Family Refuge Center 117 E. Washington Street P. O. Box 249 Lewisburg, WV 24901 304-645-6334 or Toll Free 866-645-6334 Pocahontas County dial: 799-4400 Monroe County dial: 772-5005 frc@familyrefugecenter.com

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PRACTICAL IDEAS ABOUT
HOW TO HELP

Someone you suspect
is a victim of

Domestic Violence

~ A guide for health practitioners ~

FOR MORE INFORMATION, CALL
THE FAMILY REFUGE CENTER AT
(304) 645-6334 OR (866) 645-6334

• Validate and offer support - sometimes that's all that's needed
• Know local resources, shelter location, magistrate numbers, etc.
• Know how to safety plan if she is in danger - or get someone who can
• Repeat Sara Buel suggestions:
  1. "I'm concerned for you and the safety of your children.
  2. The abuse always gets worse.
  3. I'm here for you when you're ready.
  4. You deserve better than this".
• Establish THEN FOLLOW a DV protocol. This should contain a mechanism on how to routinize inquiry about abuse and the item(s) should be placed on routine assessment tools.
• Write thorough, objective medical reports about violent incidents in the patient's own words (e.g. "my husband hit me with a ball bat" rather than "patient alleges abuse"). Medical records stand alone in misdemeanor cases in WV and you won't need to go to court to defend the medical record.
• With patient's permission, take pictures of injuries/trauma. (Be sure to include 1 of face, her name, date, and your name)
• Follow-up appointments decrease isolation and give support

During a November, 1995 conference, Dr. Ann Flitcraft, M.D. offered 3 clinical intervention strategies providers can use to assist victims in their practice. These are:

1. IDENTIFY/ACKNOWLEDGE - that the patient's abusive situation at home is a health care problem. It is not something for only the legal community to deal with. It is ridiculous to stabilize a gunshot wound without talking about how it was inflicted. Likewise it is inappropriate to prescribe with out an understanding of how the patient is treated at home.

2. PROVIDE MEDICAL CARE IN THE CONTEXT OF THE VIOLENCE - if a woman has a spinal cord injury from being thrown off a roof, she did not have an "accident". Be supportive and respectful. Don't minimize. Being able to discuss the abuse is part of the healing process. Ask supportive, non-judgmental questions, and call it what it is.

3. ALWAYS CONSIDER SAFETY - Before the patient leaves the office, address the 3 issues of injury, isolation, and fear. With respect to injury, find out if there are weapons in the home and if injuries are more frequent/severe. With respect to isolation, find out how many people (other than the abuser) the woman sees daily. Discuss outside activities, where she goes, who she sees, etc. Finally, discuss fear. The greater the fear, isolation, and injuries, the greater the level of danger.

Health Privacy Principles for Protecting Victims of Domestic Violence
This information was taken from an article at http://www.fvpf.org

Guiding Principle: All policy, protocol, and practice surrounding the use and disclosure of health information regarding victims of domestic violence should respect patient autonomy and confidentiality and serve to improve the safety and health status of victims of domestic violence.

Specific Principles:

1. De-identified information: Personal identifiers should be removed, to the fullest extent possible, before information is used or disclosed.
2. Safeguards: Health care organizations should implement security safeguards to prevent unauthorized access to health information.
3. Patient Access: An individual should have the right to access, correct, amend, and supplement her or his own health information.
4. Notice: Individuals should receive notice of how health information is used and disclosed.
5. Patient Authorization: Identifiable health information should not be disclosed without patient authorization (including minors).
6. Provider Discretion: Health care professionals should have broad discretion to withhold information from third parties when disclosure could harm the patient who is the subject of the information.
7. Alternative Address: A victim should be permitted to provide alternative contact information for billing and communications.
8. Warrants and Court Orders: Health information should not be disclosed to law enforcement personnel without a warrant or court order and only relevant information should be disclosed in civil proceedings.
9. Mandatory Reporting: Mandatory reporting and other laws specifically related to domestic violence should be examined and amended as necessary to address privacy.
10. Chain of Trust: Privacy protections should follow the data.
11. Penalties: Strong and effective remedies for violations of privacy protections should be established.

     

Domestic Violence Interventions for Medical Personnel

Create a Climate:

• Establish a safe and secure environment. Ensure confidentiality, informed consent and patient autonomy. Provide privacy; never ask about abuse in front of family or household members.
• Display posters, brochures, and publications on domestic violence in examining rooms as well as in waiting room.
• Develop knowledge of local domestic violence programs.

