Family violence, the neglect or physical abuse (actual or threatened) of a current or former intimate partner, child or elder, is a major public health issue in the United States. Although we see victims of family violence daily in our clinical practice, they present special challenges in identification and treatment. NAON and AAOS, recognizing the breadth and complexity of this issue, are collaborating to help these individuals affected by violence by mounting an interdisciplinary response based in the orthopaedic office or clinic.
The statistics are staggering. The U.S. Department of Justice (2000) cites 15-42 child abuse cases per 1000 children; 2-4 million adult women are abused per year, and 1-2 million elderly are abused or neglected. One in three women who attempt suicide and 40-70% of female psychiatric patients have domestic violence as a factor in their clinical history.
Early identification and intervention may not only prevent or reduce further suffering and violence but it may also reduce the associated health care and productivity costs estimated to be 5-10 billion dollars annually. Remarkably, in evaluating the domestic violence health care response, the Centers for Disease Control and Prevention (CDC) has demonstrated that "even brief (1-2 hour) training sessions have an impact on the staff's awareness of Intimate Partner Violence and their belief that they can do something about," thus providing strong support for early intervention practices (Short et al., 1999).
A 1991 National Survey of Attitudes Toward Family Violence cited more than 85% of respondents as indicating that, if asked, they would talk to a physician if they were a victim or a perpetrator of family violence. However, victims of domestic violence have identified medical providers as the least effective professional source for help (Alpert et al., 1998) and that the victim's reluctance to disclose information is often based on previous negative encounters with health care providers (Shea et al., 1997).
However, recent groundbreaking studies have reported significant findings on health care intervention for domestic violence. Screening can identify a subset of women "at high risk for verbal, physical, and sexual partner abuse over the following four months" (Koxiol-McLain et al., 2001).
The conclusive results of a program evaluation conducted by the CDC provide strong evidence of the efficacy of routine screening procedures in the identification and referral of patients to health care based victim services (Short et al., in press).
Screening works!! Clearly, it is up to us to be more aware of the problem of family violence and be willing to ask all patients about domestic abuse and violence. This applies to patients with chronic conditions as well as traumatic injuries. Asking about abuse provides an opportunity for the patient to talk about the abuse without having to initiate the discussion, demonstrates that the problem is important to us as health care professionals, and conveys that help is available (Varvaro, 1998).
It is our responsibility to affirm for the victim that no one has the right to abuse another person. Each of us has the right to live a life free of violence or the threat of violence. Toward this goal, NAON and AAOS are sponsoring a session at the AAOS Annual meeting in Dallas on February 14, 2002. We will be exploring with the nurses present how the orthopaedic community can help patients contact and effectively use community family violence resources.
To the many NAON members who will not be with us on that day, we ask for your contributions to this initiative. How can the office or clinic staff incorporate routine screening and interventions for family violence into the office visit? Who will be responsible for initiating the inquiry? What indicators are we looking for? How will this information be communicated? Who will be responsible for ascertaining the patient's interest in seeking assistance now or at a later time? Who in the office could be the "domestic violence specialist" responsible for referrals and community resources? Do you have a system in place for screening, identifying and referring victims of violence in place?.
Send us your ideas, concerns and comments in care of the ONJ editor, Mary Rodts, at [email protected]. We welcome your input on this important initiative
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