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C l i n i c a l  G u i d e l i n e s

 
Interventions With Patients
Who Disclose Abuse
 


Interventions can consist of a few brief questions, supportive statements, and a quick referral. 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 interventions into your office flow and tight schedule. (See also Effective Health Care Response to IPV and Tools and Forms to download) 

 

Therapeutic Messages 

  • I am sorry this is happening to you.
  • You don’t deserve to be treated like this. Nobody deserves to be abused.
  • It is not your fault.
  • Of course I believe you.
  • I am glad you told me. That must have taken a lot of courage.
  • You are not alone. There is help available

Offering these messages may be one of your most effective interventions. They are therapeutic and powerful because they directly contradict the kind of destructive messages with which abusers typically inundate their victims: You are worthless, you deserve to be treated like this, it’s your own fault for being so (stupid, ugly, fat, useless …), don’t ever tell anyone, nobody will believe you…. 

Health care practitioners have a lot of authority, so your messages can be quite powerful and sow important seeds in your patient.

 

Safety Planning

If your patient screened positive for risk factors (see: safety assessment), state:

“Experience has shown that these things [name risk factors] MAY put you at risk for serious harm. I am very concerned about your safety and would like to help you with safety planning.”

Refer for safety planning to trained staff or on call advocate from a local domestic and sexual violence program OR review safety plan yourself (use safety planning tool )

If patient not concerned about her/his safety: explain that safety planning is available through local domestic and sexual violence program AND/OR hand out safety planning tool (ask whether safe to take home).

Ask: “How can I best support your health and safety?”

 

Education

Offer some education on domestic violence as appropriate, verbally or through a brochure. This could be very brief, one or two sentences.

It might be helpful to mention

  • how this may be impacting her/his health,
  • possible impact on children,
  • prevalence (you are not alone, we know that one out of three women will experience violence from a partner over her lifetime)
  • which resources have been helpful to other survivors

It may also be helpful to identify some of the behaviors s/he is experiencing as abusive or controlling. Survivors may not have named some of the strategies as abusive (for example social isolation, refusing to use condoms, economic abuse etc) Your identifying them may validate their feelings and help them see their situation more clearly.

 

Resources/Referrals

Check for safest and most comfortable option:

  • Refer to appropriate in-house staff for in-depth consultation about resources/referrals AND/OR:
  • Give resource/referral information (brochure, pocket card )

[Consider: is it safe for her/him to take written information home? where else can s/he read it?]

AND/OR:

  • Refer to local Domestic/Sexual Violence program for options counseling and access to further resources (See: Network program list).

[Consider: will s/he be able to access the local program, ability to make confidential phone calls? does s/he need to use a phone in the clinic? would s/he like to arrange a meeting with an advocate at the clinic?]

 AND/OR:

  • Refer to other community resources depending on your patient’s needs and the options available in your community. Mental health services, legal services, services providing financial and material support, children’s services etc. An updated local and statewide referral list is an indispensable tool. For more information:
    • Resources for survivors
    • How to create a referral network – from the newsletter of the International Planned Parenthood Federation  (Basta! Summer 2000)

http://www.ippfwhr.org/publications/serial_article_e.asp?
PubID=10&SerialIssuesID=1&ArticleID=9 )

 

Effective Referrals

Simply giving out the phone number will often fail to result in an effective referral.  There are many potential barriers that may be preventing your patient from following up in the referral.

  • They may not have the ability to make a confidential phone call from home.
  • They may not be able to take the brochure or safety card because the abuser may find it.
  • They may have notions about “battered women’s services” that prevent them from reaching out to these services:
    • they may think this is only for life-threatening emergencies (“emergency hotline”)
    • they may think that the only option they will be offered is leaving home and going to a shelter (something most victims are not interested in).
    • they may have absorbed negative stereotypes about domestic violence advocates.
  • They may just be too busy trying to survive the day-to-day.
  • They may be afraid to reach out, afraid of the questions they might be asked, afraid of having to share the story with someone they don’t know.
  • They may believe they know all the options available and none will work for them.

You can address some of these barriers by: 

  • Asking about safety and access to services (See: Assessment)– will they be able to make a phone call from home? If not, how else could they reach out?
  • Not using the misleading label “shelter”. Only some of the programs have shelters (although all can refer you to safe emergency housing). Only a small number of people reaching out to domestic violence programs use shelter services. Most service users use the phone services for options counseling, information and support; the court advocacy services, and the support groups,
  • Describing the services to them. Most victim/survivors are amazed at what domestic/sexual violence programs offer. (See: For Victims and Survivors)
  • Telling them what to expect when they call. Explaining that they can just call an advocate to talk things through. That they can even call anonymously. That nobody will be forcing them to do anything. That domestic and sexual violence programs believe in supporting survivors in their own decisions, whatever they may be. (Inform yourself about the services in your area and how they work! Talk to an advocate or invite them to your staff meeting) (See: Network Program List)
  • Offering to make the first call for them and then handing the phone over to them. Offering them to make the call from a quiet space in your office or clinic.
  • Referring them in-house first, for example to a medical social worker or resource specialist. This is an easier step to take. Then the social worker can do an extended needs assessment and refer to community resources.

Explore whether your local domestic/sexual violence advocates could be available to meet patients at your clinic. This would enable you to schedule a follow-up appointment with the patient and arrange for the advocate to meet them. Vermont domestic/sexual violence programs are mostly small and have few staff members to cover their 24-hour services. However, advocates have a lot of experience collaborating in their communities and will be happy to discuss options for providing services to your patients.
 

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