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Provider Tips: How to Help Known Victims of Domestic Violence

Domestic violence symbol

1. Acknowledge and Support the Person.

When a woman affirms abuse, acknowledge that you've heard what your patient has said and you believe what you were told. Send an underlying message of concern and empathy, i.e., "No one deserves to be abused."

If time allows:

  • Let your patient tell you the story.
  • Describe the cycle of violence.
  • Reinforce the criminal nature of DV.

2. Assess Safety.

"Is it safe for you to return home?"

The decision to go home, or not to go home, must ultimately be made by the patient and respected by the physician. The patient knows the batterer; may be afraid for the safety of others, such as children, parents, or siblings. The patient may know, from prior attempts to leave, that the criminal justice system cannot really ensure safety from this individual.

If the answer is "It is not safe to return home," help by providing the number for the DV hotline from your office. (See #4 below.)

3. Assess Lethality.

The following question are targeted at identifying risk factors for lethal violence.

  • "Are there weapons in the house?"
  • "Does your partner abuse alcohol or drugs?"
  • "Has your partner ever hit you while you were pregnant?" "Is your partner violent outside the home?"
  • "Does your partner assault or mutilate the family pets?"
  • "Is your partner obsessive or jealous about you and the relationship with you? Does your partner try and control your daily activities?"
  • "Has the violence increased in frequency and severity over the past year?"
  • "Have you ever been afraid you might die while the batterer was attacking you?"
Counsel the patient who answers "Yes" to the above questions about the added danger to the patient and children.

4. Provide resource information and develop a safety plan.

"Do you have a plan if it happens again?" Help her to think about a personal safety plan:

Link to The National Center for Victims of Crime:

Domestic Violence Safety Plan Guidelines http://www.ncvc.org/infolink/INFO15.htm

Provide Number for the National Domestic Violence Hotline:

1-800-799-SAFE (7233)
or
In Washington State
1-800-562-6025

It may be necessary for your patient to hide this number in a discrete place.

5. Documentation.

Documentation will be important in the future for criminal, divorce or child custody hearings.

Include in the chart:

  • Date, time, place of incident.
  • Identity of the assailant.
  • Mechanism of injury.
  • Describe all injuries, new and older using a body map.
  • Photograph injuries if patient permits.
  • Document that resource material was provided.

Arrange a follow-up visit to address the DV issue again

It is often difficult to accept that some battered women will return to an abusive situation. On average the victim will try six or seven times before leaving permanently. You must respect the patient's right to find a solution to a difficult and painful problem. Your job is to provide information, emotional support and resources.

Useful Web Sites for Clinical Practice

http://www.sfms.org/brochure.html
"Domestic Violence: A Practical Approach for Clinicians" provided by the San Francisco Medical Society developed with Family Violence Prevention Fund, 1996, and American Medical Association, 1992.
http://www.acep.org/library/index.cfm/id/442
Domestic violence resources available on the American College of Emergency Physician's web site, ACEP Online. The ACEP is a national medical society representing over 19,000 specialists in emergency medicine.
http://www.4woman.gov/search/
The National Women's Health Information Center search page--search under "domestic violence."

Useful Web Sites for Working with a Multicultural Population

http://www.cdc.gov/ncipc/factsheets/natamer.htm
CDC's American Indian/Alaska Natives and Intimate Partner Violence factsheet.

Compiled by
Aileen MacLaren, CNM, Ph.D.
Assistant Professor
Director, Nurse Midwifery Program
Family and Child Nursing
School of Nursing
University of Washington

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