Domestic Violence Assessment Mackenzie Humberger Who should be
Domestic Violence Assessment Mackenzie Humberger
Who should be screened? “Patients should be screened for current and lifetime exposure to Intimate Partner Violence (IPV) and victimization including direct questions about physical, emotional, and sexual abuse. ” ● All adolescent and adult patients, as well as the parents caregivers of children in pediatric care ● All patients, regardless of cultural background or language barriers ● The majority of IPV perpetrators are male, so screenings all patients increases the likelihood of screening perpetrators ● Health care providers learn that their responses to lesbian, gay, transgender, bisexual and heterosexual victims is critical
Violence Indicators Common Complaints ● ● ● Indication of having been hurt physically, sexually, and/or emotionally Unexplained injuries or injuries inconsistent with history given Chronic pain syndrome, migraine headaches overdose/suicide attempts Anxiety, depression, insomnia, multiple somatic complaints Red Flags in Medical History ● ● ● Any old unexplained injuries Delay in seeking care High stress in family Documented history of family violence drug/alcohol addiction (Partner and/or patient) Red Flags of Patient Presentation ● ● ● Partner answers questions for patient Partner refuses to leave patient alone Patient presents with injuries and appears depressed Patient is evasive/guarded Patient has financial concerns
Violence Indicators (Con’t) Physical Findings ● ● ● ● Injuries to areas not prone to hurt by falls Symmetrical injuries bites/burns Black eyes Neck injury Mid arm injuries (defensive) Internal injuries Weapon injuries or marks Screening MUST be done in a private area with no one other than the patient and children under the age of three present
Denial of Abuse What to do if a patient says “no”: ● ● ● Respect his/her response Let the patient know that you are available should the situation ever change Display information and resources in exam and waiting rooms; or bathrooms Assess again at regular intervals as an indication that it is sake to disclose to you If patient says “no” but you believe she/he may be at risk, discuss the specific risk factors and offer information and resources
Abuse Identified If a patient discloses that they are currently being abused, at a minimum their immediate safety should be assessed. This can include asking: ● ● ● Are you in immediate danger? Is your partner in the facility now? Has the violence escalated or gotten worse over the past year? Has your partner threaten to kill you or children? Does your partner have access to guns or other deadly weapons? If the patient answers yes to any of these, encourage her/him to speak with a domestic violence advocate to develop a safety plan.
Remember When Responding… Empathy “I believe you and I am sorry this happened to you. ” Generalize “This happens to many people, and we often feel alone with it. ” Linking to Resources Empowerment “I believe you know what is best for you (and your children). I have information that can be helpful now and later. ” Autonomy Confidentiality Explain the limits of Resist with being confidentiality. directive (ie. “You should” “You need to. ” Adults vs. Teens “What would be helpful right now? ” “I want to give you the number to the National Domestic Violence Hotline, and the number to the local program…”
Documentation Written Documentation Document the results on the initial screening. If abuse is denied, but health care provider suspects abuse, document the suspicions and validate with objective observations that the injuries are inconsistent with patient explanation. Photo-Documentation With the patient’s permission, a physician, nurse, or other appropriate professional may take photos of any visible injury
Example Screening Document for Males
Example Screening Document for Females
Example of a Validated Abuse Assessment
Safety Plan Activity Every survivor should have access to a personalized safety plan developed with an advocate. Create a safety plan including the categories listed below. When finished, share with other groups to compare and contrast your plans. Physical Safety General Technology (Cell Phones) Technology (Internet) Keeping Children Safe Work
The 4 W’s During Screening: ● ● What happened? When did it happen? Where did it happen? Who did this? *Ask direct questions about domestic violence in the home or relationship; however do not force clients to disclose information*
Guide for Response (What should you do? ) Entry Point Screening Assessment Intervention Referral & Follow Up Documentation
References The Ohio Domestic Violence Protocol for Healthcare Providers: Standards of Care Center For Relationship Abuse Awareness. Community Education & Training. How to Screen You Clients or Domestic Violence
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