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 one’s 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 • Child’s history doesn’t 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 child’s 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 mom’s 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... • DON’T 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 you’re not alone...” and/or “I am glad you are talking to me about this, let’s 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 W’s” • 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 W’s” • 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 Women’s 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 child’s 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?