11. IPV Policies and Protocols for the Healthcare Setting

Healthcare institutions should provide their employees with clear expectations and instructions on how to assess and respond to IPV with their patients. Written IPV Policies and Protocols should be shared and discussed with all new employees during their orientation process. IPV Policies and Protocols should be reviewed regularly by the healthcare facility’s IPV Task Force to ensure that policies are base on current best and promising practices in the field and incorporate new research

The following “Minimal Elements of IPV Protocols” was developed by Futures Without Violence and is specifically designed for the healthcare setting. Hospitals and other healthcare settings can use this protocol as a template for developing internal IPV Policies and Protocols. http://www.endabuse.org/userfiles/file/HealthCare/MinimalElements.pdf

Minimal Elements of DV Protocols

  1. Definitions. Include the various manifestations and types (physical, sexual, psychological) of abuse and who (adult, adolescent, elderly, lesbian/ gay/ bisexual/ transgender) is covered by the policies. Policies on child abuse and elder abuse may vary and be addressed separately given that state reporting laws for child, adult and elders may be different.
  2. Guiding Principles. Include information reflecting the institutional philosophy on and commitment to improving the safety and health of victims of domestic violence.
  3. Identification and Assessment ProceduresInformation should be available to clinicians either within the protocol or as an addendum addressing how to ask about abuse directly, including sample questions. Specify physical as well behavioral indicators to look for when assessing a patient for abuse. Specify who is to do the assessment (i.e., physician, nurse or both). Specify precautions for ensuring safety and confidentiality (i.e., arrange for a private screening area, availability of security if necessary, etc.).
  4. Intervention Procedures.Include interviewing strategies, safety assessment and planning, and discharge instructions. Information on assessment (sample questions and techniques) and intervention (supportive information to communicate, referrals, patient education materials, etc.) should be available to clinicians either within the protocol or as addendums.
  5. State Reporting Requirements.Clarify the law(s), if any. Include procedures for the release of information to the proper authorities as required by law. Also define who is responsible for making the report.
  6. Confidentiality Rules.Clarify relevant state privacy laws as well as federal regulations and privacy principals for victims of domestic violence. Ensure that the protocol and policy surrounding the use and disclosure of health information serve to improve the safety and health status of victims of domestic violence by respecting patient confidentiality and autonomy.
  7. Collection of Evidence and Photographs. Include procedures for the collection, retention and release of evidentiary materials. In particular, clarify procedures for taking in-house photographs and securing release forms.
  8. Medical Record Documentation.Clearly delineate what information is to be included in the medical record (e.g., a description of the injuries, coloration, size, use of a body map to indicate location of injuries, stated or suspected cause of injury, action taken by clinician, etc.).
  9. Referral and Follow-Up Include instructions regarding available resources, and how to make referrals to in-house staff, domestic violence programs, legal advocacy, children’s services or other appropriate community agencies. Keep phone numbers updated on a regular basis. Include instructions for continuity of care for victims and at least one follow-up appointment with a health care provider, social worker or DV advocate for patients disclosing abuse.
  10. Plan for Staff Education. All health care personnel, including security and allied health professionals should receive ongoing training on the dynamics of domestic violence protocol and procedures with an emphasis on staff roles and coordination. The Joint Commission requires a staff education plan be developed for every department within hospitals.

Sample Suburban Cook County Hospital IPV Policy

Click here to review a current IPV Policy in place at a suburban Cook County hospital.

Implementation of Domestic Violence Protocols:

  1. Define departments within your clinic or hospital where the protocol will be used and how each department will implement and utilize the protocol.
  2. Review the various existing protocols relevant to your institution or practice.
  3. Address issues specific to your state, institution and clinical setting, such as documentation, confidentiality, liability and reporting.
  4. Determine site-specific interventions and coordination.
  5. Define roles and responsibilities regarding inquiry, identification and assessment, documentation, interventions(s) (including safety planning, discharge instructions), referrals and follow-up.
  6. Work with local domestic violence experts to develop a community-based referral network.
  7. Make the protocol easily available and accessible to each department/clinical setting by including it in the staff orientation packet or implementation packet as well as by posting it in a central area. Be sure it is produced in a “user-friendly” and readable format.

Another sample IPV policy for healthcare providers titled “Community Public Health Services Domestic Violence Protocol,” is currently used by San Francisco’s Department of Public Health. This protocol provides a definition of DV and guiding principles for healthcare providers, as well as protocols for the following activities:

  • Screening
  • Assessment
  • Intervention
  • Documentation
  • Mandatory Report of Injury
  • Continuity of Care

Appendices include:

  1. Staff Roles and Responsibilities
  2. Symptoms and Signs of Domestic Violence
  3. Approaches for Interviewing the Patient
  4. Safety Assessment and Planning
  5. Injury Location Record (Body Map)
  6. Consent to Photograph/Receipt of Evidence
  7. Summary of California Reporting Law (adapt by inserting Illinois’ Reporting Laws here)
  8. Report of Injuries by a Firearm or Assaultive or Abusive COnduct
  9. Common Questions about Mandatory Reporting
  10. DV Contact Form
  11. Community Resources
  12. Health Commission Resolution on Universal Screening
  13. Acknowledgements
  14. Signatory Page

The "Community Public Health Services Domestic Violence Protocol" can be viewed in its entirety by clicking here and Future Without Violence states ther is “no permission is needed to use or adapt this document at healthcare facilities."

“Warm Springs Health and Wellness Center Guidelines for Clinical Assessment and Intervention on Domestic Violence” is another sample IPV protocol for the medical setting from the FWV, click here.