Protocols

Getting Equipped to Make a Difference

Each appointment you have with a patient takes up just moments of the day. This means your window of opportunity to intervene in a potentially abusive situation is short and crucial. In order to make a difference, it is imperative that your practice have protocols in place to screen for abuse, counsel potential victims and refer victims to support services. The following is a recommended list of protocols and procedures that can help you and your staff make a difference in the lives of the women you see each day.

Keep violence against women on your RADAR

One of the best tools your practice can put into place is RADAR. Use this tool as a required process for individual patient meetings.

R = Routinely Screen Female Patients
A = Ask Direct Questions
D = Document Your Findings
A = Assess Patient Safety
R = Review Options & Referrals

R = Routinely Screen Female Patients

Although many women who are victims of domestic violence will not volunteer any information, they may discuss it if asked simple, direct questions in a nonjudgmental way and in a confidential setting. Interview the patient alone. Their intimate partner, children, friends and other family should not be in the room or within hearing distance.

If your patient needs an interpreter, do not use family, friends or children. Provide a qualified, third-party interpreter. Keep in mind that in small communities—areas with lower populations, a concentrated ethnic minority group, or just remotely located—the patient may already know their interpreter. Attend to this with sensitivity. If the patient and interpreter know each other, be prepared to make a follow-up appointment and have an alternate interpreter available.

A = Ask Direct Questions

Use direct, non-judgmental questioning:

• "Because violence is so common in many women's lives, I've begun to ask about it routinely."
• "Are you in a relationship in which you have been physically hurt or threatened?" If no, "Have you ever been?"
• "Have you ever been hit, kicked or punched by your partner?"
• "Do you feel unsafe at home?"
• "I notice you have a number of bruises; did someone do this to you?"

If the patient answers "yes" to any of these, encourage her to talk about it.

• "Would you like to talk about what has happened to you?"
• "How do you feel about it?"
• "What would you like to do about this?"

Listen non-judgmentally. This serves to both begin the healing process for the woman and give you an idea of what kind of referrals she may need. Validate her experience.

• "You are not alone."
• "No one has to live with violence."
• "You do not deserve to be treated this way."
• "You are not to blame."
• "What happened to you is a crime."
• "Help is available to you."

If the patient answers "no", or she will not discuss the topic, be aware of any clinical signs that may indicate abuse:

• Injury to the head, neck, torso, breasts, abdomen or genitals
• Bilateral or multiple injuries
• Delay between onset of injury and seeking treatment
• Explanation by the patient which is inconsistent with the type of injury
• Any injury during pregnancy, especially to abdomen or breasts
• Prior history of trauma or chronic pain symptoms for which no etiology is apparent
• Psychological distress such as depression, suicidal ideation, anxiety and/or sleep disorders
• A partner who seems overly protective or who will not leave the woman's side

If any of these clinical signs are present, ask more specific questions. Make sure she is alone.

• "It looks as though someone may have hurt you. Can you tell me how it happened?"
• "Sometimes when people feel the way you do, it may be because they are being hurt at home. Is this happening to you?"

If the patient denies abuse, but you strongly suspect it, document your opinion, and let her know there are resources available to her should she choose to pursue such options in the future. Make a follow-up appointment to see her.

D = Document Your Findings

• Record a description of the abuse as she has described it to you. Use statements such as: "The patient states she was..."
• If she gives the specific name of the assailant, use it in your record. "She says her boyfriend John Smith struck her..."
• Record all pertinent physical findings. Use a body map to supplement the written record. Offer to photograph injuries.
• When serious injury or sexual abuse is detected, preserve all physical evidence. Document an opinion if the injuries were inconsistent with the patient's explanation.

A = Assess Patient Safety

Before she leaves the medical setting, find out if she is afraid to go home. Has there been an increase in frequency or severity of violence? Have there been threats of homicide or suicide? Have there been threats to her children? Is there a gun present?

R = Review Options and Referrals, Reassure

If the patient is in imminent danger, find out if there is someone with whom she can stay. Does she need immediate access to a shelter? Offer her the opportunity to make a private phone call. If she does not need immediate assistance, offer information about hotlines and resources in the community. Remember that it may be dangerous for the woman to have these in her possession. Do not insist that she take them. Make a follow-up appointment to see her.

The RADAR information is borrowed from www.opdv.state.ny.us/health_humsvc/health/radar.html#screen.

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.