Northeast Florida Medicine, Spring 2016

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Northeast Florida Medicine

Vol. 67, No. 1 2016

CME

Screening Tool for Domestic Violence (Table 2). HITS

consists of four questions scored on a 5 point scale ranging

from never to frequently.

This test has a 30-100 percent

sensitivity and 55-99 percent specificity. Physicians may

also consider simply asking the patient if he/she is afraid

of their partner or anyone else. A positive response can

lead

to further questions.

Secondary and Tertiary Prevention: Four Steps to

Take Once Intimate Partner Violence is Detected

Step 1:

Be supportive. Physicians can best support

their patients by acknowledging the patient’s admission

of abuse and the difficulty the patient must have faced

in disclosing this information. In addition, the physician

can also ask the victim how they can best support them.

Step 2:

Assess the patient’s safety. Clinicians should

employ open-ended questions to ask victims of IPV about

their concerns and fears.

A validated 20-Item Danger

Assessment Tool (Figure 3) is also available to predict the

likelihood of lethality or near-lethality in a relationship

afflicted by domestic violence.

Although the majority

of patients are not in imminent danger and are not plan-

ning to leave their current abusive relationship, clinicians

should not lose sight of the fact that IPV can result in

death. Physicians should work closely with the patient

to formulate a safety plan. A Safety Packing List (Figure

4) highlights items that should be included in the safety

plan. Essential items include a set of keys, important

documents such as birth certificate(s), additional cash

and clothes, as well as the emergency numbers and the

number of someone that the victim trusts and can call in

an emergency.

Patients should be educated on the course

of domestic violence and the potential for escalation of

violence if the victim chooses to leave the relationship.

Step 3:

Know onsite, local and national resources. The

best resource for IPV victims is IPV advocacy services as

they are well trained in IPV intervention and can most

adequately assist the patient in dealing with IPV. Addi-

tionally, the National Domestic Violence Hotline is a

valuable resource as are others listed inTable 3. Physicians

and patients should ensure that any provided resources

are hidden or concealed from the abuser. References can

be small (thereby easily concealed in a shoe, etc.), obscure

(hidden on the back of the physician’s card along with

other useful numbers), or even technologically savvy.

The ASPIRE News App appears to be a news website but

actually offers a discrete way to call for help and can be

downloaded onto a phone or other electronic device.

Step 4:

Determine whether or not Child Protective

Services should be involved. If any child is thought to be

unsafe in the home, it is mandatory for the clinician to

report this. However, the IPV victim and parent of the

child should be encouraged to report on his or her own

as this may assist in custody decision making.

Documentation

Careful documentation is imperative in cases of domestic

violence, especially when the patient is contemplating pur-

suing legal intervention. Documentation should include

direct quotes from the patient regarding time, nature and

other details regarding the abuse; physical exam findings;

photography or sketches of the sustained injuries (photo-

graphs to include the patients face in case of necessity for

evidence); and comments on comorbidities and degree of

disability.

38,41

If necessary, rape kits should be obtained,

completed and documented. Physicians should not use

words such as “denies” or “claims” as this may suggest

disbelief in the patient especially in a court of law. More

appropriate language includes “patient reports” rather

than “patient denies or claims.”

Local Hotlines

Hubbard House, Inc.

(Duval, Baker and Nassau Counties)

1-800-500-1119

Quigley House

(Clay County)

1-800-339-5017

Betty Griffin House

(St. John’s County)

1-800-500-1119

Florida Coalition Against

Domestic Violence

1-850-671-3998

First Step

(Batterer’s Intervention Program)

1-904-354-0076 ext.

201

National Hotlines

National Domestic

Violence Hotline

1-800-799-SAFE

(7233)

National Sexual Assault Hotline

1800-656-4673

Child and Elder Abuse Hotline

1-800-96-ABUSE

The National Teen Dating

Abuse Helpline

1-866-331-9474

Online Resources

Futures Without Violence

www.futureswithout

violence.org

National Coalition Against

Domestic Violence

www.ncadv.org

Table 3:

Local, State and National Resources