● Step 5 - Evaluate all clinical efforts regarding screening and periodically re-evaluate for dissemination to the clinical team.
● Step 6 - Provide general information to patients outlining healthy relationships as well as healthy conflict resolution strategies (e.g., pamphlets, posters, signage).
Case study 2 Jennifer is a 32-year-old married woman who presents for an annual exam with her 6 year old daughter. She works full-time as an ophthalmologist and appears clean, professional, and poised. Jennifer and her husband have been your patients for 5 years, and her overall health is good, with only minor health concerns in her past medical history. Jennifer’s appointment is in the afternoon, and you are running late after a series of delays with previous patients. You review her vitals and start to perform a physical exam. You glance at the clock and see you are already out of time for this appointment. To save time, while you are performing a breast exam, you ask Jennifer “Do you feel safe in your relationship?” To your surprise, she suddenly tears up and averts her eyes. She does not immediately respond to the question. Questions 1. What are some examples of communication strategies you should avoid when collecting more information? _______________________________________________________________________________________________ 2. What IPV-specific documentation should you include in your progress note for this encounter? _______________________________________________________________________________________________ Discussion In the interview with Jennifer, it is important to refrain from asking questions in a manner that might frighten or intimidate your patient, increase the sense of humiliation and shame about the violence, or be interpreted as blaming the survivor for the situation. Since discussing IPV can be very difficult and can leave patients feeling vulnerable, Jennifer may feel more comfortable having a discussion while fully clothed. Discussions about IPV should be avoided in the presence of children who can comprehend the situation, so it may be best to have Jennifer’s daughter leave the room or have Jennifer call the clinic later to discuss when she is alone. In addition, Jennifer should be assured that patient confidentiality will not be broken by disclosing any information or discussing concerns with her husband. When documenting the encounter in a progress note, it is important to use Jennifer’s words in quotations whenever possible to detail her description of her relationship safety. If any injuries are found during the physical exam, they should be described in detail, as well as an opinion on whether the injuries were adequately explained. Photographs or additional imaging studies may be included if appropriate. Using community resources/referrals Clinicians who may encounter survivors of IPV
individuals may not need emergency shelter but nevertheless want to deal with the trauma of current or past abuse, and may be ready to take advantage of available support as they move forward with their lives. Many of these programs offer structured groups for parents of children exposed to IPV that deal with issues such as understanding the dynamics of violence, dealing with anger, understanding legal rights, understanding the effects of IPV on children, making and maintaining safety plans, and offering one another emotional support during important life decisions. These groups are often held in community settings so women not in shelter can also attend. Many IPV programs staff a daytime or 24-hour hotline, or link with regional or state-wide hotlines. A 24- hour national hotline is available at 1-800- 799-SAFE (7233). It is not unusual for survivors in the community to use hotline services anonymously and also to call multiple times before actually visiting an agency for in-person help. Crisis hotlines are available not only to survivors but also to concerned friends and family, as well as professionals who are seeking more accurate information about community-based services.
should explore all local support resources and keep an updated patient hand-out with their contact information. Establishing personal relationships with key personnel in community support organizations can not only improve a clinician’s understanding of the many social and legal dimensions of IPV, but it can facilitate referrals. Many community IPV programs include a confidential emergency shelter or safe house program. Some can provide temporary transitional housing or safe-at- home services. Although emergency shelter is usually a last resort for those who are in acute danger, the shelter offers a safe haven from violence and can also provide the survivor with information about rights and options as well as vital emotional and logistical support. In many programs, specialized services are available for children who have been traumatized by witnessing abuse. In shelter programs, women have a chance to meet other women who have sought shelter, which can help women break out of the profound social isolation that is so often a component of abuse. In addition, many IPV agencies offer counseling programs for survivors living in the community. These
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Book Code: CT24CME
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