Roseann Gager PGY3 CCLP FMRP Domestic Violence Roseann Gager PGY3 CCLP FMRP

Objectives Why Screen Patients? Why should you care? Screening, recs and resources

What is Domestic Violence? The willful intimidation, assault, battery, sexual assault or other abusive behavior perpetrated by one family member, household member, friend, or intimate partner against another. Intimate Partner Violence and Family Violence Many different forms: Physical, sexual, psychological/emotional, neglect

Statistics Underestimated but over 10% US 75% of all 911 calls are domestic abuse calls 74% of Americans personally know someone who is or has been a victim of domestic violence. On average, more than 3 women and 1 man are murdered by their intimate partners in this country every day. The health-related costs exceed $5.8 billion each year. $4.1 billion are for direct medical and mental health care services. $1.8 billion are for the indirect costs of lost productivity or wages.

Impact on Health ACUTE Contusions, lacerations, fractures, gyne injuries Pregnancy complications, STDs, Depression, PTSD, Suicide CHRONIC Increased use of med sys., Chronic pain sys (back, HA, pelvic), GI d/o, tension, chronic fatigue, disturbed sleeping and eating patterns, Depression, chronic anxiety, PTSD, relationship/sexual difficulties, somatization disorders, suicide

Recommendations AAFP notes FPs can provide early intervention in family violence through routine screening and the identification of abuse, and recommends that physicians BE ALERT for the presence of family violence in virtually every patient encounter. Reporting child and elder abuse to protective services is mandatory in most states, and several states have laws requiring mandatory reporting of intimate partner violence.

Recommendations USPSTF found insufficient evidence to recommend for or against routine screening of parents or guardians for the physical abuse or neglect of children, of women for intimate partner violence, or of older adults or their caregivers for elder abuse AAP recommends that all practitioners incorporate DV screening as a part of routine anticipatory guidance

Recommendations ACOG and AMA recommend that physicians routinely ask elderly patients direct, specific questions about abuse. ACOG guidelines on DV recommend that physicians routinely ask women direct, specific questions about abuse. AMA encourages physicians to inquire routinely about their patients’ DV histories and refer those patients with violence-related problems for medical and/or community-based services.

Assessing Patients Talk to the patient alone in a safe, private environment Ask simple, direct questions such as: Because violence is so common in many people’s lives, I’ve begun to ask all my patients about it routinely. Are you in a relationship with a person who physically hurts or threatens you? Did someone cause these injuries? Who?

Ask Directly However, be aware of warning signs TOO History suggesting domestic violence: traumatic -injury or sexual assault; suicide attempt, overdose; -physical symptoms related to stress; vague complaints; -problems or injuries during pregnancy; history inconsistent with injury; delay in seeking care or repeat visits. Behavioral clues: evasive, reluctance to speak in front of partner; overly protective or controlling partner. Physical clues: any physical injuries; unexplained multiple or old injuries.

Take a Domestic Violence History Past history of domestic violence, sexual assault History of abuse to any children

Send Important Messages You are not alone You are not to blame There is help available You do not deserve to be treated this way

Document Findings Use the patient’s own words regarding injury and abuse Legibly document all injuries; use a body map Take instant photographs of injuries

Assess Safety Are you afraid to go home? Have there been threats of homicide or suicide? Are there weapons present? Can you stay with family or friends? Do you need access to a shelter? Do you want police intervention?

Make Referrals Involve social worker if available Provide list of shelters, resources, and hotline numbers National Domestic Violence Hotline: (800) 799-SAFE Schedule follow-up appointment

Resources 800-799-SAFE National Domestic Violence Hotline (888) Rx-ABUSE National Health Resource Center on Domestic Violence endabuse.org/health, thehotline.org, ncadv.org dvrc-or.org CAWC 773-278-4566 cawc.org connections for abused women and children Greenhouse Shelter Haymarket Center Domestic Violence Program Hospital Crisis Intervention Program Humboldt Park Outreach Program