_________________________________________________________________ Domestic and Sexual Violence
Interprofessional collaboration provides the opportunity to make effective system changes because agencies partner together by aligning complementary and supplementary services and skills to coordinate multi-systems level services to victims [162]. Interprofessional collaboration is defined as a partnership or network of providers who work in a con- certed and coordinated effort on a common goal for clients/ patients and their families to improve health, mental health, and social and/or family outcomes [163]. This approach can be particularly helpful for certain vulnerable subpopulations. In a qualitative study, all of the stakeholders felt that interpro- fessional collaboration was beneficial in cases of domestic/ sexual violence, resulting in more coordinated and integrated services [164]. When interprofessional collaboration is work- ing well, practitioners are able to focus more fully on their tasks while remaining confident that other services are being provided. Despite these positive outcomes, there are challenges. In order to share responsibilities, all parties must respect and trust their colleagues’ roles and expertise. To this end, it is important to be very clear about each professional’s skills, competencies, and expectations. Communication is vital in helping to define boundaries and parameters [164].
BEST PRACTICES IN FOLLOW-UP CARE FOR VICTIMS OF VIOLENCE Many victims of domestic and sexual violence do not seek help for fear of retaliation, lack of knowledge regarding access services, or fear of being blamed or punished [160]. When they do seek help, practitioners should be careful not to inad- vertently retraumatize. After ensuring a safe environment, it is imperative that healthcare professionals document all findings and recommendations regarding domestic violence in the victim’s medical record, including a patient’s denial of abuse, if applicable. If domestic violence is disclosed, documentation should include relevant history, results of the physical examina- tion, findings of laboratory and other diagnostic procedures, and results of the assessment, intervention, and referral. The medical record can be an invaluable document in establishing the credibility of the victim’s story when seeking legal aid [61]. Healthcare professionals should offer a follow-up appointment if disclosure of past or current abuse is present. Reassurance that assistance is available to the patient at any time is critical in helping to break the cycle of abuse [61]. In addition to providing acute care and scheduling follow-up appointments, providers should connect victims of violence with available resources. After identifying victims and their abusers, healthcare professionals should immediately imple- ment a plan of action that includes providing a referral to a local domestic violence shelter to assist the victim and the victim’s family. The acute situation should be referred imme- diately to local law enforcement officials. Other resources in an acute situation include crisis hotlines and rape relief centers. After a victim is introduced into the system, counseling and follow-up is generally available by individual counselors who specialize in the care of domestic/sexual violence victims. These may include social workers, psychologists, psychiatrists, other mental health workers, and community mental health services. The goals are to make the resources accessible and safe and to enhance support for victims who are unsure of their options. BUILDING EFFECTIVE COMMUNITY PARTNERSHIPS AND COLLABORATIONS WITH COMMUNITY-BASED AGENCIES Domestic and sexual violence impact many domains of a vic- tim’s life, and collaboration between health, mental health, social service, forensic, law enforcement, and community-based agencies is vital to providing the best possible care and support. Community agencies provide services such as 24-hour hotlines, shelter, support groups, counseling, and legal advocacy. These agencies and the specialized services they provide for victims of sexual and domestic violence are essential [161].
APPROPRIATE RESPONSES AND DOCUMENTATION
Healthcare and mental health professionals involved in the care of patients who have been victims of abuse should fully document suspected abuse, assessment results, any evidence of abuse, and interventions/safety planning in the patient’s record or clinical notes. Bruises are less visible on persons with darker skin, and documentation may not necessarily accurately represent the severity of the abuse [165]. All aspects of patient assessment, documentation, safety planning, com- munication, intervention, and follow-up should take into account the immediate and long-term safety of the victim and any dependents [166]. All practitioners who deal with domestic and/or sexual vio- lence should periodically review safety planning with victims. Homicide is of high risk for victims; therefore, safety planning is crucial. When advocating a safety plan, it is important to: • Encourage the victim to be aware of weapons in the residence. • Have victims make a plan of what to do if violence escalates and where to go if leaving is an option. • If children are old enough, they should be instructed about the safety plan and assigned roles.
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MDCT2026
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