ask - abuse screening kit - violence prevention · 2012. 9. 10. · identification and screening...
TRANSCRIPT
ASK Abuse Screening KitViolence Prevention
ASK_final 11/10/05 8:53 AM Page 1
The most dangerous period
for a woman in an abusive
relationship is the first
3 or 4 months following
separation.
[Peel Committee Against Women Abuse (PCAWA) Best Practice Guidelines, 2001]
ASK_final 11/10/05 8:53 AM Page 2
TABLE OF CONTENTS
Introduction and Context Setting . . . . .Card 1
What to Look For [Signs/Symptoms] . .Card 2
Why and When to Screen . . . . . . . . . . . .Card 3
Creating a Safe Environment for Disclosure . . . . . . . . . . . . . . . . . . . . . .Card 4
Identification and Screening [How to Ask about Abuse] . . . . . . . . . . .Card 5
Sample Risk Assessment Questions . . . .Card 6
Safety Planning . . . . . . . . . . . . . . . . . . . . . . .Cards 7-8
Reporting and Confidentiality . . . . . . . .Card 9
Limitations Regarding Confidentiality . . .Card 10
Documenting Abuse[What and How to Document] . . . . . . .Card 10
Injury Location Diagram . . . . . . . . . . . .Card 11
Community Referrals . . . . . . . . . . . . . . .Cards 12-13
TABLE
OF C
ONTEN
TS
ASK_final 11/10/05 8:53 AM Page 3
51%
of Canadian women over the
age of 16 have experienced
at least one incident of physical
or sexual assault.
[Canadian Panel on Violence Against Women, 1993]
ASK_final 11/10/05 8:53 AM Page 4
PURPOSE OF THE ASK TOOL KIT
The ASK Tool Kit is a practical resource for healthprofessionals who provide services to women. Theinformation contained in this resource will helpyou identify and respond to women who may beexperiencing abuse or violence in their relationships.
WOMAN ABUSE: A WORKING DEFINITION
Woman Abuse is the intentional and systematic useof tactics to establish and maintain power and controlin a relationship. These tactics may include:
� Physical or sexual assault� Emotional or psychological abuse� Verbal abuse� Financial abuse� Environmental and social abuse� Religious or spiritual abuse� Stalking or criminal harassment
INTR
O &
CONT
EXT S
ETTIN
G
1
ASK_final 11/10/05 8:53 AM Page 5
50%
of women reporting physical
assault also experienced sexual
assault in the context of the
same relationship.
[Peel Committee Against Women Abuse (PCAWA) Best Practice Guidelines, 2001]
ASK_final 11/10/05 8:53 AM Page 6
WOMAN ABUSE: WHAT TO LOOK FOR
Woman abuse transcends age, race, culture, sexualorientation and socio-economic status. The bestway to find out about abuse is to ask directly.Women are excellent at hiding the effects of abuse.
LOOK FOR:
� Unexplained injuries or an explanation that does not match physical symptoms
� Delay in seeking care, particularly if pregnant � Injuries when pregnant, particularly to breasts
and abdomen� Chronic illnesses that are unresponsive to
treatment � Frequently missed appointments � Overly solicitous partner who answers questions
on behalf of woman and is unwilling to allow woman privacy
� Family history of physical, sexual, or other abuse
WHAT
TO LO
OK FO
R
2
ASK_final 11/10/05 8:53 AM Page 7
1IN6pregnant women are abused
during pregnancy.
[Middlesex – London Task Force Report, 2000]
ASK_final 11/10/05 8:53 AM Page 8
WHY SCREEN?
� 1 in 4 Canadian women have experienced violence in an intimate relationship.1
� 1 in 6 pregnant women are abused during pregnancy.2
� 40% of women who were abused during pregnancy,reported abuse began when they were pregnant.3
WHY
AND
WHEN
TO S
ECRE
EN FO
R AB
USE
3
Type of Visit
New Patient
Prenatal
Emergency
Mental Health
Other visits
How Often
At first visit,Yearly, during annual health exam, and/orWhenever they disclose a new partner.
First prenatal visit,At least once per trimester, andPostpartum visit.
At every visit.
At initial visit,Yearly during annual health exam.
