Medical Screening for Domestic & Sexual Abuse

Gynecologists can help identify sexual, physical and emotional abuse

Healthcare Consensus

Healthcare Response

Hidden Costs

Know More, Say More

Medical Power & Control Wheel

NCADV Reproductive Health, Pregnancy & Domestic Violence Fact Sheet

Preventing Domestic Violence: Clinical Guidelines on Routine Screening

Understanding Interpersonal Violence

Understanding Intimate Partner Violence

Family Violence Prevention Fund

Why screen in a medical setting?

The American Medical Association, the American College of Obstetricians and Gynecologists, the U.S. Preventive Services Task Force, the American Nursing Association, the Academy of Pediatrics and the Family Violence Prevention Fund recommend that all women and adolescent girls be screened for past and/or present intimate partner violence every time they are seen in a medical setting.

30% of the homicides of U.S. women are committed by their partner or ex-partner.

The majority of abuse victims will not present themselves to medical staff as abuse victims; i.e., they fell, or were clumsy, or ran into something, etc.; you will not know unless you screen.

37-54% of women seen in the emergency department have been abused by their partner or ex-partner at some point in their life; while 25-66% of women presenting to a primary care setting have been abused.

4-8% of pregnant adult women are abused during the course of their pregnancy, while a
staggering 21.7% of pregnant teenagers are abused during pregnancy.

40% of women in physically abusive relationships are concurrently being sexually abused
by their partner.

Poor health outcomes are just as significantly associated with psychological abuse as
with physical and sexual abuse.

Abused women are 4 times more likely to attempt suicide than non-abused women.

59% of the mothers of abused children are also being abused by the same person.

The National Institute of Health estimates that domestic crime against adults costs $67 billion annually and domestic crime against children costs $65.6 billion annually in the U.S.

Family Violence Prevention Fund

What signs and symptoms are you screening for?

• Burns (particularly those the size and shape of a cigarette)
• Finger, hand, foot (heal and/or toe of boot or shoe) shaped bruising
• Bruising in various stages of healing
• Bite marks
• Unusual bruising such as long and equally spaced or in areas not likely to be marked
• Back trauma (being kicked, drug, slammed, and punched)
• “Rug” burns
• Puncture wounds
• Evidence of nails having been dug into skin
• Hair pulled out
• Outer ear injury, ex. “cauliflower ear”, earring torn out, etc.
• Arm dislocated
• Throat striations (strangling)
• Petechiea
• Digits broken or sprained from being bent backward
• Jaw injury
• Teeth loose or knocked out
• Split lip
• Eye injury
• Concussions and skull factures
• Depression
• Anxiety
• STD’s
• Breast, vaginal and/or anal injury
• “Mounting” injuries (bruising on upper, inner thigh region)
• Menstrual problems
• Urinary tract infections
• Ligature marks
• Post-traumatic Stress Disorder (PTSD)
• Somatization (presence of physical symptoms not fully explained by a general medical condition); abuse victims average 30-50% more visits for medical attention annually than non-abuse victims
• Pre-existing condition not being properly cared for, particularly if condition requires medication (abuser may refuse to pay for medication and/or hide/destroy/use her medication)
• Persistent sleep disorders

Family Violence Prevention Fund

How do you screen a patient?

Never screen a possible victim while anyone else is in the exam room with her with the possible exception of a preverbal child. If you suspect a patient has been abused, please ask anyone accompanying her to excuse you for a moment and have them step outside the room. A victim will not disclose if the abuser is near and/or if she feels threatened or unsafe.

Always respect confidentiality and privacy. Indiana is not a mandatory report state in regards to victimization of adults; i.e., you cannot report the abuse of an adult to law enforcement without the victim’s agreement: adult victims can not be forced into the criminal justice system in the State of Indiana. By asking sincere and appropriate questions, you have opened the door for the patient to disclose to you when she feels she is ready, has accepted that your questions are genuine and that real help is available.

Use eye-to-eye contact and ask direct questions. If the patient senses that you are only asking because you have to or that you hope she won’t answer; she won’t. Asking indirect or off-hand questions are a total waste of time. Never ask “what happened?” Be sincere, alert and compassionate at all times.

Sample questions:

• I see you have bruising on your chest; I’m worried that someone has hurt you, has someone?
• I want to make sure you are safe before you leave here, can you tell me what happened to your eye?
• This is an unusual injury; can you tell me if someone hurt you?
• Is someone hurting you?
• What happens when you and your partner/boyfriend/husband disagree?
• Do you feel safe at home?
• How do you feel about the way your partner has been treating you?
• Are you afraid of your partner?
• Has your partner hit/punched/slapped/strangled you?
• Has your partner forced you to have sex when you didn’t want to?

Anticipating patient disclosure

Before beginning a screening protocol in your medical facility, contact our local domestic and sexual violence victim advocacy agency and request materials to have on hand for distribution to your clients. The best locations to place these materials are in the women’s bathroom and the individual exam rooms. It is also a good idea to have a professional advocate meet with your staff prior to beginning screening to assist you in developing an appropriate protocol and answering questions you will have.

Crisis Connection has a professional victim’s advocate on call 24-hours a day, 7-days a week; the advocate can come to your office or hospital to be with the patient. Our staff is knowledgeable and experienced in questioning victims and assisting them in exploring their options. Encourage the patient to allow you to call Crisis Connection; however, if the patient does not want an advocate, please be sure she has a Crisis Connection card so if and when she is ready to make a change in her life, she will know where to call.

Family Violence Prevention Fund

For additional information please see:

• Crisis Connection Statistics
• Crisis Connection Home Page
• Crisis Connection Domestic Violence
• Crisis Connection Sexual Violence
• What’s it like to be partnered with an abusive man?
• NCADV Health Care & Domestic Violence
• NCADV Pregnancy and Domestic Violence
• Are you safe in your home?
• Violence Stalks Pregnant Women
• Successful Collaboration Wheel
• Advocacy Empowerment Wheel
• Community Accountability Wheel
• Continuum of Caring Wheel
• Coordinated Community Action Model
• Making a Difference…One Life at a Time
• Speakers Available