HealthStream Regulatory Script
[Identifying and Assessing Victims of Domestic Abuse]
Version: [12.02.04]
Lesson 1:
Lesson 2:
Lesson 3:
Lesson 4:
Lesson 5:
Introduction
Dynamics and Consequences
Identifying Victims
Assessment and Referral
Reporting Requirements
Lesson 1: Introduction
1001
Introduction
Welcome to the introductory lesson on identifying and assessing
victims of domestic abuse.
IMAGE: 1001.JPG
Domestic abuse is a significant public health concern in the United
States:
• Two to four million women are assaulted by their intimate
partners each year.
• Almost 25% of all women will be victims of domestic abuse
at some point in their lives.
• Between 1993 and 1998, domestic abuse accounted for
22% of all violent crime experienced by females.
• According to FBI statistics, 30% of the women murdered in
1990 were killed by their husbands or boyfriends.
• Among women who have ever been married, 14% report
having been raped by their current or former husband.
• As many as 60% of all adolescents may experience dating
violence.
Sources:
-The Family Violence Prevention Fund: National Consensus Guidelines on
Identifying and Responding to Domestic Violence Victimization in Health Care
Settings
-American Medical Association: Diagnostic and Treatment Guidelines on Domestic
Violence
Point 1 of 5
2
1002
Introduction: JCAHO Standard PC.3.10
In recognition of the significance of all forms of abuse as a public
health concern, the 2004 JCAHO [glossary] Comprehensive
Accreditation Manual for Hospitals (CAMH) includes a standard for
victims of abuse (Standard PC.3.10).
IMAGE: 1002.GIF
The rationale for the standard reads as follows:
Victims of abuse or neglect may come to a hospital in a variety of
ways. The patient may be unable or reluctant to speak of the
abuse, and it may not be obvious to the casual observer. Staff
needs to be able to identify abuse or neglect as well as the
extent and circumstances of the abuse or neglect to give the
patient appropriate care.
Criteria for identifying and assessing victims of abuse or neglect
should be used throughout the hospital. The assessment of the
patient must be conducted within the context of the requirements
of the law to preserve evidentiary materials and support future
legal actions.
Point 2 of 5
1003
Course Rationale
This course focuses on domestic abuse, to provide you with the
information you need to identify, assess, refer, and (as mandated)
report victims of this form of abuse.
NO IMAGE
By doing so, you can:
•
•
Maintain compliance with JCAHO Standard PC.3.10, with
regard to victims of domestic abuse.
Improve public health and your facility’s quality of patient
care.
Note: For a thorough treatment of JCAHO Standard PC.3.10, and
an overview of all types of abuse/neglect, see the course:
Identifying and Assessing Victims of Abuse and Neglect.
As your partner, HealthStream strives to provide its customers with excellence in
regulatory learning solutions. As new guidelines are continually issued by regulatory
agencies, we work to update courses, as needed, in a timely manner. Since
responsibility for complying with new guidelines remains with your organization,
HealthStream encourages you to routinely check all relevant regulatory agencies
directly for the latest updates for clinical/organizational guidelines.
Point 3 of 5
1004
Course Goals
After completing this course, you should be able to:
•
•
•
•
•
NO IMAGE
Describe the dynamics of a domestically violent
relationship.
List the effects that domestic abuse has on the victim and
his or her children (if any).
Recall methods for identifying victims of domestic abuse,
both through direct questioning and through recognition of
signs and symptoms.
Describe the process of assessing a victim of domestic
abuse.
Recall the significance of state-mandated requirements for
reporting domestic abuse.
Point 4 of 5
1005
Course Outline
This introductory lesson provides you with the course rationale,
course goals, and course outline.
FLASH ANIMATION: 1005.SWF/FLA
Lesson 2 presents background information on domestic abuse, to
help you a) understand the dynamics of an abusive relationship
and b) recognize the far-reaching effects of abuse.
Lesson 3 provides information on identifying victims of domestic
abuse.
Lesson 4 presents information on assessment and referral in
cases of domestic abuse.
Finally, lesson 5 details issues related to reporting domestic
abuse.
Point 5 of 5
Lesson 2: Dynamics and Consequences
2001
Introduction
Welcome to the lesson on the dynamics and effects of domestic
abuse.
FLASH ANIMATION: 2001.SWF/FLA
Both the dynamics of abusive relationships and the potential
effects of abuse tend to be similar, from case to case and from
victim to victim.
Understanding these aspects of abuse will contribute to:
•
•
Your understanding of domestic abuse as a public health
threat
Your ability to identify and care for victims in an
appropriate way
Point 1 of 18
2002
Objectives
After completing this lesson, you should be able to:
•
•
•
•
NO IMAGE
Identify the most common perpetrators [glossary] and
victims of domestic abuse.
Recall the importance of control in an abusive
relationship.
List examples of physical, psychological, and sexual
abuse.
List important effects of domestic abuse, for the victim as
well as his or her children (if any).
Point 2 of 18
2003
Domestic Abuse
Domestic abuse also may be referred to as:
• Domestic violence
• Intimate partner violence (IPV)
• Partner abuse
IMAGE: 2003.JPG
In domestic abuse:
• The victim is an adult or adolescent (in 85% of cases, a
woman).
• The abuser is a person (most often a man) who is, was,
or wishes to be in an intimate or dating relationship with
the victim.
Important note: Although the majority of victims of domestic
abuse are women in heterosexual relationships, victims also may
be:
• Men in heterosexual relationships
• Men or women in same-sex relationships
Point 3 of 18
2004
Dynamics and Forms of Abuse
The dynamics of domestic abuse are quite specific:
the abuser engages in a pattern of assaultive
[glossary] and coercive [glossary] behaviors, with
the goal of establishing control over the victim.
These assaultive and coercive behaviors may
include:
• Physical abuse
• Emotional and psychological abuse
• Sexual abuse
Let’s take a closer look at each of these on the
following screen.
CREATE TABLE
Dynamics of Power and Control in Domestic Abuse
Common Characteristics of the
Common Characteristics of the
Abuser
Victim
Controls access to money,
Is fearful of the abuser
property, other items of value
Is outwardly jealous of the victim’s Is not allowed access to family,
friends, family, coworkers
friends, other sources of social
support
Does not respect the victim’s point Rarely exercises or experiences
of view
independence/self-determination
Claims authority, knowledge,
Experiences negative or abusive
and/or power through status
consequences as a result of any
symbols such as profession,
attempts to exercise
citizenship, age, family
independence
background, education, etc.
