Professional curiosity – You can ask about Domestic Abuse.
We ask an awful lot of personal questions; but professional curiosity is the hallmark of proactive safeguarding in primary care. Being the first clinician to hear a victim’s story is a privilege; ask once and get it right first time.
Sarah Petter, IRIS Clinical Lead, gives some advice on how to approach the subject of domestic abuse with a client.
In my experience it’s not a story they often repeatedly re-tell; and we usually get more than one opportunity to ask. Sometimes a patient may not say anything on the first consultation. We know from research our patients want to be asked; survivors say that their doctor is one of the few people they will disclose to and want them to respond appropriately (Feder 2006). 85% of patients sought help from professionals an average of five times before they got effective help to stop abuse (SafeLives 2015).
Before you ask – check that there are no children over 2 present. Make sure that the patient is alone, and – if you are talking on the telephone – that the patient knows that the line is confidential and safe to use. Use an interpreter if English is not the patient’s first language: don’t rely on a relative.
Start with – “Is everything ok at home? Is your partner being supportive with – for example – your pregnancy /mental health?”
Explain that – “We know domestic abuse is very common and 1 in 4 women will experience it in their lifetime. We see a lot of people in our practice – are you experiencing abuse at home now or in the past?
Domestic abuse isn’t always about being hit or physically assaulted or threatened. It can be any kind of controlling behaviour, and include emotional abuse. It can be financial – controlling someone by controlling their money.
Did someone hurt you? Do you feel unsafe at home? Is your partner preventing you from making choices in your own life?”
Listen. Stay Calm, be non- judgemental, thank them for telling you – for trusting you.
Respond positively. “What is happening to you is abusive, and you are not to blame.”
Next – check the safety SPECSSS (Separation, Pregnancy Escalation (threats to Kill) Cultural, Stalking, Sexual Assault, Stragulation/Suffocation) from training. If the patient consents, then give their details to the IRIS Advocate Educator and let the patient know that she will be in touch.
Feel free to contact Sarah Petter if you want to discuss how we can ask these questions in clinical practice and if you’d like to explore other strategies to engage with victims and survivors of domestic abuse.
The training covers the health costs and indicators of Domestic Abuse and enables participants to ‘Identify, Ask, Respond, Document, Assess Risk and then Refer’.