Resources for Healthcare Providers
Lumina Alliance is here to help healthcare providers.
Discussing sexual assault/abuse and intimate partner violence with your patients can feel daunting and intimidating. You might worry about being intrusive; maybe you’re not sure what to say to a patient who shares their experience of abuse with you, or maybe you are unsure of the correlation between abuse and health care. Perhaps you’re concerned about the time constraints of making a report to law enforcement.
This webpage can help healthcare providers navigate these conversations when their patients disclose abuse. The state-certified advocates at Lumina Alliance are here to answer questions and support anyone in need of assistance, including healthcare providers, in San Luis Obispo County at any time.
Violence, Abuse, & Health
Sexual violence refers to any sexual act that occurs without consent. This includes a wide range of assaults, including rape, attempted rape, sexual battery, incest, molestation, spousal rape, and statutory rape. Intimate partner violence, or domestic violence, takes many forms, including: sexual, emotional, verbal, financial, psychological, spiritual, digital, and physical. Visit our Intimate Partner Violence and Sexual Assault/Abuse pages for more detailed information.
Intimate partner violence is associated with increased morbidity and mortality. Recent studies show that sexual assault/abuse and intimate partner violence have short-term and long-term effects on survivors’ health even when they haven’t sustained physical injuries.
Findings from the National Intimate Partner and Sexual Violence Survey (2010)(1) reveal that survivors can experience mental health consequences—like depression, anxiety, suicidality— as well as physical health consequences like gastrointestinal disorders, sexually transmitted infections, and peripartum and postpartum complications. Sexual assault/abuse and intimate partner violence are public health concerns, as recognized by the World Health Organization.
Survivors commonly experience headaches, stomachaches, depression, anxiety, post-traumatic stress disorder (PTSD), sleep disturbances, and many other physical and psychological ailments.
- 60% more likely to have asthma
- 70% more likely to have heart disease
- 80% more likely to have a stroke
- Twice as likely to be a current smoker
- Twice as likely to suffer from depression and headaches
Healthcare providers are in a unique position to provide care and referrals for ailments caused by violence and abuse. As healthcare providers can sometimes be the only outside person to interact with a survivor, up-to-date training and trauma-informed care are key components of delivering care.
In addition to mandating screening for intimate partner violence during intake interviews, the Affordable Care Act also greatly expands support and insurance coverage for survivors. Exclusions based on pre-existing conditions, such as a history of intimate partner violence, are prohibited. The law exempts survivors from penalties for not having insurance, requires coverage for mental health and substance abuse treatment and increases support for Native American survivors.
Visit the Department of Health and Human Services’ Division of Family Violence Prevention and Services webpage for more information.
A trauma-informed care approach is strengths-based and grounded in an understanding of the impact of trauma. Such an approach:
- Recognizes that trauma exposures are pervasive through both individual and collective experiences.
- Emphasizes the physical, psychological, and emotional safety of both providers and survivors and focuses on creating opportunities for communication, support, and safety at all levels of an organization.
- Is culturally sensitive and person-centered and expands on a foundation of patient autonomy and choice to ensure that an individual’s unique trauma history is as integral a component to care as the patient’s concerns, preferences, and values.
- Responds to disclosures with understanding and recognition of the effects of all kinds of trauma (childhood exposure to violence, sexual violence, historical trauma, etc.) by building trust and providing a safe environment for receiving services.
- Actively avoids re-traumatization. Conversations around past trauma as well as physical exams should take into consideration any triggers the patient/survivor might have.
This information was adapted with permission from FUTURES Without Violence.
The goal of trauma-informed care is to help survivors rebuild a sense of control and empowerment. People experience trauma through physical and sexual violence, racism, structural violence, poverty, homophobia, transphobia, witnessing violence, health inequity, war or natural disaster, emotional abuse and neglect, and more.
Visit the Safe Place webpage for information on implementing trauma-informed care in your clinic.
Routine assessment as part of preventative health care screenings should be incorporated into clinical settings. The CDC is a resource for assessment instruments that can be used in healthcare settings. The two-question screening tool is a validated tool that can be used in primary care settings. The Danger Assessment can be used to determine a person’s risk of homicide after experiencing violence. When talking to your patients, keep in mind that disclosing can only come when the patient/survivor is ready.
Many clinics and hospitals are updating their intake forms and electronic health records to include questions about sexual assault/abuse and intimate partner violence.
Lumina Alliance encourages providers to use the evidence-based CUES assessment method and the safety cards developed by Futures Without Violence to talk to their patients about healthy and unhealthy relationships. To request safety cards, email [email protected].
CUES stands for the following protocol:
- Confidentiality: Disclose your limits of confidentiality. Always see the patient alone for at least part of every visit to ensure a safe space to discuss relationship violence.
- Universal Education & Direct Inquiry: Give the patient a safety card that educates on how relationships can affect health. Reiterate that you are a safe person to speak with.
- Support: Know that disclosure is not the goal. Survivors get to decide if or when they are ready to share their experience. If your patient discloses that they have been in or are currently in a physically or emotionally abusive relationship, before anything else, start by believing and thanking them for their courage in disclosing. Offer to call an advocate from Lumina Alliance. Treat any injury or illness without fear of “tampering with evidence.”