Minimizes or makes excuses for
Feels guilty and is willing to
abusive behavior
accept blame for the abuse
Has offensive injuries [glossary]
Suffers serious injuries (to the
(i.e., scratches or bite marks), if
head, neck, torso), and complains
any
of various stress-related health
problems
Point 4 of 18
2005
Forms of Abuse: Physical
When domestic violence involves physical abuse, this abuse
usually:
• Occurs repeatedly
• Increases in both frequency and severity, over the course
of the abusive relationship
IMAGE: 2005.JPG
Examples of physically abusive acts that may occur in domestic
abuse include:
• Pushing or shoving
• Slapping, punching, or kicking
• Choking
• Assault with a weapon
• Holding, tying down, or otherwise restraining
• Leaving the victim in a dangerous place
• Refusing to provide assistance when the victim is sick or
injured
Point 5 of 18
2006
Forms of Abuse: Emotional and Psychological
Emotional and psychological abuse in a domestically violent
relationship:
•
May precede or accompany acts of physical violence
•
Help the abuser control the victim through fear and
degradation [glossary]
IMAGE: 2006.GIF
Examples of emotional and psychological abuse include:
•
•
•
•
•
•
•
•
Threatening or intimidating the victim
Enforcing physical and/or social isolation on the victim
Ignoring, dismissing, or ridiculing the victim’s needs
Depriving the victim of needed items
Degrading and humiliating the victim
Constantly criticizing, insulting, or belittling the victim
Making false accusations against the victim
Lying and breaking promises to the victim
Point 6 of 18
2007
Forms of Abuse: Sexual
Sexual abuse is often the most difficult form of abuse for victims of
domestic violence to discuss.
IMAGE: 2007.GIF
Examples include any form of forced sex or sexual degradation:
• Forcing the victim to perform sexual acts against his or her
will
• Pursuing sexual activity without asking the victim, or when
the victim is not fully conscious or is afraid to say no.
• Physically harming the victim during sexual activity
• Assaulting the victim in a sexual way, including the use of
objects or weapons intravaginally, orally, or anally
• Forcing the victim to participate in sex without protection
against pregnancy or STD’s
Point 7 of 18
2008
Consequences of Domestic Abuse
Domestic abuse may affect the victim’s:
• Medical health
• Health during pregnancy (if the victim is a pregnant
woman)
• Management of chronic illness
• Participation in preventive health measures
• Mental health
• Children
FLASH ANIMATION: 2008.SWF/FLA
Let’s take a closer look at each of these categories.
Point 8 of 18
2009
Consequences: Medical Health
In addition to suffering acute injury from physical and/or sexual
assault, victims of domestic abuse can develop chronic stressrelated and other medical illnesses, as a result of ongoing physical
and psychological abuse.
FLASH ANIMATION: 2009.SWF/FLA
These illnesses may include:
• Arthritis
• Chronic neck or back pain
• Migraine and other types of headache
• STDs (including HIV/AIDS)
• Chronic pelvic pain
• Peptic ulcers
• Chronic irritable bowel syndrome
• Frequent indigestion, diarrhea, or constipation
Point 9 of 18
2010
Consequences: Health in Pregnancy
Six percent of all pregnant women in the United States are abused
by intimate partners.
FLASH ANIMATION: 2010.SWF/FLA
Abused women have significantly higher rates of the following
complications in pregnancy:
• Low weight gain
• Anemia
• Infection
• First and second trimester bleeding
• Depression
• Suicide attempts
• Substance abuse
Point 10 of 18
2011
Consequences: Management of Chronic Illness
In cases of domestic abuse, the abuser often:
• Limits the victim’s access to medical care
• Interferes with the victim’s compliance with medical
regimens
FLASH ANIMATION: 2011.SWF/FLA
As a result, victims of domestic abuse often have poor
management of chronic illnesses such as:
• Asthma
• HIV/AIDS
• Seizures
• Diabetes
• Gastrointestinal disorders
• Hypertension
Point 11 of 18
2012
Consequences: Participation in Preventive Health Measures
As compared to women who are not abused, female victims of
domestic abuse are:
•
•
FLASH ANIMATION: 2012.SWF/FLA
Less likely to participate in preventive health screenings (such as
annual Pap smears or mammography)
More likely to participate in harmful behaviors, such as smoking
Point 12 of 18
2013
Consequences: Mental Health
Victims of domestic abuse are at increased risk for mental health problems
such as:
•
Substance abuse
•
Depression
•
Traumatic and posttraumatic stress disorder
•
Anxiety
•
Suicidal ideation
FLASH ANIMATION: 2013.SWF/FLA
Adolescents, especially, are at risk when it comes to mental health.
Adolescents who have experienced sexual or physical dating violence are
at increased risk for:
•
Suicide attempts
•
Eating disorders
•
Substance abuse, including smoking and cocaine use
Point 13 of 18
2014
Consequences: Children
Domestic abuse in the home is an important risk factor for child
abuse.
FLASH ANIMATION: 2014.SWF/FLA
Even children who do not become direct victims of abuse,
however, can be affected by domestic violence.
Point 14 of 18
2015
Exposure to Domestic Violence
Children who are exposed to domestic abuse may develop:
•
•
•
Symptoms of posttraumatic stress disorder
Physical health problems
Behavioral health problems, such as depression, anxiety, or
violence toward peers
IMAGE: 2015.GIF
Childhood exposure to domestic violence increases the risk of:
•
Suicide attempts
•
Substance abuse
•
Running away from home
•
Engaging in teenage prostitution
•
Being involved in crimes of sexual assault
Any of these problems may continue into adulthood.
Point 15 of 18
2016
Review
Which of the following could be a victim of domestic abuse?
a.
b.
c.
d.
e.
A middle-class Latino woman who lives in the suburbs with her
husband
A wealthy Caucasian woman who lives in the city with her lesbian
partner
An impoverished African-American man who lives in a rural
community with his wife
Any of these
None of these
MULTIPLE CHOICE INTERACTION
Correct answer: D
Feedback for A: Incorrect. Most victims of domestic abuse are
women in heterosexual relationships; however, heterosexual men
as well as homosexual men and women also can be victims.
Domestic abuse occurs in every community, in all socioeconomic
classes, and among all ethnic groups. Therefore, the best answer
choice is D.
Feedback for B: Incorrect. Most victims of domestic abuse are
women in heterosexual relationships; however, heterosexual men
as well as homosexual men and women also can be victims.
Domestic abuse occurs in every community, in all socioeconomic
classes, and among all ethnic groups. Therefore, the best answer
choice is D.
Feedback for C: Incorrect. Most victims of domestic abuse are
women in heterosexual relationships; however, heterosexual men
as well as homosexual men and women also can be victims.
Domestic abuse occurs in every community, in all socioeconomic
classes, and among all ethnic groups. Therefore, the best answer
choice is D.
Feedback for D: Correct. Most victims of domestic abuse are
women in heterosexual relationships; however, heterosexual men
as well as homosexual men and women also can be victims.
Domestic abuse occurs in every community, in all socioeconomic
classes, and among all ethnic groups.
Feedback for A: Incorrect. Most victims of domestic abuse are
women in heterosexual relationships; however, heterosexual men
as well as homosexual men and women also can be victims.
Domestic abuse occurs in every community, in all socioeconomic
classes, and among all ethnic groups. Therefore, the best answer
choice is D.
Point 16 of 18
2017
Review
The only potential physical effects of domestic abuse are acute injuries
from physical or sexual assault.
a. True
b. False
TRUE / FALSE INTERACTION
Correct answer: B
Feedback for A: Incorrect. In addition to suffering acute
injury from physical and/or sexual assault, victims of
domestic abuse can develop chronic stress-related and
other medical illnesses, as a result of ongoing physical and
psychological abuse.
Feedback for B: Correct. In addition to suffering acute
injury from physical and/or sexual assault, victims of
domestic abuse can develop chronic stress-related and
other medical illnesses, as a result of ongoing physical and
psychological abuse.
Point 17 of 18
2018
Summary
You have completed the lesson on the dynamics and
consequences of domestic abuse.
