Healthcare Providers
How is interpersonal violence a healthcare problem?
In addition to physical trauma, victims of interpersonal violence may experience other medical and psychosocial problems as a result of on-going abuse including headaches, chest or abdominal pain, musculoskeletal complaints, sleep disorders, depression, and anxiety. As victims continue to be injured; they continue to require more and more medical interventions; their health deteriorates; and healthcare costs increase. To provide appropriate care to interpersonal violence victims, healthcare providers must be able to identify, assess, and intervene in culturally appropriate ways that directly address both the problem of interpersonal violence and its immediate health consequences.
The Joint Commission on the Accreditation of Healthcare Organization requires all providers to develop protocols that include a vehicle for screening, identification and assessment of patients who may be victims of interpersonal violence. Healthcare providers can play significant roles not only in improving the health of individual patients, but also in stopping interpersonal violence by participating in a coordinated community response. This is a public health issue and stopping it requires the efforts of all community institutions working together to:
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Increase the safety of interpersonal violence victims;
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Respect the autonomy of interpersonal violence victims, and;
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Hold interpersonal violence perpetrators, not victims, accountable for stopping the abuse.
Identifying Interpersonal Violence
Victims of abuse and neglect may come to the hospital through a variety of channels. The patient may be unable or reluctant to speak of abuse and it may not be obvious to the casual observer. Nevertheless, hospital staff members need to know if a patient has been abused, as well as the extent and circumstances of the abuse to give the patient appropriate care.
The hospital has objective criteria for identifying and assessing possible victims of abuse and neglect, and they are used throughout the organization. To review hospital policies see sections PM-06, PR-14, PV-21, and CP-35 of the BIDMC Policy Manual.
Staff should be trained on the use of these criteria. The Center for Violence Prevention and Recovery are available to provide trainings on issues related to interpersonal violence.
The criteria focus on observable evidence and not on allegation alone. They address, at least the following situations:
- Physical assault
- Rape or other molestation
- Domestic abuse
- Abuse and neglect of elders and children
When used appropriately by qualified staff members, this criteria prevents any action or questions that could create false memories of abuse in the individual being assessed. Staff members are able to make appropriate referrals for victims of abuse and neglect. To help them do so, the hospital maintains a list of private and public community agencies that provide help for abuse victims.
Tips for Screening
Screen for interpersonal violence only when you have privacy with the patient, away from family or friends. Present the screening in a calm, routine way. Be matter-of-fact and non judgmental of the patient. The style of the interview approach often increases or decreases the patient's willingness to disclose.
If the patient denies interpersonal violence as an issue in his/her life, accept the response. Not all patients are domestic violence victims. Recent research indicates that most patients appreciate routine questions about their overall health.
You may suspect that there are interpersonal violence issues in the life of a patient who denies the abuse. That's OK. You have already established yourself as a resource by asking the questions and the patient may seek assistance from you.
If a patient admits interpersonal violence is an issue, stay calm and non-judgmental. Let the patient know that there are resources for him/her. Have materials available that he/she can read for more information. You can download free brochures from our website. If you are practicing at BIDMC (East or West Campus) you may ask the patient if he/she would be willing to speak with a domestic violence advocate. If the patient agrees, call Safe Transitions at the Center for Violence Prevention & Recovery at 617-667-8141.
Example
Set the stage, normalize the question: "Since many people report experiencing some type of violence in their lives, we ask all our patients about their safety at home and in their communities."
Ask the questions:
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"Do you feel afraid in any of your relationships (partner or family members)?"
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"Have you ever been physicially, sexually, or verbally hurt by a person close to you?"
Download Center for Violence Prevention and Recovery Provider Resource Card
Helpful WebSites
There are a number of websites that provide valuable information for providers about the issue of interpersonal violence.
Additional Readings
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Bancroft, Lundy. Why Does He Do That? Inside the minds of Angry and Controlling Men. Berkley Publishing Group, 2003 (paperback); G. P. Putnam’s Sons, 2002 (hardcover).
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Herman, Judith Lewis. Trauma and Recovery. Basic Books, 1992, 1997.
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Island, David, and Patrick Letellier. Men Who Beat the Men Who Love Them: Battered Gay Men & Domestic Violence. Haworth Press, 1991.
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Jones, Ann R., and Susan Schecter. When Love Goes Wrong: What to do When You Can't Do Anything Right. Harper Collins Publishers, 1992.
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Katz, Judith. No Fairy Godmothers, No Magic Wands: The Healing Process After Rape. R&E Publishers, 1984.
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Ledray, Linda. Recovering from Rape. Henry Holt & Company (Owl Books), 1994.
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Levy, Barrie, ed. Dating Violence. Young Women in Danger. Seal Press, 1998.
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Lobel, Kerry, ed. Naming the Violence: Speaking Out About Lesbian Battering. For the National Coalition Against Domestic Violence Lesbian Taskforce. Seal Press, 1986.
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Neimeyer, Robert. Lessons of Loss, A Guide to Coping. Brunner Routledge, 2001.
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Nicarthy, Ginny. Getting Free: You Can End Abuse and Take Back Your Life. Seal Press, 1997.
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Noel, Brooke, and Pamela Blair. I wasn’t Ready to Say Goodbye: Surviving, Coping and Healing After the Death of a Loved One. Champion Press, Ltd., 2000.
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Scott, Kay. Sexual Assault: Will I Ever Feel Okay Again? Bethany House Publishers, 1993.
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Warshaw, Robin. I Never Called It Rape. Harper Collins Publishers, 1998. Harper Perennial, 1994.
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White, Evelyn C. Chain Chain Change: For Black Women in Abusive Relationships. Seal Press, 1995.
