Respond To Intimate Partner Violence In Your Medical Practice

1

Intimate Partner Violence In Your Practice

By

Ellen Taliaferro, MDMedical Director

Keller Center for Family Violence Intervention

San Mateo Medical CenterSan Mateo, CA

www.healthaftertrauma.com

www.healthaftertrauma.com 2

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

3www.healthaftertrauma.com

Objectives:

Detecting IPV Complying with CA mandated reporting laws Responding to IPV on the spot


History: inconsistent, vague, or changing Delay in seeking care or cancelled

appointments Hovering husband Suggestive trauma patterns


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


Environmental: posters, HITS screening tool, computer kiosk in waiting room

Forms and questionnaires Ask the question


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


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


• 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.


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.


• 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


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.


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


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


1.Throwing things, punching the wall2.Pushing, shoving, grabbing, throwing things

at the victim3.Slapping with an open hand4.Kicking, biting


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


Ask two questions:◦ When did this happen?◦ How has this impacted your life?

Listen Assure Refer or reschedule


Respond To Intimate Partner Violence In Your Medical Practice

Health & Medicine

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