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C l i n i c a l  G u i d e l i n e s

 
Intimate Partner Violence
Health and Safety Assessment



The goals of the assessment are

  • To show your concern and give your patient the opportunity to share sensitive information with you
  • To enable you to gather information about how the abuse impacts your patient’s health, access to health care, and ability to comply with the treatment regimen
  • To assess the immediate and long-term health and safety needs of your patient in order to create and effective response.

Think with your health care team about defining roles, responsibilities and procedures. A well-thought out protocol and a supply of forms and practitioner resources will support you in integrating effective assessments into your office flow and tight schedule. (see also Effective Health Care Response to IPV and Tools and Forms to download)

1. Assess the immediate safety needs of the patient.

  • Are you in immediate danger?
  • Where is the perpetrator now? Is he/she at this health facility now?
  • Is it safe for you to go home?
  • Do you want the police or security to be notified?
  • Is it safe to take this written information home with you?
  • Will it be safe for you to meet with advocates in the community or would you like to meet with them in one of our offices?

Respond to the safety needs! (Helpful tool: A good office protocol that outlines roles, responsibilities and resources to respond to immediate safety needs of patients.)


2. Assess the pattern and history of abuse.

Assess the perpetrator’s physical, sexual, or psychological tactics, as well as the social isolation and economic coercion of the patient. Document this, including the perpetrator’s name and dates of assault(s) if possible. (See: Documentation).  How long has the violence been going on?

  • What was the most serious thing he/she ever did to you?
  • Has your partner forced you to have sex? Hurt you sexually? Forced you into sexual acts that made you uncomfortable?
  • Does your partner control what you do? Whom you see? etc

 

3. Assess the connection between the violence and the patient’s health issues.

Assess the impact of the violence on the victim’s physical and psychological well-being:

  • Have there been other incidents that caused injuries or illness?
  • How is this situation affecting the way the patient feels and thinks?
  • How is this affecting the patient’s ability to access health care and comply with treatment regimens?  

Document the health impact. (See: Documentation).


4. Assess patient’s safety risks.

Intimate Partner Violence: is there increased risk of injury or death?

Risk factors that increase risk of injury or death include:

Perpetrator’s
  • possession of weapons
  • use or threatened use of weapons
  • threats of homicide or suicide
  • recent escalation in frequency and severity of attacks
  • recent unemployment
  • heavy use of alcohol or drugs

Victim 

  • has increased fear of injury or death
  • is planning to leave perpetrator or has recently left
  • is being stalked

Also ask about the children’s safety (explain limitations of confidentiality re: child abuse!).


Risks related to Sexual Violence:

§         Risk of repeated assault or retaliation for reporting

§         Infection with HIV/STI

§         Pregnancy

§         Suicide risk or risk of self-injury

§         Hidden internal injuries

 

5. Assess the patient’s current access to advocacy and support resources.

  • Has the patient usedor is the patient currently using community resources like hotlines, support groups, family centers, counselors, legal advocacy or resources etc?
  • How helpful is/was that?
  • What else does the patient need and what else might be available?

~respond/refer  See: Interventions

Clinical Tool: Assessment Tool, or Family Violence Prevention Fund, National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings (Appendix D) http://endabuse.org/programs/healthcare/files/Consensus.pdf go to page 48/Appendix D.

Expanded Assessment areas (related health problems, extended history, questions about batterer, suicide and homicide assessment):

Family Violence Prevention Fund, National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings (Appendix F) http://endabuse.org/programs/healthcare/files/Consensus.pdf go to page 49/Appendix F.
 

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