NO IMAGE
Remember:
•
•
•
•
•
•
Domestic abuse occurs between intimate partners. The
majority of victims are women, and the majority of abusers
are men.
Domestic abuse occurs in all communities, socioeconomic
classes, and ethnic groups.
In domestic violence, the abuser engages in a pattern of
assaultive and coercive behaviors, with the goal of
establishing control over the victim.
Domestic abuse may be physical, emotional/psychological,
and/or sexual.
Domestic abuse tends to escalate over time.
Domestic abuse may affect the victim’s medical health,
health during pregnancy, management of chronic
illnesses, participation in preventive health measures,
mental health, and/or children.
Point 18 of 18
Lesson 3: Identifying Victims of Domestic Abuse.
3001
Introduction
Welcome to the lesson on identifying victims of domestic abuse.
FLASH ANIMATION: 3001.SWF/FLA
As stated in JCAHO Standard PC.3.10:
Victims of abuse or neglect may come to a hospital in a variety of
ways. The patient may be unable or reluctant to speak of the
abuse, and it may not be obvious to the casual observer. Staff
needs to be able to identify abuse or neglect as well as the
extent and circumstances of the abuse or neglect to give the
patient appropriate care.
Point 1 of 16
3002
Objectives
After completing this lesson, you should be able to:
•
•
•
•
•
NO IMAGE
Recall the benefits of routine screening for domestic
abuse.
List situations in which domestic abuse screening should
and should not occur.
Formulate questions appropriate for domestic abuse
screening.
List signs and symptoms of domestic abuse.
Recall what to do when a patient denies that abuse has
occurred.
Point 2 of 16
3003
Identifying Victims
To identify victims of domestic abuse, your facility should screen
patients routinely.
IMAGE: 3003.JPG
As part of a standard health history, patients should be asked
direct questions regarding physical, emotional, and sexual abuse
by past or current intimate partners, whether or not there are
obvious indicators of abuse.
Point 3 of 16
3004
Routine Screening: All Patients or Females Only?
Given the dynamics of domestic abuse (as described in the
previous lesson), experts differ as to whether routine screening for
domestic abuse victimization should include:
•
•
IMAGE: 3004.GIF
All adolescent and adult patients
Female adolescents and adults only
Consult your supervisor or facility guidelines for facility-specific
policies on the screening of all patients or female patients only.
Point 4 of 16
3005
Routine Screening: Benefits
Healthcare providers have a unique opportunity for early
identification and prevention of domestic abuse.
IMAGE: 3005.JPG
Routine screening (with or without apparent indicators of abuse):
• Increases the opportunity to identify victims
• Increases the opportunity to help victims and their children
• Sends a message of support to victims
• Provides an opportunity for healthcare workers to educate
victims
• Validates domestic abuse as a legitimate healthcare issue
Point 5 of 16
3006
Routine Screening: When and Where
Element 4 of PC.3.10 states that victims of abuse and neglect
must be identified at entry into the hospital system and on a
continual basis.
IMAGE: 3006.GIF
Each hospital must choose appropriate opportunities for “continual”
screening.
Consult your supervisor regarding screening policies at your
facility.
Point 6 of 16
3007
Routine Screening: When NOT to Screen
Do NOT screen for domestic abuse if:
•
•
•
IMAGE: 3007.JPG
It is not possible to do so in private (i.e., away from any
friends or family members, especially the patient’s intimate
partner).
Screening may be unsafe for the patient or the provider.
An appropriate interpreter is not available (for patients who
require foreign-language, sign-language, or other
interpretation).
If routine screening is not performed at one of the specified
opportunities:
• Make a note in the patient’s chart.
• Schedule a follow-up appointment with the patient.
Point 7 of 16
3008
Routine Screening: Questions and Strategies
When screening for domestic abuse on a routine basis, you may
wish to frame your inquiry with an introductory statement, such as:
IMAGE: 3008.JPG
Because domestic violence is so common today, I ask all patients
about it.
After framing your inquiry, ask direct questions, in a nonjudgmental
manner:
Has your intimate partner ever punched or slapped you?
Does your intimate partner ever force you to participate in sex?
Did someone cause these bruises? Was it your partner?
Point 8 of 16
3009
Routine Screening: Cultural Competence
When screening for domestic abuse, be certain to do so in a
culturally competent manner.
IMAGE: 3009.JPG
Ask questions in a culturally sensitive way, with awareness that
each patient will experience abuse and the healthcare system
differently, depending on cultural expectations and norms.
Point 9 of 16
3010
Disclosure
As indicated earlier in the lesson, direct, routine inquiry into
domestic abuse helps:
• Communicate support to victims.
• Validate domestic abuse as a legitimate healthcare issue.
IMAGE: 3010.JPG
This increases the likelihood that victims will disclose and discuss
abuse.
Many victims, however, will not disclose, due to:
• Embarrassment or shame
• Fear that their abuser will retaliate
Therefore, all healthcare staff must be alert for signs and
symptoms of domestic abuse.
Point 10 of 16
3011
Indicators (1)
Indicators of domestic abuse can include patterns such as:
• Failure to keep medical appointments or comply with
medical advice (because abusers often restrict access to
medical help, medication, etc.)
• Secrecy or discomfort when questioned about intimate
relationships and the possibility of abuse
• Presence of a partner who:
• Controls or dominates your interview with the patient
• Appears unreasonably anxious or concerned
• Will not leave the patient alone with you
• Unusually high number of healthcare visits
• Repeated return visits with vague complaints
• Health problems often associated with abuse
• High number of STDs, pregnancies, miscarriages, and/or
abortions
• Repeat vaginal or urinary tract infections
IMAGE: 3011.JPG
Point 11 of 16
3012
Indicators (2)
Additional indicators of domestic abuse include suspicious injuries:
•
•
•
•
•
•
•
IMAGE: 3012.JPG
Unexplained injuries
Inconsistent or unlikely explanations for injuries
Seeking delayed medical treatment for an injury
Injuries to the head, neck, chest, breasts, abdomen, or
genitals
Bilateral or multiple injuries
Multiple injuries in different stages of healing
Physical injury during pregnancy, especially on the breasts
or abdomen
Point 12 of 16
3013
Responding to Indicators
The indicators of domestic abuse listed on the previous two
screens warrant follow-up questions.
IMAGE: 3013.JPG
If the patient discloses abuse, follow up as described in the next
lesson.
If the patient denies abuse:
• Respect his or her right not to disclose.
• Inform the patient of your ongoing support and availability.
• Offer the patient information on domestic violence
resources available in your community, especially if you
believe the patient may be at high risk for serious injury.
• Reassess the patient at appropriate intervals (as described
previously).
Point 13 of 16
3014
Review
A 32-year-old woman presents in the Emergency Room with
bilateral fractured ribs, as well as a faded black eye in a much later
stage of healing. Her husband is with her, and refuses to leave her
side. He appears frantic with worry, and explains that she fell down
the stairs after tripping over one of the children’s toys. You should:
a. Call security and ask them to escort the husband to a
waiting room.
b. Ask the husband whether he is responsible for his wife’s
fractured ribs.
c. Perform a routine screening for domestic abuse, after
stabilizing the patient and treating her injuries.
d. Treat the patient’s injuries, then schedule a follow-up visit
to monitor her healing and screen for domestic abuse.
