Pathways To Change
Refraining and Responding to Violence against Women
Health care Professionals are among the first person to whom a victim of abuse will turn for help. This present a significant opportunity to offer effective, timely interventions that help victims regain a sense of control over their lives.
Identifying Domestic Violence in Clinical Settings:
- Asking about domestic violence during regularly scheduled visits for all patients provides a structure to identify domestic violence. It should be part of the assessment for all new patients.
- After an initial incident of abuse has been shared, reassess safety by routinely asking at each subsequent visit.
- Interview the patient privately, away from her partner, family members or friends.
- Screening questions about domestic violence fit into the social history and/or the review of systems.
- When the Clinical Presentation suggests domestic violence, it is appropriate to include questions about interpersonal violence in the evaluation of the Chief Complaint or presenting problem.
- The following findings are indicators of possible abuse:
- Injuries and including injuries during Pregnancy,
- Injury Sequelae,
- Symptoms of Stress,
- Mental Health Problems,
- Difficulty in staying in rehabilitation programs or substance abuse treatment programs,
- Situational dynamics: victims of abuse may appear unreliable, non-compliant or unaware of appropriate health behaviors. Perpetrators of violence may appear: overprotective, unwilling to leave partner's side and quick to supply answers or explanations with exaggerated concern.
Components of Effective Assessment:
Assessment begins with a patient-centered interview conducted in a place that affords privacy. Regardless of why a woman has stayed in an abusive relationship or whether she has tried to leave, most battered women talk frankly about their predicament in the context of a supportive and confidential interview. Full assessment include:
- Careful history of Adult Trauma,
- Overview of the dynamics in the relationship (pattern of control, strategies for resistance),
- Review of health and mental health problems that may be associated with abuse,
- Consideration of risk to any children involved,
- The possibility of life-threatening violence must be always considered, particularly in violence has resulted in hospitalization.
Assessment should differentiate long-standing personality disorder or psychiatric disease from adaptations to the situational stress of a battering relationship. Suicide is also a risk that must be weighed, particularly if there are previous suicide attempts or the women is severely depressed, anxious about the fate of her children and isolated from friends or family, or feels "trapped."
Planning for Safety:
Confidentiality in all aspects of working with battered woman is a precondition to implementing a safety plan. The objectives are to review the woman's priorities in relation to available options and resources. Facilitate the implementation of a safety plan for the woman and her children, and plan for ongoing support.
Designed for short-term crisis intervention — the battered woman's shelter meets the need for safe housing and can usually offer counseling around violence, housing child care and advocacy with the legal, social service and welfare systems.
When serious psychiatric conditions are present, an appropriate discharge plan includes psychiatric evaluation and referral. If mental health professionals and services are unfamiliar with the special issues posed by domestic violence, continued advocacy may be needed, to ensure the patient's safety .
Help is available and health care providers can help her contact the services. Help by these three simple steps: AAA — Ask-Assess-Advocate.
Empowerment Critical To Recovery:
Interventions around woman battering should not be confused with strategies used to resolve family "conflict" such as couple's counseling or parenting education. The empowerment strategies appropriate with battered women differ markedly from the protective service orientation that characterized intervention with the vulnerable populations of children or the elderly. Planning for safety with battered women often includes women's groups, ongoing physical therapy, changing jobs, continuing education, applying for emergency assistance, counseling for children and working with child and/or adult protective services and programs for the disabled.
The success of each stage of the process — identification, assessment, the formulation of a safety plan, and referral, depends on follow up through each stage. Monitoring and feedback, including follow up to determine, what has actually changed in relation to what a woman hopes to gain through each step in her plan.
Even if things go badly after discharge, as they may, the sense of control a woman gains from identifying her problem, and developing a plan to mange it, is a significant step toward her recovery.
Send Important Messages To Patient:
- She is not alone
- No one has the right to hurt her
- Domestic violence is against the law
- Domestic violence is not her fault
- Help is available and you can help her contact services
Published: 14 October 2009
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