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50 Vol. 67, No. 1 2016 Northeast Florida Medicine DCMS online . org
CME
Mandatory Reporting
\In the state of Florida, physicians are not required to report
domestic abuse unless serious injury or gunshot wounds were
inflicted. Reporting of domestic abuse without the informed
consent of the patient is illegal even if the patient admits to
the violence.42 If there is a suspicion of child abuse or an
admission of such, the child abuse must be reported to the
Department of Children and Families.
As of 2012, only a minority of states had mandatory
reporting of IPV which is largely due to the concern that
mandatory reporting requirements threaten patient-phy-
sician confidentiality and may deter women from seeking
needed medical attention or discussing abuse.43,44 In
surveys of victims presenting to emergency departments,
most victims do not support mandatory reporting.45 This
is likely due to the fact that these women recognize that
the reporting may lead to an escalation of the violence
by their abuser. Nonetheless, it is important that health
care providers be familiar with their state requirements
for mandatory reporting of IPV.
Intervention
Randomized control trials studying IPV are not feasible
because of the nature of the “disease.” However, in recent
years, many meta-analyses have been performed to further
investigate the effectiveness of intervention in IPV. In
2013, the World Health Organization issued guidelines
stating that, except for women who have spent one or more
nights in a shelter or pregnant women, there was insuffi-
cient evidence that interventions for IPV improved health
outcomes. 46,47 Since that time, one large meta-analysis
was published suggesting that women-centered advocacy
and home-visitation programs reduce a woman’s risk of
further violent abuse.48
The effectiveness of batterer’s intervention is also not
completely understood. Therapy for batterers includes
counseling and group therapy. The duration of treatment
in the state of Florida is 26 weeks. In this setting men
with previous abusive behavior challenge other men about
their unacceptable behavior. Many men are court ordered
into these intervention programs and for those men who
do complete at least a six month program, there is some
data to show that the recidivism rate is low.
Conclusion
Domestic violence is prevalent and impacts the psycho-
logical and physical well-being of the victims, as well as
the children in the homes where the abuse occurs. It is also
associated with financial and societal ramifications. Health
care providers need to pursue a better understanding of
victims and their perpetrators, the clinical presentation,
who and how to screen for IPV and the resources that
are available to victims. Be your patient’s advocate! v
References
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