Responding

When your patient answers NO to IPV screening
 
Even if abuse is not acknowledged, providing all patients with educational materials normalizes the conversation, making it acceptable for women to receive information without disclosure.  Convey to all women that:
  • information is available (keep brochures/posters in bathroom, exam room, waiting room) and hand out a small IPV resource card that can fit in patient’s shoe or other concealable area.
  • you/staff are available for help and support.
  • everyone has the right to a healthy and safe relationship.
  • abuse is wrong and it is not the victim’s fault.
 
“I just want you to know that if anything like this ever does come up, this is a safe place to talk about it and get help.”
 
When your patient answers YES to IPV screening
It can take a patient an enormous amount of courage to disclose abuse and it is very important that even the busiest provider offers support and validation.  This can be as simple as saying: 
 
“I am sorry this is happening to you and nobody deserves to be treated that way. Unfortunately this happens to a lot of my patients and it can impact your health. Also, I can connect you right here with someone who has helped a lot of women before if you would like to talk to her now.”
 
Be non-judgmental and supportive as you respond. Here are a few suggestions to try out:
 
  • Thank you for telling me – I know it was difficult to do.
  • I’m very glad you told me. I care. I’m concerned about the health and safety of you and your children.
  • I believe you.
  • You are not alone
  • There are people who can help you
  • This is against the law.
  • I'm sorry you have been hurt.
  • It's not your fault. You are not to blame.
  • No one deserves to be treated this way.
  • I understand how difficult it is to change this situation. It may take some time to figure out what to do.
  • I will support you no matter what you decide to do.
 
When the abuse was in the past
  • See above “When your patient acknowledges abuse”
  • Is it over (stalking)? (see Safety Assessment)
  • Has she recovered?
    Assess depression, anxiety, PTSD
  • Educate about effects on health
  • Refer for counseling and/or community DV services (see Maryland Domestic Violence Programs)
When your patient is experiencing abuse (no injuries)
 
  • See “When your patient acknowledges abuse”
  • Assess depression, anxiety, PTSD, suicidality
  • Assess safety (see Safety Assessment)
  • Refer to in-house resources (if available) or local DV program (see Maryland Domestic Violence Programs and Hotlines)
  • Child/vulnerable adult abuse? If yes, this requires mandatory reporting; see reporting requirements
  • Harm Reduction Strategies when appropriate (see below)
  • Educate about effects on health
  • Document (see Documenting)
  • Schedule follow-up
When your patient is experiencing abuse (with injuries)
 
Harm Reduction Strategies for Reproductive Coercion
 
  • Contraception - Women experiencing reproductive coercion are good candidates for contraception that is more difficult for partner to detect or sabotage 
    LARC (long acting reversible contraception, i.e IUD, Implanon
    Depo
  • Pregnancy Options Counseling – for an unintended pregnancy or one that is unwanted by the partner along with safety assessment/planning.