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Figure 3. Intimate Partner Violence (IPV) Clinical Pathway: Treatment after Disclosure (initial visit only)

Physicians, nurses, social workers immediate response at disclosure:

  1. Believe patient and tell patient the behavior reported is abuse.
  2. Assure patient violence is the fault of perpetrator and not the victim.
  3. Assure patient that there are options and offer referral to IPV Program Social Worker or other appropriate resource.
  4. Give patient hotline number. National (1-800-799-SAFE) and Local HOTLINE telephone number.
ActivityInitial Visit

(Physician and nurse do physical and mental health assessment and treatment; social Worker or IPV Advocate/Nurse does social assessment and treatment)

Physical Assessment and TreatmentPresenting Complaint:
  1. Assess trauma.
  2. Document with body map/photos and description.
  3. Refer or treat as appropriate.
  4. Report to police if gunshot or knife wound or according to State law.
Physical Assessment and TreatmentSexual Trauma:
  1. Ask about forced or undesired sex.
  2. If NO: document only.
    If YES and not IPV RAPE: examine for injuries, treat, refer, document. Discuss contraceptive options, prevent pregnancy and STDs.
    If YES and IPV RAPE (within last 72 hours do pelvic exam, evidence collection); examine for injuries, treat, refer, document. OFFER pregnancy test and STD/HIV test.
Physical Assessment and TreatmentPain:
  1. Assess site, type, severity, and duration.
  2. If NO: document only.
    If YES: assess pain in relation to violence history and its possible influence on sign/symptoms/illnesses, especially: Neurological, GI/Abdominal, GYN, Chronic stress, Other. Document, refer and/or treat.
Psychiatric/Mental Health Assessment and TreatmentSubstance Abuse:
  1. Screen for current substance abuse problems of patient and abuser.
  2. If NO: document.
    If YES: inform of treatment options and refer if interested at this time. Document.
  3. Reinforce that this is a separate health problem from IPV although it may be exacerbated by or exacerbate IPV.
Psychiatric/Mental Health Assessment and TreatmentDepression:
  1. Assess symptoms of depression, severity and duration and relationship to IPV history.
  2. Assess client's need for medication. If appropriate, prescribe psychotropic medication and/or refer for psychiatric services or counseling.
  3. Using danger assessment guidelinesa assess for: suicide/homicide potential or attempts. If YES, refer for psychiatric consult. Document. Review legal protections available for homicide prevention.
Psychiatric/Mental Health Assessment and TreatmentPTSD/Anxiety:
  1. Assess sleep, startle, anxiety, re-experiencing of trauma (flashback), numbing.
  2. If YES, refer for psychiatric consult.
Social Assessment and Treatment IPV Services:
  1. IPV counselor meets with patient.
  2. Assess trauma history.
Social Assessment and TreatmentAdditional Demographics:
  1. Marital status with abuser: married, separated, divorced, widow, single.
  2. Living with abuser: yes, no, sometimes.
  3. Harassment and/or stalking by abuser?
  4. Children: number and ages. Custody?
  5. Health insurance: none, abuser's policy, personal policy.
Social Assessment and TreatmentInformation on Children:
  1. During woman's treatment/hospitalization: children living with patient? Where are they now? How can their safety and care be assured? How support mother's custody?
  2. Child trauma: ask if children demonstrating signs of trauma from observing violence (i.e., sleep problems, nightmares, aggressiveness or withdrawal, school problems). Refer if indicated.
Social Assessment and TreatmentDanger:
  1. Use Danger Assessment guidelinesa to assess IPV severity and extent of danger. Express concern for safety.
  2. Explain police services. Ask if victim desires for provider to call police.
  3. Explain court ex parte/protection orders and victim's services and legal assistance options. Give resource sheet.
  4. Explain mandatory legal reporting of child abuse. Inquire if children have been abused and refer if indicated.
Social Assessment and TreatmentSafety Planning:
  1. Use guidelinesb to assess safety behaviors and plans for future.

a Campbell JC. Danger assessment. Web site: www.son.jhmi.edu/research/cnr/homicide/da_instrument.htm. Accessed Dec 12, 2003.
b McFarlane J, Parker B, Cross B. Abuse during pregnancy: a protocol for prevention and intervention, 2nd ed. March of Dimes nursing module. 2001. March of Dimes Fulfillment Center, P.O. Box 1657, Wilkes-Barre, PA 18773. Web site: www.modimes.org.

Source: Jacqueline Dienemann, Visiting Professor, University of North Carolina at Charlotte, Department of Adult Health Nursing, 9201 University City Boulevard, Charlotte, NC 28223; E-mail: jadienem@uncc.edu or jpdien@bellsouth.net. Used with permission.

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