PCM: Domestic Violence Interview

=Prevalence=
 * Domestic Partner or Intimate Partner Violence is most commonly discussed between a man and female partner in heterosexual relationships. But it can occur between any intimate partners or family members (ie uncle, brother) or between homosexual partners of the same gender.


 * Prevalence numbers vary widely and depend on definitions of abuse (ie emotional, physical, and/or controlling behavior), and sampling methods.  3-22% current year; 13-30% lifetime.


 * For the Purposes of PCM the prevalence is 1 out of 3 women presenting to the ED with trauma (no reference/evidence). Other studies show a 2 - 12% incidence of current IPV in the ED. (see Witting).

Increased risk

 * 1) Pregnant women (8 - 26%, current)
 * 2) Primary care population, double the population, up to 65% lifetime
 * 3) Emergency department trauma patients: 1 out of 3

=Strategy=
 * Empathy
 * Understand Background information/Social History
 * Ensure confidentiality
 * Evaluate Safety & Potential Violence
 * Offer resources, plant seeds: solutions rarely come in 1 encounter
 * Understand Mandatory reporting laws

=Survey Questions=
 * If a patient is at high suspicion of being a victim of intimate partner violence, it is recommended that you conduct a danger assessment. IPV assessment (PDF)

Partial list of survey questions

 * The CDC reference above demonstrates a dozen different screening techniques and lines of questioning. Students should be prepared to recite these questions.  Here are a few:

1. Are you in immediate danger? 2. Is your partner at the health facility now? 3. Do you want to (or have to) go home with your partner? 4. Do you have somewhere safe to go? 5. Have there been threats of direct abuse of the children (if s/he has children)? 6. Are you afraid your life may be in danger? 7. Has the violence gotten worse or is it getting scarier? Is it happening more often? 8. Has your partner used weapons, alcohol, or drugs? 9. Has your partner ever held you or your children against your will? 10 Does your partner ever watch you closely, follow you or stalk you? 11. Has your partner ever threatened to kill you, him/herself or your children?

Answer these questions Yes or No. The “he” in the questions refers to your husband, partner, ex- husband, or whoever is currently physically hurting you. ___1. Has the physical violence increased in frequency over the past year? ___2. Has the physical violence increased in severity over the past year and/or has a  weapon or threat from a weapon ever been used? ___3. Does he ever try to choke you? ___4. Is there a gun in the house? ___5. Has he ever forced you to have sex when you did not wish to do so? ___6. Does he use drugs? By drugs, I mean “uppers” or amphetamines, speed, angel dust, cocaine, “crack”, street drugs or mixtures. ___7. Does he threaten to kill you and/or do you believe he is capable of killing you? ___8. Is he drunk every day or almost every day? (In terms of quantity of alcohol.) ___9. Does he control most or all of the your daily activities? For instance: does he tell you who you can be friends with, how much money you can take with you shopping, or when you can take the car? (If he tries, but you do not let him,  check here: ____) ___10. Have you ever been beaten by him while you were pregnant? (If you have never  been pregnant by him, check here: ____ ___11. Is he violently and constantly jealous of you? (For instance, does he say “If I   can’t have you, no one can.”) ___12. Have you ever threatened or tried to commit suicide? ___13. Has he ever threatened or tried to commit suicide? ___14. Is he violent toward your children? ___15. Is he violent outside of the home? Reference.

=References= Michael D. Witting, Jon P. Furuno, Jon Mark Hirshon, Scott D. Krugman, André R. S. Périssé, Rhona Limcangco. Support for Emergency Department Screening for Intimate Partner Violence Depends on Perceived Risk. Journal of Interpersonal Violence, Volume 21 Number 5