How to Screen IPV

1
How to Screen IPV

• Child Family Safety Project

2
Screening Setup

• GOAL Well-being of everyone in family
• Provide a context
• Talk to non-abusive parent and possibly child in
  a safe, private environment
• It seems that many families, like the ones
  we have in our clinic, are dealing with
  violence, so I routinely ask parents about this.

3
Be alert to clues during well-child or sick
visits

• One partner insists on accompanying other parent
  and often times speaks for them
• Non-abusive parent reluctant to talk
• Childs history doesnt fit injury or illness

4
Be alert to clues during well-child or sick
visits

• Parent makes frequent appointments for vague
  complaints
• Medical attention sought much later than
  anticipated
• Injuries at various healing stages

5
Well Child Visits

• Tends to be easiest situation to assess IPV
• Intermix safety questions about mom into
  anticipatory guidance section of visit
• E.g. asking about smoke detectors in the house,
  car seats, etc, could say
• Ok, now to shift gears a little, I want to ask
  you about your own safety b/c when moms are safe,
  kids are safe...has anyone ever hit, slapped,
  hurt you in anyway...

6
Sick Child Visits

• May be more uncomfortable (more left field)
• These visits tend to be the only time victims
  seek medical attention as the childs illness
  becomes a priority

7
Sick Child Visits

• Suggestions
• Assess IPV after exam and diagnosis in order to
  focus on child 1st
• Stress again and again Interested in moms
  safety b/c it is related to child safety

8
How To Screen

• Ask Behavior-Specific Questions (Direct)
• Poor Question Do you feel safe?
• Direct Question Has anyone hit, kicked,
  slapped, threatened, or hurt you in anyway such
  as deprived access to medical attention,
  financial resources, or isolate you from friends
  or family?
• GOAL To ask direct questions that minimize
  ambiguity and potential misunderstandings.

9
If Mom/Child says No...

• Take Home Universalize IPV experiences by
  saying, Good, I am glad to hear that this is not
  happening to you and your child, b/c
  unfortunately, we know it happens to a lot of
  women from various backgrounds.
• Emphasize that University Pediatric is a safe
  place
• Provide with resources

10
If Mom/Child says No...

• Accept Results, but continue screening every
  visit
• Explain you are available to help if support
  needed in future
• Have resources available each visit

11
If Mom/Child Says Yes...

• DONT Panic Understand Your Role
• You are not responsible in making sure that she
  leaves partner or makes life changing decisions
  at that moment
• PRIORITY 1A Validate Experience
• I am sorry this is happening, I want you to
  know youre not alone... and/or I am glad you
  are talking to me about this, lets see how we
  can work together to keep you and your child safe
  and healthy.
• (Of course, when applicable, treat injuries of
  child 1st if suspect IPV, look for hidden
  injuries)

12
If Mom/Child Says Yes...

• PRIORITY 1B Safety Assessment 4 Ws
• WHO? (e.g. other family members)
• WHERE? (e.g. home, near children)
• WHEN? (e.g. under influence of drugs)
• WHAT? (e.g. suicide threats, hostages)

13
DO NOT

• Do not ask WHY?
• Do not assess with male or partner in room
• Do not assess with children over 2 years of age
  in room
• PRIORITY 1 Safety Assessment 4 Ws
• WHO?
• WHERE?
• WHEN?

14
Safety Planning

• After Safety Assessment and Mom says yes
• Make sure mom and kids are safe by reducing harm
• Are weapons present? (e.g. if guns, remove
  ammunition)
• Safe places in home if violence begins (options)
• Extra keys
• Hide money
• - Provide resources

15
Safety Planning

• Resources
• Legal Advocates for Abused Women (LAWW)
  314-535-5229
• Womens Support Community Service
• 314-531-2003
• Redevelopment Opportunities for Women (ROW)
• National Domestic Violence Hotlines
• 1-800-799-SAFE

16
After the Assessment

• Document Visit
• Explain what will put in records (legal access
  concerns)
• Use patients own words to describe IPV
• Use body map to document injuries (maybe photos)
• Record treatment, consults, referrals, meds,
  follow-up
• Determine if mandated reporting necessary

17
After Assessment

• Plan Follow up
• Monitor progress indirectly (missed or cancelled
  appointments esp. by abuser)
• Next visit
• Gather information (what happened since last
  visit?)
• Review validation (health care issue that can be
  discussed without shame or fear)
• Remind mom and YOU Violence is complex health
  issue, and like smoking or obesity, it takes time
  to resolve

18
Take Home

• Determine if Safe and Treat Injuries
• Explain nature of IPV (lasting effects on
  children violence tends to escalate over time)
• Discuss Options (various resources, make
  referrals if needed and wanted)
• Document Follow-Up

19
Getting Started...Ask Direct ?s

• Do you and your children feel safe at home, do
  you ever feel threatened there?
• Has your partner or anyone ever slapped, hit,
  shoved, or hurt you or your child emotionally or
  physically?
• Are your childs symptoms the result of someone
  hurting him? Was it your partner?

20
Getting Started...Ask Direct ?s

• Has anyone had difficulties with drugs or alcohol
  in your home?
• Do you keep guns or rifles at home? How are they
  kept, or they unlocked or locked?
• Would you like information about violence or
  substance abuse programs?