respond to intimate partner violence in your medical practice
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Intimate Partner Violence In Your Practice
By
Ellen Taliaferro, MDMedical Director
Keller Center for Family Violence Intervention
San Mateo Medical CenterSan Mateo, CA
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What’s in a name?
Old terms: battered wife and abused women IPV is the CDC preferred term for domestic
violence Domestic Violence preferred term legal
community Intimate relationship abuse captures health
assessment needs
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Objectives:
Detecting IPV Complying with CA mandated reporting laws Responding to IPV on the spot
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History: inconsistent, vague, or changing Delay in seeking care or cancelled
appointments Hovering husband Suggestive trauma patterns
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Mental Health problems: depression, PTSD, eating disorders, anxiety, drug or alcohol abuse
Numerous STD’s, including HIV Multiple problems associated with
strangulation assault (23% of physical assaults)
Nonspecific medical problems
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Environmental: posters, HITS screening tool, computer kiosk in waiting room
Forms and questionnaires Ask the question
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Time Management
Negative screen: 10 seconds Positive (non-urgent) screen: 2-3 minutes
✂Rapid Assessment, Information, Schedule Follow-up
Positive (urgent )screen: 10-12 minutes ✂Rapid Assessment, Action Plan
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Three Outcomes of Screening
There is no IPV in your patient’s life--85% no action needed
Screening reveals past or current IPV but situation stable--14%: 2 to 3 minutes needed to determine safety and make appointment to focus on the problem
IPV present and an emergency--1%: response equivalent to a resuscitation
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• Any health practitioner, who provides medical services for a physical condition to a patient whom he or she knows or reasonably suspects of suffering from injuries resulting from a firearm or assaultive or abusive conduct, is required to make a report.
• If several health practitioners are involved in the care of the patient, only one needs to submit a report.
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Health care providers are required to make a report if they provide medical services to a patient whom they suspect is suffering from a physical injury due to a firearm or assaultive or abusive conduct.
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• A telephone report must be made immediately or as soon as practically possible, and a written report must be sent within two working days
• Inform the patient that by law you must report the incident to law enforcement
• Work with advocates and authorities to implement a process for responding to reports that enhance safety and autonomy
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Duty to report: injury + reasonable suspicion Immunity Liability◦ Civil: A physician who treats a victim and does not inquire
about domestic abuse or accepts an unlikely explanation for the injury could be held liable if the victim returns to the abuser and is injured again. ◦ Criminal: A violation of this reporting law is a
misdemeanor punishable by imprisonment in the county jail not exceeding 6 months, or by a fine not exceeding $1,000, or both.
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Assess patient safety Therapeutic messages to reassure the
patient Manage patient and refer to proper
specialists and services when indicated Document your findings, the care rendered,
and referrals
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Conduct a safety assessment Immediate referral to in-house services or a
local agency to set up a safety plan Key goal: have a safety plan in place before
your patient leaves your office
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1.Throwing things, punching the wall2.Pushing, shoving, grabbing, throwing things
at the victim3.Slapping with an open hand4.Kicking, biting
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1.Hitting with closed fists2.Attempted strangulation3.Beating up (pinned to the wall, repeated
kicks, punches)4.Threatening with a weapon5.Assault with a weapon
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Ask two questions:◦ When did this happen?◦ How has this impacted your life?
Listen Assure Refer or reschedule
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