ASK - Abuse Screening Kit - Violence Prevention · 2012. 9. 10. · IDENTIFICATION AND SCREENING...

ASK Abuse Screening KitViolence Prevention

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The most dangerous period

for a woman in an abusive

relationship is the first

3 or 4 months following

separation.

[Peel Committee Against Women Abuse (PCAWA) Best Practice Guidelines, 2001]

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TABLE OF CONTENTS

Introduction and Context Setting . . . . .Card 1

What to Look For [Signs/Symptoms] . .Card 2

Why and When to Screen . . . . . . . . . . . .Card 3

Creating a Safe Environment for Disclosure . . . . . . . . . . . . . . . . . . . . . .Card 4

Identification and Screening [How to Ask about Abuse] . . . . . . . . . . .Card 5

Sample Risk Assessment Questions . . . .Card 6

Safety Planning . . . . . . . . . . . . . . . . . . . . . . .Cards 7-8

Reporting and Confidentiality . . . . . . . .Card 9

Limitations Regarding Confidentiality . . .Card 10

Documenting Abuse[What and How to Document] . . . . . . .Card 10

Injury Location Diagram . . . . . . . . . . . .Card 11

Community Referrals . . . . . . . . . . . . . . .Cards 12-13

TABLE

OF C

ONTEN

TS

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51%

of Canadian women over the

age of 16 have experienced

at least one incident of physical

or sexual assault.

[Canadian Panel on Violence Against Women, 1993]

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PURPOSE OF THE ASK TOOL KIT

The ASK Tool Kit is a practical resource for healthprofessionals who provide services to women. Theinformation contained in this resource will helpyou identify and respond to women who may beexperiencing abuse or violence in their relationships.

WOMAN ABUSE: A WORKING DEFINITION

Woman Abuse is the intentional and systematic useof tactics to establish and maintain power and controlin a relationship. These tactics may include:

� Physical or sexual assault� Emotional or psychological abuse� Verbal abuse� Financial abuse� Environmental and social abuse� Religious or spiritual abuse� Stalking or criminal harassment

INTR

O &

CONT

EXT S

ETTIN

G

1

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50%

of women reporting physical

assault also experienced sexual

assault in the context of the

same relationship.

[Peel Committee Against Women Abuse (PCAWA) Best Practice Guidelines, 2001]

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WOMAN ABUSE: WHAT TO LOOK FOR

Woman abuse transcends age, race, culture, sexualorientation and socio-economic status. The bestway to find out about abuse is to ask directly.Women are excellent at hiding the effects of abuse.

LOOK FOR:

� Unexplained injuries or an explanation that does not match physical symptoms

� Delay in seeking care, particularly if pregnant � Injuries when pregnant, particularly to breasts

and abdomen� Chronic illnesses that are unresponsive to

treatment � Frequently missed appointments � Overly solicitous partner who answers questions

on behalf of woman and is unwilling to allow woman privacy

� Family history of physical, sexual, or other abuse

WHAT

TO LO

OK FO

R

2

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1IN6pregnant women are abused

during pregnancy.

[Middlesex – London Task Force Report, 2000]

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WHY SCREEN?

� 1 in 4 Canadian women have experienced violence in an intimate relationship.1

� 1 in 6 pregnant women are abused during pregnancy.2

� 40% of women who were abused during pregnancy,reported abuse began when they were pregnant.3

WHY

AND

WHEN

TO S

ECRE

EN FO

R AB

USE

3

Type of Visit

New Patient

Prenatal

Emergency

Mental Health

Other visits

How Often

At first visit,Yearly, during annual health exam, and/orWhenever they disclose a new partner.

First prenatal visit,At least once per trimester, andPostpartum visit.

At every visit.

At initial visit,Yearly during annual health exam.

Whenever there are physical or behavioural signs of abuse, orWhen client presents with chronic-somatic complaints.

WHEN TO SCREEN?

1 Canadian Panel on Violence Against Women, 1993

2 Middlesex-London Health Unit, 2000

3 Canadian Panel on Violence Against Women, 1993

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95%

of women abused during

the 1st trimester, reported

the violence escalated after

the baby was born.

[Society of Obstetricians and Gynaecologists of Canada (SOGC) Clinical Practice Guidelines:Intimate Partner Violence Consensus Statement, No. 157, April 2005]

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CREATING A SAFE ENVIRONMENT FOR DISCLOSURE

Facilitating disclosure of abuse is partly dependanton offering a safe and secure environment forwomen to talk about the abuse.

TIPS FOR CREATING A SAFE ENVIRONMENT:

� Create a patient-friendly office with access to community resources and up-to-date informationon woman abuse and violence.

� Offer a private space for interviewing/examiningwomen. If husband is present, suggest reasons why it is necessary to see the patient in private (e.g., collection of a fresh urine specimen). Neverask about abuse when the partner is present.

� Ensure there is access to appropriate translators (who are NOT family members, partners, children or friends).

� Use a non-threatening tone and body language (e.g., sit at or below the woman’s level).

� Be familiar with community supports and services for women experiencing abuse or violence [see cards 12 and 13].