Routine Screenings:

• "Because abuse and violence have become so common, I routinely ask all my patients about this problem." Institute routine screening on all patients *JCAHO Standards.
• Interview in private.
• Be alert for subtle signs as well as red flags.
• Inquire in a sensitive, respectful, non-judgmental manner.
• Take complete history - Presenting problem or chief complaint. Review previous and current charts. Patient's appearance and demeanor. Relevant medical, sexual, social, and medication history.
• Don't judge patient (or yourself) by patient's response to you. A victim of abuse will take steps to leave when they have the strength and support to do so.
• Health provider role is to provide medical care, acknowledge and validate the home situation as being abusive, offer options and referrals to local domestic violence program.

Intervene by Building Trust and Providing Support

• Listen actively, non-judgmentally, with respect.
• Assure concern for health and welfare. Assess for potential danger and develop a safety plan.
• If patient is not ready to acknowledge fears, abuse, or ask for help; you could say:
  1. I am afraid for your safety.
  2. I am afraid for the safety of your children.
  3. It will only get worse. Violence increases in seriousness over time without some type of intervention.
  4. I am here for you when you are ready to leave. We also have a local domestic violence program, which can help you plan to leave safely.
  5. You deserve better than this. No one deserves to be treated this way.

Document Injury and Symptoms Records should include:

• Patient's history and statements.
• Description and location of injuries (use body map).
• Physical examinations (symptoms and clinical findings).
• Diagnostic procedures, including lab and x-ray.
• Photographs of injuries with consent form and time, date and name of photographer.
• Community consultations and resource referrals.

Referral to Local Resources

• Contact your local domestic violence agency for information, brochures, posters and services provided. They often can provide an in-service training for your staff. All people in your offices should know and be able to refer domestic violence victims to local resources in case you are unavailable
• Check out other resources such as National Domestic Violence Hotline 1-800-799-SAFE(7233)
• Family Violence Prevention Fund at www.fvpf.org

 

DOMESTIC VIOLENCE HEALTH STATISTICS

SCOPE OF THE PROBLEM

1. 8 million women are physically, sexually, or emotionally abused annually in the U.S. (AMA)

2. Battering is the #1 cause of injury to women in the U.S. It accounts for more injury to women than rapes, muggings, and car accidents combined. (AMA)

3. 50% of all women seen in medical practices in the U.S. will receive at least 1 serious beating from a partner or spouse in her lifetime. (AMA)

4. The average victim of DV will be physically abused 3 times per year. (AMA)

5. The National Crime Survey reports that DV is associated with: 30,000 ER visits, 40,000 physician visits, 21,000 hospitalizations, and more than 100,000 days of hospitalization time per year (Moss & Taylor)

6. The total annual health care costs of DV are estimated at $44,393,700.00 (Moss & Taylor)

7. 20-45% of all injuries seen in ERs are the result of DV (Flitcraft)

8. 2/3 of all women who are murdered die as a result of DV (Flitcraft)

9. Battered women are given 3 times more psychotropic meds, pain pills, and tranquilizers than their non-battered counterparts (Moss & Taylor)

10. Of battered women who seek medical treatment, only 1 in 10 is identified as a battered woman by the ER physician/nurse. For primary care clinics, the number stands at 1 in 20 (Sassetti)

11. Only 1 in 25 women who are battered seek medical treatment immediately following a violence incident (Sassetti)

12. 25-45% of all women who are battered are battered during pregnancy (March of Dimes)

13. In 1995, on average, 2.3 victims were murdered per month in WV. The total number of shelter nights provided in WV that year was 18,665 (WVCADV)

14. These figures are markedly low & do not provide accurate statistics.

Personalized safty plan for the abused
A print ready page that lists steps and items to prepare in case a speedy escape is required.

For more information:

	Family Refuge Center 117 E. Washington Street P. O. Box 249 Lewisburg, WV 24901 304-645-6334 or Toll Free 866-645-6334 Pocahontas County dial: 799-4400 Monroe County dial: 772-5005 frc@familyrefugecenter.com
We can not guarantee your confidentiality or safety if you use the internet to contact us. Someone may be able to access or read e-mail to us or you. Please call or write if you need total secrecy

This page has been accessed times since July 31, 2000.

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This page was created Nov 28,1997