Domestic violence has many implications for our healthcare systems. Physicians, nurses and other medical professionals are in a unique position to recognize signs of abuse and help to intervene.

(From “The Facts on Health Care and Domestic Violence”—The Family Violence Prevention Fund)

• An estimated 37 percent of women who seek care in hospital emergency rooms for violence-related injuries have been injured by a current or former partner -Bureau of Justice Statistics, 1997
• The costs for medical and mental health treatment due to intimate partner violence are estimated to be $4.1 billion dollars per year -Center for Disease Control and Prevention, 1994
• Women suffer higher rates of intimate partner violence during pregnancy than preeclampsia or gestational diabetes. Screening is routine for the latter two conditions, but fewer doctors ask about violence at home -Maternal Health and Child Journal, 2000
• Studies have found that between 70 and 81 percent of victims of abuse would like their physician to privately screen for intimate partner violence -South Medical Journal, 1997, Archives of Family Medecine, 1992, 1996, 1998.

Guidelines for Routine Screening

(Adapted from “Preventing Domestic Violence: Clinical Guidelines on Routine Screening” The Family Violence Prevention Fund)

• Screen all girls and women 14 and older.
• Ask about abuse occurring in the last year and ask at each visit.
• Include screening as a part of a face-to-face interview encounter and a written health questionnaire
• Ask privately and discuss confidentiality, including the limits of confidentiality.
• Use professional interpreters rather than a friend or family member when relevant.

Guidelines suggest it is the most critical for the following providers to include intimate partner violence in their routine screening: Primary Care, Urgent Care, Ob/Gyn and Family Planning, Mental Health, and Inpatient.

Suggested Screening Questions

Framing your questions

These examples of framing help normalize asking questions about domestic violence and may put both the healthcare provider and the patient more at ease:

• “Because violence happens in a lot of people’s lives I’ve begun to ask all my patients about it…”
• “I don’t know if this is a problem for you but many of the patients I see are dealing with abusive relationships. Sometimes it’s uncomfortable for them to bring it up themselves so I’ve started asking about it routinely…”

Questions:

• Has your partner ever hit you or physically hurt you? Has he ever threatened to hurt you or someone close to you?
• Do you ever feel controlled by your partner or isolated by your partner?• Do you ever feel afraid or intimidated by your partner?
• Have you ever been hit, kicked, slapped, pushed or shoved by your partner?

Additional Possibilities:

• Have you been emotionally or physically abused by someone close to you? Who was it?
• Does your partner treat you well?
• Do you feel safe?
• Does your partner let you make your own decisions? Does s/he listen to what you would like to have happen?

Referring Screened Patients

Asking the question does not make you responsible for the problem. Be prepared to provide patients with written information and resources such as a crisis line. If you work in a hospital collaborate with your social work department. Patients and their family members can call SafeHouse Denver’s 24 Hour Crisis and Information Line at 303-318-9989. Depending on the context, you may also need to develop a procedure for when a patient feels s/he is at immediate risk upon leaving the health care setting.