CREA

TING

A SA

FE E

NVIRO

NMEN

T

4

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Young women under 25

are at greatest risk of

spousal homicide.

[Statistics Canada, 1999]

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IDENTIFICATION AND SCREENING

Routine Universal Comprehensive Screening(RUCS) Protocol

Asking women directly if they have been abusedremains the most important tool for identifyingabuse or violence. The following questions are aGENERAL guide to help screen women for abuse.

ASKING ABOUT ABUSE:

To help me get to know my patients, I am asking all my patients how things are at home or in theirrelationships. I know that many women experiencesome form of physical, emotional or sexual abusein their lives and that this directly affects theirhealth. I am wondering whether you have everexperienced abuse or violence, either as a child,an adolescent or as an adult?

For further tips on handling a “yes” or “no”response, see Assessing Risk Questions, card 6.

IIDEN

TIFICA

TION

AND

SCRE

ENIN

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5

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43%

of women being abused require

medical attention.

[New England Journal of Medicine, Sept. 1999, Vol. 341, No. 12]

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ASSESSING RISK QUESTIONS

IF ANSWER IS YES Assess Risk� Has the abuse occurred in the past 12 months? � Is the abuse still going on?� Do you still have contact with the abuser?� Do you feel safe now?� Are there children at risk of being abused?

IF YES TO ANY OF THE ABOVE:� Document details of abuse in patient’s own words.� Refer to social worker or community agency

[see cards 12 and 13].

� Address safety issues [see card 7].

IF ANSWER IS NO…� Accept her response. She may not feel safe or

ready to disclose. No could also mean No.� Use as an opportunity to educate your patient

about woman abuse and it’s health effects.� Repeat that asking about abuse is now a routine

part of your health assessments and in about one year you will “check in” again, as situations can change.

ASSE

SSIN

G RIS

K QU

ESTIO

NS

6

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Women seek medical attention

in emergency departments

about 28 times before being

identified as abused.


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SAFETY PLANNING

Safety of your patient and her children is the firstpriority. If you, or your patient, feel that she is indanger, collaborate with her to begin a safety plan.

SPECIFICALLY:

� Ask her directly what assistance she wants.� Warn her not to tell her abuser if she is planning

to leave the abusive relationship. Women are at greater risk of violence or murder just after theyleave their husbands or partners.1

� Inform her that the police can be asked to accompany a woman returning home to retrievebelongings. A referral to a shelter can be made on behalf of the woman, provided she agrees.

� Extend her support system by providing her withinformation on community resources [see cards 12 and 13].

� Safety planning is not the expertise of most healthprofessionals, and it may be more appropriate torefer her to a community agency specializing in safety planning [see card 8].

Some women will decide that returning home istheir safest option. This decision MUST BErespected and supported.

SAFE

TY PL

ANNI

NG

7

1 Statistics Canada, 2004

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Health care providers

identify only 3% of

abused women.


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SAFETY PLANNING

A woman cannot control her abuser’s violence,but it may be possible to increase her own and herchildren’s safety.

� Provide emergency numbers, shelters and resources (e.g., Peel Public Health’s Crisis Numbers for Women and Children).

� Suggest she:� Tell someone about the abuse.� Plan an escape route – where to go in an

emergency situation.� Ask a neighbour she can trust to call the

police if they hear a disturbance coming fromher home.

� Collect essential documents and keep them ina safe place (e.g., birth certificates, marriage license, passports/immigration papers, bank books, rent receipts).

For additional information on Safety Plans, contactyour local shelter or visit www.shelternet.ca. Thebooklet, Creating a Safety Plan, can be ordered bycalling the Peel Committee Against Woman Abuseat 905-282-9792.

SAFE

TY PL

ANNI

NG

8

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In 39% of violent marriages

children have witnessed

an assault on their mother.

[Suderman & Jaffe, 1998]

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REPORTING & CONFIDENTIALITY

All alleged or suspected cases of child abuse mustbe reported to Peel Children’s Aid Society [see card 12].Among others, child abuse MUST be reported when:

REPORTING

� A woman discloses abuse and there are children in the home

� A woman discloses that her children are at risk for abuse

� An examination/interview with a child indicatesthat he/she is being abused

� An adolescent pregnant woman is being abused1

CONFIDENTIALITY

Protecting the confidentiality of an abused womanis very important.

� Do not discuss or inform any person or authoritythat your patient has disclosed abuse without your client’s verbal or written informed consent

� Do not pressure her to report/disclose her abuseto the police or any other person or authority

� Inform her of your professional obligation in this regard

REPO

RTIN

G AN

D CO

NFIDE

NTIAL

ITY

9

1 National Clearing House on Family Violence, 1999

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It is now suggested that

80 – 90% of children in

such homes are aware of

and affected by the abuse,

“whether it is seen, heard or

otherwise sensed”.

[Suderman & Jaffe, 1998]

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LIMITATIONS REGARDING CONFIDENTIALITY

Confidentiality cannot be guaranteed when:� The patient is actively suicidal or homicidal.� There are child welfare concerns (the Child and Family

Services Act supercedes the right to confidentiality).

