Some examples: • “I’m really sorry that happened to you.” • “That sounds like it was a terrifying experience.” • “I’m really glad you had the courage to tell me.” • “I want you to know it wasn’t your fault.” When documenting responses in a medical chart, use the patient’s own words. Evaluate the patient’s needs • Is the patient in current danger? • If the assault happened recently, does the patient want a forensic exam to be performed? • If the assault happened within the past 120 hours, and the patient is female, does the patient want emergency contraception? • Does the patient need or want prophylaxes for HIV or other sexually transmitted infections? • Does the patient have acute injuries that need medical attention? • Do special accommodations need to be made to make the patient feel safe? • Does the patient need to schedule a follow-up appointment? • Does the patient wish to speak with a sexual assault advocate? Provide education (verbally and in writing) about violence and health issues. Make referrals • The Rape, Abuse, and Incest National Network (RAINN) offers a hotline (1-800-656-HOPE) that refers victims to local rape crisis centers. °
Collaborations can ensure that sexual violence assessments are effective while strengthening the community effort to identify and respond to victims of sexual violence. Selected assessment instruments The CDC has compiled a list of instruments that can be used to screen for sexual violence entitled Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Health care Settings. 66 Instruments outlined in this document include: • Abuse Assessment Screen (AAS) - Five items that assess physical, sexual, and emotional abuse. • Screening Tools-Sexual Assault - Five items that assess sexual assault and knowledge of risk reduction strategies. • Sexual and Physical Abuse History Questionnaire - Six of the items in this scale assess sexual abuse. • Two-Question Screening Tool - One of two items assesses sexual violence. • Universal Violence Prevention Screening Protocol - Five items that assess recent physical, sexual, and emotional abuse. • Victimization Assessment Tool - Five items that assess a variety of kinds of violence, including sexual violence. *This material was reprinted, with permission, from the National Sexual Violence Resource Center’s publication entitled Assessing patients for sexual violence: A guide for health care providers. This guide is available by visiting www.nsvrc.org Conclusions IPV is a relatively recent priority as a public health issue, and is driven by the insistence that IPV is wrong, unacceptable, and usually illegal. Clinicians can help communicate this message in the course of medical practice. When clinicians and their staff model competence and concern about IPV, patients can more effectively face these difficult issues, and lives can be saved. Resources Academy on Violence and Abuse www.avahealth.org CDC National Center for Injury Prevention and Control, Division of Violence Prevention www.cdc.gov/ncipc/dvp/dvp.htm
National Center on Elder Abuse https://ncea.acl.gov/ National Domestic Violence Hotline https://www.thehotline.org/ 800-799-SAFE (7233) TTY 800-787-3224
National Coalition Against Domestic Violence www.ncadv.org National Health Collaborative on Violence and Abuse www.nhcva.org
National Human Trafficking Hotline https://humantraffickinghotline.org/ 888-373-7888
National Network to End Domestic Violence www.nnedv.org
National Resource Center on Domestic Violence www.nrcdv.org
National Teen Domestic Violence Hotline 866-331-9474
TTY 866-331-8453 Text: loveis to 22522 www.loveisrespect.org
Nursing Network on Violence Against Women International www.nnvawi.org Partnership Against Domestic Violence www.padv.org Rape, Abuse and Incest National Network www.rainn.org U.S. Department of Justice, Office of Violence Against Women www.justice.gov/ovw
The NSVRC’s Directory of Sexual Assault Centers in the United States contains contact information for sexual assault crisis centers and state, territory, and tribal coalitions in the United States and its territories. www.nsvrc.org or 877- 739-3895. Crime victim compensation programs are often able to provide financial support to victims of violence for medical expenses and other costs that arise as a result of the crime. A directory of these programs is available online at https://ovc.ojp.gov/ directory-crime-victim-services. 65
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If the patient does not disclose sexual violence Offer education and prevention information and provide follow-up at the next visit. Collaborating with community partners Collaborating with local sexual violence experts is key to successful assessment and support for victims. Each program in such collaborations can provide the others with referrals, professional in- services, training, public education/outreach, and specialized services. For example, state sexual violence coalitions and community-based sexual violence prevention and services centers can often provide publications to help healthcare providers educate patients about sexual violence.
Faith Trust Institute www.faithtrustinstitute.org
Futures Without Violence www.futureswithoutviolence.org
Health Professional Education, Advocacy and Linkage (HEAL) Trafficking www.healtrafficking.org
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