Black and blue vinyl bumper stickers drive home the message: “There’s No Excuse for Domestic Violence”. Available in both English and Spanish (“No Hay Excusa Para Violencia Domestica”) 3 x 11 inches in size.

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This laminated 3″ x 5″ pocket reference card is an excellent tool for health care providers who are learning how to conduct routine assessment for domestic violence. The card includes a definition of domestic violence and model assessment questions, as well as listing validating messages to convey to patients who disclose abuse and tips for assessing patient safety. The card also lists the number of the National Hotline on Domestic Violence and reminds providers how to document findings. The card is lined by a 5″ ruler for measuring injuries that may have resulted from domestic violence.

Endorsed by the American Medical Association, American Nurses Association, American College of Physicians, American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, and other leading national health groups.

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In 2004, The Joint Commission instituted new standards for hospitals on how to respond to domestic abuse, neglect and exploitation, and later revised these standards in 2009. To help hospitals comply with these requirements, Futures Without Violence summarized the standards and provided recommendations for each with links to on-line resources and tools. This tool is available as a PDF only.

The primary resource to help hospitals comply with the Joint Commission’s standards for hospitals on responding to domestic abuse, neglect and exploitation is Futures Without Violence’s National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings.

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This Trainer’s Manual was developed to help health care providers and domestic violence advocates meet the challenge of training clinicians and other staff within the busy clinic or hospital setting. The Manual provides step-by-step instructions for teaching each section of the Resource Manual including the basics of domestic violence, clinical skills, legal issues, community resources, and role play scenarios. It also includes a special module on cultural diversity. Each training module is roughly one hour long—ideal for workshops, in-service trainings and grand rounds.

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This resource manual aims to educate health care providers on how to improve their response to domestic violence. The Resource Manual includes:

Information: the dynamics of domestic violence; screening, identification, assessment and intervention with victims of domestic violence; and interventions with batterers.

Practical Tools: Including a Model Hospital Intervention packet outlining effective protocols and sample forms for screening, domestic violence/abuse assessment, documentation, safety planning and discharge.

Ideas: To help develop and implement response strategies and programs within a variety of health care practices and settings.

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A victim of domestic violence, concerned for her safety, may be discouraged from seeking health care services because she fears that her health information will not remain confidential. Given the consequences of inappropriate disclosures, it is crucial that everyone interested in improving the safety and health status of battered women get involved to ensure adequate privacy protections at every level — from institutional policies to federal laws.

The following guiding principle and specific principles are designed to improve and build upon existing confidentiality safeguards to ensure that domestic violence victims are not placed at increased risk of retaliatory violence, discrimination, harassment, denial of insurance benefits, and other harm. Advocates, health care providers, administrators, oversight agencies, and policy makers can use these principles to improve health care delivery through health care practice, institution, and system reforms, as well as Federal and State legislation.

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This tool was developed by Dr. Therese Zink for primary care offices (pediatric, family medicine, internal medicine and obstetrics/gynecology). It was developed by modifying Dr. Jeffrey Coben’s “Delphi Instrument for Hospital Domestic Violence Programs”. The tool may be used to assess family violence efforts in primary care at the beginning of a program’s implementation and intermittently when focusing on family violence as a quality improvement goal. It is meant to be a tool for identifying deficiencies so that they can be remedied to improve care to patients living with violence and abuse.

The project was funded by a Robert Wood Johnson Generalist Faculty Scholar grant.

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Each year, more than three million women in the U.S. are abused by their intimate partners – and more than 1,200 are killed by their abusers. These victims of homicide or attempted homicide are often unaware that their lives are in danger prior to the attack. The Danger Assessment instrument, developed by Johns Hopkins University School of Nursing Associate Dean Dr. Jacquelyn Campbell, is available online to help women at risk learn their level of danger and to train domestic violence advocates, law enforcement, and health care professionals in measuring and warning danger levels.

