Intimate Partner Violence: Compassionate Care, Effective Assessment _ _______________________________
In addition, many IPV agencies offer counseling programs for survivors living in the community. These individuals may not need emergency shelter but nevertheless want to deal with the trauma of current or past abuse, and may be ready to take advantage of available support as they move forward with their lives. Many of these programs offer structured groups for parents of children exposed to IPV that deal with issues such as understanding the dynamics of violence, dealing with anger, understanding legal rights, understanding the effects of IPV on children, making and maintaining safety plans, and offer- ing one another emotional support during important life decisions. These groups are often held in community settings so women not in shelter can also attend. Many IPV programs staff a daytime or 24-hour hotline, or link with regional or state-wide hotlines. A 24-hour national hotline is available at 1-800-799-SAFE (7233). It is not unusual for survivors in the community to use hotline services anony- mously and also to call multiple times before actually visiting an agency for in-person help. Crisis hotlines are available not only to survivors but also to concerned friends and family, as well as professionals who are seeking more accurate informa- tion about community-based services. Some IPV programs offer legal advocacy, and in some cases, actual legal representation. Legal advocates can educate sur- vivors about their legal rights and options, including applying for orders of protection, or representation in divorce and custody hearings. TRANSLATION SERVICES Professional interpreters or translators who are trained in maintaining patient confidentiality should be used whenever possible if a language barrier is evident in a clinical encounter involving IPV. Otherwise, there is a risk of compromising the quality of the information being translated and can put the survivor in danger or lead to a missed opportunity for interven- tion. Providers should never use accompanying persons (i.e., friends, relatives, children) as interpreters. The person chosen could actually be the perpetrator or they could inadvertently breach confidentiality by speaking about the conversation with others. Additionally, if the translator is a member of the survivor’s community, shame or stigma may prevent the survivor from disclosing the abuse. Remote telephone interpretation services are an appropriate alternative when an in-person interpreter is from the survivor’s small community or is not available. Regardless of language, providers need to avoid assuming literacy. Just because a patient can speak a language does not mean they can read or write it, and vice versa.
INTERVENTION STRATEGIES The USPSTF, in a systematic review of the literature, found “adequate” evidence that effective IPV interventions that pro- vide or refer patients to ongoing support services can reduce violence, abuse, and physical or mental harms for women of reproductive age [1]. Evidence from randomized trials sup- port various interventions including counseling, home visits, information cards, referrals to community services, and men- toring support. Depending on the type of intervention, these services may be provided by clinicians, nurses, social workers, non-clinician mentors, or community workers. Counseling generally includes information on safety behaviors and com- munity resources. In addition to counseling, home visits may include emotional support, education on problem-solving strategies, and parenting support [1]. Health care providers should bear in mind four guiding principles of intervention when addressing IPV with their patients [33]: PATIENT SAFETY Patient assessment, documentation, safety planning, commu- nication, intervention, and follow-up must be conducted with utmost concern for the immediate and long-term safety of the survivor and their dependent children. The clinician should ask, “Is what I am asking/doing/recommending going to help my patient become safer, or at least not place the patient at risk for further harm?” SURVIVOR EMPOWERMENT Abused individuals have often been denied their freedom to make informed, independent choices about their (and their children’s) lives. Facilitating the patient’s ability to make their own choices is key to restoring a sense of purpose and well-being for survivors of IPV, and can facilitate a patient’s readiness to take proactive steps to end the violence. PERPETRATOR ACCOUNTABILITY It is important to frame violence as occurring because of the perpetrator’s behavior and actions, not the survivor’s. It thus follows that the problem of violence in the relationship, and thus the need to take definitive steps to end the violence, is the perpetrator’s responsibility. This guiding principle assumes the importance of survivor safety, but rejects victim-blaming and other excuses offered by the offender as “explanations” for the violence.
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