Preparing to address intimate partner violence

By Mark J. Netoskie,
M.D., M.B.A., FAAP

As physicians, all of us will come into contact at one time or another with intimate partner violence (IPV) – sometimes known as domestic violence (DV) – which can take many forms. It is the willful intimidation – emotional, sexual, psychological or physical – of a household member. It can target spouses – men and women, children and even our elderly. The statistics of abuse are startling.

• According to reports from the National Institutes of Justice and the Centers for Disease Control and Prevention, a woman is battered every 9 seconds in the United States.
• A report of child abuse is made every 10 seconds, and there are nearly 3 million reports of child abuse annually, according to Childhelp®, a national nonprofit organization.
• A report presented to the Senate Judiciary Committee cited that 50 percent of all homeless women and children in this country are fleeing domestic violence.

IPV/DV is a national epidemic that affects individuals in every community, regardless of age, economic status, race, religion, sex, nationality or educational background. The associated costs are equally staggering. In a 2003 report, the Centers for Disease Control and Prevention estimated that the health-related costs alone in the United States exceeded $5.8 billion per year. By the sheer numbers, it’s easy to recognize that IPV/DV is real, but how do you diagnose it? And, how do you begin the conversation to discuss it?

In 1998, the American College of Physicians (ACP) published Tips for Detecting – And Treating – Domestic Abuse because the ACP recognized that physicians needed some help in talking about abuse. “Many times doctors simply do not ask about domestic violence, even when they take patient histories or see obvious signs of abuse,” according to the article in the ACP Observer.

interviewed for the article, said that screening for domestic violence can be a short and effective process. Working with colleagues at the University of Colorado, she developed a three-question tool, called the Partner Violence Screen Test. The tool has physicians ask the following questions:

• Have you been hit, kicked, punched or otherwise hurt by someone within the past year? If so, by whom?
• Do you feel safe in your current relationship?
• Is there a partner from a previous relationship who is making you feel unsafe now?

Although Dr. Feldhaus admits that the tool is not perfect, “using such a short, simple interview makes it a practical tool.”

The ACP Observer article also offered other expert advice:

• Establish a safe environment to interview the victim privately and assure him/her confidentiality.
• Validate the victim’s feelings and reassure the individual that he/she does not deserve to be abused.
• Document any injuries, even if the patient denies abuse has occurred. In the patient’s chart, use descriptive rather than subjective terms and draw a body map to record injuries. When possible, include direct quotes from the patient and photographs of the injuries.
• Make appropriate referrals to local shelters or counselors.
• Discuss a safety plan, including emergency phone numbers, particularly if the patient chooses not to leave a dangerous situation. Make a follow-up appointment if appropriate.
• Let the patient take control. Avoid replicating the abuse cycle by imposing your own opinions on the patient.

For local Houston resources, the Harris County Public Health and Environmental Health Services’ Web site has a comprehensive list of local shelters and counseling services, law enforcement agencies, legal assistance and counseling for batterers. The site is available at www. harriscountyhealth.com/dv/DVResources. htm and links to many external resources.

Another great online resource is the Texas Department of Human Services’ family violence shelters. The Web site, available at www.hhsc.state.tx.us/programs/ familyviolence/shelters.html, lists out the phone number and address for shelters statewide, including shelters in the outlying areas of Houston.

The last important Houston resources you should be aware of are the Houston Area Women’s Center (HAWC) and Houston Safety Net.