Domestic Violence

Thursday, May 05, 2011

3:03 PM

Understand the importance of asking direct questions, screening routinely and validation
Ask "Are you safe in your relationship?" - looks for implicit threats, hard for pts to articulate
these
Emotional damage is most devastating
Must say "you don't need this" -- ask "what's the worst thing that ever happened?"
"I'm afraid you're going to die next time, even if you think its okay now--let me help you"
"If they're not willing to practice safe sex or contraception -- they don't care about you"
30% pt presenting with injuries (can also be depression, suicide, fibromyalgia, ulcers) --> fr
violence
"I am concerned about the violence in my pt's lives"
"Is anyone hurting you, hitting you, or putting you down?"
"Are you stressed?"
Don't use DV-specific CPT and ICD-9 codes bc of insurance discrimination
Cycle of Violence:
3 phases
Tension building "walking on eggs"
Battering
Calm / honeymoon / hearts and flowers -- "I'm sorry, I'll never do it again"
Understand that domestic violence is pervasive in all patient populations
Battering during pregnancy more common than placenta previa or diabetes --> causing spon
abortions, stillbirths, preterm deliveries
Overlap bet domestic violence and child abuse
Children: boys tend to be disobedient, girls - anxiety
95% women physically injured
Ongoing, Debilitating
Physical, psychological, sexual, financial
INC isolation, DEC personal freedom, access to resources, placed in physical danger or
controlled by threat or physical force
Emotional or Psychological Abuse
Jealousy --> red flag
Be aware of the state mandated requirement for reporting physical injury
95 CA Assembly Bill 840
Protocols to screen
Ongoing procedures for complete doc of battering
Use of DV referral list
Reporting is small part --> only have to report a physical injury
<18 yo abuse --> child abuse file report
Mentally incompetent abuse --> elder abuse file report
2 days to report w/in 2 days
Victim's name, whereabouts, extent of injuriesidentity of alleged perpetrator &
location where injury occurred. Were children present? (they can get $ for counseling)
5 Things to say to Victim who Says they CANNOT leave
Validate you did not deserve ot cause this!
Deppe Page 1

Validate you did not deserve ot cause this!

I am afraid of your safety.
I am afraid for the safety of your kids.
It will likely get worse.
We are here for you when you are ready to leave.

Deppe Page 2