Interventions that Help Victims of Domestic Violence
A Qualitative Analysis of Physicians’ Experiences
The data we presented on documenting abuse, providing referrals, and planning for safety concur with the practices recommended by Physicians for a Violence-Free Society.42 We suggest that health care settings develop a domestic violence packet containing a body chart, documentation instructions, and referral sheets. We also suggest they provide Polaroid cameras to document specific injuries, since pictures offer an inviolable record of the abuse.42 Survivors report that the process of documenting abuse can serve to validate the individual if accompanied by genuine nonjudgmental statements of concern.33
Although the physicians in our study were aware of the need to provide victims with referrals to community resources and assess their safety needs,6,8,42,43 they had developed their own styles of intervention and admitted that victims sometimes refused referrals. One solution offered by participants in our study is to put easy-to-hide business-size cards with local domestic violence hot-line and shelter numbers in all of the bathrooms. We also suggest that physicians continue to offer referrals time after time: repetitive offering or availability of referrals may help survivors feel like they are not alone and may reassure them that support is available within and outside the health care system when they are ready to seek it. Physicians should remember that a woman may be able to talk about the abuse long before she can actualize any change. They should also be aware that ending the relationship does not necessarily end the abuse; it may escalate it.44 The study physicians were careful to consider safety from the battered woman’s point of view and to take preventive measures. We suggest that physicians review their options for facilitating safety (ie, availability of resources and time) and, when necessary, connect the victim by telephone to an agency trained in assessing and planning for their safety. Battered women report that they want physicians to offer referrals and help them plan for safety.37
Although current guidelines call for physicians to play a large role in identifying, intervening with, and following up on cases of partner abuse,6,45,46 the physicians in our study emphasized the need to work as a team to identify and provide optimal care to victims. This requires flexibility of roles within the health care team and ready access to on-site and community domestic violence resources. In an attempt to improve health care for victims of domestic violence, experts and researchers in the field have proposed simplifying and limiting the tasks of physicians in this area. One model uses the acronym AVDR: physicians should ask patients about abuse; provide validating messages that battering is wrong and the patient is a worthy individual; document presenting signs, symptoms, and disclosures; and refer victims to specialists in domestic violence.47 At that point specialists on site or on call from the community would assess the patient’s safety, make appropriate safety plans, and perform other in-depth interventions.
Physicians face ever-increasing demands on their limited time, yet these physicians committed to helping battered women found multiple ways to enable them to intervene. The holistic approaches described here—using a team approach, prioritizing domestic violence, developing a culture of caring—send a powerful message of prevention and intervention to victims: Battering is not a private, shameful issue, but a health care issue of great concern to physicians. These approaches also provide health care professionals with systematic support for helping battered women, perhaps allowing committed physicians to act as agents of change in battered women’s lives.5
Women who are being controlled by the abusive actions of their intimate partners report that even small signs of compassion from health care professionals have made a difference to them. As stated by physicians in this study and by survivors in our previous study,33 these acts of caring plant the seeds for change. In their efforts to help battered women, physicians must remember that incremental changes and small moments of recognition can eventually lead to major shifts in the lives of these women. Every time physicians successfully intervene with a person whose health problems are caused by abuse they have engendered a positive outcome.
Acknowledgments
Our project has been supported by the National Institute of Mental Health Grant #1 R01 MH51580. We thank the physicians who participated in the focus groups and those who participated in reviewing the study findings. We also thank Stephanie Greer and Survey Methods Group for their assistance in recruiting physician participants and organizing the focus groups; Candace Love, PhD, and Richard Carlton, MPH, for assisting the authors with moderating focus group sessions; Priscilla Abercrombie, NP, PhD, for assisting with coding the data; Karen Herzig, PhD, for assisting with the literature review; and Jennifer Fechner for transcribing the focus group session audiotapes and proofreading the manuscript.
