Intimate Partner Violence: Compassionate Care, Effective Assessment _ _______________________________
5. Sharing control A core aspect of sexual or physical abuse is the loss of control over one’s body, hence it’s vital for patients to have a sense of control with clinicians who unavoidably occupy a position of power. Sharing control of what happens in the clinician/patient interaction enables individuals to be active participants in their own care, rather than passive recipients of treatment. 6. Respecting boundaries Beginning a procedure without first asking for the consent of the patient, or asking very personal questions before establishing rapport can feel like a violation of personal boundaries (both physical and emotional). 7. Fostering mutual learning The best teachers about the health effects of IPV and about how to work effectively with survivors are often survivors themselves. Clinicians who demonstrate genuine compassion and an interest in learning from their patients will be better positioned to respond effectively to future survivors of IPV. 8. Understanding non-linear healing The degree to which a survivor is able to tolerate or participate in treatment may vary from one healthcare encounter to the next due to the natural variability in the dynamics at work in IPV. Clinicians need to recognize and accept this variability and check in with patients at each encounter and adjust behavior as needed. 9. Demonstrating awareness and knowledge of IPV Many survivors of IPV look for signs of a clinician’s awareness of issues of interpersonal violence, such as in posters or pamphlets from local IPV-related organizations or the Family Violence Prevention Fund (endabuse.org). It’s also important that visible signs of a clinician’s awareness be inclusive, for example mentioning, or illustrating, that abuse can occur in same-sex couples. Office staff should receive periodic in- service training about IPV, referral resources, protocols, and office safety procedures. TIME MANAGEMENT Clinicians may not screen for IPV because they think they don’t have enough time in their daily practice to inquire, assess, and respond appropriately. Judicious time management and an outlined protocol or established clinical process, however, will allow for universal inquiry, appropriate guidance, and targeted follow-up. Routinely asking about IPV (usually as part of the social his- tory) should take no more than 10 seconds, and yet may have a dual beneficial effect: if the answer is negative, the clinician will be reassured that the patient is not at risk for abuse (or that the patient, if affected, is not ready or able to disclose at that time); and the patient will be made aware that the clinician is concerned, knowledgeable, and able to respond should IPV become an issue at any time in the future.
• Do not break patient confidentiality by disclosing any information or discussing your concerns with the patient’s partner. • Most survivors do not identify themselves as abused because of the perception of shame and worthlessness associated with that term. Therefore, avoid using the words “victim,” “abused,” or “battered” when speaking with the survivor. Instead, use words like “hurt,” “frightened,” or “treated badly.” • Assure the survivor that everyone deserves to feel safe and no one deserves to be abused. Never ask your patient what they did to bring on the violence. • Do not ask your patient why they have not left their partner. • A survivor may leave a partner only to later return. If this is the case with your patient, avoid asking why they have returned. THE TRAUMA-INFORMED CARE MODEL As potentially valuable as they may be, medical encounters can also be stressful for abused patients. Because of this, healthcare providers should care for all patients in a trauma-informed manner. The nine principles of trauma-informed care are [31]: 1. Respect Because abuse undermines a person’s personal boundaries and autonomy, they may be sensitive to any hint of disrespect. Many survivors say that being accepted and heard by a clinician helped them feel respected. 2. Taking time The time pressures in clinician/patient interactions may compound survivors’ feelings of being depersonalized and devalued. 3. Rapport Rapport is essential in every therapeutic relationship, but it is particularly necessary when supporting survivors of IPV. Good rapport not only increases patients’ sense of safety, it promotes clear communication and engenders cooperation. 4. Sharing information Some IPV survivors say they don’t know what clinicians do and, therefore, don’t know what to expect in terms of questions, procedures, or decisions. Having these things explained clearly and simply on an ongoing basis can help allay fear and anxiety. Clinicians should also seek ongoing feedback from patients about their understanding as well as any reactions they might have to questions or procedures.
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MDFL0627
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