Screening for Domestic Violence and Human Trafficking
Screening all patients for domestic violence and abuse is a vital part of completing a patient’s health history—no matter what the healthcare setting may be or the background of the patient.
“I learned early on in my career that it is impossible to look at a patient and determine if they are in an abusive situation,” says Walden University School of Nursing Field Education Supervisor Pamela Glenn, CNM, APRN. “One day, I was running behind on my clinic schedule and a professional woman came in for her annual exam. She could be described as confident, intelligent, successful, and well-dressed. The fleeting thought crossed my mind, 'She doesn’t look like someone who is in an abusive situation.’”
Although it was tempting to skip her screening questions and save time, Glenn asked them anyway. It was revealed that despite the patient’s success and confident manner, she had a very abusive situation happening with her partner. In that moment, Glenn realized she needed to ask all her patients about this important health topic.
Since abuse and trafficking do not discriminate among gender, age, or socioeconomic status, it’s critical to screen all patients for this health issue. It can be easy to stereotype who gets abused and who may be abusive. Stereotyping keeps people from seeing that someone sitting right in front of them may be dealing with an unhealthy situation.
“It’s important for us all to identify the stereotypes we may be holding in our minds and then let them go, so we don’t limit our screening efforts,” says Glenn.
The trauma resulting from domestic violence, abuse, and trafficking can potentially lead to poor health if not addressed appropriately. Research shows that patients in these situations often keep it a secret from family and friends but are more likely to disclose it to a healthcare provider when asked. Because of this, it’s essential for healthcare workers to demonstrate compassion during the screening process and provide a safe, nonjudgmental space for these discussions.
“At a recent doctor’s visit, the nurse quickly asked me whether I’ve ever had diabetes, if my medication has changed, and other predictable questions—while staring at a computer screen,” says Glenn. “She then promptly asked whether I’ve experienced any domestic violence or abuse. Because of the way she asked me this very personal question, without pausing or making eye contact, I would never have disclosed if I was in an abusive relationship or being trafficked.”
Through her experience, Glenn has learned to completely avoid using the word ‘abuse’ during initial screenings because patients often think it only applies to situations of physical violence. Instead, she recommends first inquiring about their relationship in a conversational manner to help develop a trusting environment. Once this has been established, healthcare providers should specifically ask about unhealthy or emotionally abusive behaviors that may be occurring. The conversation can conclude by inquiring about physical violence and forced sexual activity.
It’s important for healthcare providers and staff to be trained in these issues and aware of the warning signs. For example, the person accompanying the patient may talk for them, be overly concerned, and remain at their side to be sure nothing is disclosed about the true nature of their relationship. In other cases, patients may schedule medical visits under vague reasons because they don’t understand how this issue has impacted their health or to make contact with someone who can potentially help them.
“That’s when it’s critical for providers to stop and explore what the underlying issue is,” says Glenn. “A proper screening can lead to an accurate diagnosis, and thus a more effective plan of care."
In addition, she maintains it’s important for healthcare providers to realize that not all victims are ready to disclose abuse, even when screening is done appropriately. Victims often feel shame, embarrassment, and fear, which may keep them from sharing this information. Glenn says it’s about understanding and respecting their process in leaving an abusive partner.
“When I go home, I need to be at peace with the fact that I’ve done my job by bringing it up, giving them resources, and sharing my concerns for their safety. If anything, I know I nudged them so the next time they return to a safe place, they may be ready to disclose and accept help.”