______________________________________________________________ Understanding Domestic Violence
If state law or institutional policies require reports to law enforcement, inform the patient about the limitations of confidentiality before they disclose any information that must be reported. If they opt not to disclose due to confidentiality concerns, provide them with confidential resources they can utilize, such as the National Domestic Violence Hotline at 800-799-SAFE (7233). Collaborate with the patient on how information about their relationship should be documented in their medical record, taking into consideration whether their partner has access to it. Additionally, inform the patient that the information recorded in their medical chart may be used in a legal context if they choose to pursue legal action in the future (American Medical Women’s Association, 2023). UNDERSTANDING RESOURCES Many professionals may effectively screen for IPV, yet they may lack knowledge about how to proceed when a patient screens positive. It’s essential to have a plan in place for such situations. Familiarize yourself with local resources or social work organizations to which patients can be referred. Consider reaching out to these organizations while the patient is still in the office to facilitate the process. Coordinate the safest method of communication with the patient regarding this matter outside of appointments (American Medical Women’s Association, 2023). While discussions centered on rescue attempts may be well- intentioned, they may feel intrusive to the patient initially. Therefore, it’s crucial to maintain a nonjudgmental and sup- portive approach. Offer the patient various options and allow them to choose how they wish to proceed. Ensure that the process remains patient-centered. Raise awareness throughout the year about the significance of awareness, education, and advocacy regarding domestic violence. CULTURAL CONSIDERATIONS To maintain a client-centered approach, treatment providers must consider cultural factors that influence the survivor’s perception of their experience and their willingness to discuss it. Many survivors feel profound shame about being battered and feel compelled to keep it secret at all costs. Others may be uncomfortable discussing family matters openly with nonfam- ily members (Center for Substance Abuse Treatment, 1997). To establish rapport and ensure the survivor feels comfortable, it may be beneficial for the interviewer to ask for their permis- sion before delving into screening questions. This can be done sensitively, with language such as: “To better assist you, I’d like to ask about what’s been happening in your home. Would it be okay if I asked you some questions about you and your [partner, spouse]? Or would you prefer to discuss this at another time?”
Respecting the survivor’s need for privacy in this manner can empower her and give her a sense of control over their situa- tion, which is particularly important given that many survivors seek help during crises. For instance, a woman experiencing domestic violence who seeks assistance for substance abuse issues may have recently left her abusive partner or may be going through withdrawal. This approach can help alleviate some of the survivor’s feelings of powerlessness (Center for Substance Abuse Treatment, 1997). CHILD ABUSE If a treatment provider suspects that a client’s child has been subjected to violence, it is imperative to promptly refer the child to a healthcare provider. If there are concerns that the parent may not seek medical attention for the child (which is legally required if abuse is suspected), the provider must contact home health services or CPS. This action should be taken even if the child appears unharmed, as some injuries may not be immediately evident (Center for Substance Abuse Treatment, 1997). Addressing the child’s emotional well-being is also crucial. Emergency room physicians or nurses conducting physical examinations may not have the capacity to thoroughly evaluate the impact of abuse on the child’s emotional state. Initially, providing reassurance to the child that they are safe and will receive care may be necessary. However, it is advisable to refer the child to a therapist specializing in counseling traumatized children ideally. REPORTING SUSPECTED NEGLECT OR ABUSE Clients must be informed that mandated reporters are obli- gated to notify Child Protection Services if they suspect child abuse or neglect. Furthermore, clients should be aware of their right to report their partner’s abuse of children. Regardless of who ultimately notifies CPS, the responsibility lies with the mandated reporter to ensure that the appropriate action is taken (Center for Substance Abuse Treatment, 1997). The treatment provider must assess the potential impact on a survivor client of reporting suspected or confirmed child abuse or neglect. If the client cannot be protected from their abuser on a 24-hour basis, they may face violence if the abuser blames them for the report. Therefore, a safety plan should be developed. Additionally, it is essential to consider and explain to the client in advance the possible consequences of reporting child abuse on the children and the family as a whole (Center for Substance Abuse Treatment, 1997). For example, if CPS is unable to substantiate the allegations of abuse or neglect, the children may be at risk if the abuser learns of the report. Alternatively, CPS may temporarily remove the children from the home pending further investigation. If the investigation confirms abuse or neglect, the family may need to navigate a series of court appearances, and the children may
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