July 2015
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Recommended Courses*

  • Detecting Domestic Violence
    • Counseling: #611914
    • Social Work: #69514
  • Intimate Partner (Domestic) Violence: Assessment and Treatment
    • Nursing: #37915
    • Physician: #21415
    • Counseling: #610314
  • Intimate Partner (Domestic) Violence: Typology and Causality
    • Counseling: #611914
    • Nursing: #37515
    • Physician: #21315
    • Counseling: #610414

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October 2016

Domestic Violence

Every October, Domestic Violence Awareness Month (DVAM) raises awareness on the devastating effects domestic violence has on individuals, families and communities. This provides an opportunity for healthcare organizations to educate staff about ways to identify and respond to victims of abuse.

Domestic violence is defined by the National Coalition Against Domestic Violence (NCADV) as willful intimidation, physical assault, battery, sexual assault or other abusive behavior as part of a systematic pattern of power and control perpetrated by one intimate partner against another. Within the context of domestic violence; partner, child, elder and sibling violence tend to coexist. The World Health Organization (WHO) has recognized domestic violence as a global public health concern affecting individuals in every community, regardless of age, economic status, sexual orientation, gender, race, religion or nationality. In the U.S.:

  • 1 in 3 women and 1 in 4 men have been physically abused by an intimate partner
  • On average, 20 people are physically abused by an intimate partner every minute
  • Domestic violence accounts for 15% of all violent crimes
  • Victims are most commonly women between 18 and 24 years old
  • 1 in 15 children are exposed to domestic violence each year
  • 21% to 60% of victims of domestic violence lose their jobs due to reasons stemming from abuse
  • Between 2003 and 2008, 142 women were murdered in their workplace by their abuser – 78% of all women killed in the workplace during that timeframe

In addition to the immediate trauma caused by abuse, domestic violence contributes to chronic health problems including depression, alcohol and substance abuse, sexually transmitted diseases such as HIV/AIDS, and may limit the ability to manage other chronic illnesses such as diabetes and hypertension.

For a number of reasons, healthcare visits provide a critical window of opportunity to stop a cycle of violence.

  1. Battered women tend to seek medical care for themselves and their children before seeking help from advocacy organizations, shelters or police.
  2. Health professionals have a reputation for being a source of comfort, care and trust, making it more likely for a patient to talk openly about abuse.
  3. The environment offers a safe place away from an abuser.
  4. Health professionals are trained to identify and assist victims of domestic abuse.

Major medical associations and organizations recommend routine screening for domestic violence, including the Joint Commission, American Medical Association, American College of Obstetrician Gynecologists, American Nurses Association and the U.S. Preventive Services Task Force. Screening questions should be asked in a nonjudgmental manner in a private place, away from family, friends or children. They should open with a supportive statement, such as “Because abuse and violence are so common in women’s lives, we ask all patients about it.”

Some examples of screening questions recommended by the American Medical Association include:

  1. Are you in a relationship in which you’ve been physically hurt or threatened by your partner?
  2. Has your partner ever threatened or abused your children?
  3. Has your partner ever forced you to have sex when you didn’t want to or that made you feel uncomfortable?
  4. Do you ever feel afraid of your partner?
  5. Has your partner ever prevented you from leaving the house, seeing friends, getting a job or continuing your education?
  6. Do you have guns in your home? Has your partner ever threatened to use them?

For more information about screening and assessment, The Centers for Disease Control and Prevention, National Center for Injury Prevention and Control has published the Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings.

If a patient discloses that they are being abused:

  1. Provide assurance that he or she is not alone, you care about their wellbeing and that help is available.
  2. Express belief that the abuse is unacceptable and that the patient is not to blame.
  3. Ensure confidentiality. He or she may fear retaliation.
  4. Document the case thoroughly.
  5. Educate the patient about the cycle of violence and options for ending abuse.
  6. Assess the level of immediate safety for the patient and children. Questions to ask might include:
    • Where is the abuser now?
    • Does the abuser know where you are now?
    • Do you feel safe leaving here?
    • Has your partner threatened to kill you or your children?
    • Does your partner have access to a gun or other deadly weapon?
  7. Provide information about available resources, such as shelters, advocacy organizations and hotlines. The National Domestic Violence Hotline is available 24 hours per day and provides crisis intervention assistance, counseling and referrals.
  8. Respect autonomy. It is a healthcare provider’s role to inform the patient of all options but decisions about going home to an abuser must be made by the patient and respected by healthcare personnel.

Mandatory reporting laws vary from state-to-state, but most states have some type of statute that requires physicians to report to law enforcement officials about certain injuries that appear to have resulted from a criminal act. View the Compendium of State Statutes and Policies on Domestic Violence and Health Care provided by The Family Violence Prevention Fund.


Domestic Violence Quiz for Health Professionals

When a patient is a victim of domestic violence, it is important for healthcare personnel to respond appropriately. See how well you answer these DO or DON’T questions.


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Tell the victim that she needs to leave the abuser.

Answer: DON’T – She already knows she needs to leave but she doesn’t feel she can. Instead, discuss a safety plan.

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Affirm that domestic violence is wrong and that talking to you is the right thing to do.

Answer: DO – Violent partners often blame the victim for their actions. Reassure him or her that it’s not their fault and that no one deserves to be abused.

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Stay quiet if physical and other signs indicate abuse could be occurring, but the victim denies violence as the cause.

Answer: DON’T - Let the victim known you’re concerned and that the type of signs you’re seeing are sometimes associated with abuse. Provide referral information and encourage a return visit if violence occurs in the future. Ensure him or her that confidentiality is a priority. Document your concern in the medical record.

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Health professionals should confront an abuser about their behavior if they are present.

Answer: DON’T – An abuser may try to harm a confronter or retaliate against a victim for talking about abuse. Instead, talk to the patient about a safety plan.

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Take photographs of injuries caused by domestic violence.

Answer: DO – Photos are valuable evidence should a case be filed against the abuser in the future. Ask the patient for permission and obtain written consent. Let him or her know that photos will become part of the medical record and can only be released to the police or prosecutor with his or her permission or by court order.

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