MULTIPLE CHOICE INTERACTION
Correct answer: D
Feedback for A: Incorrect. Because you suspect domestic
abuse, you must proceed carefully. If the husband has not
abused his wife, it is not appropriate to call security. If he
has abused her, it may be even more important not to call
security. The patient’s safety must be your paramount
concern. If you anger her husband, he may retaliate
against her later. The best answer is D. Treat the patient’s
injuries, then schedule a follow-up visit to check the
patient’s healing and screen for domestic abuse.
Feedback for B: Incorrect. Because you suspect domestic
abuse, you must proceed carefully. The patient’s safety
must be your paramount concern. If you anger her
husband (e.g., by revealing your suspicions), he may
retaliate against her later. The best answer is D. Treat the
patient’s injuries, then schedule a follow-up visit to check
the patient’s healing and screen for domestic abuse.
Feedback for C: Incorrect. Do not screen for domestic
abuse if you cannot do so privately (i.e., without the
patient’s husband present). The best answer is D. Treat
the patient’s injuries, then schedule a follow-up visit to
check the patient’s healing and screen for domestic abuse.
Feedback for D: Correct. This is the best answer.
Point 14 of 16
3015
Review
The 32-year-old woman with fractured ribs returns for her follow-up
visit. Her husband is not with her. Which of the following
statements/questions would be most appropriate?
a. I think your husband fractured your ribs. What did you do
to make him that angry and violent?
b. I wonder whether you really fractured your ribs in an
accidental fall. Did someone hit or kick you?
c. I know your husband was lying! How could you let him do
that to you? How could you let him lie about it?
d. I hope you haven’t left your children at home with your
husband! I would never leave my children with such a
monster.
MULTIPLE CHOICE INTERACTION
Correct answer: B
Feedback for A: Incorrect. Asking the patient what she did
to “make” her husband that angry and violent implies that
she is responsible for his actions (if, in fact, he did assault
her). It is important to ask questions in a nonjudgmental
manner that supports and validates the victim, and does
not suggest that she might be to blame. The best answer is
B.
Feedback for B: Correct.
Feedback for C: Incorrect. Asking the patient how she
could “let” her husband abuse her implies that she is at
fault for the abuse (if, in fact, he did assault her). It is
important to ask questions in a nonjudgmental manner that
supports and validates the victim, and does not suggest
that she might be to blame. The best answer is B.
Feedback for D: Incorrect. Although it is important to
educate victims of domestic abuse regarding the risk of
child abuse in homes with domestic violence, it is important
to do so in a nonjudgmental manner that supports and
validates the victim. The best answer is B.
Point 15 of 16
3016
Summary
You have completed the lesson on identifying victims of domestic
abuse.
NO IMAGE
Remember:
•
•
•
•
•
•
Screening for domestic abuse should be part of routine
clinical practice. Check with your supervisor or consult
facility guidelines for facility-specific policies on the routine
screening of all adult and adolescent patients or female
adults and adolescents only.
Routine screening increases the opportunity to identify and
help victims, and validates domestic abuse as a legitimate
healthcare issue.
Routine screening for domestic abuse should be ongoing.
Domestic abuse screening should include direct questions
to the patient regarding abuse by past or current intimate
partners. Be sure to ask questions in a culturally sensitive
way.
Because some victims may not disclose abuse, healthcare
staff must be alert for signs and symptoms of domestic
abuse. Familiarize yourself with these signs and
symptoms.
If a patient denies domestic abuse, respect the right not to
disclose, and communicate your ongoing support and
availability.
Point 16 of 16
Lesson 4: Assessment and Referral
4001
Introduction
Welcome to the lesson on assessment and referral for victims of
domestic abuse.
FLASH ANIMATION: 4001.SWF/FLA
Element 5 of JCAHO Standard PC.3.10 specifies that victims of
abuse or neglect must be assessed. Each hospital should designate
qualified staff to conduct assessments, or should refer victims to
appropriate outside agencies for assessment.
The rationale for Standard PC.3.10 further states: “The assessment
of the patient must be conducted within the context of the
requirements of the law to preserve evidentiary materials and support
future legal actions.”
In this lesson, we will take a look at appropriate assessment and/or
referral for victims of domestic abuse.
We also will discuss appropriate procedures for collecting and
documenting evidence of abuse as part of the patient assessment.
Point 1 of 25
4002
Objectives
After completing this lesson, you should be able to:
•
•
•
•
NO IMAGE
Identify the components of an appropriate assessment of a
suspected victim of domestic abuse.
Recognize the elements of a safety plan.
Recall when and how victims of domestic abuse should be
referred to alternate providers or services.
Describe appropriate procedures for collecting and
documenting evidence of domestic abuse as part of a
comprehensive patient assessment.
Point 2 of 25
4003
Assessment
The responsibility for assessing identified victims of domestic abuse
should be assigned to trained healthcare staff only.
IMAGE: 4003.JPG
The goals of the assessment are:
•
•
•
To create a supportive environment in which the patient can
discuss the abuse
To collect information about health problems associated with
the abuse
To assess the patient’s immediate and long-term health and
safety needs, with the further goal of developing and
implementing an appropriate safety plan
Point 3 of 25
4004
Assessment Components
Unless the patient is in crisis, a thorough domestic abuse
assessment may take place as an ongoing process, starting with the
patient’s initial disclosure, and continuing through a number of followup appointments.
IMAGE: 4004.GIF
Immediate components of the assessment should include:
• Validation of the patient’s experience
• Communication of domestic abuse information to the patient
• Assessment of the patient’s immediate safety
Additional components should include:
• Discussion and assessment of health issues related to the
abuse
• Discussion and assessment of social, cultural, and personal
issues related to the abuse
• Questions regarding the pattern and history of abuse
• Questions about the abuser
• Assessment of the patient’s suicide and homicide risk
Let’s take a closer look at each immediate and additional component.
Point 4 of 25
4005
Assessment Components: Validation
Provide validation by:
•
•
•
IMAGE: 4005.GIF
Listening non-judgmentally
Expressing concern for the patient’s safety
Emphasizing that the patient is not to blame for the abuse
Point 5 of 25
4006
Assessment Components: Information
In this part of the assessment, provide the patient with basic
information on domestic abuse, such as:
•
•
•
•
IMAGE: 4006.GIF
Domestic abuse is common in all kinds of relationships.
Domestic abuse tends to continue over the course of a
relationship, becoming more frequent and more severe.
Domestic abuse can affect the health of the victim in many
ways.
Domestic abuse can be emotionally and physically
dangerous to children in the home.
Point 6 of 25
4007
Assessment Components: Immediate Safety
In this part of the assessment, ask questions aimed at establishing:
• Whether the patient is in immediate danger
• Whether the patient has a safe place to go
• Whether the patient’s children (if any) may be in danger
• Whether the violence has escalated recently
• Whether the abuser has used weapons
• Whether the abuser has held the patient against his or her
will
• Whether the abuser has stalked the patient
IMAGE: 4007.GIF
Based on the answers to these questions, refer the patient to local
resources for safety (e.g., the police, emergency shelters, etc.)
and/or help the patient plan for safety.
Continue on to the next screen for more information on safety
planning.
Point 7 of 25
4008
Planning for Safety
To help victims plan for safety, go over a safety brochure or form.
