National Consensus Guidelines - …

1 ON IDENTIFYING ANDRESPONDING TODOMESTIC VIOLENCEVICTIMIZATIONIN HEALTH CARE SETTINGSN ationalConsensusGuidelinesProduced byTHE FAMILY VIOLENCE PREVENTION FUNDF unded byTHE CONRAD N. HILTON FOUNDATION AND THE DEPARTMENT OF HEALTH AND HUMAN SERVICES,ADMINISTRATION FOR CHILDREN AND FAMILIESF amily Violence Prevention FundFor more than two decades, the Family ViolencePrevention Fund (FVPF) has worked to endviolence against women and children around theworld. Instrumental in developing the landmarkViolence Against Women Act passed by Congressin 1994, the FVPF has continued to break newground by reaching new audiences including menand youth, promoting leadership withincommunities to ensure that violence preventionefforts become self-sustaining, and transformingthe way health care providers, police, judges,employers and others address FVPF is a National non-profit organizationcommitted to mobilizing concerned individuals,allied professionals, women s rights, civil rights,other social justice organizations and children'sgroups through public education/preventioncampaigns, public policy reform, model training.

2 Advocacy programs and copies of this publication may be purchased or by phone: (415) 252-8089 FAMILY VIOLENCE PREVENTION FUNDHEALTH STAFF:Lisa James, MA, Debbie Lee, Anna Marjavi,Vibhuti Mehra, MA, Fran Navarro, Rebecca Whiteman, MAAny adaptation or reprinting of thispublication must be accompanied by thefollowing acknowledgement:PRODUCED BYThe Family Violence Prevention Fund383 Rhode Island Street, Suite 304 San Francisco, CA 94103-5133(415) 252-8900 TTY (800) 595-4889 First Printing: September, 2002 Updated: February, 2004If you would like more information aboutimproving the health care system s responseto domestic violence contact:The Family Violence Prevention Fund sNational Health Resource Center onDomestic : 1-800-595-4889 FUNDED BYThe Conrad N.

3 Hilton Foundation and Department of Health and HumanServices, Office of Community Services,Administration for Children and FamiliesGraphic design by Liz ChalkleyFamily Violence Prevention FundNational Consensus Guidelines ON IDENTIFYING AND RESPONDING TO DOMESTIC VIOLENCE VICTIMIZATIONIN HEALTH CARE SETTINGSNATIONALGUIDELINESCONSENSUSS pecial Thanks to theNATIONAL ADVISORY COMMITTEE MEMBERSF amily Violence Prevention FundNational Advisory Committee MembersElaine Alpert, MD, MPHB oston University School of Public HealthMassachusettsJacquelyn C. Campbell, PhD, RN, FAANJ ohns Hopkins UniversityMarylandLinda Chamberlain, PhD, MPHA laska Family Violence Prevention ProjectAlaskaAnne L.

4 Ganley, PhDUniversity of WashingtonWashingtonLeigh Kimberg, MDMaxine Hall Health CenterCaliforniaMargaret M. McNamara, MDUniversity of California, San FranciscoCaliforniaTerri E. Pease, PhDServiceNetMassachusettsPatricia R. Salber, MDPhysicians for a Violence-free SocietyCaliforniaThe Family Violence Prevention Fund (FVPF) wishes to thank the National Advisory Committeemembers for the National Consensus Guidelines on Identifying and Responding to DomesticViolence Victimization for their time and rigorous attention to the development of these Consensus can be complicated and the expertise, experience and guidance of AdvisoryCommittee members were invaluable. These individuals include members from the advisorycommittee for the FVPF s original Preventing Domestic Violence: Clinical Guidelines on RoutineScreening as well as representatives from fourteen states participating in the FVPF's NationalHealth Care Standards Campaign on Domestic Violence.

5 Carole Warshaw, MDHospital Crisis Intervention ProjectIllinoisDeborah Zilmer, MDAmerican Academy of Orthopaedic SurgeonsIllinoisNational Advisory Committee Members from the National Health Care Standards Campaignon Domestic ViolenceALABAMA:Angie Boy Alabama Coalition Against Domestic ViolenceCALIFORNIA:Angela KaufmanCity of Los AngelesConnie Mitchell, MDCalifornia medical Training Center,University of California, DavisFLORIDA:Sandi RobinsonDomestic and Sexual Violence ProgramDoris Campbell, PhDUniversity of South FloridaNEVADA:Shelly Baker, MSWS outhwest medical Associates Eryn BranchNevada Network Against Domestic ViolenceNEW HAMPSHIRE:Deb Hastings MS, RN, CNORSt. Anselm College, ManchesterMargo Krasnoff, MDSection of General Internal MedicineJennifer Pierce-Weeks, RNNew Hampshire Coalition Against Domestic and Sexual ViolenceOHIO:Sandy HuntzingerOhio Coalition Against Domestic ViolencePENNSYLVANIA:Nancy DurborowPennsylvania Coalition Against Domestic ViolenceWASHINGTON :Kim Bullock, MDProvidence HospitalWEST VIRGINIA:Laurie ThompsenWest Virginia Coalition AgainstDomestic ViolenceWISCONSIN:Susan RamspacherWisconsin Coalition Against Domestic ViolenceIOWA:Binnie LeHewIowa Department of HealthKathy Dolan, RN, CENE mergency Nurse s AssociationILLINOIS.