Twenty-five years ago, Campbell created the first Danger Assessment (DA) tool to help victims of abuse and the professionals who work with them to better understand the threats to their safety and well-being. In 2005, Campbell revised and updated the assessment to incorporate the findings of recent domestic violence research and to deliver the mechanism to a wider audience through the website, www.dangerassessment.org. Women who feel they are in danger may visit the website and download the DA for free. The results are best interpreted, however, by a person certified to use the DA scoring system. Criminal justice, health care and advocacy practitioners who wish to administer the assessment and interpret the scoring system also may use the website to obtain training and certification.

This tool is available online: www.dangerassessment.org as a PDF. Please visit this website to obtain the tool; Futures Without Violence is unable to send the document directly.

This guide includes the minimal elements of a domestic violence protocol, guidelines for clinical assessment & intervention, a model employee domestic violence policy, and a guide to community public health services.

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The following instrument was created by Jeff Coben and the Agency for Healthcare Research and Quality (AHRQ). It can be used to help track and measure a hospital’s progress in improving its institutional response to domestic violence. The instrument should first be completed before a new plan is implemented and then completed every six months, for the duration of 2-5 years.

Procedures for Administration and Suggested Uses

The attached instrument can be self-administered or administered by an independent evaluator in conjunction with a representative from the hospital IPV program. In either situation, the individual who is most familiar with the IPV program should participate in the process. The required information can be best obtained via a “site visit” of the hospital. The hospital should be provided with sufficient time to assemble the materials that need to be reviewed (3 weeks advance notice is suggested). The assessment procedures should include a review of these materials as well as a physical tour of the facility to examine posters, brochures, documentation procedures, equipment (i.e., cameras), and other supplies. Approximately four hours should be allocated for completion of the instrument.

The instrument can be used for a variety of purposes. First, the measures can serve as useful benchmarks or objectives for program achievement. Second, the assessment of an individual site’s performance can be conducted repeatedly over time to determine progress in program implementation. Ideally, sites should perform a baseline assessment prior to implementing a new program and re-assess their status with annual assessments. Third, the instrument can be used by researchers and program administrators to compare and contrast different programs across different sites. Finally, if linked to appropriate outcome measures, the instrument could be used to help determine which program features are most important in creating positive long-term outcomes for IPV victims.

The focus of this instrument is on hospital-based IPV programs. While IPV programs have been implemented in many other settings, the generalizability of the instrument to other settings, including other health care settings (such as private physician offices or outpatient clinics), has not been tested.

Coben JH. Measuring the quality of hospital-based domestic violence programs. Academic Emergency Medicine, 2002;9(11):116-123.

Coben JH, and Fisher EJ. Evaluating the Implementation of Hospital-based Domestic Violence Programs. The e-Journal of Family Violence Prevention and Health Practice. July, 2005.

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This paper focuses on the need for accurate documentation and coding of domestic violence in medical records and provides recommendations on how to do so. The accurate and expanded documentation and coding for domestic violence in medical records can give us data and reimbursement mechanisms that will undeniably shape our understanding of domestic violence, our health policy reform efforts, and our ability to encourage health care providers to identify and respond to victims of domestic violence. Available only as a PDF.

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Leading medical and domestic violence experts challenged the U.S. Preventive Services Task Force’s conclusion that there is insufficient evidence to screen patients for domestic violence. Medical leaders from diverse fields asserted that the Task Force used the wrong criteria to assess screening, and warned that more victims and their children will be harmed if health care providers stop assessing for abuse.

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In the largest-ever survey of its kind, a 2008 Centers for Disease Control and Prevention report on health and violence found that 39 percent of Native women reported that they were victims of intimate partner violence – a rate higher than any other race or ethnicity surveyed. Because most American Indian/Alaska Native individuals are seen at some point by a health care provider, the health care setting offers a critical opportunity for early identification and primary prevention of abuse.

