_________________________________________________________________ Domestic and Sexual Violence
ASSESSMENT OF IMMEDIATE SAFETY FOR DOMESTIC VIOLENCE VICTIMS
Are you in immediate danger? Is your partner at the health facility now? Do you want to (or have to) go home with your partner? Do you have somewhere safe to go? Have there been threats or direct abuse of the children (if s/he has children)? Are you afraid your life may be in danger? Has the violence gotten worse or is it getting scarier? Is it happening more often? Has your partner used weapons, alcohol or drugs? Has your partner ever held you or your children against your will? Does your partner ever watch you closely, follow you or stalk you? Has your partner ever threatened to kill you, him/herself or your children? Source: [61]
Table 3
( Table 3 ). If the patient is in immediate danger, referral to an advocate, support system, hotline, or shelter is indicated [61]. If the patient is not in immediate danger, the assessment may continue with a focus on the impact of IPV on the patient’s mental and physical health and the pattern of history and current abuse [61]. These responses will help formulate an appropriate intervention. Culturally Sensitive Assessment Many trauma-related symptoms and disorders are culture spe- cific, and a patient’s cultural background should be considered in screening and assessment [145]. During the assessment process, a practitioner should be open and sensitive to the patient’s worldview, cultural belief systems and how he/she views the illness [150]. Assessment tools should be culturally appropriate for the patient, whenever possible. This may reduce the tendency to over-pathologize or minimize health concerns of ethnic minority patients. Pachter proposed a dynamic model that involves several tiers and transactions [151]. The first component of Pachter’s model calls for the practitioner to take responsibility for cultural awareness and knowledge. The professional should be will- ing to acknowledge that he/she does not possess enough or adequate knowledge in health beliefs and practices among the different ethnic and cultural groups he/she comes in contact with. Reading and becoming familiar with medical anthropol- ogy is a good first step. The second component emphasizes the need for specifically tailored assessment [151]. Pachter advocates the notion that there is tremendous diversity within groups. For example, one cannot automatically assume that a Cuban immigrant adheres to traditional beliefs. Often, there are many variables, such as level of acculturation, age at immigration, educational level, and socioeconomic status, that influence health ideologies.
Universal Trauma-Informed Education A trauma-informed approach to screening and care of victims of violence creates a space that is supportive, safe, and condu- cive to healing. Trauma-informed care principles emphasize that trauma affects many dimensions of an individual’s and their family’s lives. Practitioners should be mindful that trig- gers in the environment can result in retraumatization, and their responses can also inadvertently retraumatize the victim [148]. Therefore, universal trauma-informed education focuses less on formalized screening tools and checklists and more on creating spaces in which traumatic experiences are freely discussed. The space should be safe and there should be no distractions so the practitioner can actively listen and engage with the victim [148]. In this approach, the practitioner conveys universal information about intimate partner violence, in some cases tailored to the specific setting or patient population [149]. These settings “facilitate disclosure for victims of IPV and meet disclosure with empathy, competence, and appropriate referrals” [149]. This approach can be used in any healthcare or human services setting. ASSESSMENT Healthcare providers have reported that even if routine screen- ing and inquiry results in a positive identification of IPV, the next steps of assessing and referring are often difficult, and many feel that they are not adequately prepared [143]. Accord- ing to the Family Violence Prevention Fund, the goals of the assessment are to create a supportive environment, gather information about health problems associated with the abuse, and assess the immediate and long-term health and safety needs for the patient to develop an intervention [61]. Assessment of domestic violence victims should occur immediately after disclosure of abuse and at any follow-up appointments. Assessing immediate safety is priority. Hav- ing a list of questions readily available and well-practiced can help alleviate the uncertainty of how to begin the assessment
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MDCT2026
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