Domestic Violence/Intimate Partner Violence:
Applying Best Practice Guidelines

Best Practice Guidelines for Domestic Violence/Intimate Partner Violence, Con't.

Introduction

Defining the Problem

Statistics

Identifying Abuse

Consequence of Violence

Risk Factors for Victimization and Preparation

Dynamics of Abuse

Select Populations and IPV/DV

Barriers to Identifcation of Intimate Partner Violence/Domestic Violence

Best Practice Guidelines for Intimate Partner Violence/Domestic Violence

Safety Planning

Conclusion

Resources

References

Test

Exit to Menu

Confidentiality

Inappropriate disclosure of health information may violate patient/provider confidentiality, including the federal Healthcare Insurance Portability Act (HIPAA). As important, the inappropriate disclosure of suspected IPV/DV can threaten patient safety. Perpetrators who discover that a victim has sought care may retaliate with further violence. Employers, insurers, law enforcement agencies, and community members who discover abuse may discriminate against a victim or alert the perpetrator. It is imperative that policy, protocol, and practice surrounding the use and disclosure of health information regarding victims of IPV/DV should respect patient confidentiality and autonomy and serve to improve the safety and health status of victims of IPV/DV.

Florida mandates that reports are made for the treatment of gunshot wounds. Florida statute requires that physicians, nurses and employees or hospitals, clinics, nursing homes and sanitariums must report treating any person sustaining a gunshot wound, or life-threatening injury indicating an act of violence, or receiving a request for such treatment. Reports are to be made to the sheriff's department or the police department. Failing to report is a 1st degree misdemeanor and is punishable by up to a $1,000 fine and up to one year in prison.

Florida law also mandates the reporting of child abuse or neglect and elder abuse or abuse of the disabled.

Documentation

Documentation is critical, both for the protection of the patient and of the healthcare provider. Document relevant history, including:

• Chief complaint or history of present illness.
• Record details of the abuse and its relationship to the presenting problem.
• Document any concurrent medical problems that may be related to the abuse.
• For current IPVDV victims, document a summary of past and current abuse including:
  • Social history, including relationship to abuser and abusers name if possible;
  • Patient's statement about what happened, not what lead up to the abuse (e.g." boyfriend John Smith hit me in the face" not "patient arguing over money");
  • Include the date, time, and location of incidents where possible;
  • Patients appearance and demeanor (e.g. "tearful, shirt ripped" not "distraught");
  • Any objects or weapons used in an assault (e.g. knife, iron, closed or open fist);
  • Patients accounts of any threats made or other psychological abuse;
  • Names or descriptions of any witnesses to the abuse.

Document results of physical examination:

• Findings related to IPV/DV, neurological, gynecological, mental status exam if indicated; " If there are injuries, (present or past) describe type, color, texture, size, and location;
• Use a body map and/or photographs to supplement written description;
• Obtain a consent form prior to photographing patient. Include a label and date.

Document laboratory and other diagnostic procedures:

• Record the results of any lab tests, x-rays, or other diagnostic procedures and their relationship to the current or past abuse Document results of assessment, intervention and referral:
• Record information pertaining to the patient's health and safety assessment including your assessment of potential for serious harm, suicide and health impact of IPV/DV; " Document referrals made and options discussed;
• Document follow-up arrangements.

If patient does not disclose IPV/DV victimization:

• Document that assessment was conducted and that the patient did not disclose abuse;
• If you suspect abuse, document your reasons for concerns: i.e. "physical findings are not congruent with history or description," "patient presents with indications of abuse".

Follow-up

At least one follow-up appointment (or referral) with a healthcare provider, social worker or IPV/DV advocate should be offered after disclosure of current or past abuse:

• "If you like, we can set up a follow-up appointment (or referral) to discuss this further";
• "Is there a number or address that is safe to use to contact you?";
• "Are there days/hours when we can reach you alone?";
• "Is it safe for us to make an appointment reminder call?".

At every follow up visit with patients currently in abusive relationships:

• Review the medical record and ask about current and past episodes of IPV/DV;
• Communicate concern and assess both safety and coping or survival strategies:
  • "I am still concerned for your health and safety"
  • "Have you sought counseling, a support group or other assistance?"
  • "Has there been any escalation in the severity or frequency of the abuse?"
  • "Have you developed or used a safety plan?"
  • "Told any family or friends about the abuse?"
  • "Have you talked with your children about the abuse and what to do to stay safe?"
• Reiterate options to the patient (individual safety planning, talking with friends or family, advocacy services and support groups, transitional/temporary housing, etc.).

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