Resident Editor: Gladys Rodriguez, MD

Faculty Editor: ***

Background:

• Intimate Partner Violence or IPV (also referred to as Domestic violence or DV) involves physical violence, sexual violence, stalking and psychological aggression including coercive acts by a current or former intimate partner.
• IPV affects millions of American’s yearly.
• According to the CDC’s National Intimate Partner and Sexual Violence Survey, 1 in 4 women and 1 in 9 men are victims of IPV in the United States.
• IPV impacts people of all ages, sexual orientations, gender identities, races and ethnicities and socioeconomic classes.

Clinical Presentation

• The following are examples of aspects that a clinician might elicit or uncover on history of physical exam that would be concerning for IPV.

Screening

• Screening is recommended for all patients on initial PCP visit.
• Before questioning a patient about abuse, it can be helpful to "normalize" the inquiry and frame the questioning as a routine part of everyday practice.
• Multiple screening tools are available including:
  • HITS: How often does your partner Hurt you physically? Insult you or talk down to you? Threaten you with harm? Scream or curse at you?
  • STaT: Have you ever been in a relationship where your partner has: Pushed or Slapped you? Threatened you with violence? Thrown, broken or punched things?
• If you get a positive screen, assure the patient that it is not their fault, provide assurance that you will be available to the patient in the future, assess for victim’s safety AND contact the social worker at your institution.

Helping a Target of Intimate Partner Violence: The SOS-Doc Intervention

S:  offer Support and assess Safety

• Support: talk in private; make eye contact; assure confidential discussion, unless the patient expresses plan to harm self or another person
  • I am sorry this happened. You have a right to be safe and respected. The violence is not your fault.
• Safety: identify risk markers—increasing severity and frequency of violence, weapons used or available, threats to kill, forced or threatened sexual acts, life transitions (e.g., pregnancy, separation, divorce), drug and alcohol abuse, and history of violence and/or suicide attempts
  • Do you feel safe going home? Are your children safe?

O: discuss Options, including safety planning and follow up

• Options: legal tools and community resources; promote safety planning and offer safety planning handout. You can find some of these handouts under APEX smart phrases: Intimate Partner Violence.
  • If you decide to leave, where would you go? How would you get there? Can you keep clothes, money, and copies of keys and important papers in a safe place? Many women call a women’s shelter to learn more about it. Would you like to use our office phone?

S: validate patient’s Strengths: Identify and validate the patient’s strengths

• You have shown great strength in very tough circumstances. I can see that you care deeply about your children. It took courage for you to talk with me today about the violence.

Do:  Document observations, assessment and plans

• Subjective: record what the patient said; use quotation marks to document exact words
• Objective: describe the behavior and injuries observed, use drawings and photographs describing location and type of injuries; ask the patient permission before including a photograph; for photographs, include a ruler for scale, patient’s face, if allowed by patient, for identity
• Assessment: your assessment of potential partner violence
• Plans: describe safety planning and follow-up plans

 C: offer Continuity: Offer a follow-up appointment and assess barriers to access

• Do you have transportation? Will your partner try to prevent you from returning?

It may not be safe for patient to take documents on referrals for support and counseling home; they can make phone calls from your office and leave referrals there.

Legal obligations

• Requirements for reporting vary by state.
• In California, California Injury Reporting Law, DV (PC 11160) requires that any health provider  who cares for a physical condition and identifies injuries suspiciously related to assault/abuse must notify law enforcement by BOTH:
  • Telephone: make a report as soon as possible to the SFPD at 415-553-9220 and include:
    • Victim’s name, address, telephone number
    • Assailant’s name, address, telephone number
    • Description of event & description of injuries
  • File “Report of Injuries by a Firearm or Assaultive of Abusive Conduct” form; send reports to SFPD Domestic Violence Unit within two business days.

National resources/hotlines

SF Bay Area Resources