Domestic Violence Tips For Health Care Professionals

It is a JCAHO Standard to Screen Regularly for Domestic Violence

R.A.D.A.R.: A Domestic Violence Intervention Tool

R= ROUTINELY SCREEN FEMALE PATIENTS

• Although many women who are victims of domestic violence will not volunteer any information, they will discuss it if asked simple, direct questions non-judgmentally and in a confidential setting. Interview the patient ALONE.

A= ASK DIRECT QUESTIONS

• For example: “Because violence is so common in many women’s lives, I’ve begun to ask about it routinely. Are you in a relationship in which you have been physically hurt or threatened?
• If no, “Have you ever been?” “Have you ever been hit, kicked, or punched by your partner?” “Do you feel safe at home?” “Does your partner try to control where you go or what you do?” “I notice you have a number of bruises; did someone do this to you?”
• IF PATIENT ANSWERS “YES,” see below for responses, and continue with the following steps

D= DOCUMENT YOUR FINDINGS

• Record a description of the abuse as she has described it to you. Use statements such as “the patient states she was…” If she gives the specific name of the assailant use it in your record. “She says her boyfriend, John Smith, struck her….”
• Record all pertinent physical findings. Use a body map to supplement the written record. Offer to photograph injuries. When serious injury or sexual abuse is detected, preserve all physical evidence. Document an opinion if the injuries were inconsistent with the patient’s explanation.

A= ASSESS PATIENT SAFETY

• Before she leaves the medical setting, find out if she is afraid to go home. Has there been an increase in frequency or severity of violence? Have there been threats of homicide or suicide? Have there been threats to her children or pets? Is there a gun or other weapon present?

R= REVIEW OPTIONS AND REFERRALS

• If the patient is in imminent danger, find out if there is someone with whom she can stay. Does she need immediate access to a shelter? Offer her the opportunity of a private phone to make a call. If she does not need immediate assistance, offer information about hotlines and resources in the community. Remember that it may be dangerous for the woman to have these resources in her possession. Do not insist that she take them. Try to make a follow-up appointment to see patient.

IF THE PATIENT ANSWERS YES TO THE QUESTIONS ASKED…

• Encourage her to talk about it.
• Listen non-judgmentally.
• Validate her experience.

IF THE PATIENT ANSWERS NO, OR WILL NOT DISCUSS THE TOPIC…

• Be aware of any clinical signs that may indicate abuse: Injury to the head, neck, torso, breasts, abdomen, or genitals.
• Bilateral or multiple injuries.
• Delay between onset of injury and seeking treatment.
• Explanation by the patient which is inconsistent with the type of injury.
• Any injury during pregnancy, especially to the abdomen or breasts.
• Prior history of trauma.
• Chronic pain symptoms for which no etiology is apparent.
• Psychological distress such as depression, suicidal ideation, anxiety, and/or sleep disorders.
• A partner who seems overly protective or who will not leave the woman’s side.

IF PATIENT DENIES ABUSE, BUT YOU STRONGLY SUSPECT IT, DOCUMENT IT, AND LET HER OR HIM KNOW THERE ARE RESOURCES AVAILABLE. MAKE SURE THE PATIENT KNOWS THAT SHE or HE IS NOT ALONE.