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Domestic violence (or partner abuse) is a public health issue affecting
as many as 4 million women each year in the United States. The medical
setting is a primary place where victims of domestic abuse seek help.
Our supportive response as medical providers can make the difference
between safety and continued abuse, injury and even death.
Domestic violence is a pattern of coercive control and abusive behaviors
in intimate relationships. It includes any or all of the following
types of abuse: verbal, emotional, economic, physical, sexual, threats
to harm, harassment, intimidation, isolation and deprivation of basic
needs and basic human rights. Women in heterosexual and same-sex relationships
are most often the victims. Gay men are also abused at similar rates
as women. Domestic violence occurs across the life span with women
of all ages affected. Domestic violence exists in all communities,
regardless of race and ethnicity, social class, or religious background.
In addition to suffering traumatic injury, victims of domestic violence
experience higher incidences of gastrointestinal and gynecological
disorders, substance abuse, eating disorders, chronic pain, sexually
transmitted diseases and suicidality.
Universal and routine screening of all female patients is recommended.
Screening is a tool to identify domestic violence and an intervention
in itself. Even if a patient does not disclose abuse, screening gives
the message that domestic violence is an important health issue and
conveys that the hospital/clinic is a safe place to access assistance
should the patient need it in the future. Abuse screening should always
occur when alone with a patient in a private setting. State to family
and friends, "I meet alone with all patients for a few minutes
and ask that you remain in the waiting area until I call you in."
Most effective screening questions ask about three key components
of abuse: fear, control and harm. Always meet alone with a patient,
ensure privacy, and provide a rationale for screening. Explain the
following: "Because abuse against women has impact on health
and well-being and happens to so many women, I ask all my female patients
if anyone is frightening or harming them in any way." Recommended
screening questions include: "Have you ever felt unsafe or been
afraid of anyone? "Does your partner ever try to control you
and the things you do?" and "Have you ever been hurt or
threatened by your partner?"
If a patient answers "Yes" to screening questions:
- 1. Convey support and validate the person’s experience.
Appropriate statements include: "Thank you for telling me –
I’d like to help," "You are not alone," "I’m
concerned for your safety," and "There are resources available
here for you."
- 2. Respond to the patient’s immediate safety concerns. Call
for consultation from the hospital’s domestic violence program
or social worker. (See BWH and MGH resources below.)
- 3. Document the screening, the patient’s response and your
response (safety plan and/or referrals) in the medical record. State
objective information and quote patient statements. Use patient’s
words to describe the abuse, including specific information about
the partner, types of abuse experienced and any physical findings
related to the abuse.
If a patient answers "No" to screening questions:
- 1. Let the patient know that the hospital has programs available
for domestic abuse should the patient or a family member or friend
need it in the future.
- 2. Document screening in patient’s medical record: "[Date],
Screened for domestic abuse, Patient states that abuse is not an
issue at the present time." Do not write: "Patient denies
abuse." Many abused women are afraid to talk about their situation,
but may return in the future and disclose. If a medical record later
becomes evidence in a legal matter, a provider’s note of "denies
abuse" creates a legal doubt about the patient’s credibility.
Passageway, in collaboration with the Office for Women, Family and
Community Programs and the Department of Care Coordination, develops,
implements, supports and evaluates interventions that increase identification
of domestic violence and improve access to safety and coordinated
care for those experiencing domestic violence. Passageway
offers free, voluntary and confidential advocacy services to patients
and employees of BWH. The program also provides consultation
to providers and managers, training, linkages to community agencies,
quality improvement projects and evaluation.
For patient referrals: Passageway advocates
are available weekdays, 8:30 am - 5 pm. After hours and on weekends,
social workers in the Department of Care Coordination are available
via the paging system. Before referring a patient to Passageway, explain
that all services are voluntary. If a patient agrees to the referral,
contact the social worker assigned to your clinical area who will
respond to the patient’s immediate concerns and facilitate the
referral to a Passageway advocate. As long as it is safe for the patient
to do so, an advocate will meet with a patient in-person at the time
of the referral. At any time, providers can consult with an advocate
directly regarding screening, identification, the patient referral
or other issues related to domestic violence. Use the on-line paging
system or call the BWH page operator at 617-732-6660 and ask for Passageway
on pager #31808.
For employee and staff referrals: Employees
can self-refer to Passageway by using the on-line paging system or
calling the operator at 617-732-6660 and asking for pager #31808.
Likewise, managers, co-workers and anyone concerned about domestic
violence, can contact the program at any time for assistance. Advocates
work closely with employees to ensure that their confidentiality and
privacy is assured. The advocates may refer to the Partners Employee
Assistance Program if requested by an employee and/or domestic violence
services outside of the hospital system - whatever helps an employee
safe access to support.
For Consultation: Page the advocate
on beeper #31808 or call 617-732-8753. Advocates provide consultation
on screening for domestic violence, how to respond to victims, the
dynamics of abusive relationships, how to address batterers in the
health care setting, and other issues related to safety planning and
accessing resources for victims of domestic violence.
Note: If present danger exists
to a patient, provider, or employee/staff, call Security at the stat
line, 617-732-6555 or call 911. Do not try to manage an escalating
or threatening situation yourself. Seek assistance as soon as you
become aware of an immediate safety threat.
MGH DOMESTIC VIOLENCE SERVICES: HAVEN PROGRAM
HAVEN is a program jointly sponsored by the Department of Social Services
and the Employee Assistance Program. HAVEN was developed to improve
and enhance the MGH health care response to both patients and employees
whose lives have been affected by domestic violence. HAVEN provides
assessments, safety planning, referrals, ongoing support groups, consultations,
clinician training and special services for employees. The staff is
multicultural and multilingual.
For Patient referrals: Before referring a patient to the program,
explain that all services are voluntary. If the patient agrees, a
referral can be made to HAVEN at 724-0054. For urgent consultations
or referrals, press "0" and ask for the advocate on call,
Monday - Friday, 8:30 am - 5 pm. An advocate can meet with the patient
either at that time or at a future scheduled appointment. On evenings
and weekends call the Page Operator at 726-2241 and ask for the social
worker on call.
For employee referrals: For employees—including
residents and fellows—who need help, call the Employee Assistance
Domestic Violence Specialist at 726-6976. Confidentiality is assured.
The EAP can provide workplace support and advocacy as well as all
the services available to HAVEN clients who are patients.
For Consultations: Sometimes a patient
will not be interested in advocacy services, but the health care provider
would like consultation with HAVEN staff. Call 724-0054 and ask to
speak with an advocate. Advocates provide consultations on screening
for DV, basic information on the dynamics of DV and the common impacts
of DV on physical and mental health, safety planning and community
resources throughout the U.S. and abroad.
Note: If present danger exists to either the patient or
provider, call Police and Security first at 726-2121 before contacting
HAVEN. Do not try to manage aggressive or threatening behavior yourself.
Seek help before a safety problem arises.
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