Clinical indicators of abuse
- Ask non judgmentally
- Are you now or have you recently been afraid of your partner/expartner?
- What happens when your partner gets angry?
- Have you felt humiliated or emotionally abused by your partner/expartner?
- Sometimes partners use physical force. Is this happening to you?
- Has your partner ever physically threatened or hurt you?
- Have you been kicked, hit, slapped or otherwise physically hurt by your partner/expartner?
- Within the past year, have you been forced to have any kind of sexual activity by your partner/expartner?
- Validate decision to disclose
- Everybody deserves to feel safe at home
- No-one deserves to be hit or hurt in relationships
- I am concerned about your safety and wellbeing.
- Let’s work together on this
- Abuse is common and happens in all kinds of relationships.
- It tends to continue.
- You are not to blame
- Abuse can affect your health and that of your children
- Acknowledge
- complexity of the issue, respect the woman’s unique concerns and decisions
- Take time to listen, provide information and offer referral to specialist help
- Explain violence unacceptable
- Enquire immediate safety/ arrange safe accommodation
- Safety Planning
- Compline a list of emergency numbers
- Help to identify a safe place and how to get there
- Identify a safe place to store valuables and important documents
- Identify family and friends who can provide support
- Ensuring cash available
- Safety of children
- Safety to go home
- Offer/recommend police involvement
- Offer aboriginal health worker
- Reassure about confidentiality/limits
- Offer legal avenues
- Services
Sexual assault
- Offer support
- Assess mental health risks
- Offer emergency contraception if within 72 hours
- Offer STI investigation/ prophylaxis/ treatment as appropriate
- Offer option police report
- Forensic exam preferably within 72 hours
- Refer sexual assault resources
- Follow up STI checks 2,6,12 weeks
- Consider if likely immune hep B – may give vaccine
Trauma-Informed Care (TIC) in General Practice
Definition:
Trauma-Informed Care (TIC) is an approach in healthcare that recognizes and responds to the impact of trauma on patients’ health. TIC emphasizes understanding, recognizing, and responding to the effects of all types of trauma. It seeks to provide care that is sensitive to the experiences of trauma survivors and aims to avoid re-traumatization.
Principles of Trauma-Informed Care:
- Safety: Ensuring the physical and emotional safety of patients.
- Trustworthiness and Transparency: Building and maintaining trust through clear and consistent communication.
- Peer Support: Utilizing peer support and mutual self-help as integral aspects of the service delivery model.
- Collaboration and Mutuality: Emphasizing partnership and leveling power differences between staff and patients.
- Empowerment, Voice, and Choice: Recognizing patient strengths and experiences, fostering autonomy and empowerment.
- Cultural, Historical, and Gender Issues: Acknowledging and addressing cultural, historical, and gender differences and their impacts on trauma.
Implementation in General Practice:
- Environment: Creating a welcoming and safe clinical environment. This can include having a comfortable waiting area, private spaces for consultation, and supportive materials readily available.
- Staff Training: Training all staff, including receptionists, nurses, and doctors, to understand trauma, recognize trauma symptoms, and know appropriate responses.
- Patient Interaction:
- Screening: Implementing routine screening for trauma exposure and symptoms in a sensitive manner.
- Communication: Using clear, compassionate, and respectful communication. Avoiding medical jargon and explaining procedures and treatments in an understandable way.
- Patient History: Taking a detailed history that includes questions about past trauma when appropriate and relevant to the patient’s condition.
- Empowerment: Involving patients in their care decisions, respecting their preferences and choices, and providing them with information about their health and treatment options.
- Policies and Procedures: Developing and implementing policies that reflect a trauma-informed approach, such as protocols for handling disclosures of trauma and ensuring patient confidentiality.
- Referral and Support: Establishing a network of mental health and social support services to refer patients who need specialized trauma services.
Example in Practice:
Case Study: Jane, a 35-year-old woman, presents with chronic pelvic pain.
- Initial Consultation: The GP notices Jane is anxious and avoids eye contact. Instead of proceeding directly to a physical examination, the GP asks open-ended questions about Jane’s overall health and well-being.
- Trauma Screening: Jane reveals she has a history of domestic abuse. The GP acknowledges this information with empathy and explains that past trauma can impact physical health.
- Collaborative Care Plan: The GP discusses different treatment options, involving Jane in decision-making. They agree on a step-by-step approach, starting with non-invasive treatments and gradually moving to more specific interventions if necessary.
- Environment: The GP ensures that follow-up appointments are scheduled at times when the clinic is less busy to reduce Jane’s anxiety.
- Referrals: The GP provides Jane with information about counseling services and supports her in contacting a local support group for survivors of abuse.
- Follow-Up: Regular follow-up appointments are scheduled to monitor Jane’s progress and adjust the care plan as needed, always prioritizing her comfort and safety.