n a medica al setting? Whyy screen in The A American Me edical Association, the Ame erican College e of Obstetriccians and Gyn necologists, th he U.S. Preveentive Serviices Task Forcce, the American Nursing A Association, tthe Academy of Pediatrics and the Fam mily Violence P Prevention Fund d recommend that all wom men and adole escent girls be e screened foor past and/or present intimate partnerr violence everyy time they are seen in a m medical settin ng. 30% of the homicides of U.S. w women are co ommitted by ttheir partner or ex‐partner. The m majority of ab buse victims w will not prese ent themselve es to medical staff as abusse victims; i.e.., they fell, orr were clumsy, or ran into o something, etc.; you will not know un nless you screeen. 37‐54 4% of women n seen in the emergency department haave been abuused by their partner or exx‐partner at some point in their life; while 25 5‐66% of wom men presentin ng to a primary care settinng have been abused. 4‐8% % of pregnant adult women n are abused during the co ourse of theirr pregnancy, w while a staggeering 21.7% o of pregnant teenaagers are abu used during pregnancy. 40% of women in physically ab busive relation nships are concurrently beeing sexually abused by their partner. Poor health outco omes are just as significanttly associated d with psychoological abusee as with physsical and sexu ual abuse. Abussed women arre 4 times mo ore likely to attempt suicid de than non‐aabused womeen. 59% of the mothe ers of abused children are also being ab bused by the ssame person. The N National Institute of Health estimates that domesticc crime againsst adults costts $67 billion aannually and domestic crimee against child dren costs $6 65.6 billion an nnually in the U.S. What signs and symptoms are you screening for?  Burns (particularly those the size and shape of a cigarette)  Finger, hand, foot (heal and/or toe of boot or shoe) shaped bruising  Bruising in various stages of healing  Bite marks  Unusual bruising such as long and equally spaced or in areas not likely to be marked  Back trauma (being kicked, drug, slammed, and punched)  “Rug” burns  Puncture wounds  Evidence of nails having been dug into skin  Hair pulled out  Outer ear injury, ex. “cauliflower ear”, earring torn out, etc.  Arm dislocated  Throat striations (strangling)  Petechiea  Digits broken or sprained from being bent backward  Jay injury  Teeth loose or knocked out  Split lip  Eye injury  Concussions and skull factures  Depression  Anxiety  STD’s  Breast, vaginal and/or anal injury  “Mounting” injuries (bruising on upper, inner thigh region)  Menstrual problems  Urinary tract infections  Ligature marks  Post‐traumatic Stress Disorder (PTSD)  Somatization (presence of physical symptoms not fully explained by a general medical condition); abuse victims average 30‐50% more visits for medical attention annually than non‐abuse victims  Pre‐existing condition not being properly cared for, particularly if condition requires medication  Persistent sleep disorders How do you screen a patient? Never screen a possible victim while anyone else is in the exam room with her with the possible exception of a preverbal child. If you suspect a patient has been abused, please ask anyone accompanying her to excuse you for a moment and have them stop outside the room. A victim will not disclose if the abuser is near and/or if she feels threatened or unsafe. Minn. Stat. § 626.52 requires health professionals to immediately report all bullet wounds, gunshot wounds, powder burns, or any other injury arising from, or caused by the discharge of a firearm, or any wound that the reporter has reason to believe has been inflicted on a perpetrator of a crime by a dangerous weapon other than a firearm (defined in § 609.02) to local law enforcement authorities. Health professionals must also report second or third degree burns of more than 5% of the body, burns to the upper respiratory tract or those that are life threatening to the state fire marshal. Always respect confidentiality and privacy. By asking sincere and appropriate questions, you have opened the door for the patient to disclose to you when she feels she is ready, has accepted that your questions are genuine and that real help is available. Use eye‐to‐eye contact and ask direct questions. If the patient senses that you are only asking because you have to or that you hope she won’t answer; she won’t. Asking indirect or off‐hand questions are a total waste of time. Never ask “what happened?” Be sincere, alert and compassionate at al times. Sample questions:  I see you have bruising on your chest; I’m worried that someone has hurt you, has someone?  I want to make sure you are safe before you leave here, can you tell me what happened to your eye?  This is an unusual injury; can you tell me if someone hurt you?  Is someone hurting you?  What happens when you and your partner/boyfriend/husband disagree?  Do you feel safe at home?  How do you feel about the way your partner has been treating you?  Are you afraid of your partner?  Has your partner hit/punched/slapped/strangled you?  Has your partner forced you to have sex when you didn’t want to? Anticipation patient disclosure Before beginning a screening protocol in your medical facility, contact our local domestic and sexual violence victim advocacy agency and request materials to have on hand for distribution to your clients. The best locations to place these materials are in the women’s bathroom and the individual exam rooms. It is also a good idea to have a professional advocate meet with your staff prior to beginning screening to assist you in developing an appropriate protocol and answering questions you will have. Sample Screening Questions Use your own words in a non‐threatening, non‐judgmental way. “Domestic Violence is so common I ask all my female patients about abuse in the home” Use questions that are direct, specific and easy to understand.  Do you feel safe in your current relationship?  Have you or your children ever been threatened or abused (physically, sexually or emotionally) by your partner?  Is there a partner from a previous relationship who is making you feel unsafe? Discuss with patients the confidentiality of these questions and the mandatory reporting of child abuse. Modified from Put down the chart pick up the questions (PCAR) Normalize the subject “Domestic and sexual violence is so common that I ask all my patients these questions because we know that experience with violence can have lasting effects on our patient’s health.” Ask clear direct questions (beating around the bush reveals your discomfort with the subject and makes the patient uncomfortable)  Do you feel safe in your current relationship?  Has your partner every physically, sexually or emotionally abused yo or your children?  Is your partner yelling at you, belittling you, or trying to isolate you from friends and family?  Have you ever been physically, emotionally or sexually abused by a former partner?  Were you ever abused as a child or lived in a home where domestic violence occurred?  Have you ever been touched sexually against your will or without your consent?  Have you ever been forced or pressure to have sex?  Do you feel you have control over your sexual relationship and will be listened to if you say no to having sex?  Do you feel safe going back to the place you were living? Cornerstone | cornerstonemn.org | facebook.com/asktohelp | 952.884.0376 Day One® Minnesota Domestic Violence Crisis Line: 1.866.223.1111