________________________________ Intimate Partner Violence: Compassionate Care, Effective Assessment
ADVOCACY FOR SOCIAL CHANGE Clinicians acting alone cannot meet all the needs of survivors of IPV. As healthcare professionals and systems grapple with the complex issues involved in understanding and responding to IPV, the need to collaborate with others in healthcare, as well as those in law enforcement, the faith community, and society at large, becomes apparent. Establishing linkages with dedicated violence prevention community agencies and sexual victims crime units in advance can provide a more seamless inclusion of these resources into clinical care when needed. Clinicians can be important catalysts for change so that IPV can be more effectively identified, and ultimately prevented. SPECIFIC INTERVENTIONS Clinicians need to establish realistic and achievable goals with their abused patients. One goal may be to aid the patient in leaving the relationship. That may not be what the patient wants or thinks is appropriate at that time. There are many goals from self-disclosure, education, and empowerment to departure that often need to occur first. The survivor knows their situation better than anyone else and needs to incorporate information about risks and danger into decisions regarding leaving and safety. Leaving an abuser is usually a process that takes time—often years. Clinicians can help their patients make progress toward leaving by giving them information about options, and by letting them know that they are there to provide help, safety planning, and support as they take the steps necessary to break free from abuse. Specific steps the physician can take include: • Offer messages of validation and support: ‒ Thank the patient for sharing what must be a difficult and painful situation. ‒ Validate the patient’s courage, integrity, and worth as an individual. ‒ Communicate concern for patient’s safety. ‒ Reinforce that the patient is believed, and that the patient does not deserve to be abused. ‒ Reframe abusive behavior as unacceptable and possibly criminal. ‒ Place responsibility for the abuse unequivocally on the perpetrator. ‒ Assess for safety. ‒ Initiate safety planning. • Evaluate mandated reporter requirements for patients who are: ‒ Children. ‒ Elderly. ‒ Disabled.
• Oversee clinical evaluation and care: ‒ Carefully and without judgment, document findings in the medical record (see details of documentation above). ‒ Diagnose and treat (or refer for treatment) specific injuries and other medical problems related to ongoing or past victimization, or any psychological and behavioral problems in survivors and dependent children. ‒ Discuss safer sex practices and protection against sexually transmitted diseases and pregnancy, especially for patients who have been raped or who have experienced coercive sexual activity. The pregnancy prevention approaches with the least risk of external intervention should be recommended (e.g. implantable contraception over condoms or pills). ‒ Consider the risks of prescribing potentially sedating medications that could impair the survivor’s ability to respond appropriately if rapid action or escape become necessary. • Arrange appropriate referrals to community-based advocates and other experts who provide direct service to survivors of IPV (see resources at the end of this document). • Assure follow-up both for the presenting complaint and for comprehensive primary care. Offering validation, support, and basic information about IPV to survivors are legitimate therapeutic interventions. DEVELOPING A SAFETY PLAN To develop a safety plan, the patient’s level of danger and the resources needed to allow the patient to escape a situation quickly must be addressed. The plan should include a place to go (friends, family, or shelter) and other resources for daily living such as money, personal papers (health insurance cards, house deed, social security/ green card, pay stubs, driver’s license or photo identification), car and house keys, and a change of clothing for the patient and their children. If an order of protection (restraining order) has been issued, your patient should carry a copy of it at all times and, if possible, have a digital image of the document saved on their phone. Inform your patient that local domestic violence programs provide free and confidential services, and that trained advocates from these programs can provide information about: Legal rights. • Police and court procedures for protective orders. • Shelter availability. • Support groups and other support resources.
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