CLICK TO REVEAL
These forms help victims learn and remember what to do to protect
themselves and their children (if any) from domestic violence.
Safety during a violent incident
This section of a safety form asks the victim to complete
statements such as:
• If I have to leave home during a violent incident, I
will go _______.
• I can keep my car keys ready in/at ______, to be
prepared to leave quickly.
Forms are often divided into sections, such as:
•
•
•
•
Safety during a violent incident
Safety when preparing to leave an abuser
Safety at home
Safety with a protection order
Click on each item to learn more.
Safety when preparing to leave an abuser
This section of a safety form asks the victim to complete
statements such as:
• I will keep copies of important documents, keys,
clothes, and money in/at _______.
• I will open a savings account within ________
days/weeks/months, to increase my independence.
Safety at home
This section of a safety form reminds the victim of how to
stay safe in his or her own home, for example:
• Change the locks.
• Replace wooden doors with steel doors.
Safety with a protection order
This section of a safety form reminds the victim of how to
use a protection order to best ensure safety, for example:
• Always carry a certified copy of the order, and
keep a photocopy.
• Give a copy of the order to local police
departments.
Point 8 of 25
4009
Assessment Components: Abuse-Related Health Issues
In this part of the assessment, address any health issues related to
the abuse.
IMAGE: 4009.GIF
Do you remember the potential physical and mental health
consequences of domestic abuse discussed in lesson 2?
Click here for a brief review. [link to pop-up]
[Pop-up]
Potential physical and mental health consequences of domestic
abuse include:
• Arthritis
• Chronic neck or back pain
• Migraine and other types of headache
• STDs (including HIV/AIDS)
• Chronic pelvic pain
• Peptic ulcers
• Chronic irritable bowel syndrome
• Frequent indigestion, diarrhea, or constipation
• Complications in pregnancy
• Poor management of chronic illness
• Substance abuse
• Depression
• Traumatic and posttraumatic stress disorder
• Anxiety
• Suicidal ideation
Point 9 of 25
4010
Assessment Components: Abuse-Related Social, Cultural, and Personal Issues
Discuss and/or assess:
•
•
•
•
•
•
•
IMAGE: 4010.GIF
Whether the patient was a victim of abuse as a child
Whether the patient has social supports in place (e.g.,
friends, family, church)
Whether the patient is pursuing, or interested in pursuing,
separation, divorce, or emergency shelter
How the patient’s community views abuse, marriage,
divorce, health, and healing
How the patient responds to community views and
expectations
How the abuse has affected the patient’s children (if any)
How the abuse has affected the patient’s life, work, school,
and/or other relationships
Point 10 of 25
4011
Assessment Components: Pattern and History of Abuse
To gather information about the pattern and history of abuse, ask
the patient questions related to:
•
•
•
•
•
•
IMAGE: 4011.JPG
When the abuse started
Whether the abuse has ever led to hospitalization
What happened during the most serious abusive event
Whether the abuse has included forced sexual acts
Whether the abuser controls or limits the victim’s access to
friends, family, coworkers, money, food, medical care, etc.
Whether the abuser has ever hurt other family members,
children, or family pets
Point 11 of 25
4012
Assessment Components: Characteristics of the Abuser
Ask questions to find out whether the abuser:
•
•
•
•
•
IMAGE: 4012.GIF
Uses illegal drugs or alcohol
Is more violent when using drugs/alcohol
Has mental health problems
Takes medication
Has a criminal record
Point 12 of 25
4013
Assessment Components: Homicide/Suicide Risk
Determine whether the patient is at risk for killing him- or her- self
and/or his or her abuser.
IMAGE: 4013.GIF
Ask questions such as:
•
•
Do you think about killing yourself? Do you have a plan?
Have you ever thought about killing your abuser? Do you
have a plan?
Point 13 of 25
4014
Domestic Abuse: Referral
If your facility is unable to provide an appropriate domestic abuse
assessment (as described on the previous screens), identified
victims should be referred to another hospital or facility for
assessment.
IMAGE: 4014.GIF
If qualified healthcare staff in your facility are able to perform
assessments, all staff members still should be prepared to provide
referrals to other local resources.
These resources may include:
• Emergency shelter/housing
• Transportation
• Organizations able to provide for other basic needs (e.g.,
food, clothing)
• Counseling or support groups for victims and their children
• Childcare/welfare assistance
• Legal assistance
• Substance abuse treatment
• Police (to file a report)
• The legal system (to secure a protection order)
Important note: Victims of domestic abuse should NOT be
referred to couples counseling, as this may increase the risk of
serious abuse and harm to the patient.
Point 14 of 25
4015
Documentation and Collection of Evidence
When assessing victims of domestic abuse, careful documentation
is critical for future legal actions.
IMAGE: 4015.JPG
In some cases, the medical record provides the only evidence of
abuse.
Point 15 of 25
4016
Documentation: Written Record
As possible and available, the following should be documented, in
a precise, professional manner:
•
•
•
•
•
•
•
•
IMAGE: 4016.GIF
Statements made by the victim, including any taped
interviews
Observed appearance and behavior of the victim
Name of the abuser and his or her relationship to the
victim
Date, time, location, and description of the abusive
event(s)
Any objects or weapons used during the abusive event(s)
Names and descriptions of any witnesses to the abuse
Detailed description of injuries (see text image to the right)
Results of pertinent laboratory or other diagnostic
procedures
Point 16 of 25
4017
Documentation: Photographs
Photographs should not replace a detailed written description of
injuries, but can provide valuable corroborating [glossary]
evidence.
IMAGE: 4017.JPG
When taking photographs of injuries:
• Photograph prior to providing medical treatment, if
possible.
• Use color film and a color standard.
• Photograph bite marks in black-and-white, as well as color,
if possible.
• Hold up a coin, ruler, or other object to show the size of
the injury.
• Include the victim’s face in at least one picture.
• Take at least two pictures of every major injury.
• Carefully label all photographs.
Point 17 of 25
4018
Collection of Evidence: Rape Kit
In the case of domestic abuse that involves sexual assault, each
state has legally mandated procedures for collecting evidence to:
•
•
IMAGE: 4018.GIF
Establish the time and place of the assault.
Establish the identity of the rapist.
These procedures are organized into a protocol called a “rape kit.”
Point 18 of 25
4019
Rape Kit Protocol (1)
Typical elements of a rape kit protocol include:
•
•
•
•
•
•
•
•
•
IMAGE: 4019.JPG
Have the patient disrobe on a clean piece of cloth or paper
sheet.
Have the patient bag each item of clothing in a separate
paper bag (healthcare staff, wearing gloves, can help as
necessary).
Have the patient place the cloth or sheet in an additional
paper bag.
Give the patient a gown and have the patient lie on the
exam table.
Collect blood samples.
Perform an oral examination for injuries, and collect saliva.
Collect fingernail scraping from under the patient’s nails.
Document all physical injuries.
If available, use a Wood’s light [glossary] to inspect the
patient for dried semen. Document the location(s) of
semen.
Point 19 of 25
4020
Rape Kit Protocol (2)
•
•
Perform a genital exam:
• Collect samples of pubic hair, as well as head and body
hair.
• Collect pubic hair combings.
• Inspect external genitalia for injury and particulate
evidence.
• Conduct an internal exam and collect vaginal and/or
anal swabbings.