Whenever there are physical or behavioural signs of abuse, orWhen client presents with chronic-somatic complaints.
WHEN TO SCREEN?
1 Canadian Panel on Violence Against Women, 1993
2 Middlesex-London Health Unit, 2000
3 Canadian Panel on Violence Against Women, 1993
ASK_final 11/10/05 8:53 AM Page 9
95%
of women abused during
the 1st trimester, reported
the violence escalated after
the baby was born.
[Society of Obstetricians and Gynaecologists of Canada (SOGC) Clinical Practice Guidelines:Intimate Partner Violence Consensus Statement, No. 157, April 2005]
ASK_final 11/10/05 8:53 AM Page 10
CREATING A SAFE ENVIRONMENT FOR DISCLOSURE
Facilitating disclosure of abuse is partly dependanton offering a safe and secure environment forwomen to talk about the abuse.
TIPS FOR CREATING A SAFE ENVIRONMENT:
� Create a patient-friendly office with access to community resources and up-to-date informationon woman abuse and violence.
� Offer a private space for interviewing/examiningwomen. If husband is present, suggest reasons why it is necessary to see the patient in private (e.g., collection of a fresh urine specimen). Neverask about abuse when the partner is present.
� Ensure there is access to appropriate translators (who are NOT family members, partners, children or friends).
� Use a non-threatening tone and body language (e.g., sit at or below the woman’s level).
� Be familiar with community supports and services for women experiencing abuse or violence [see cards 12 and 13].
CREA
TING
A SA
FE E
NVIRO
NMEN
T
4
ASK_final 11/10/05 8:53 AM Page 11
Young women under 25
are at greatest risk of
spousal homicide.
[Statistics Canada, 1999]
ASK_final 11/10/05 8:53 AM Page 12
IDENTIFICATION AND SCREENING
Routine Universal Comprehensive Screening(RUCS) Protocol
Asking women directly if they have been abusedremains the most important tool for identifyingabuse or violence. The following questions are aGENERAL guide to help screen women for abuse.
ASKING ABOUT ABUSE:
To help me get to know my patients, I am asking all my patients how things are at home or in theirrelationships. I know that many women experiencesome form of physical, emotional or sexual abusein their lives and that this directly affects theirhealth. I am wondering whether you have everexperienced abuse or violence, either as a child,an adolescent or as an adult?
For further tips on handling a “yes” or “no”response, see Assessing Risk Questions, card 6.
IIDEN
TIFICA
TION
AND
SCRE
ENIN
G
5
ASK_final 11/10/05 8:53 AM Page 13
43%
of women being abused require
medical attention.
[New England Journal of Medicine, Sept. 1999, Vol. 341, No. 12]
ASK_final 11/10/05 8:53 AM Page 14
ASSESSING RISK QUESTIONS
IF ANSWER IS YES Assess Risk� Has the abuse occurred in the past 12 months? � Is the abuse still going on?� Do you still have contact with the abuser?� Do you feel safe now?� Are there children at risk of being abused?
IF YES TO ANY OF THE ABOVE:� Document details of abuse in patient’s own words.� Refer to social worker or community agency
[see cards 12 and 13].
� Address safety issues [see card 7].
IF ANSWER IS NO…� Accept her response. She may not feel safe or
ready to disclose. No could also mean No.� Use as an opportunity to educate your patient
about woman abuse and it’s health effects.� Repeat that asking about abuse is now a routine
part of your health assessments and in about one year you will “check in” again, as situations can change.
ASSE
SSIN
G RIS
K QU
ESTIO
NS
6
ASK_final 11/10/05 8:53 AM Page 15
Women seek medical attention
in emergency departments
about 28 times before being
identified as abused.
[New England Journal of Medicine, Sept. 1999, Vol. 341, No. 12]
ASK_final 11/10/05 8:53 AM Page 16
SAFETY PLANNING
Safety of your patient and her children is the firstpriority. If you, or your patient, feel that she is indanger, collaborate with her to begin a safety plan.
SPECIFICALLY:
� Ask her directly what assistance she wants.� Warn her not to tell her abuser if she is planning
to leave the abusive relationship. Women are at greater risk of violence or murder just after theyleave their husbands or partners.1
� Inform her that the police can be asked to accompany a woman returning home to retrievebelongings. A referral to a shelter can be made on behalf of the woman, provided she agrees.
