WORKING WITH BATTERED WOMEN: A Handbook for Health Care Professionals
Table of Contents
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I. IDENTIFICATION
How to Ask About Domestic Violence
Identification is the first aspect of care. In order for you to identify if domestic violence is affecting a patient's health, it is crucial to ask all women who come to you for care about domestic violence. To be effective, the screening procedure should be made a part of regular routine. All professional staff should become familiar and proficient with various ways of asking patients about abuse they may be experiencing and at communicating this information to appropriate referral sources.
How to Ask About Domestic Violence:
- Most importantly, you interview the patient on her own—away from anyone who may have accompanied her, including sisters, daughters, friends, children or partner. She especially may not feel free to speak openly and honestly if her partner is nearby.
- Consider starting with the first two questions of the Woman Abuse Screening Tool (WAST) on the next page. These questions can "easily and unobtrusively" be asked along with the usual questions during a complete physical (i.e. questions about history of heart disease in the family, or alcoholism), or asked during other routine check-ups.
"The [first] two simple and non-threatening questions from the WAST were effective in detecting women who might be experiencing abuse and who warranted further questioning with the full WAST. From a clinical perspective, these two questions can be easily and unobtrusively included in a family physician's interactions with female patients during routine office visits. If a woman answers "A lot of tension" and "Great difficulty", respectively, to these first two questions, the physician can then use the remaining WAST questions or other appropriate questions to elicit more information about the patient's experience of abuse"
(from Judith Belle Brown, PhD; Barbara Lent, MD, CCFP; Pamela J Brett, MA; George Sas, MD, CCFP; Linda L. Pederson, PhD, Development of the Woman Abuse Screening Tool for Use in Family Practice, Family Medicine (Fam Med 1996; 28(6):422-8) p. 426)
When asking questions 3 to 7 of the WAST (or other questions about abuse):
- Avoid an intimidating stance: sit at or below the patient's level.
- Use questions that tell her that you know wife abuse exists, that you will believe her if she tells you, that you won't be shocked by her answer, and that you are concerned.
- Ask about abuse in a direct and compassionate way. Focus your attention directly on the person to increase trust and build rapport. Avoid doing paperwork during the interview.
- Affirm clearly that you believe violence against women is a crime.
- Offer support in an emphatic, non-judgmental way that shows you respect the patient.
- Make it clear that you will not compromise her safety if she discloses to you.
- Assure her that what she says to you is confidential—you will only call the police if she wants.
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