Ask the patient to give a urine specimen.
IMAGE: 4019.JPG
Important: All elements of this protocol may not apply in your state.
Check with your supervisor or experienced legal counsel.
Point 20 of 25
4021
Forensic Evidence
Corroborating forensic evidence also may be collected in cases of
non-sexual domestic abuse.
NO IMAGE
This evidence may include:
•
•
•
•
•
•
•
•
•
Torn, stained, or bloody clothing
Fingernail scrapings
Hair
Fibers
Soil
Debris
Other foreign materials
Blood
Saliva
As with the rape kit, collect, store, and transfer evidence of
domestic abuse with strict adherence to chain-of-evidence
protocols[glossary].
Point 21 of 25
4022
Review
FLASH ANIMATION: 4021.SWF/FLA
Choose the appropriate word from each pair to fill in the blanks in
the following sentences:
1. Domestic abuse is ________ in intimate relationships.
(common/uncommon).
2. Domestic violence tends to recur in an abusive relationship,
becoming ______ frequent and _________severe over time.
(more/less, more/less).
3. Domestic abuse can contribute to _______ medical illness in the
victim. (stress-related/phantom).
4. Domestic abuse ______ harm children who only witness it.
(can/cannot)
Point 22 of 25
4023
Review
FLASH ANIMATION: 4022.SWF/FLA
You are reviewing a safety brochure with a victim of domestic
abuse. She is having trouble completing some of the statements.
She asks you to suggest two or three possibilities for each of the
blanks, to give her some ideas. Type your thoughts in the spaces
below, then click Submit to compare your suggestions to ours.
1. If I have to leave home during a violent incident, I will go to
______.
2. I can keep my car keys ready _________, to be prepared to
leave quickly.
3. I can teach my children to _________ during a violent incident.
Feedback:
Did you come up with two or three suggestions for each
blank? Here are our suggestions:
1. If I have to leave home during a violent incident, I will go
to ______.
-A neighbor’s house
-A friend’s house
-A relative’s house
2. I can keep my car keys ready _________, to be
prepared to leave quickly.
-On a hook by the front door
-In my purse in the front closet
-Under a rock by the garage
3. I can teach my children to _________ during a violent
incident.
-Call the police
-Leave the house
Point 23 of 25
4024
Review
Rape kits are the same in all states.
a. True
b. False
TRUE / FALSE INTERACTION
Correct answer: B
Feedback for A: Incorrect. State and local protocols for
collecting evidence of sexual assault (i.e., rape kits) vary
considerably. If you will be assessing victims of sexual
assault, it is important to familiarize yourself with local
requirements.
Feedback for B: Correct. State and local protocols for
collecting evidence of sexual assault (i.e., rape kits) vary
considerably. If you will be assessing victims of sexual
assault, it is important to familiarize yourself with local
requirements.
Point 24 of 25
4025
Summary
You have completed the lesson on assessing and referring victims
of domestic abuse.
NO IMAGE
Remember:
•
•
•
•
•
The goals of a domestic abuse assessment are to create a
supportive environment, to collect pertinent information,
and to determine the patient’s immediate and long-term
health and safety needs.
The domestic abuse assessment has a number of different
components. Familiarize yourself with these, as
appropriate for your role in identifying and assessing
victims of domestic abuse.
Be prepared to refer victims of domestic abuse to other
local resources.
When assessing victims of domestic abuse, careful
documentation is critical for future legal actions.
Familiarize yourself with the items that should be
documented in the medical record, as appropriate for your
role in identifying and assessing victims of abuse.
Familiarize yourself with local rape kit requirements, as
appropriate for your role in identifying and assessing
victims of abuse.
Point 25 of 25
Lesson 5: Reporting Requirements
5001
Introduction
Welcome to the lesson on state-mandated reporting requirements
for suspected cases of domestic abuse.
FLASH ANIMATION: 5001.SWF/FLA
Element 6 of JCAHO Standard PC.3.10 specifies that all identified
cases of abuse, neglect, or exploitation [glossary] must be reported
to outside agencies as mandated by hospital policy and applicable
law.
This lesson provides an overview of state-mandated reporting
requirements for domestic abuse.
Point 1 of 6
5002
Objectives
After completing this lesson, you should be able to:
•
•
NO IMAGE
Recall the importance of learning the reporting
requirements in your state.
Describe how mandatory reporting laws affect your
interaction with patients.
Point 2 of 6
5003
Reporting Requirements
As of March 2002, 47 states required healthcare providers to
report certain cases of domestic abuse, depending on the types of
injuries involved (see table at right).
IMAGE: 5003.GIF
Learn the mandatory reporting requirements in your state.
Point 3 of 6
5004
Reporting Requirements: Significance
If your state requires you to report domestic abuse:
•
•
IMAGE: 5004.GIF
Inform your patients of this limit on confidentiality before
beginning any domestic abuse inquiry or assessment.
Bear in mind that reporting can compromise the safety of
victims, by prompting the abuser to retaliate with further
abuse. Inform identified victims of your obligation to report,
and help assess and plan for their safety needs.
Point 4 of 6
5005
Review
Most states require healthcare providers to report certain cases of
domestic abuse, depending on the:
a.
b.
c.
d.
Age of the victim
Types of injuries involved
Mental-health history of the abuser
Presence of witnesses to the abuse
MULTIPLE CHOICE INTERACTION
Correct answer: B
Feedback for A: Incorrect. The correct answer is B.
Reporting requirements are based on the types of injuries
sustained by the victim.
Feedback for B: Correct. Reporting requirements are
based on the types of injuries sustained by the victim.
Feedback for C: Incorrect. The correct answer is B.
Reporting requirements are based on the types of injuries
sustained by the victim.
Feedback for D: Incorrect. The correct answer is B.
Reporting requirements are based on the types of injuries
sustained by the victim.
Point 5 of 6
5006
Summary
You have completed the lesson on reporting requirements.
NO IMAGE
Remember:
•
•
•
Most states require healthcare providers to report
certain cases of domestic abuse, depending on the
types of injuries involved.
Learn the reporting requirements in your state.
Inform patients of your obligation to report, if any.
Point 6 of 6
Course Glossary
#
Term
Definition
chain of evidence protocols
offensive injuries
FBI
JCAHO
perpetrator
procedures (including documentation and testimony) that ensure that evidence is not
altered or tampered with in any way after being obtained; also referred to as chain of
custody protocols
injuries sustained when attacking or assaulting another person
Federal Bureau of Investigation
Joint Commission on the Accreditation of Healthcare Organizations
one who commits an offense
assaultive
coercive
degradation
STD
plausible
of an attacking nature
intended to compel or force
diminishment or demeaning
sexually transmitted disease
reasonable
corroborate
Wood’s light
to add credibility by confirming facts or evidence
ultraviolet light used to reveal semen in the assessment of sexual abuse
exploitation
victimization; unfair treatment
[Identifying and Assessing Victims of Domestic Abuse]
Pre-Assessment
1. Of the following patients, which should be screened for domestic abuse victimization?
a. A 42-year-old Latina woman who presents at an STD clinic, requesting HIV testing
b. A 37-year-old African-American woman who presents at a walk-in health clinic for her annual gynecological exam
c. A 26-year-old Caucasian woman who presents in the Emergency Room with multiple injuries to the head and chest
d. All of these
e. None of these
Correct answer: D
Rationale: All adolescent and adult women should be screened for domestic abuse victimization, whether or not they present with obvious signs or
symptoms of abuse. Screening should take place in any setting that provides health services to women.