� Extend her support system by providing her withinformation on community resources [see cards 12 and 13].
� Safety planning is not the expertise of most healthprofessionals, and it may be more appropriate torefer her to a community agency specializing in safety planning [see card 8].
Some women will decide that returning home istheir safest option. This decision MUST BErespected and supported.
SAFE
TY PL
ANNI
NG
7
1 Statistics Canada, 2004
ASK_final 11/10/05 8:53 AM Page 17
Health care providers
identify only 3% of
abused women.
[New England Journal of Medicine, Sept. 1999, Vol. 341, No. 12]
ASK_final 11/10/05 8:53 AM Page 18
SAFETY PLANNING
A woman cannot control her abuser’s violence,but it may be possible to increase her own and herchildren’s safety.
� Provide emergency numbers, shelters and resources (e.g., Peel Public Health’s Crisis Numbers for Women and Children).
� Suggest she:� Tell someone about the abuse.� Plan an escape route – where to go in an
emergency situation.� Ask a neighbour she can trust to call the
police if they hear a disturbance coming fromher home.
� Collect essential documents and keep them ina safe place (e.g., birth certificates, marriage license, passports/immigration papers, bank books, rent receipts).
For additional information on Safety Plans, contactyour local shelter or visit www.shelternet.ca. Thebooklet, Creating a Safety Plan, can be ordered bycalling the Peel Committee Against Woman Abuseat 905-282-9792.
SAFE
TY PL
ANNI
NG
8
ASK_final 11/10/05 8:53 AM Page 19
In 39% of violent marriages
children have witnessed
an assault on their mother.
[Suderman & Jaffe, 1998]
ASK_final 11/10/05 8:53 AM Page 20
REPORTING & CONFIDENTIALITY
All alleged or suspected cases of child abuse mustbe reported to Peel Children’s Aid Society [see card 12].Among others, child abuse MUST be reported when:
REPORTING
� A woman discloses abuse and there are children in the home
� A woman discloses that her children are at risk for abuse
� An examination/interview with a child indicatesthat he/she is being abused
� An adolescent pregnant woman is being abused1
CONFIDENTIALITY
Protecting the confidentiality of an abused womanis very important.
� Do not discuss or inform any person or authoritythat your patient has disclosed abuse without your client’s verbal or written informed consent
� Do not pressure her to report/disclose her abuseto the police or any other person or authority
� Inform her of your professional obligation in this regard
REPO
RTIN
G AN
D CO
NFIDE
NTIAL
ITY
9
1 National Clearing House on Family Violence, 1999
ASK_final 11/10/05 8:53 AM Page 21
It is now suggested that
80 – 90% of children in
such homes are aware of
and affected by the abuse,
“whether it is seen, heard or
otherwise sensed”.
[Suderman & Jaffe, 1998]
ASK_final 11/10/05 8:53 AM Page 22
LIMITATIONS REGARDING CONFIDENTIALITY
Confidentiality cannot be guaranteed when:� The patient is actively suicidal or homicidal.� There are child welfare concerns (the Child and Family
Services Act supercedes the right to confidentiality).
DOCUMENTING ABUSEWhat to Document:� Description of the abuse, and how it occurred,
in the woman’s own words� Description of injuries (i.e., type, location, length, width,
shape, colour, depth, level of healing), including notation if sexual assault has occurred or is suspected
� Emotional status� Treatment required� Any referral/consultations (written or verbal)
given to patient� Follow-up plans made
How to Document:� Use an Injury Location Diagram [see card 11] to help
document the location of reported current or past abuse � Mark with an X the location of any bruises,
fractures, lacerations, burns, etc.� Attach any diagrams or photographs taken to
the medical records
LIMITA
TIONS
REG
ARDIN
G CO
NFIDE
NTIAL
ITY |
DOC
UMEN
TING
ABUS
E
10
ASK_final 11/10/05 8:53 AM Page 23
In a survey of 245 women
with disabilities, it was found
that 40% had experienced abuse
and 12% had been raped.
