director); and to refer women to support services. Training also includes how to refer affected children (and abusive partners) to available services. All intervention administrative staff will be trained about patient safety and confidentiality, supportive responses and culturally safe clinic environments. In addition we train all clinic staff on entering routine ethnicity data depending on software (Medical Director or Best Practice, that covers 80% of all Australian practices) . The caseworker/advocate will continue to provide support throughout the year long intervention through: (i) weekly or fortnightly visits with intervention GP clinics for consultation and to provide feedback at clinic meetings; (ii) providing casework support (as per inTouch (Multicultural Centre Against Family Violence) standard family violence casework practice for women referred to In Touch; (iii) accurately record and feedback casework data on referral rates to intervention practices; and (iv) providing ad hoc secondary phone consultation with intervention clinicians about patient cases and referral. The training extends those developed by Kelsey Hegarty at PHCRU, University of Melbourne, in the IRIS trial of Gene Feder and colleagues at Bristol Uni, together with contributions by Angela Taft at La Trobe University and In Touch. HARMONY training however, focuses specifically on cultural safety and competency and has developed new material to this end.