2. The dynamics of domestic abuse center around:
a. Want and need
b. Power and control
c. Passion and desire
d. Success and failure
Correct answer: B
Rationale: The dynamics of domestic abuse are quite specific: the abuser engages in a pattern of assaultive and coercive behaviors, with the goal
of establishing control over the victim.
3. Which of the following may be a component of domestic abuse?
a. Rape
b. Making false accusations
c. Slapping, punching, or kicking
d. All of these
e. None of these
Correct answer: D
Rationale: All of these are potential components of domestic abuse. Rape is a form of sexual abuse; slapping, punching, and kicking are examples
of physical abuse; and a pattern of making false accusations against the victim is a form of psychological abuse.
4. What is the best explanation for the occurrence of chronic irritable bowel syndrome (IBS) as a consequence of domestic abuse?
a. Victims of domestic abuse may develop IBS as a result of the psychosomatic impact of ongoing abuse.
b. Victims of domestic abuse may develop IBS as a direct result of injuries sustained during sexually abusive incidents.
c. Victims of domestic abuse may develop IBS as a direct result of injuries sustained during physically abusive incidents.
d. None of these explanations is accurate.
Correct answer: A
Rationale: In addition to suffering acute injury from physical and/or sexual assault, victims of domestic abuse can develop chronic stress-related
illnesses, as a result of ongoing physical and psychological abuse. These may include IBS, as well as headaches and other stress-related
conditions.
5. Which of the following best explains the poor management of chronic illnesses (e.g., asthma, diabetes, hypertension) often seen in victims of
domestic abuse?
a. The abuser frequently limits the victim’s access to medical care and prevents the victim from complying with medical regimens.
b. Victims of domestic abuse enjoy pain, suffering, and ill health, as evidenced by the fact that they allow themselves to be abused.
c. The abuser frequently tries to control the victim’s medication and treatment schedule, and the victim refuses to take medication or
participate in treatment as an act of rebellion.
d. Victims of domestic abuse are typically oppositional and non-compliant, which helps to explain both their failure to follow medical advice
and their tendency to provoke acts of violence by their intimate partners.
Correct answer: A
Rationale: With domestic abuse, the abuser frequently limits the victim’s access to medical care and prevents the victim from complying with
medical regimens, resulting in poor management of chronic illnesses. It is a myth that victims of domestic abuse provoke and/or enjoy the abuse;
victims stay in abusive relationships for a variety of reasons, which rarely if ever have to do with masochistic desires. Victims tend not to be
rebellious, oppositional, or non-compliant. On the contrary, victims of domestic abuse tend to have reduced autonomy, as attempts to express
autonomy are met with abusive consequences.
6. Adolescent victims of sexual or physical dating violence are at increased risk for eating disorders.
a. True
b. False
Correct answer: A
Rationale: Adolescent victims of sexual or physical dating violence are at increased risk for eating disorders, as well as suicide attempts, smoking,
and cocaine use.
7. Regarding childhood exposure to domestic violence, all of the following statements are true EXCEPT:
a. Children exposed to domestic abuse are at increased risk for substance abuse.
b. Children who are exposed to domestic abuse may develop symptoms of posttraumatic stress disorder.
c. Children who live in violent homes but do not witness abuse directly will not suffer consequences of exposure.
d. Physical and behavioral health problems arising from childhood exposure to domestic violence may continue into adulthood.
Correct answer: B
Rationale: “Exposure” includes not only witnessing abusive incidents, but also overhearing acts of abuse, seeing the aftermath of abuse (injuries,
fear, etc.), being used by the abuser to intimidate the victim, or being forced by the abuser to participate in the abuse. Any one of these forms of
exposure can have the same harmful consequences.
8. You are taking a standard health history for a 34-year-old woman during her annual exam. You should not ask direct questions regarding
domestic abuse if:
a. The patient does not exhibit any obvious signs or symptoms of current domestic abuse victimization.
b. The patient’s chart indicates that she was screened for domestic abuse at her last checkup, and no indications of abuse were noted at that
time.
c. The patient’s best friend has accompanied the patient for “moral support” (doctors make the patient nervous) and remains with the patient
throughout the checkup.
d. All of these are contraindications to a domestic abuse inquiry.
e. None of these contraindicates domestic abuse inquiry.
Correct answer: C
Rationale: Routine screening for domestic abuse victimization should be part of a standard health history for all adult and adolescent women, at
each periodic checkup, whether or not there are obvious indicators of abuse. Screening, however, should not be performed if it is not possible to
do so in private (i.e., away from any friends or family members).
9. Which of the following is LEAST likely to be an indicator of domestic abuse?
a. Failure to keep medical appointments
b. Unusually high number of healthcare visits
c. Seeking prompt medical treatment for injuries
d. Physical injury to the abdomen during pregnancy
Correct answer: C
Rationale: Seeking delayed medical treatment for injuries may be an indicator of abuse.
10. A thorough domestic abuse assessment may take place as an ongoing process, starting with the patient’s initial disclosure, and continuing
through a number of follow-up appointments.
a. True
b. False
Correct answer: A
Rationale: Unless the patient is in crisis, a thorough domestic abuse assessment may take place as an ongoing process, starting with the patient’s
initial disclosure, and continuing through a number of follow-up appointments.
11. A 19-year-old woman presents in the Emergency Room with multiple injuries to the head, chest, and abdomen. After the patient is stabilized,
you take the health history. The patient discloses that her boyfriend hit her for the first time several months ago, and that, since then, violent
episodes have become more frequent and more severe. The most violent episode yet occurred today, and resulted in her current injuries. Of the
following, the best response to this disclosure would be:
a. Why on earth have you stayed in the relationship? You need to break up with him right away!
b. We see battered women all the time. It seems as though all women have to do their time in at least one abusive relationship!
c. Thank you for sharing this information with me. I am concerned for your safety, especially since the violence has escalated so rapidly.
d. Women in abusive relationships frequently provoke the abuse, sometimes without realizing it. Can you think of anything that you do that
might cause your boyfriend to hit you?
Correct answer: C
Rationale: When a patient discloses abuse, it is important to respond in a nonjudgmental manner, expressing concern for the patient’s safety and
emphasizing that the patient is not to blame for the abuse.
12. You are performing an assessment on an identified victim of domestic abuse. Currently, you are assessing the patient’s immediate safety. Of
the following, which is in indicator of increased immediate danger to the patient?
a. My boyfriend has never stalked me.
b. My boyfriend doesn’t use knives or other weapons. He just hits me with his fists.
c. If things get really bad, I sometimes go stay with my sister for a few days. He usually cools off by then.
d. My boyfriend sometimes keeps me from leaving the house for days at a time, even when I have to go to work.
Correct answer: D
Rationale: The victim is likely to be at increased danger if the abuse has involved stalking, weapons, or holding the victim against her will. The
immediate danger tends to be less if the patient has a safe place to go.
13. JCAHO requires all accredited hospitals to maintain a current list of local resources, to facilitate referrals for victims of domestic abuse.
a. True
b. False
Correct answer: A
Rationale: This statement is true.