[Society of Obstetricians and Gynaecologists of Canada (SOGC) Clinical Practice Guidelines:Intimate Partner Violence Consensus Statement, No. 157, April 2005]
ASK_final 11/10/05 8:53 AM Page 24
BODY - FRONT BODY - BACK
INJURY LOCATION DIAGRAM
INJU
RY LO
CATIO
N DIA
GRAM
11
Mark all injuries relevant to the assault, as well as areas of tenderness and Woods light findings on the diagram. Describe colour,
appearance and size of injuries. Provide a brief history of injuries.
USE QUOTATION MARKS IF YOU ARE USING THEEXACT WORDS OF THE VICTIM.
DESCRIPTION OF INJURIES
Physician/Nurse Examiner’s Signature Date Time
[Trillium Health Centre Sexual Assault and Domestic Violence Services]
ASK_final 11/10/05 8:53 AM Page 25
Violence against women costs
more than 4.2 billion dollars
a year in social services/education,
health/medicine, criminal
justice and labour/employment.
[Greaves et al, 1995]
ASK_final 11/10/05 8:53 AM Page 26
COMMUNITY REFERRALS
Peel Regional Police . . . . . . . . . . . . . . .905-453-3311
Health Services � Credit Valley Hospital . . . . . . . . . . .905-813-4253� Trillium Health Centre
Sexual Assault and Domestic Violence Services . . . . . . . . . . . . . . . .905-849-7600
� Peel Public Health . . . . . . . . . . . . . .905-799-7700
Shelters and 24-Hour Crisis Lines� Family Transition Place . . . . . . . . . .1-800-265-9178� Interim Place
Mississauga Site . . . . . . . . . . . . . . .905-403-0864Malton Site . . . . . . . . . . . . . . . . . . .905-676-8515Transitional Support Program . . .905-676-0257
� Salvation Army Family Life Resource Centre (Brampton)
Shelter . . . . . . . . . . . . . . . . . . . . . . .905-451-4115Crisis Line . . . . . . . . . . . . . . . . . . .905-451-6108
� Armagh . . . . . . . . . . . . . . . . . . . . . . .905-855-0299(second stage housing up to 6 months)
24-Hour Crisis Line Services� Assaulted Women’s Helpline . . . . . .1-866-863-0511� Family Transition Place . . . . . . . . . .1-800-265-9178� Victim Services of Peel . . . . . . . . . .905-568-1068
COMM
UNITY
REF
ERRA
LS
12
ASK_final 11/10/05 8:53 AM Page 27
1IN3women treated for trauma
in the ER has been injured
by an intimate partner.
[Middlesex-London Health Unit, 2000]
ASK_final 11/10/05 8:53 AM Page 28
COMMUNITY REFERRALS
Community Counselling and Support Services� Catholic Cross Cultural Services . . .905-457-7740� Catholic Family Services of
Peel-Dufferin . . . . . . . . . . . . . . . . . .905-450-1608� Family Services of Peel . . . . . . . . . . .905-270-2250� India Rainbow Community Services905-275-2369� Malton Neighbourhood Services . .905-677-6270� Muslim Community Services . . . . .905-790-1910� Salvation Army Women’s
Counseling Services . . . . . . . . . . . . .905-820-8984
Legal Services� Victim Witness Assistance Program . .905-456-4797� Victim Services of Peel . . . . . . . . . . .905-568-8800
Services for Children� Peel Children’s Aid Society . . . . . . .905-363-6131� Catholic Family Services of
Peel-Dufferin . . . . . . . . . . . . . . . . . .905-450-1608
Programs for Abusive Men� Catholic Family Services of Peel-Dufferin
(Man-to-Man Program) . . . . . . . . .905-450-1608� Merge Counselling and
Education Services . . . . . . . . . . . . .905-855-8028
Elder Abuse� Elder Help Peel . . . . . . . . . . . . . . . . .905-457-6055
COMM
UNITY
REF
ERRA
LS
13
ASK_final 11/10/05 8:53 AM Page 29
Is there anything you’d
like to talk about?
SOME WOMENARE DYING TOBE ASKED.
Funding provided by the Government of Ontario. The views expressedin this report are the views of the public health unit and do not
necessarily reflect those of the Government of Ontario.
FamilyAbusePrevention.ca
ASK_final 11/10/05 8:53 AM Page 30