Routinely asking women about domestic violence in health settings

Abstract

Health professionals are ideally placed to identify domestic violence but cannot do so without training on raising the issue and knowledge of advice and support servicesThe stigma surrounding domestic violence means that many of those affected are reluctant or do not know how to get help. A systematic review of screening for domestic violence in healthcare settings concluded that although there was insufficient evidence to recommend screening programmes, health services should aim to identify and support women experiencing domestic violence.1 The review highlighted the importance of education and training of clinicians in promoting disclosure of abuse and appropriate responses.1 We argue that a strong case exists for routinely inquiring about partner abuse in many healthcare settings. Size of problemDomestic violence includes emotional, sexual, and economic abuse as well as physical violence. The different forms of abuse may occur together or on their own, although always in the context of coercive control by one partner over the other. To reinforce the fact that domestic violence does not necessarily involve physical violence, we prefer the term partner abuse. Abuse can continue after the partners have separated.Partner abuse occurs in all types of relationships, both same sex and heterosexual.2 Although about one in seven men in the United Kingdom report experiencing physical assault by a current or former partner, 3 these incidents are generally less serious than those reported by women, and men are less likely to be injured, frightened, or seek medical care. 4 The context and severity of violence by men against women makes domestic violence against women a much larger problem in public health terms.2 5 Worldwide, 10-50% of women report having been hit or physically assaulted by an intimate partner at some time. w1 In the United Kingdom, 23% of women aged 16-59 have been physically assaulted by a current or former partner, and two women are killed every week.3 This article therefore focuses on routine inquiry of women accessing health services.

Screening for Domestic Violence in Public Welfare Offices

“…Research contrasting methods for uncovering abuse in professional encounters indicates that women are more likely to divulge this concern if asked directly during the interview (Family Violence Prevention Fund, 2004;Morrison, Allan, & Grunfeld, 2000;Saunders et al, 2005;Taket et al, 2005). Asking directly also results in greater numbers of women disclosing domestic violence than using written formats such as check-off forms (Campbell, 2000;McClosky & Grigsby, 2005).…”

“…Frontline workers in welfare offices play a pivotal role in the detection and response to domestic violence, and their screening procedures are a critical factor in identifying survivors and connecting women to appropriate services. Research and practice indicate that screening should be universal to be effective (American Medical Association, 2003;McCloskey & Grigsby, 2005;Taket et al, 2005). Even if screening is universal, victims may not be identified if the procedures used fail to create the necessary trust between client and worker, or do not provide information that allows a woman to judge the risks and benefits of disclosure.…”

How Much Health Promotion and Disease Prevention Is Enough? Should Chiropractic Colleges Focus on Efficacy Training in Screening for Family Violence?

“…36 These low rates of routine screening are especially noteworthy given that family violence is unlikely to be spontaneously reported by patients in the absence of direct questioning by providers. 41,43 Given the common focus across professional groups on screening and detecting family violence, 13,20,27,29,31,34,37,38 the data indicating that screening enhances detection, 18,29,44 and health care providers' own acknowledgment of the importance of early detection, 6 considerable research has sought to identify the obstacles to universal family violence screening. Among the wide variety of barriers reported over the past several years, those most commonly reported have centered on four broad categories, including limitations in professional preparation, scope of practice concerns, inadequate system support, and a lack of interdisciplinary collaboration.…”

“…13,14 For instance, despite the general consensus that family Moreover, estimates on the epidemiology of family violence are complicated by the comorbidity among different subtypes, such as the noted relationship between intimate partner violence and child abuse. 17,18 Nevertheless, prevalence estimates suggest, for example, that 25-30% of women have been physically victimized by an intimate partner, 11,19,20 that nearly 20% of men seeking emergency medical services in urban areas are intimate/family violence victims, 21 that about 1 million child abuse cases are identified annually, 20 and that more than 1.5 million elders are mistreated annually, 22 with a predicted upsurge in rates as "baby boomers" age. [23][24][25] In addition to the associated physical and psychosocial comorbidities, considerable evidence suggests that abuse heightens the risk for health-detrimental behaviors, emergency mental health, general health care overutilization, and subsequent re-victimization.…”

“…[3][4][5][6][7][8][9]11,20,21,[26][27][28] Children exposed to family violence both directly and vicariously also experience comparable health-relevant sequelae contemporaneously and as adults. 6,18,20,29 Hence, it is likely that most health practices include numerous affected patients. 10,11,28,[30][31][32][33] For this reason, the World Health Organization has identified family violence as a multifaceted health care concern, 10 and Healthy People 2010 proposes screening and treatment as an important public health goal.…”