Screening for domestic abuse in all its forms -- physical, psychological, financial and sexual -- is vital, say women's protection advocates. But, they add, no health care professional should screen for domestic violence without learning how to do so safely.
Family physicians have numerous resources to help them respond to domestic violence. Among them: their states' domestic violence prevention coalitions. For a list of the state coalitions, their telephone and fax numbers, addresses and Web sites, visit "Get Help in Your State."
Equally valuable is the Family Violence Prevention Fund's National Health Resource Center on Domestic Violence. The fund's Web site includes the National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings (98 pages / 3.92 MB. More information about PDF files), free technical assistance, a health care professionals' resource manual for responding to domestic violence, and information about model domestic violence prevention programs across the country.
Among protection advocates' tips:
- Watch for inconsistencies between injury pattern and patient's story; notice behavioral clues such as reluctance to speak in front of partner.
- Be prepared with nonjudgmental responses to affirmative screening; many domestic violence prevention coalitions provide scripts for screening and responding to patients' situations.
- Determine whether an abused woman is in imminent danger; if so, implement urgent intervention. If she needs information or literature, ensure she can safely hide it -- often in the sole of her shoe or in feminine hygiene products -- so her abuser won't find it.
- Become familiar with your state's family law. Not all states have mandated reporting laws for health care providers. You may need the patient's permission to call the police.
- Don't recommend marriage counseling for couples. "It's not a marriage problem," said Aimee Patton of Safehome in Overland Park, Kan. "Marriage counseling gives the woman a sense of false security, and she may tell all. But in abusive situations, the rules change every day, and what may have been OK to talk about last week is no longer OK this week. And he'll take it out on her when they get home."
- Document the woman's story verbatim; diagram the injuries on a body chart if available.
Correctly code and document your domestic violence encounters. Download "Coding and Documentation of Domestic Violence" (21 pages / 76 KB. More information about PDFs) by the Family Violence Prevention Fund.
