all health care services within a county be represented in any county-wide attempt to develop and coordinate services for victims of domestic violence.
In addition to incorporating the recommendations outlined in the Guiding Principles and the Employers sections into their responses to domestic violence, and being mindful of the potential need for individualized responses based on factors such as socio-economic status, race, ethnicity, sexual orientation, age, religious affiliation, physical and mental disabilities, immigrant status, education, employment status, urban vs. rural residency, and marital status, health care providers should also integrate the following recommendations specific to the health care system.
1.VICTIM SAFETY AND SELF-DETERMINATION
a.Private, routine screening for domestic violence should be conducted with all female patients to determine if they are being abused by their intimate partners.
Because domestic violence and its medical and psychiatric consequences for women are so prevalent, both the New York State Department of Health's protocol, Identifying and Treating Adult Victims of Domestic Violence, and the American Medical Association's Diagnostic and Treatment Guidelines on Adult Domestic Violence, recommend routine screening of all women patients for domestic violence. In addition, the AMA Guidelines recommend routine screening of all women patients in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. Some recent research recommends more intensive screening for"high risk"populations including pregnant and suicidal women.
Including a screening question for domestic violence in routine questionnaires increases identification significantly. When a female patient is either identified or strongly suspected of being a victim of domestic violence, it is incumbent upon the health care provider to engage in a more intensive screening process.
In order to maintain patient confidentiality and safety, patients should always be screened alone and out of earshot and eyesight of any accompanying partners, as well as being screened away from their children who may repeat information to the patient's partner. Police should be called only to report legally mandated injuries or with the patient's knowledge and consent. Current Penal Law requires the reporting of gunshot and stab wounds, and life-threatening injuries to the local police. Burn injuries and wounds must be reported to the Office of Fire Prevention and Control.