- Warm Referral & Follow-Up Visit: Assess your patient’s level of risk for future violence, provide resources, and make a warm referral to Lumina Alliance. Advocates can accompany patients to forensic medical exams and can meet patients at any clinic or hospital to inform them of their rights, reporting options, and services available including safety planning, temporary restraining orders, counseling, and emergency shelter. Schedule a follow-up visit to check their injuries and ask about their relationship again. This shows support and empathy for your patients, increases their sense of safety and security and may contribute to improved health outcomes.
Reporting To Police
How you document your patients’ injuries can determine legal outcomes and recovery for your patients. The following tips can help you when documenting disclosed or suspected abuse or violence:
- With permission from your patient, objectively document injuries by taking photographs or by completing a body map that lists the location, number, type, and characteristics of the injuries.
- Use quotation marks to document your patient’s experience in their own words instead of paraphrasing. Identify the perpetrator(s) your patient describes in quotation marks such as “my husband” or “my mother.”
- Avoid legal jargon and personal conclusions about the case. For example, avoid phrases such as, “Patient alleges she is a battered woman experiencing intimate partner violence.” Instead, document injuries and record direct quotations from your patient. You can also record your own observations about your patient’s general appearance or demeanor.
For more information on best practices for documenting intimate partner violence, refer to the National Institute of Justice’s article “Documenting Domestic Violence: How Health Care Providers Can Help Victims.”
California law states all healthcare providers are mandated reporters. This means that healthcare providers are required to contact law enforcement if they are treating a physical injury resulting from disclosed or suspected violence. The following can help you when reporting:
- Before directly asking your patient about their experience, let them know that you are a mandated reporter. This allows your patient to make an informed decision about whether and how much to disclose, and prevents your patient from feeling blindsided should you be required to make a report.
- If a person accompanying your patient is under suspicion of perpetrating the assault, do not leave your patient alone with that person.
- Treat your patient’s injuries, address their health concerns, and provide emotional support.
- If your patient has experienced sexual assault/abuse or intimate partner violence, they have the right to an advocate. Explain an advocate’s role (to provide emotional support, information about patients’ rights and options, and referrals to local resources) and that they are available by phone or can come to your location. Offer to call Lumina Alliance.
- Explain your patient’s rights when disclosing or reporting, emphasizing they do not have to answer any questions and they are not required to stay.
- If needed, explain what a forensic medical or Suspected Abuse Response Team (SART) exam is. Your patient can contact Lumina Alliance, law enforcement, Child Welfare Services, or the San Luis Obispo Public Health office to schedule an exam.
- Follow-up Care & Referrals: Refer your patient to Lumina Alliance for support services including safety planning, temporary restraining orders, counseling, and emergency shelter. Schedule a follow-up visit to check their injuries. Ensure your patient has a safe place to go prior to discharge.
- Depending on the situation or whether or not your patient wants to be involved in the reporting process, call law enforcement as soon as possible before or after your patient is discharged. Call the law enforcement agency in the jurisdiction where the abuse took place.
- Request and document the name and badge number of the assigned law enforcement officer(s) in the patient record.
- The report should include (A) the name of the injured person if known, (B) the injured person’s whereabouts, if known, (C) the character and extent of the person’s injuries, and (D) the identity of any person(s) the injured person alleges inflicted the injury if known. A report must be made even if the person has died, regardless of whether or not the injury contributed to their death, and even if evidence of the conduct of the perpetrator was discovered during an autopsy.
- Fill out a Suspicious Injury Report OES 2-920, Suspected Elder/Dependent Adult Abuse Report, or Suspected Child Abuse Report as appropriate within 48 hours of report filing and contact local law enforcement.
For more information about California mandated reporting laws and processes, review California’s Domestic Violence & Mandatory Reporting Law.
The state-certified advocates at Lumina Alliance/Alianza Lumina are here to answer questions and support anyone, including healthcare providers, in San Luis Obispo County at any time.
Lumina Alliance can assist your patients with safety planning, temporary restraining orders, individual and group counseling, and emergency and transitional housing. Our agency can also help connect your patients to many other community resources including long-term housing, health insurance, food assistance, and childcare.
Calling 2-1-1, which is free and confidential, or visiting 211slo.org can also connect you and your patients to information and community resources in San Luis Obispo County.
Lumina Alliance encourages all healthcare providers to have a policy that gives providers the opportunity to see their patients alone at some point in the visit. If your clinic does not have this policy, please contact us at [email protected] to learn about clinical best practices and policies, and to discuss ways for you and your patients to have confidential conversations about healthy and unhealthy relationships.
Organizational assessment tools can be used to help improve the response to IPV and/or SA. Lumina Alliance is also available to give presentations to your clinic or hospital staff on best practices and trauma-informed care.
Visit the Futures Without Violence Health webpage to learn more about the connections between health and sexual assault/abuse and intimate partner violence, watch informational videos about how to talk with patients about healthy and unhealthy relationships, and read articles about trauma-informed policies, procedures, and best practices. Lumina Alliance is also available to give presentations and further education to staff and clinics.
- Black, M. B. (2011). The National Intimate Partner and Sexual Violence Survey (VNVIS). Atlanta, CA: Center for Disease Control.
- Team, N. M. (2015, February 13). Abusive relationships can affect your long-term health. NOMORE.org | Together we can end domestic violence and sexual assault. Retrieved October 8, 2021, from https://nomore.org/abusive-relationships-can-affect-long-term-health/.