6 Lynda DautenhahnIllinois Department of Public HealthJohn Lumpkin, MD, MPHI llinois Department of Public HealthBarbara ShawIllinois Violence Prevention AuthorityMASSACHUSSETTS:Paulani EnosNortheastern UniversityAnnie Lewis-O Connor, RNCS, MSN, MPHB oston UniversityCarlene PavlosViolence Prevention and Intervention UnitLiza Sirota, MSJLSJane Doe :Julie Beck, LMSWThe Bridge Program, Rose Brooks CenterCathy Blair, RN, LCSWAWARE, Barnes Jewish HospitalDr. Stephanie Ellison, MDTruman medical Center WestAdvisory CommitteeFamily Violence Prevention FundFamily Violence Prevention FundFamily Violence Prevention FundPART IINTRODUCTION, DEFINITIONS AND RATIONALEPART IIGUIDELINES FOR RESPONDING TO INTIMATE PARTNER VIOLENCE VICTIMIZATION INHEALTH SETTINGSPART IIIQUALITY IMPROVEMENT GOALS AND IMPLEMENTATION MEASURESAPPENDICESAPPENDIX A:Setting Specific Clinical Responses: A Quick Reference GuideAPPENDIX B:Dilemmas Faced by Child Health ProvidersAPPENDIX C:Dilemmas When Assessing All Patients for VictimizationAPPENDIX D:Suggested Assessment Questions and StrategiesAPPENDIX E:Validated Abuse Assessment ToolsAPPENDIX F.

7 Expanded AssessmentAPPENDIX G:Indicators of AbuseAPPENDIX H:Safety Plan and Discharge InstructionsAPPENDIX I:Interventions with Current or Past Victims of Domestic ViolenceAPPENDIX J:State Codes on Intimate Partner ViolenceVictimization ReportingAPPENDIX K:Photo Documentation and Forensic Evidence CollectionAPPENDIX L:Confidentiality ProceduresAPPENDIX M:Preparing Your PracticeAPPENDIX N:Resources and ReferralsAPPENDIX L:Confidentiality ProceduresREFERENCESTRAINING & EDUCATION MATERIALS CATALOGCONTENTS1112125 Family Violence Prevention FundINTRODUCTIONF amily Violence Prevention Fund1 IntroductionFor over a decade, the Family Violence Prevention Fund (FVPF) through its publications,practices, educational programs, and outreach efforts, has promoted routine assessment fordomestic violence and effective responses to victims in health care settings.

8 Other healthprofessional organizations including the American medical Association, American College ofObstetricians and Gynecologists, American Academy of Family Physicians, AmericanPsychological Association, American Nurses Association, American Academy of Pediatrics,the Joint Commission on the Accreditation of Health Care Organizations, and the Instituteof Medicine, have promulgated policy statements, position papers, Guidelines andmonographs about this important health 1999, in collaboration with an expert advisory committee, the FVPF publishedPreventing Domestic Violence: Clinical Guidelines on Routine Screening. This documentendorsed a set of National Guidelines on screening for abuse and offered recommendationson whom to screen, how often and in what settings.

9 As inquiry for domestic violencebecomes more widespread, the need to expand these Guidelines to include guidanceregarding assessment and response has become apparent. It is critical that providersunderstand how to respond to domestic violence victims once they are identified, includingproviding appropriate health and safety assessment, intervention, documentation and indicates that the vast majority of victims of abuse in intimate relationships arewomen whose partners are men. Emerging research has not only confirmed earlier findings,but also has indicated that men in same-sex relationships experience domestic violence atrates at least equal to that of women in heterosexual relationships, and that lesbians andsome men in heterosexual couples also experience abuse.

10 Therefore, these Guidelines havebeen expanded to recommend assessment of all female and male adolescent and adultpatients for domestic violence victimization. INTRODUCTIONPART IThe National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimizationpresent recommendations on how inquiry for domestic violence victimization, assessment, documentation,intervention and referrals should occur in multiple settings, and in various professional disciplines. Theydo not however, address inquiry for perpetration. Part I of the Guidelines reviews current findingsregarding the prevalence and health impact of domestic violence, presents a rationale for regular androutine inquiry and response, and underscores the importance of culturally competent practice inaddressing domestic violence.