Legal and regulatory issues for clinicians related to IPV Healthcare providers must comply with relevant requirements regarding the implementation of IPV protocols and educational programs. The Joint Commission on Accreditation of Healthcare Organizations' standards call for identification and assessment of abuse victims, appropriate Mandatory reporting Most states require healthcare providers to file a report to a state criminal justice or public health agency when a patient has an injury that appears to be caused by a weapon. States may also mandate reporting of injuries due to criminal acts, acts of violence, or non-accidental acts. Since IPV injuries are sometimes caused by weapons and involve crimes, these laws may apply. Some states have laws that specifically address reporting of suspected IPV. Laws vary from state to state regarding such factors as who must report, the degree of suspicion that triggers a report, to whom reports are made, penalties for failure to report, and immunity from liability for clinicians who make reports in good faith. A state may also have case law governing liability for failure to report abuse or for reporting when not required by law. Unlike pediatric child abuse reporting, IPV-related reporting needs to occur in a collaborative fashion with the patient. Not doing so has potentially harmful Treatment options for abusers Although the focus of this learning activity, and of much of the medical, cultural, and sociological efforts over the past several decades, has been on the survivors of IPV, professional attention may also be necessary for the perpetrators of violence, their own problematic emotional conditions, and the need for interventions with abusers that may reduce future violence. 50 Edward Gondolf summarized and published an evaluation of programs for perpetrators of domestic violence, as well as data from his own large national study. 50 The vast majority of offenders will not seek help voluntarily; most come into an intervention program only as the result of a court order. The second most frequent way that offenders enter a program is when their partner has “mandated” intervention, often by leaving with a condition that the partner enrolls in an intervention program before returning to the relationship. It is also important to realize that even once ordered, many offenders choose not to participate or will drop out before program completion. Monitoring by a probation office/agent or another official within the court system is needed to ensure that if the offender does not complete treatment, there will be additional legal sanctions. Studies have shown that among men who complete treatment, a significant percentage are not reported to engage in violence during the following year. The percentage remaining nonviolent varies from 53% to 85%, with lower rates reported in studies based on
documentation, intervention and referral, and staff education. 54 Some states have enacted laws mandating IPV protocol development or training for providers in practice (e.g. required continuing medical education credits) and in professional schools. consequences. Reporting without the patient’s knowledge or consent—even when required by law—may put abused individuals at risk of retaliation from the batterer, and thus may deter survivors from seeking health care or being candid with their clinicians about the cause of their injuries. Reporting without patient consent also infringes on patient autonomy and may further victimize an abused person. The abrogation of physician- patient confidentiality that may result from unrequested reporting may undermine the patient's trust in the physician and in the healthcare system as a whole. While required to comply with all legal requirements, clinicians should strive to minimize the potential harms of laws that may place patients in danger. Most importantly, clinicians and their staff should provide ongoing, supportive care, address patient safety, and educate the patient about available options and community-based resources. survivor reports of violence. 50 Men who drop out of treatment are significantly more likely to continue to be violent than men who complete the treatment. Substance abusers are also more likely to continue to be violent, and substance abuse treatment may be needed in addition to offender intervention programs. In fact, research has shown that both treatment modalities are needed; substance abuse treatment alone will not end the violence, and abuser intervention alone will not address substance abuse problems. In some clinical trials, the mean difference in violent acts has not been significantly different between those attending programs and those not, showing that although some offenders do indeed improve, others do not. Additionally, some of the more dangerous abusers may not be appropriate candidates for offender intervention programs. It is also important to realize that research suggests that simply going to court and being monitored may account for a significant proportion of the deterrent effect. Treatment is best offered in a community-based setting backed by the courts, in a program that is both certified and also long enough to be potentially successful. Many certified abuser intervention programs have treatment programs lasting up to 48 weeks. Other counseling programs may also be helpful for abusers who have PTSD from child abuse or from warfare, however, the therapist needs to know that there is violence in the relationship and be
Book Code: CT24CME
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