Putting the Pieces in Place to Support Patients in Crisis
Not long ago, quality providers approached potential victims of domestic violence with direct questions when they thought something might be wrong: “How did you get these bruises?” “This is the third time I’ve seen you this year for this kind of injury. Is someone hurting you?” However, now we understand that patients don’t want to feel singled out or judged, but are looking to providers to offer support and connection.
THE KEY COMPONENTS TO PUT IN PLACE
NORMALIZE THE “HEALTHY RELATIONSHIP” CONVERSATION
While providers were previously encouraged to question certain physical injuries or watch body language to screen for signs of domestic violence, recent approaches show that more traction can be made by talking to all patients about how their relationships impact their health. Patients who talk to their providers about abuse are four times more likely to use an intervention.
On average, more than 3 WOMEN a day are
MURDERED by their partners in the United States1
“We are moving away from disclosure-driven practice,” says Kate Vander Tuig, Senior Health Specialist at Futures Without Violence. “For years, we focused on ‘screening, screening, screening’ in order to be vigilant, and then offered a referral if a disclosure of domestic violence was made. However, we have learned that screening alone may not actually be helpful for survivors.”
“What is working? Brief, educational moments that make the connection between relationships and health,” continues Vander Tuig. “We want to make sure all patients have access to important information and resources, regardless of whether they choose to disclose or not. This shifts more power to the patient and creates the opportunity not only for the patient to access help on their own terms, but also to be able to help their friends and family, which studies show is very healing.”
In studies done in reproductive-health and adolescent-health settings, researchers found that survivors’ health improved when clinicians utilized a universal education approach in which all patients were given information about how intimate-partner violence can affect their health, and where they can turn if they or friends of theirs need help. Normalizing the conversation about healthy and unhealthy relationships is a proactive approach that is directly relevant to the health and wellbeing of your patient. Addressing the topic via a pragmatic, health-focused dialogue helps reduce any shame, fear, or judgment the patient might feel. “There are many reasons why a patient might not feel safe disclosing violence: worries about mandatory reporting requirements, being judged, privacy issues, etc.,” says Vander Tuig. “What we want to do is create an environment where survivors feel safe to talk about their relationships, but do not need to in order to get support from confidential resources like a domesticviolence advocate.”
Approximately 1 in 3 ADOLESCENT GIRLS in the United States
is a victim of physical, emotional, or verbal ABUSE from a dating partner2
Plus, shifting the approach towards an educational conversation allows the patient to remain in control of his or her own situation. The simple offer of a wallet-sized patient-safety card is a discreet but powerful gesture that lets the patient take action when they are ready without increasing their risk level. To start this conversation, see Futures Without Violence’s Patient Education Resources at IPVhealth.org.
CONNECT WITH COMMUNITY PARTNERS
“Providers don’t need to be the experts, but it’s critical for them to partner with their local domestic-violence advocates,” says Vander Tuig.
The domestic-violence (DV) advocates in your area are a vital resource, because they know the unique risks your patients are up against, as well as the laws and services that will be the most protective of them given their situation. Providing more than just emergency shelter, advocates offer access to counseling, legal help, case management, family resources, 24-hour crisis support, and more. Once a patient decides to make a move to get the resources they need, support from local advocates is vital. Don’t wait until you have a patient asking for help; physicians should be connected to local resources before a patient crisis occurs. In the swift moments during which a survivor is ready to take action, you don’t want to be researching the “who, what, and where” of immediate, local support. Make this information available to all the providers at your clinic as a matter of course. And if a patient discloses violence, offer them a warm referral to a local advocate, using language like this: “Thank you so much for sharing that with me. A lot of patients in similar situations have found that it can be helpful to talk to an advocate over at [local domestic-violence agency] who can offer free and confidential support. If this is something you are interested in, I can connect you with them today, or just give you their information.”
To locate the community DV experts in your area, simply call the National Domestic Violence HOTLINE at (800) 799-7233 and speak with a counselor.
1 in 4 WOMEN in the U.S. experiences
VIOLENCE by a partner at some point in her life3
Remember, there is no perfect plan, and there is no one-size-fits-all solution. Vander Tuig advises that it’s important to go with whatever angle offers the most leverage as you meet with patients who may be in crisis. Any step you take with a domestic-violence survivor will provide needed help. The important thing is to not get overwhelmed with doing just the right thing. When you normalize the conversation around healthy, intimate relationships and are connected to local DV experts, you’ll have the pieces in place to support your patients when the time comes.
1 Catalano, Shannan. “Intimate Partner Violence in the United States.” U.S. Department of Justice, Bureau of Justice Statistics. 2007. Available at http://www.ojp.usdoj.gov/bjs/intimate/ipv.htm
2 Davis, Antoinette, MPH. “Interpersonal and Physical Dating Violence among Teens.” The National Council on Crime and Delinquency Focus. 2008. Available at http://www.ocjs.ohio.gov/TDVMonth/Interpersonal_Teens.pdf
3 “Adverse Health Conditions and Health Risk Behaviors Associated with Intimate Partner Violence, Morbidity and Mortality Weekly Report.” Centers for Disease Control and Prevention. February 2008. Available at http://www.cdc.gov/mmwr/PDF/wk/mm5705.pdf