Training Encourages Health Care Providers to Spot Domestic Violence

Domestic violence transcends race, ethnicity, age, national origin, sexual orientation, and religious and socioeconomic factors. According to the American Bar Association's Commission on Domestic Violence, up to four million American women are seriously assaulted by an intimate partner during an average 12-month period. And nearly one in three adult women experience at least one physical assault by a partner during adulthood. According to the commission, nearly 50% of men who beat their wives do so at least three times a year. And up to 60% of men who abuse women also abuse children.

Domestic violence often goes unrecognized by health care professionals. Many symptoms, even physical injuries, are not obviously from domestic violence. Physicians may not be comfortable asking about domestic violence, and victims who are not asked often don't volunteer such information. According to the commission, battered women comprise up to 30% of ambulatory care patients, but only one in 20 is correctly identified as such. One study found that less than 3% of women visiting emergency rooms disclosed or were asked about domestic violence.

To overcome barriers among health care providers in diagnosing domestic violence, a Medical College of Wisconsin psychologist helped develop a three-hour training program. L. Kevin Hamberger, PhD, Professor of Family and Community Medicine who sees patients at the Racine Family Practice Center, was part of a team that developed and evaluated training that could mean more victims of domestic violence receive the care and assistance they need.

The training of about 800 health care providers in Racine, Wisconsin, introduced them to the concept and dynamics of domestic violence -- how it works, why some people feel trapped in abusive relationships and can't leave, and why victims don't want to talk about it. The new training is focused on supporting adults in intimate relationships who are being abused or beaten, live in fear or are being controlled by a significant other. Training also provided health care practitioners with information about community Resources that offer assistance to domestic violence victims. During role-play training, participants practiced inquiring about domestic violence and providing support should patients disclose they're in a violent relationship.

"Many health care providers don't feel they have enough knowledge about domestic violence to adequately broach the topic with patients," Dr. Hamberger says. "Or they may not feel confident in addressing the issue or are afraid of offending patients. Training helps health care professionals feel comfortable with the subject and realize that domestic violence is as much a health care issue as smoking or other lifestyle factors."

There are other signs of domestic violence besides physical injuries. Insomnia, fatigue, depression, drug or alcohol abuse, sexual dysfunction or children acting out are some of them. As health care providers seek an underlying cause for such problems, they should ask about the patient's relationships and the possibility of abuse. Whether physical or emotional, the symptoms of domestic violence will reoccur unless the root cause is identified and addressed.

"We help those patients who struggle with domestic violence find resources to assist them," Dr. Hamberger notes. "And our screening has a preventive effect as patients realize the health care community is concerned about domestic violence."

Six months after training was done, a random survey was conducted and found gains in the attitudes and preparedness of training participants. Focus groups were also held to uncover any obstacles to implementation. Sometimes there were issues within an organization or department, for example, that inhibited domestic violence screening. The next step for Dr. Hamberger's team is ongoing quality management, which includes auditing medical charts and domestic violence screening practices, and providing in-service training tailored to the specific needs of different departments.

"Physicians are naturally concerned about the well-being and safety of their patients, and treating domestic violence is part of that," Dr. Hamberger says. "When physicians are provided with training, they have the tools to diagnose and treat symptoms as well as refer patients to community resources for more support."

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.