Domestic and Sexual Violence __________________________________________________________________
Trauma-informed screening is an essential part of the intake evaluation and the treatment planning process. Trauma- informed practices include [144]: • Reflecting an understanding of trauma and its many effects on health and behavior • Addressing both physical and psychological safety concerns • Using a culturally informed, strengths-based approach • Helping to illuminate the nature and effects of abuse on victims’ everyday experience • Providing opportunities for patients to regain control over their lives Screening processes can be developed that allow staff without advanced degrees or graduate-level training to conduct them, whereas assessments for trauma-related disorders require a mental health professional trained in assessment and evalua- tion processes. The most important domains to screen among individuals with trauma histories include [145]: • Trauma-related symptoms • Depressive or dissociative symptoms, sleep disturbances, and intrusive experiences • Past and present mental disorders, including typically trauma-related disorders (e.g., mood disorders) • Severity or characteristics of a specific trauma type (e.g., forms of interpersonal violence, adverse childhood events, combat experiences) • Substance abuse • Social support and coping styles • Availability of resources • Risks for self-harm, suicide, and violence • Health screenings In addition to broad screening tools that capture various traumatic experiences and symptoms, other screening tools, such as the Intimate Partner Violence Screening Tool, focus on acknowledging a specific type of traumatic event [145]. These tools may be used to screen and assess for the presence of adverse or traumatic life experiences. However, it is not neces- sary to use a formal tool to screen for trauma and exploration of trauma should be done by trained, experienced, and skilled staff. This process requires a safe, comfortable, and respectful environment and a trusting, caring relationship. Terms such as “violence,” “abuse,” and “battering” should be avoided, as patients may not identify with these terminologies and they can be stigmatizing [146]. As mentioned previously, it is not necessary for an individual to disclose painful experiences to be helped. By using universal precautions and treating all people as if they have been exposed to trauma and by using trauma-informed approaches, healing and recovery can be promoted [147].
ASSESSMENT AND SCREENING METHODS
SCREENING There is no universal guideline for identifying and responding to domestic violence, but it is universally accepted that a plan for screening, assessing, and referring patients of suspected abuse should be in place at every healthcare facility. Guidelines should review appropriate interview techniques for a given setting and should also include the utilization of assessment tools. Furthermore, protocols within each facility or healthcare setting should include referral, documentation, and follow- up. This section relies heavily on the guidelines outlined in the Family Violence Prevention Fund’s National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings; however, protocols should be customized based on individual practice settings and resources available [61]. The CDC has provided a compilation of assessment tools for healthcare workers to assist in recognizing and accurately interpreting behaviors associated with domestic violence and abuse, which may be accessed at https://stacks.cdc.gov/view/cdc/44660 [141]. In a study with 170 nurses, 56% stated that they have almost never screened their patients for domestic violence [142]. Several barriers to screening for domestic violence have been noted, including a lack of knowledge and training, time constraints, lack of privacy for asking appropriate questions, disruption to normal routines, lack of organizational policies, lack of supervision, personal discomfort, and the sensitive nature of the subject [18; 61; 142]. Although awareness and assessment for IPV has increased among healthcare provid- ers, many are still hesitant to inquire about abuse [143]. At a minimum, those exhibiting signs of domestic violence should be screened. Typical injury patterns include contusions or minor lacerations to the head, face, neck, breast, or abdomen and musculoskeletal injuries. These are often distinguishable from accidental injuries, which are more likely to involve the extremities of the body. Abuse victims are also more likely to have multiple injuries than accident victims. When this pattern of injuries is seen, particularly in combination with evidence of old injury, physical abuse should be suspected [134]. As a result of prolonged stress, various psychosomatic symp- toms that generally lack an organic basis often manifest. For example, complaints of backaches, headaches, and digestive problems are common. Often, there are reports of fatigue, restlessness, insomnia, or loss of appetite. Great amounts of anxiety, guilt, and depression or dysphoria are also typical. Women who experience IPV are also more likely to report asthma, irritable bowel syndrome, and diabetes [6]. Healthcare professionals should look beyond the typical symptoms of a domestic violence victim and work within their respective prac- tice settings to develop appropriate assessment mechanisms to detect victims who exhibit less obvious symptoms.
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MDCT2026
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