________________________________ Intimate Partner Violence: Compassionate Care, Effective Assessment
ASSESSING PATIENTS While studies have shown that most female patients want to be asked about their experiences with sexual violence by their healthcare providers[58], few medical professionals screen any patients, female or male, for such trauma [59]. This may be due to a lack of training, time, or comfort on the part of the healthcare provider [60]. However, doctors’ offices can be safe, confidential places to address sexual violence in which survivors can feel comfortable disclosing and confident in receiving the care and services they need. Many prominent health organizations recommend that provid- ers screen their patients for violence, including the American Medical Association, the World Health Organization, the American College of Obstetricians and Gynecologists, the American Academy of Pediatricians, and the American Nurses Association [61]. Although most of the current research and recommendations regarding screening patients for sexual violence focuses on women, some programs have begun screening both male and female patients with promising results. The Veterans Health Administration recently implemented a universal screening program for male and female veterans, providing free care for patients experiencing conditions resulting from military sexual trauma [62]. Screening patients is only one step in the process. A full assess- ment requires that healthcare providers also develop plans and protocols for what to do when a patient discloses incidents of sexual victimization. DEVELOPING ASSESSMENT PROTOCOLS Healthcare providers should develop protocols that ensure consistent, effective practices for providing care to patients that experience sexual violence. One promising tool that can aid providers in these efforts is the SAVE method, which was devel- oped by the Florida Council Against Sexual Violence (2003): • S creen all of your patients for sexual violence. • A sk direct questions in a non-judgmental way. • V alidate your patient’s response. • E valuate, educate, and make referrals. Healthcare providers should avoid: • Asking patients about their victimization when other people are present. • Only asking patients who “seem” like victims about their experiences. • Using the term “rape,” as some survivors may not label their experience as rape [64]. • Using formal, technical, or medical jargon [61]. • Only asking about specific types of violence or recent violence [63]. • Expressing value judgments.
Recent evidence-based data reveals that perpetrator interven- tion best occurs within system change through a local coordi- nated community response– not exclusively on an individual level [50]. Couple counseling is generally contraindicated. There are a few programs specifically designed for low-level violence between couples that have been shown to be effec- tive, but few communities have these models in place, and regular marital counseling can be dangerous for the survivor. Generally, the focus must be on ending the violence first, with any couples-focused work waiting until the survivor is no longer afraid of being attacked if they speak candidly about issues within the relationship. At each point, it is important that the offender and the survivor are assessed separately and treated separately, and that no couple’s counseling occurs until the survivor requests it and there is no longer a danger of physical violence. The delay between the offense and the start of treatment should be as minimal as possible to make sure that there are sanctions for noncompliance. Knowledge that an offender will either go to jail or go back to court and suffer a stiffer penalty can be an important motivator for change. Steps should be taken to provide for the survivor’s safety while the offender is going through court-ordered intervention. It is important that the survivor has realistic expectations and not assume false hopes. The abused individual needs to have a protection plan in place while the offender is going through treatment. Perpetrator intervention offers offenders a chance at rehabilitation, but it cannot work with those who do not attend or complete the program.
ASSESSING PATIENTS FOR SEXUAL VIOLENCE
Sexual violence is a common experience in the lives of women and men [55]. People who have been sexually victimized are more likely to suffer from chronic physical and mental health problems than those who have not been victimized, and believe that their health is fair or poor [56]. Female survivors of sexual violence visit the doctor more often than women who have not been victimized [57]. Given the high rates of sexual violence and potential health impacts, it is therefore likely that most healthcare providers will come into contact with victims of sexual violence. A variety of tools and guidelines have been created to address the need for screening patients for histories of sexual violence. This guide aims to build on those tools and encourage health- care providers to conduct full assessments with patients to encourage interventions that provide adequate treatments and recommendations for survivors of sexual violence.
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