Creating a Health Care Response

Last updated May 2019

Health care institutions can use many different models to develop institutional responses to domestic violence. While some locations have trained advocates available to provide assistance and advice, other programs train all staff to provide such support to patients as it is needed. Further, some programs take a combined approach. For example, under the Intervention and Referral to Improve Safety intervention (IRIS), the entire practice team receives training while one general practitioner is appointed the clinical lead and delivers training alongside an IRIS advocate-educator who is employed by a local domestic violence advocacy organization.[1] Regardless of the route chosen by a health care institution, the response to domestic violence must be tailored to address the context in which the violence occurs.[2]

Futures Without Violence recommends the following five steps in the process of integrating a domestic violence response to health care settings:

  1. Establish and strengthen relationships between health care providers and domestic violence advocates;
  2. Implement or update exiting domestic violence policies in partnership with local domestic violence advocates and resources;
  3. Educate patients on the links between domestic violence and health and wellbeing using evidence-based strategies;
  4. Train all members of the staff on the realities of domestic violence as well as how work alongside domestic violence advocates; and
  5. Continuously evaluate strategies and progress.[3]

Additionally, the U.N. Population Fund (UNFPA) and the WAVE Network have developed a detailed resource package for those seeking to address how health care institutions respond to domestic violence.[4] The resource package include information from the nature of violence against women to detailing the steps health care providers should take in identifying DV, providing victim-sensitive examinations and care, documentation, and following up with risk assessments and safety planning.[5]

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.

[1] Alex Hardip Sohal et al, Improving the Healthcare Response to Domestic Violence and Abuse in Primary Care: Protocol for a Mixed Method Evaluation of the Implementation of a Complex Intervention, 18 BMC Pub. Health 3 (2018).

[2] World Health Organization, Responding to Intimate Partner Violence and Sexual Violence against Women: WHO Clinical and Policy Guidelines 11 (2013).

[3] Futures Without Violence, Prevent, Assess, and Respond: A Domestic Violence Toolkit for Health Centers & Domestic Violence Programs 3 (2017).

[4] UNFPA & WAVE Network, Strengthening Health System Responses to Gender-based Violence in Eastern Europe and Central Asia: A Resource Package (2014).

[5] Id. at 70.