To help address this problem, in partnership with faculty from Sacred Circle and Mending the Sacred Hoop Technical Assistance Project, Futures Without Violence worked with more than 100 Indian, Tribal and Urban health care facilities as well as domestic violence (DV) advocacy programs across the United States to improve the health system response to domestic violence. Funded by the Indian Health Service and Administration for Children and Families, the IHS/ACF Domestic Violence Project (2002-2009), trained thousands of health care providers and community advocates, identified and empowered national experts, instituted sustainable DV response programs in hospitals and clinics, developed model policies and tools to better address abuse and prevent violence, and dramatically increased screening for DV. This report explains how that work can be replicated by highlighting stories and models from the field and identifying 10 important action steps.

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Developed by Barbara Gerbert, PhD, Director of the Center for Health Improvement and Prevention Studies, and colleagues at the University of California San Francisco School of Dentistry, The Ask, Validate, Document, Refer (AVDR) Tutorial for Dentists DVD provides a brief, interactive learning experience to help dental professionals and dental students respond to domestic violence. The 15 minute tutorial provides a case study demonstrating how to conduct the AVDR intervention—steps that may be used by dentists and other oral health care professionals as part of a simple, yet effective response to domestic violence. Two controlled trials have demonstrated that this brief tutorial prepares dental professionals and dental students to help their patients who face domestic violence. For more information about this DVD, contact: Barbara.gerbert@ucsf.edu

NOTE TO DENTISTS AND DENTAL OFFICE STAFF: The AVDR Tutorial can be shared with the entire staff. On a computer, open the folder called DVD-Rom/Dentists and review the document called “Training your Staff.” This 2-page document can be downloaded and printed, and explains how to use the tutorial in a small group, practice the AVDR steps, and assign follow-up, like creating or updating your list of local resources.

NOTE TO INSTRUCTORS: The AVDR Tutorial is an ideal classroom tool. On a computer, open the folder called DVD-Rom/Dental Schools and review the document called “Instructional Plan.” The Instructional Plan explains how to make use of the other documents in that folder (such as the Small Group Discussion Guide). These documents can be downloaded and printed.

Project funded by the National Institute of Dental and Craniofacial Research.

For information regarding this resource please contact Barbara Gerbert:

Barbara Gerbert, PhD
Barbara.gerbert@ucsf.edu
415-385-9831

This publication of best practices was written in 1997 to highlight innovative health care-based domestic violence programs across the U.S. Today, Futures Without Violence shares this resource as a historical piece for those interested in understanding the development of this work and an overview of some of the pioneering programs to help develop a health response to domestic violence. The guide is an excellent resource for students, scholars, and program managers to learn about the progression of health care-based domestic violence response programs and their core elements. 

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Co-edited by nursing scholars Jacquelyn Campbell, PhD, RN, FAAN and Annie Lewis-O’Connor RNCS, PhD, MPH, this six-page folio outlines the Nurse’s role in routine assessment for intimate partner violence (IPV). Complete with a fact sheet, national resource list, action steps to get involved, a pocket card with assessment tips, and summaries on JCAHO standard PC.3.10, mandatory reporting and privacy issues with corresponding web links for more information. The folio also highlights six national Nurses Associations’ position statements on domestic violence (including ACNM, ANA and ENA) to help make the argument that routine assessment for IPV is good practice.

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Edited by Pat Salber, MD, MBA (former Executive Director of Physicians for a Violence-Free Society) this six pages folio provides an overview of the health care response to domestic violence. Complete with a fact sheet, national resource list, action steps to get involved, a pocket card with assessment tips, and summaries on JCAHO standard PC.3.10, mandatory reporting and privacy issues with corresponding web links for more information.

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With editorial support from the American Dental Association, California Dental Association, Dental Professionals Against Violence and Tufts University School of Dental Medicine, this six page folio is one of the first specialized tools to enhance dental professionals’ response to domestic violence.

Complete with an overview of clinical signs of domestic violence, routine assessment, documentation, and intervention, a fact sheet, national resource list, action steps to get involved, a pocket card with assessment tips, and summaries of JCAHO standard PC.3.10, mandatory reporting and privacy issues with corresponding web links for more information.

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