Domestic Violence: The Florida Requirement _ ____________________________________________________
The unique relationship dynamics of the abuser and abused are not easily detected under the best of circumstances. They may be especially difficult to uncover in circumstances in which the parties are suspicious and frightened, as might be expected when a victim presents to the emergency department. The key to detection, however, is to establish a proper assessment tool that can be utilized in the particular setting and to maintain a keen awareness for the cues described in this course. Screening for IPV should be carried out at the entry points of contact between victims and medical care (e.g., primary care, emer- gency services, obstetric and gynecologic services, psychiatric services, and pediatric care) [35]. The key to an initial assessment is to obtain an adequate history. Establishing that a patient’s injuries are secondary to abuse is the first task. Clearly, there will be times when a victim is injured so severely that treatment of these injuries becomes the first priority. After such treatment is rendered, however, it is important that healthcare professionals not ignore the reasons that brought the victim to the emergency department [35].
ASSESSMENT OF IMMEDIATE SAFETY FOR DOMESTIC VIOLENCE VICTIMS Are you in immediate danger? Is your partner at the health facility now? Do you want to (or have to) go home with your partner? Do you have somewhere safe to go? Have there been threats or direct abuse of the child(ren) (if applicable)? Are you afraid your life may be in danger? Has the violence gotten worse or is it getting scarier? Is it happening more often? Has your partner used weapons, alcohol, or drugs? Has your partner ever held you or your child(ren) against your will? Does your partner ever watch you closely, follow you or stalk you? Has your partner ever threatened to kill you, him/herself or your child(ren)? Source: [35] Table 1 CULTURALLY SENSITIVE ASSESSMENT During the assessment process, a practitioner should be open and sensitive to the patient’s worldview, cultural belief systems and how he/she views the illness [47]. This may reduce the tendency to over-pathologize or minimize health concerns of ethnic minority patients. Pachter proposed a dynamic model that involves several tiers and transactions [48]. The first component of Pachter’s model calls for the practitioner to take responsibility for cultural awareness and knowledge. The professional should be will- ing to acknowledge that he/she does not possess enough or adequate knowledge in health beliefs and practices among the different ethnic and cultural groups he/she comes in contact with. Reading and becoming familiar with medical anthropol- ogy is a good first step. The second component emphasizes the need for specifically tailored assessment [48]. Pachter advocates the notion that there is tremendous diversity within groups. For example, one cannot automatically assume that a Cuban immigrant adheres to traditional beliefs. Often, there are many variables, such as level of acculturation, age at immigration, educational level, and socioeconomic status, that influence health ideologies. Finally, the third component involves a negotiation process between the patient and the professional [48]. The negotia- tion consists of a dialogue that involves a genuine respect of beliefs. It is important to remember that these beliefs may affect symptoms or appropriate interventions in the case of domestic violence.
ASSESSING DOMESTIC VIOLENCE AND ABUSE
Healthcare providers have reported that even if routine screen- ing and inquiry results in a positive identification of IPV, the next steps of assessing and referring are often difficult, and many feel that they are not adequately prepared [46]. Accord- ing to the Family Violence Prevention Fund, the goals of the assessment are to create a supportive environment, gather information about health problems associated with the abuse, and assess the immediate and long-term health and safety needs for the patient to develop an intervention [35]. Assessment of domestic violence victims should occur immediately after disclosure of abuse and at any follow-up appointments. Assessing immediate safety is priority. Hav- ing a list of questions readily available and well-practiced can help alleviate the uncertainty of how to begin the assessment ( Table 1 ). If the patient is in immediate danger, referral to an advocate, support system, hotline, or shelter is indicated [35]. If the patient is not in immediate danger, the assessment may continue with a focus on the impact of IPV on the patient’s mental and physical health and the pattern of history and current abuse [35]. These responses will help formulate an appropriate intervention.
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