14. When describing known or suspected abuse-related injuries in the medical record, which of the following should be documented?
a. Degree of healing
b. Patient’s explanation of injuries
c. Provider’s opinion as to whether the explanation provided is plausible
d. All of these
e. None of these
Correct answer: D
Rationale: All of these items should be documented. In addition, the type, number, size, location, and possible causes of injuries should be
recorded.
15. In all cases, prompt medical treatment should be provided before photographing abuse-related injuries.
a. True
b. False
Correct answer: B
Rationale: If possible, injuries should be photographed before medical treatment is provided.
16. Which of the following are the same in all states?
a. Rape kits
b. Forensic evidence protocols
c. Reporting requirements for domestic abuse
d. All of these
e. None of these
Correct answer: E
Rationale: Rape kits (a set of protocols for collecting forensic evidence of sexual assault) and reporting requirements for domestic abuse vary from
state to state. Learn the laws in your state.
Final Exam
Question Title: Question 1
Question: Which of the following is most likely to be a victim of domestic abuse?
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
A woman in an intimate relationship with a man
A man in an intimate relationship with a woman
A man in an intimate relationship with another man
A woman in an intimate relationship with another woman
Correct Answer: A woman in an intimate relationship with a man
Answer Rationale: Although anyone in an intimate relationship could be a victim of domestic abuse, most victims are women in heterosexual
relationships.
Question Title: Question 2
Question: Over the course of an abusive relationship, physical abuse tends to:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Increase in both frequency and severity.
Decrease in both frequency and severity.
Increase in frequency, but decrease in severity.
Decrease in frequency, but increase in severity.
Correct Answer: Increase in both frequency and severity.
Answer Rationale: Physical domestic abuse tends to recur, increasing in both frequency and severity.
Question Title: Question 3
Question: A man cannot rape his own wife.
Answer 1: True
Answer 2: False
Answer 3:
Answer 4:
Answer 5:
Correct Answer: False
Answer Rationale: In violent marriages, rape is a common form of domestic abuse.
Question Title: Question 4
Question: Which of the following patterns of behavior is a form of domestic abuse?
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
A pattern of slapping, punching, or kicking an intimate partner
A pattern of lying and breaking promises to an intimate partner
A pattern of pursuing sexual activity with an intimate partner, when he or she is afraid to say no
All of these
None of these
Correct Answer: All of these
Answer Rationale: Slapping, punching, and kicking are examples of physical abuse; lying and breaking promises are forms of psychological
abuse; and pursuing sexual activity when the victim is afraid to say no is an example of sexual abuse.
Question Title: Question 5
Question: Victims of domestic abuse often have poor management of chronic illnesses such as diabetes or hypertension.
Answer 1: True
Answer 2: False
Answer 3:
Answer 4:
Answer 5:
Correct Answer: True
Answer Rationale: In cases of domestic abuse, the abuser often limits the victim’s access to medical care, and interferes with the victim’s
compliance with medical regimens. As a result, victims of domestic abuse often have poor management of chronic illnesses.
Question Title: Question 6
Question: Adolescents who have experienced physical or sexual dating violence are at increased risk for:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Suicide attempts
Eating disorders
Cocaine use
All of these
None of these
Correct Answer: All of these
Answer Rationale: Adolescent victims of physical or sexual dating violence are at increased risk for all of these problems.
Question Title: Question 7
Question: During your assessment of an identified victim of abuse, you mention the potential effects of childhood exposure to domestic violence.
The victim explains that she can usually tell when her partner is likely to be violent, and she sends her children to stay with a neighbor. True or
False: As long they are never in the home during violent incidents, this woman’s children are not at risk of experiencing any adverse
consequences of the abuse in their home.
Answer 1: True
Answer 2: False
Answer 3:
Answer 4:
Answer 5:
Correct Answer: False
Answer Rationale: Even if these children never witness the abuse directly, they still are exposed to the aftermath (e.g., their mother’s bruises,
other visible injuries, fear, intimidation, etc.). This indirect exposure can have the same negative consequences as more direct forms of exposure.
Question Title: Question 8
Question: You are performing a standard health history on a 28-year-old woman. You should ask direct questions about domestic abuse only if
the patient presents with obvious signs and symptoms of abuse.
Answer 1: True
Answer 2: False
Answer 3:
Answer 4:
Answer 5:
Correct Answer: False
Answer Rationale: As part of a standard health history, patients should be asked direct questions regarding physical, emotional, or sexual abuse
by past or current intimate partners, whether or not there are obvious indicators of abuse.
Question Title: Question 9
Question: Routine screening for domestic abuse increases the likelihood of disclosure by:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Communicating support to victims
Validating domestic abuse as a legitimate healthcare issue
Both of these
Neither of these
Correct Answer: Both of these
Answer Rationale: Routine screening for domestic abuse both communicates support to victims and validates domestic abuse as a legitimate
healthcare issues, increasing the likelihood of discussion and disclosure.
Question Title: Question 10
Question: Physical injuries typical of domestic abuse include:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Single injuries
Bilateral injuries
Injuries fully explained by the history given
Injuries, such as bruising and fractures, to the arms or legs
Correct Answer: Bilateral injuries
Answer Rationale: Injuries that are relatively likely to indicate abuse include: multiple injuries, especially if in different stages of healing; bilateral
injuries; injuries to the head, neck, chest, breasts, abdomen, or genitals; injuries not adequately explained; and physical injuries during pregnancy,
especially on the breasts or abdomen.
Question Title: Question 11
Question: When a patient discloses abuse, it is important to validate his or her experience by:
Answer 1: Expressing concern for the patient’s safety
Answer 2: Asking the patient what he or she does to provoke the abuse
Answer 3: Explaining that domestic violence is just a temporary phase that many relationships go through
Answer 4: All of these
Answer 5: None of these
Correct Answer: Expressing concern for the patient’s safety
Answer Rationale: Provide validation for victims of abuse by listening in a nonjudgmental way, expressing concern for their safety, and
emphasizing that they are not to blame for the abuse.
Question Title: Question 12
Question: JCAHO requires that all accredited hospitals develop and implement policies and programs to meet all of the needs of victims of
domestic abuse.
Answer 1: True
Answer 2: False
Answer 3:
Answer 4:
Answer 5:
Correct Answer: False
Answer Rationale: JCAHO requires that all accredited hospitals develop and implement policies and programs to identify victims of domestic
abuse. Once identified, victims may be referred to other local resources for assessment and/or non-medical assistance. Per JCAHO, facilities
must maintain a current list of local resources, to facilitate referrals.
Question Title: Question 13
Question: If forensic evidence of domestic abuse is not collected, stored, and transferred with strict adherence to chain-of-evidence protocols, the
evidence may not be legally admissible in future court cases.
Answer 1: True
Answer 2: False
Answer 3:
Answer 4:
Answer 5:
Correct Answer: True
Answer Rationale: This statement is true. Be certain to follow chain-of-evidence protocols!
Question Title: Question 14
Question: If your state requires you to report domestic abuse, inform your patients of this limit on confidentiality before beginning any domestic
abuse inquiry or assessment.
Answer 1: True
Answer 2: False
Answer 3:
Answer 4:
Answer 5:
Correct Answer: True
Answer Rationale: Always inform patients of limits on patient-provider privilege before they disclose sensitive information.