Domestic Violence Assessment and Intervention
provided by the Family Violence Prevention Fund
It is critical that providers understand how to respond
to domestic violence victims once they have been identified.
Policies and protocols on domestic violence must also include
guidelines on effective assessment, intervention, documentation
and referral. The Family Violence Prevention Fund (FVPF)
recommends that providers receive training on these skills
prior to implementing a protocol screening. Model training
materials, department guidelines, protocols and other tools
are available through the FVPFís toll free number 888-Rx-Abuse,
- Assess the immediate safety needs of the victim. "Are
you in immediate danger? Where is your partner now? Where
will he or she be when you are done with your medical
care? Do you want or need security, or the police to
be notified immediately?"
- Assess the pattern and history of the abuse. Assess
the partnerís physical, sexual, or psychological tactics,
as well as the economic coercion of the patient. "How
long has the violence been going on? Has your partner forced
or harmed you sexually? Has your partner harmed your family,
friends, or pets? Does your partner control your activities,
money, or children?"
- Assess the connection between domestic violence and
the patientís health issues. Assess the impact
of the abuse on the victimís physical, psychological,
and spiritual well being. What is the degree of the partnerís
control over the victim? "How is your partnerís
abusive behavior affecting your physical health? (For
example, arthritis, chronic neck or back pain, migraine
and other frequent headaches, stammering, problems seeing,
sexually transmitted infections, chronic pelvic pain,
stomach ulcers, spastic colon, and frequent diarrhrea,
constipation or eating disorders). How is the abusive
behavior affecting your mental health? (For exaomple,
depression, suicidal ideation, stress, psychiatric disorder,
substance abuse problems)."
- Assess the victimís current access to advocacy and
support groups. Are there culturally appropriate
community resources available to the patient? What resources
(if any), in addition to the health care provider, are
available now? "What resources
have you used , or tried in the past? What happened?
Did you find them helpful or appropriate?"
- Assess patientís safety: Is there future risk or death
or significant injury or harm due to the domestic violence? Ask
about the partnerís tactics: escalation in frequency
or severity of the violence, homicide or suicide threats,
use of alcohol or drugs, as well as about the health
consequences of past abuse.
"Has your partner ever:
- Used or threatened to use weapons against you?
- Choked, or attempted to strangle you?
- Taken you or your children hostage to get what he
or she wants?
- Stalked you?
- Hurt or threatened to hurt your children?
Has the abuse been getting worse? Are you afraid for
your life? Does your partner use alcohol or drugs? Have
you ever felt so bad that you didnít want to go on living?
Have you ever thought about killing yourself? Have you
attempted to do so in the past.
Goals for effectively responding to domestic violence
- Increase victim safety and support victims in protecting
themselves and their children by validating their experiences,
providing support, and providing information about resources
- Inform patients about any limits in confidentiality for
example, child abuse or domestic violence reporting requirements.
- The goal is not to get patients to leave their abusers,
or to "fix" the problem for the patient, but
to provide support and information.
Listen to the patient and provide validating messages:
- "You donít deserve this. There is no excuse for
domestic violence. You deserve better."
- "I am concerned. This is harmful to you (and
it can be harmful to your children)."
- "This is complicated. Sometimes it takes time
to figure this out."
- "You are not alone in figuring this out. There
may be some options. I will support your choices."
- "I care. I am glad you told me. I want to work
together to keep you as safe and healthy as possible."
- "Stopping the abuse is the responsibility of
your partners, not yours"
Provide information about domestic violence to the patient:
- Domestic violence is common and happens in all kinds
- Most violence continues and often becomes more frequent
- Violence in the home can hurt children (if the patient
- Domestic violence impacts the patientís health.
- Stopping domestic violence is the responsibility of the
perpetrator, not the victim.
Listen and respond to safety issues:
- Show the patient a brochure about safety planning and
go over it with her or him.
- Review ideas for how to keep information private and
safe from the abuser.
- Offer the patient immediate access to an advocate 24
hour local, state, or national domestic violence hotline
- Offer to have a provider or advocate discuss safety then
or at a later appointment.
- If the patient says she or he feels she or he is in danger,
take this very seriously.
- If the patient is at high risk and is planning to leave
the relationship, explain that leaving without telling
the partner is the safest alternative.
- Make sure the patient has a safe place to go and encourage
her or him to talk to an advocate.
- Reinforce patientís autonomy in making decisions regarding
Make referrals to local resources:
- Explain any advocacy and support systems within the health
- Refer patient advocacy and support services within the
community including legal options, advocacy services, etc.
- When possible, refer patients to organizations that reflect
their cultural background or address their special needs
such as organizations with multiple language capacity,
those that specialize in working with teen, disabled, deaf,
hard of hearing, or lesbian, gay, bisexual, or transgender
If no local resources are available, refer patient to
an advocate from the multi-lingual National Domestic Violence
Hotline 24 hours a day by dialing 800-799-SAFE, TTY 800-787-3224.
Follow-up steps for health care practitioners:
- Schedule a follow-up appointment. Ensure the patient
will have a connection to a primary care provider.
- Domestic violence, like other health issues (smoking,
poor nutrition, high blood pressure, etc.), often requires
multiple interventions over time. Ask what happened after
the last visit.
- Review medical records and ask about past episodes of
domestic violence in order to communicate a concern for
the patient and a willingness to address this health issue
- Ask the patient if there is a phone number or address
that is safe to contact them.
Download the Safety Planning
Sheet (pdf format)