1. Respect Because abuse undermines a person’s personal boundaries and autonomy, they may be sensitive to any hint of disrespect. Many survivors say that being accepted and heard by a clinician helped them feel respected. 2. Taking time The time pressures in clinician/patient interactions may compound survivors’ feelings of being depersonalized and devalued. 3. Rapport Rapport is essential in every therapeutic relationship, but it is particularly necessary when supporting survivors of IPV. Good rapport not only increases patients’ sense of safety, it promotes clear communication and engenders cooperation. 4. Sharing information Some IPV survivors say they don’t know what clinicians do and, therefore, don’t know what to expect in terms of questions, procedures, or decisions. Having these things explained clearly and simply on an ongoing basis can help allay fear and anxiety. Clinicians should also seek ongoing feedback from patients about their understanding as well as any reactions they might have to questions or procedures. 5. Sharing control A core aspect of sexual or physical abuse is the loss of control over one’s body, hence it’s vital for patients to have a sense of control with clinicians who unavoidably occupy a position of power. Sharing control of what happens in the clinician/ patient interaction enables individuals to be active participants in their own care, rather than passive recipients of treatment. Time management Clinicians may not screen for IPV because they think they don’t have enough time in their daily practice to inquire, assess, and respond appropriately. Judicious time management and an outlined protocol or established clinical process, however, will allow for universal inquiry, appropriate guidance, and targeted follow-up. Routinely asking about IPV (usually as part of the social history) should take no more than 10 seconds, and yet may have a dual beneficial effect: if the answer is negative, the clinician will be reassured that the patient is not at risk for abuse (or that the patient, if affected, is not ready or able to disclose at that time); and the patient will be made aware that the clinician is concerned, knowledgeable, and able to respond should IPV become an issue at any time in the future. Most patients with a history of being abused, although perhaps dealing with difficult medical and emotional sequelae, are not in acute danger at the time of the visit. If the patient discloses victimization, the physician should conduct a brief safety assessment (see above), offer information and hotline numbers, convey concern and support for the patient, and arrange a follow-up to discuss the abuse and possible options in greater detail. Only rarely will the clinician
6. Respecting boundaries Beginning a procedure without first asking for the consent of the patient, or asking very personal questions before establishing rapport can feel like a violation of personal boundaries (both physical and emotional). 7. Fostering mutual learning The best teachers about the health effects of IPV and about how to work effectively with survivors are often survivors themselves. Clinicians who demonstrate genuine compassion and an interest in learning from their patients will be better positioned to respond effectively to future survivors of IPV. 8. Understanding non-linear healing The degree to which a survivor is able to tolerate or participate in treatment may vary from one healthcare encounter to the next due to the natural variability in the dynamics at work in IPV. Clinicians need to recognize and accept this variability and check in with patients at each encounter and adjust behavior as needed. 9. Demonstrating awareness and knowledge of IPV Many survivors of IPV look for signs of a clinician’s awareness of issues of interpersonal violence, such as in posters or pamphlets from local IPV-related organizations or the Family Violence Prevention Fund (endabuse.org). It’s also important that visible signs of a clinician’s awareness be inclusive, for example mentioning, or illustrating, that abuse can occur in same-sex couples. Office staff should receive periodic in-service training about IPV, referral resources, protocols, and office safety procedures. be confronted with a patient in extreme danger or who has acute needs. In this situation, as in the case of any medical emergency, urgent action is needed. While there are various guidelines outlining what patients may need from the health care system after experiencing IPV, there is little guidance on how to actually integrate and implement these practices within clinics. Treating IPV in a chronic care model and creating a team within clinical settings helps improve screening rates and provides interventions in a timely manner. The following six-point model summarizes how to create a sustainable system-level program: 32 ● Step 1 - Identify an IPV Champion (someone with on-site IPV expertise). ● Step 2 - Train all staff and define roles when responding to IPV (i.e., saturation training). ● Step 3 - Create clinic-based policies and procedures. These will outline staff training efforts, use of EMR documentation, identification of “at risk” patients longitudinally, create follow-up plans, and streamline referral to internal and local community programs. ● Step 4 - Use the IPV Champion to build bridges and collaboration with local advocacy agencies and IPV experts. This ultimately allows for effective communication and “warm” referrals.
Book Code: CT24CME
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