Respond To Intimate Partner Violence In Your Medical Practice

Intimate Partner Violence In Your Practice By Ellen Taliaferro, MD Medical Director Keller Center for Family Violence Intervention San Mateo Medical Center San Mateo, CA www.healthaftertrauma.com

www.healthaftertrauma.com

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

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

Throwing things, punching the wall
Pushing, shoving, grabbing, throwing things at the victim
Slapping with an open hand
Kicking, biting

Hitting with closed fists
Attempted strangulation
Beating up (pinned to the wall, repeated kicks, punches)
Threatening with a weapon
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

by Ellen Taliaferro MD on Feb 27, 2009

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Respond To Intimate Partner Violence In Your Medical Practice — Presentation Transcript