DOCUMENTING ABUSEWhat to Document:� Description of the abuse, and how it occurred,

in the woman’s own words� Description of injuries (i.e., type, location, length, width,

shape, colour, depth, level of healing), including notation if sexual assault has occurred or is suspected

� Emotional status� Treatment required� Any referral/consultations (written or verbal)

given to patient� Follow-up plans made

How to Document:� Use an Injury Location Diagram [see card 11] to help

document the location of reported current or past abuse � Mark with an X the location of any bruises,

fractures, lacerations, burns, etc.� Attach any diagrams or photographs taken to

the medical records

LIMITA

TIONS

REG

ARDIN

G CO

NFIDE

NTIAL

ITY |

DOC

UMEN

TING

ABUS

E

10

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In a survey of 245 women

with disabilities, it was found

that 40% had experienced abuse

and 12% had been raped.

[Society of Obstetricians and Gynaecologists of Canada (SOGC) Clinical Practice Guidelines:Intimate Partner Violence Consensus Statement, No. 157, April 2005]

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BODY - FRONT BODY - BACK

INJURY LOCATION DIAGRAM

INJU

RY LO

CATIO

N DIA

GRAM

11

Mark all injuries relevant to the assault, as well as areas of tenderness and Woods light findings on the diagram. Describe colour,

appearance and size of injuries. Provide a brief history of injuries.

USE QUOTATION MARKS IF YOU ARE USING THEEXACT WORDS OF THE VICTIM.

DESCRIPTION OF INJURIES

Physician/Nurse Examiner’s Signature Date Time

[Trillium Health Centre Sexual Assault and Domestic Violence Services]

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Violence against women costs

more than 4.2 billion dollars

a year in social services/education,

health/medicine, criminal

justice and labour/employment.

[Greaves et al, 1995]

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COMMUNITY REFERRALS

Peel Regional Police . . . . . . . . . . . . . . .905-453-3311

Health Services � Credit Valley Hospital . . . . . . . . . . .905-813-4253� Trillium Health Centre

Sexual Assault and Domestic Violence Services . . . . . . . . . . . . . . . .905-849-7600

� Peel Public Health . . . . . . . . . . . . . .905-799-7700

Shelters and 24-Hour Crisis Lines� Family Transition Place . . . . . . . . . .1-800-265-9178� Interim Place

Mississauga Site . . . . . . . . . . . . . . .905-403-0864Malton Site . . . . . . . . . . . . . . . . . . .905-676-8515Transitional Support Program . . .905-676-0257

� Salvation Army Family Life Resource Centre (Brampton)

Shelter . . . . . . . . . . . . . . . . . . . . . . .905-451-4115Crisis Line . . . . . . . . . . . . . . . . . . .905-451-6108

� Armagh . . . . . . . . . . . . . . . . . . . . . . .905-855-0299(second stage housing up to 6 months)

24-Hour Crisis Line Services� Assaulted Women’s Helpline . . . . . .1-866-863-0511� Family Transition Place . . . . . . . . . .1-800-265-9178� Victim Services of Peel . . . . . . . . . .905-568-1068

COMM

UNITY

REF

ERRA

LS

12

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1IN3women treated for trauma

in the ER has been injured

by an intimate partner.

[Middlesex-London Health Unit, 2000]

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COMMUNITY REFERRALS

Community Counselling and Support Services� Catholic Cross Cultural Services . . .905-457-7740� Catholic Family Services of

Peel-Dufferin . . . . . . . . . . . . . . . . . .905-450-1608� Family Services of Peel . . . . . . . . . . .905-270-2250� India Rainbow Community Services905-275-2369� Malton Neighbourhood Services . .905-677-6270� Muslim Community Services . . . . .905-790-1910� Salvation Army Women’s

Counseling Services . . . . . . . . . . . . .905-820-8984

Legal Services� Victim Witness Assistance Program . .905-456-4797� Victim Services of Peel . . . . . . . . . . .905-568-8800

Services for Children� Peel Children’s Aid Society . . . . . . .905-363-6131� Catholic Family Services of

Peel-Dufferin . . . . . . . . . . . . . . . . . .905-450-1608

Programs for Abusive Men� Catholic Family Services of Peel-Dufferin

(Man-to-Man Program) . . . . . . . . .905-450-1608� Merge Counselling and

Education Services . . . . . . . . . . . . .905-855-8028

Elder Abuse� Elder Help Peel . . . . . . . . . . . . . . . . .905-457-6055

COMM

UNITY

REF

ERRA

LS

13

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Is there anything you’d

like to talk about?

SOME WOMENARE DYING TOBE ASKED.

Funding provided by the Government of Ontario. The views expressedin this report are the views of the public health unit and do not

necessarily reflect those of the Government of Ontario.

FamilyAbusePrevention.ca

ASK_final 11/10/05 8:53 AM

ASK - Abuse Screening Kit - Violence Prevention · 2012. 9. 10. · IDENTIFICATION AND SCREENING...

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