Domestic Violence Assessment and Intervention provided by the Family Violence Prevention Fund

It is critical that providers understand how to respond to domestic violence victims once they have been identified. Policies and protocols on domestic violence must also include guidelines on effective assessment, intervention, documentation and referral. The Family Violence Prevention Fund (FVPF) recommends that providers receive training on these skills prior to implementing a protocol screening. Model training materials, department guidelines, protocols and other tools are available through the FVPF’s toll free number 888-Rx-Abuse, TTY:800-595-4889.

Assessment

• Assess the immediate safety needs of the victim. "Are you in immediate danger? Where is your partner now? Where will he or she be when you are done with your medical care? Do you want or need security, or the police to be notified immediately?"

• Assess the pattern and history of the abuse. Assess the partner’s physical, sexual, or psychological tactics, as well as the economic coercion of the patient. "How long has the violence been going on? Has your partner forced or harmed you sexually? Has your partner harmed your family, friends, or pets? Does your partner control your activities, money, or children?"
• Assess the connection between domestic violence and the patient’s health issues. Assess the impact of the abuse on the victim’s physical, psychological, and spiritual well being. What is the degree of the partner’s control over the victim? "How is your partner’s abusive behavior affecting your physical health? (For example, arthritis, chronic neck or back pain, migraine and other frequent headaches, stammering, problems seeing, sexually transmitted infections, chronic pelvic pain, stomach ulcers, spastic colon, and frequent diarrhrea, constipation or eating disorders). How is the abusive behavior affecting your mental health? (For exaomple, depression, suicidal ideation, stress, psychiatric disorder, substance abuse problems)."
• Assess the victim’s current access to advocacy and support groups. Are there culturally appropriate community resources available to the patient? What resources (if any), in addition to the health care provider, are available now? "What resources have you used , or tried in the past? What happened? Did you find them helpful or appropriate?"
• Assess patient’s safety: Is there future risk or death or significant injury or harm due to the domestic violence? Ask about the partner’s tactics: escalation in frequency or severity of the violence, homicide or suicide threats, use of alcohol or drugs, as well as about the health consequences of past abuse.

"Has your partner ever:

• Used or threatened to use weapons against you?
• Choked, or attempted to strangle you?
• Taken you or your children hostage to get what he or she wants?
• Stalked you?
• Hurt or threatened to hurt your children?

Intervention

Goals for effectively responding to domestic violence victims:

• Increase victim safety and support victims in protecting themselves and their children by validating their experiences, providing support, and providing information about resources and options.
• Inform patients about any limits in confidentiality for example, child abuse or domestic violence reporting requirements.
• The goal is not to get patients to leave their abusers, or to "fix" the problem for the patient, but to provide support and information.

Listen to the patient and provide validating messages:

1. "You don’t deserve this. There is no excuse for domestic violence. You deserve better."
2. "I am concerned. This is harmful to you (and it can be harmful to your children)."
3. "This is complicated. Sometimes it takes time to figure this out."
4. "You are not alone in figuring this out. There may be some options. I will support your choices."
5. "I care. I am glad you told me. I want to work together to keep you as safe and healthy as possible."
6. "Stopping the abuse is the responsibility of your partners, not yours"

Provide information about domestic violence to the patient:

• Domestic violence is common and happens in all kinds of relationships.
• Most violence continues and often becomes more frequent and severe.
• Violence in the home can hurt children (if the patient has children).
• Domestic violence impacts the patient’s health.
• Stopping domestic violence is the responsibility of the perpetrator, not the victim.

Listen and respond to safety issues:

• Show the patient a brochure about safety planning and go over it with her or him.
• Review ideas for how to keep information private and safe from the abuser.
• Offer the patient immediate access to an advocate 24 hour local, state, or national domestic violence hotline number.
• Offer to have a provider or advocate discuss safety then or at a later appointment.
• If the patient says she or he feels she or he is in danger, take this very seriously.
• If the patient is at high risk and is planning to leave the relationship, explain that leaving without telling the partner is the safest alternative.
• Make sure the patient has a safe place to go and encourage her or him to talk to an advocate.
• Reinforce patient’s autonomy in making decisions regarding her treatment.

Make referrals to local resources:

• Explain any advocacy and support systems within the health care setting.
• Refer patient advocacy and support services within the community including legal options, advocacy services, etc.
• When possible, refer patients to organizations that reflect their cultural background or address their special needs such as organizations with multiple language capacity, those that specialize in working with teen, disabled, deaf, hard of hearing, or lesbian, gay, bisexual, or transgender clients.

If no local resources are available, refer patient to an advocate from the multi-lingual National Domestic Violence Hotline 24 hours a day by dialing 800-799-SAFE, TTY 800-787-3224.

Follow-up steps for health care practitioners:

• Schedule a follow-up appointment. Ensure the patient will have a connection to a primary care provider.
• Domestic violence, like other health issues (smoking, poor nutrition, high blood pressure, etc.), often requires multiple interventions over time. Ask what happened after the last visit.
• Review medical records and ask about past episodes of domestic violence in order to communicate a concern for the patient and a willingness to address this health issue openly.
• Ask the patient if there is a phone number or address that is safe to contact them.

Download the Safety Planning Sheet (pdf format)