Coroner's Finding: May, Kunmanara

Contributing factors

• failure by police to document and investigate domestic violence reports
• lack of police training and experience in family violence
• inadequate inter-agency information sharing
• ineffective Family Safety Framework meetings
• staffing and resource shortages in child protection
• cultural reluctance to involve police in Aboriginal communities
• victim's fear of child removal deterring disclosure
• lack of perpetrator accountability and intervention

Coroner's recommendations

1. Await outcomes of South Australian Royal Commission into Domestic, Family and Sexual Violence before determining specific reforms, given breadth of issues to be examined
2. Consultation with service providers and Yalata Community to determine appropriate model for crisis care facility for domestic violence victims in the community
3. Thorough analysis of perpetrator services currently available to those in Aboriginal communities including Yalata; consideration of expansion of Cross Borders Indigenous Family Violence Program
4. Continuation of specialised risk assessment and safety management training for Family Safety Framework referrers and meeting representatives on an ongoing basis with dedicated funding