Establishing a Working Office

Take the following steps to ensure your office is prepared and capable of dealing with violence against women.

1. Set up an office task force

Each office should establish a VAW (Violence Against Women) task force and team lead. This team will serve as a main office resource and will stay informed on social, medical and legal information regarding violence against women, especially as it specifically pertains to the health care community. This task force will be responsible for fostering an environment of awareness about VAW within the office, writing protocols, as well as implementing those protocols into office routines.

2. Write protocols

Collaborate and generate written office protocols that will serve to detect, treat and prevent violence against your female patients and their families. Verbally introduce these protocols to your staff, take questions and answer any questions. Clearly post these protocols in break areas, administrative areas and other non patient areas.

3. Standardize VAW assessments

Integrate assessment questions and the RADAR system into standardized questionnaires. Assure that questions are culturally/linguistically appropriate and posed to possible victims non-judgmentally. Include a code for violence against women in all emergency department logs.

4. Train your staff

Offer and require regular VAW trainings and awareness classes. There are many resources available for training members of the medical community to effectively deal with the issue of violence against women. Click here for a list of local resources in your area.

5. Offer patients resource materials

Offer patients who are victims of violence region- or city-specific resources for where to get help. Prominently display informational posters, safety cards and patient education materials in waiting rooms, restrooms and exam rooms. Clearly post information for a crisis resource.

6. Monitor the process

Establish quality assurance mechanisms to regularly check on staff progress and monitor patient response. Offer monthly, scheduled staff check-ins to discuss concerns, answer questions and accept suggestions for process improvement.

7. Collaborate with community violence experts

Community violence experts can serve as valuable partners in ending VAW. Invite local professionals from these community groups to present their experience, perspective and understanding of violence against women. Enlist their help in training your staff, collaborating on materials and serving victims of abuse. Developing an ongoing relationship with these individuals will assure that you have the most up-to-date resources and will solidify your place in the community as an advocate for change.

8. Become an advocate

Encourage your colleagues to screen for violence in their own practices. Share your experience at association meetings. Support your local victim service program by becoming a member of their board of directors, supporting their fund-raising efforts, and talking about the need to prevent violence against women in your community.

Note for Sole Providers

If you are a health care provider who works alone, you can still take steps to prevent, detect and treat violence against women. In order to do this effectively, it is imperative that you establish yourself within a network of other advocates. Consider becoming an associate participant of an existing practice that has set up practices to deal with violence against women. Look for opportunities to network with other sole providers who want to address the same issue. Tailor the previous guidelines to fit your own practice. Above all, do not underestimate your role as a sole provider. It only takes one person to make the difference in the life of an abused woman—you can be that difference.

Other things to consider:

How to support staff in this area

The best way to support your staff in their effort to prevent violence against women is to foster an environment where violence screening is the norm, staff-education is encouraged and resources are offered and utilized on a regular basis. Staff, both clinical and office, must receive adequate training and support in order to effectively identify and respond to domestic violence. Adequate training includes an opportunity to address barriers to identification and intervention as well as to learn necessary clinical skills. Ongoing partnerships with community-based advocate programs are essential, as is methodical, timely follow-up training. For more information, see creating a toolkit and implementing guidelines or visit the resources portion of this website.

Recognize barriers

Until recently, health care practitioners rarely addressed issues of abuse and violence, even when the signs or symptoms were present. The same personal, emotional and social stigmas about violence that keep female patients from discussing abuse also sometimes prevent members of the medical community from discussing it. These reasons include:

• Lack of awareness of the prevalence, means of identification, or severity of the problem and lack of recognition of the social and psychological costs of abuse
• Thinking it is not a their place to intervene, or that the woman must have provoked the abuse
• Believing identification of abuse and referral for services is not part of their role
• Not knowing how to intervene or help even if a woman is recognized as being battered
• "Blaming the patient" and feeling frustrated or angry if the woman doesn't leave her partner (She becomes the problem for being noncompliant with the timetable assumed by the caregiver)
• Disbelief because the alleged assailant is present and seems very concerned and pleasant
• Concern that discussing psychosocial issues will take an overwhelming amount of time
• Difficulty dealing with the feelings evoked by listening to a woman describe what has been done to her. The caregiver might feel helpless or inadequate if he or she can't "do something" to fix the situation

It is important that the office task force and its lead be aware of these barriers and address them with their staff; the path to ending violence against women depends on an ability to approach the topic.

Legal Responsibility

The legal remedies available to women who are victims of violence vary from state to state and from one perpetration to another. Community-based advocacy programs can often explain to women the legal options that are available and can help them access the legal system. Reported abuse can lead to criminal investigation, criminal prosecution and/or civil actions such as protective, injunction or restraining orders, which are court orders that direct the perpetrator to stop abusing the victim. In some states, the court may have the authority to order a domestic abuser to leave a shared residence, receive counseling, make support payments, pay medical bills or take other action. Depending on the jurisdiction, police also may be required to arrest abusers who violate protective orders. In the case of suspected child abuse or vulnerable adult abuse, the health care provider is legally obligated to report to authorities. In any event, a woman's safety must be continually reassessed since a protective order or criminal prosecution does not guarantee it.

In Washington State, the legal responsibility of the health care provider varies from profession to profession. For more information on violence against women and your legal responsibility, check with your professional association.

Portions of these guidelines are lifted from www.ama-assn.org.

Emergency

If you are experiencing abuse in your home, work or community, call the Domestic Violence Hotline at 1-800-562-6025 or click here for a list of local resources.

More Than a Statistic

One in three — the number of women who are raped, assaulted by a partner, or otherwise victims of sexual or domestic violence. This represents a wife, a girlfriend, a mother, a friend. Many survive. Some do not. Help prevent violence against women. You are in the position to help detect, treat and prevent abuse. You can make a difference, one woman at a time.