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How to Solve Domestic Violence: a follow up to DV training in hospitals

Posted Oct 02 2009 3:07pm
How can we solve domestic violence? How can we solve any problem that ruins society? The key word in both of these questions is "we", "we" is the solution. First, we must get past the idea that domestic violence, or any problem in society, affects only "some" of us, it simply does not. So, how can we solve domestic violence? We must all be involved in the solution. Ignorance has been acceptable, and it still is--which is why domestic violence is so prevalent and still continues. We must all see this problem for what it is, a problem that persists, a problem that most are ignorant too, a problem that needs our attention, a problem that we can solve, if we all take part in the solution. This mentality can be applied to any problem, and it can work. In the past year I have been in contact with people that have the drive, the motivation, the will to actively take part in a solution, and it has inspired me to take part as well. These people aren't from DV organizations or agencies, they are just women, some men, and they all recognize the same thing I recognized when I got involved--victims are not being properly assisted in the US. In a short period of six months, I have come up with seven unique ideas for new legislation that if introduced, would combat domestic violence on a multitude of levels. I am one person, not experienced in domestic violence issues, but I have come up with ideas that I know would work, and I am actively trying to get those ideas introduced as bills. One has been introduced, an extension on the statute of limitations in cases involving domestic violence for NY. Now I've become interested in discussing my other ideas. A week ago I wrote about domestic violence training in hospitals. A week ago I was not aware of the disconnect between hospitals and domestic violence training services. Since then, I have been educating myself on this issue, making calls and sending emails, asking questions and getting answers. I will share the information here tonight.

I have become interested in DV training in hospitals because of my own experience. Just two years ago when I arrived at the ER with broken bones, my abuser at my side, I was not screened for domestic violence--therefore, today there is no hospital record stating that my injury was caused by domestic abuse. Why is this bad? Because accurate documentation of injuries that stem from abuse are critical for criminal/civil/family court cases. Without this documentation, women must work harder in proving their cases in court, in some cases it might even prevent a victim from getting a restraining order against their abuser. This becomes yet another problem for a victim seeking help from a court of law. I have nine screws and a plate in my left leg due to domestic abuse and because I wasn't screened in the ER upon arrival, there is no accurate medical documentation about my injury available.

Back in the 90s, there were two programs in the US that implemented screening in health care settings. WATCH, a pilot program in Massachusetts, collected data from female patients 12 and older in the ER at 23 random hospitals. North Carolina had a program too, one that they dropped due to employee turn over, lack of time, insufficient administrative support, and a fear of offending patients. In the 90s, The University of NC Hospitals screened people 16 and older in the ER, much like the program WATCH. The problem with these programs, in my opinion, was their goal. I found the goal of the screening programs while reading through several articles, the primary goal of both of the programs was to collect data for surveys and to provide referrals and information to victims. As a victim of brutal DV, I was surprised to find out that this was in fact the goal of the screening programs, it is no wonder they both failed. The goal should have been: 1. To save the lives of women affected by domestic violence through screening and reporting abuse. 2. To provide a confidential, accurate report of domestic abuse related injury to the victim, documenting any injury to the victim relating to violence. This would have been my goal.

I started making phone calls to DV shelters in my area. I found out that most shelters provide free DV training to hospital staff members, and some hospitals seek training for their staff. But it is up to the hospital whether or not they want the free services, they may choose not to take part in the free training. According to the information I found, it is not mandatory that a hospital receives training on domestic violence. Also, if hospitals do seek training from shelters, they are not required to follow up with the service providers about the training and the screening results. So, many shelters that offer these services for free, are unable to examine the results of their services, which means there is no oversight and the type of screening is up to the hospital alone. Although it is mandatory for hospitals to screen for "abuse", domestic violence is under this category, it is primarily up to the institution as far as what type of screening method is used. The Joint Commission, an organization that accredits health care institutions, does have "standards for abuse" that hospitals must adhere to, but again, this commission cannot stipulate what criteria a hospital must use in the screening process, only that they use some kind of criteria. Also, hospitals must report abuse to the authorities, if they suspect it, but if they aren't screening properly and effectively, if their goal is not to combat DV in the ER, then they will fail in reporting the abuse, and in some cases it might cost women their lives. In my case, I was sent home with my batterer the night of my injury due to a lack of screening in the ER and an inability of staff members to recognize my non-verbal cues, which were intense sadness and constant crying.

This brings me to DV training in hospitals. It is critical that staff members be trained in the ER in all hospitals, it should be mandated that every hospital must follow up with the DV service providers so that results of the training can be properly assessed and audited. Handing out pamphlets and hotline numbers is not good enough in these situations anymore. I found that there is a disconnect here, there is a disconnect with the hospitals and the DV service providers that offer the free training, and even the Joint Commission, although the Joint Commission does not accredit every hospital in the US and is not to blame. The problem is, there seems to be no standard of DV training in hospitals, no follow up with training facilities, no set protocol/screening for all hospitals to use for victims that enter the ER due to domestic abuse. It is vital that all hospital staff members are not only familiar with DV, but are thoroughly trained in assessing the non-verbal cues victims give in the ER. Sometimes, most times, victims are accompanied by their batterers and cannot speak out in fear of retaliation, therefore staff members, including doctors, need to be trained to recognize the signs of abuse and take action. We need to make a connection, we need to work together to combat this problem, and most importantly, we need to all want to do it.

These are my ideas on domestic violence training in hospitals. Hospitals should be mandated to get proper DV training from DV service providers (shelters or DV organizations). Hospitals should be mandated to follow up with their service providers so that results of screening/protocol in the ER can be audited and assessed, and hospitals need to confidentially document cause of injury for the patient so that a victim of DV has accurate documentation of the abuse for future use. We need to recognize problems and disconnects and find solutions. We need to "check" each other, and be able to tell our neighbor if they are doing something that could use improvement, and we need to find ways to help each other solve these problems. Domestic violence is too widespread, too persistent, too devastating to sit back and choose not to be a part of the solution to end it.
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