Creating a Health Care Response
last updated February 1, 2006

Health care institutions can use many different models to develop institutional responses to domestic violence. Some locations have trained advocates available to provide assistance and advice. One advantage of having specialized staff is that these staff are better equipped to provide advice and support. At the same time, it is useful to train all staff on the basics of domestic violence so everyone is prepared to make necessary referrals to specialized staff.

Other programs train all staff to provide such support to patients as it is needed. One program in San Francisco trains all staff members, including janitorial staff, on issues of domestic violence so that "anyone who might come into contact with a battered woman [will] know how to talk to her sensitively about her concerns, situation, and options." This comprehensive training enabled a member of the janitorial staff to identify a domestic violence issue that others missed; the staff member noticed that a woman was crying herself to sleep every night, and asked her why she was crying. From Janet Nudelman & Helen Rodriguez Trias, Building Bridges Between Domestic Violence Advocates and Health Care Providers (1999).

The development of domestic violence programs in a health care context should be guided by the following key questions:

  • Will this program or policy make battered women safer?
  • Will this program or policy hold institutions accountable for the role they can play in preventing and responding to domestic violence?
  • Will this program or policy hold individual health care providers accountable for employing attitudes and actions that are sensitive to the needs of battered women?
  • Will this program or policy hold perpetrators accountable for their violence?
  • Will this program or policy make all women safer?

Nudelman and Trias also discuss the respective roles that can be taken by health care providers and domestic violence advocates, ways that advocates can assist health care providers, and the importance of involving administrators in order to facilitate implementation of the program.

Once the framework of the program has been developed, specific policies and procedures should be memorialized in written protocols. These protocols establish how staff will screen for domestic violence, provide information about resources, document injuries, and protect patient confidentiality. The existence of protocols ensures consistency of the response and provides measurable goals for evaluating the success of the program.

The FVPF offers an overview of different models for health care programs. An article published through the Urban Institute for the Office of the Assistant Secretary of Planning and Evaluation, Sandra J. Clark et al., Coordinated Community Responses to Domestic Violence in Six Communities: Beyond the Justice System (1996), details some of the issues that might need to be addressed when attempting to integrate health care services in a coordinated community response to domestic violence. The Agency for Healthcare Research and Quality offers a useful tool that describes the steps that can be taken to evaluate hospital-based domestic violence programs.