Clinical Notes : Medico-legal
111. Domestic Partner Abuse

Adapted from NB Medical Education Out of Hours 2015
NICE 2014
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DVA is a common hidden problem
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Complex issue needs sensitive handling by all health care professionals,
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Cost (human and economic) are huge
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Chronic health problems, PTSD, depression, anxiety, substance misuse
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A&E attendance/ OOH care
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Don't forget that men too can be victims
Types
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Partner abuse amongst adults
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26% of women and 14% of men report to have suffered
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50% of female murders were by their partner, 12 % of men by their partner
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Affects same sex relationships as well as heterosexual
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Partner abuse amongst young people is common
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72% girls and 51% boys aged 13-16 in intimate relationships
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Abuse between parents is the most frequently reported form of trauma for children
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24.8% of those 18-24 citing domestic abuse during their childhood
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Honour based violence and forced marriage
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Abuse of older person
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Abuse of parents by children
Essential features of NICE guidance 2014
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Have a high index of suspicion
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Repeat attenders, chronic health problems, PTSD, depression, anxiety, substance misuse
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Clear and good lines of communication when people are considered at risk
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Integrated working with all health care and social care groups
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Create an environment to disclose abuse
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Posters on waiting room walls
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Leaflets in consultation rooms
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Ensure front line staff including reception and admin teams are aware of referral processes and local support networks
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Ensure you ask about abuse if suspected
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Tailor support to each individual. Have a card/ leaflet to hand out with support networks information
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Prioritise patient safety
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Refer children to social services if domestic violence is suspected or disclosed
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Recommended training for GP's from NICE
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How to ask about domestic violence and abuse in a way to make it easier to disclose
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Understand epidemiology and how it affects lives
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How to respond with empathy and understanding
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Assessment of immediate safety
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How to refer to specialist units
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Tips on asking about Domestic Violence and abuse
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Have a high index of suspicion in
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Repeat attendee
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Chronic physical and mental health problems
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Substance misuse
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Create an environment which supports disclosure
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Ask about abuse if suspected
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Be safe
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Do not ask about DV in presence of another family member
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Be gentle
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Do not 'force' a disclosure; this may take years, but just asking is helpful for victims
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Start with non-judgemental open questions:
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'are there any problems at home?'
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`sometimes people who attend here often have expeirenced abuse at home — might that be happening to you?'
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Move on to more direct questions:
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'are you afraid of your partner/relative?'
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'have they hurt you, now or in the past?'
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The HARK questions have been developed & validated in primary care
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Does your partner humiliate or hit you?
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Are you ever afraid of your partner?
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Has your partner ever raped you?
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Has your partner ever kicked or physically hurt you?
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Acknowledge admission of abuse
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Thank you for trusting us to tell us/You are not alone/Help is available
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Provide details of local agencies
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Consider child protection
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Guidelines suggest child protection referral in all cases where a child under 12 is in the household
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Assess safety and risk of immediate harm
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Are you safe to go home? Discuss police.
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Document injuries clearly
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photographs
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