Domestic Abuse

Question 1

What is domestic abuse defined as

Answer 1

Any form of physical, verbal, sexual, psychological or financial abuse which might amount to criminal conduct and which takes place within the context of a relationship
The relationship will be between partners (married, cohabitating, civil partnership or otherwise) or ex-partners

Question 2

Where does domestic abuse take place

Answer 2

The abuse can be committed in the home or elsewhere including online

Question 3

What is gender based violence

Answer 3

Violence directed against a person on the basis of gender

Question 4

What are different types of abuse

Answer 4

Verbal 
Emotional 
Physical 
Sexual 
Financial

Question 5

What is coercive control

Answer 5

pattern of behaviour which aims to isolate someone

Question 6

What is the aim of coercive control

Answer 6

make the person being abused to have low self esteem and make them feel as though it is their fault

Question 7

What are examples of coercive controls

Answer 7

There is micro-regulation of all aspects of the persons life (Money, the way they dress and surveillance of the person)
Abusers are often very charming to everyone else which serves to increase the isolation

Question 8

Why should a clinician get involved with suspected domestic abuse

Answer 8

Violence is a public health issue; everyone has a role in prevention
You have a duty of care to your patient’s
As a group you can have a role in advocating for social change and in changing attitudes
You might be the only person they tell
You are in a good position to spot the signs - both physical and behavioural
Many abused women (and men) will initially talk to someone they trust who is not a close friend or family member

Question 9

How do you recognise domestic abuse through behaviour

Answer 9

Low self-esteem
Victims may appear fearful, anxious or sad
Constant phoning or texting by a partner while they are with you
Alcohol
If the partner is present he may do all of the talking, patient may not speak while partner is present
Partner may insist on female clinician
Missed or frequent appointments
However, it is important to realise that some of these issues may be due to other things which is why it is important to give people room to speak

Question 10

What are physical things to look out for in regards to domestic abuse

Answer 10

Repeated injuries
Bruises at different stages of healing
Dental/maxillofacial injuries
Unlikely explanation of injuries
Facial bruising, bruising or strangle marks around the neck, fingertip bruising on the arms or neck or behind the ears, base of skull fracture
Delay in seeking help for injuries
TMJ problems
Orofacial pain - 69% had a history of abuse
Think if asked about emergency contraception - remember incidence of rape

Question 11

What is the role of the clinician in domestic abuse

Answer 11

We see victims at different time from police (usually the police are called at crisi point)
We have a different window of opportunity
We can provide a lifeline

Question 12

What is AVDR

Answer 12

Ask, Validate, Document, Refer

Question 13

What is AVDR

Answer 13

ask
validate
document
refer

Question 14

What do we ask about

Answer 14

Ask about abuse
Try to ask in as private a setting as you can
Don’t ask in front of other family members and never ask family members to translate if English is not their first language
Use non-judgemental language
Sometimes people may not be ready to talk and even if they are not you can still support them and be there when they are ready

Question 15

What questions do we ask

Answer 15

Is everything okay?
I’ve noticed you’ve got some bruises on your neck, is everything okay? Has someone hurt you?
I’m worried that you don’t seem your usual self, is everything okay?
Do you feel safe?

Question 16

How do we validate?

Answer 16

This is just a way of showing someone that you are concerned about them
This removes blame, shows them that you believe them and shows them that you are taking this seriously

Question 17

What do we say when we validate

Answer 17

Ways of validating: ‘you do not deserve to be hurt or hit no matter what happened’, ‘I am concerned about your safety’
Even if your patient denies abuse you should still do this - it may provide some relief or comfort
It may help them to realise that they are in a serious situation and need to get help

Question 18

What is important in documenting

Answer 18

Be specific and detailed (make sure they are as accurate as possible)
Use the person’s own words as well as clinical notes
Describe injuries in as much detail as possible or take photographs if able
Remember your records could end up in court many years later
Domestic abuse often happens in private with no witnesses and corroboration is still a requirement

Question 19

What is meant by refer

Answer 19

Referral in this case means ‘signposting’
Your patient needs to take action rather than you
You need to signpost to appropriate services
Even if your patient doesn’t seem keen or denies any abuse you should still offer, they may go away and think about it and take action later
Do not attempt to deal with the problem yourself

Question 20

What is the scottish organisation for domestic abuse

Answer 20

The core Scottish organisation is the Scottish Domestic Abuse Helpline

Question 21

What do we give patients we suspect of domestic abuse

Answer 21

A small card with contact details for domestic abuse organisations
A small gift with the domestic abuse helpline number concealed on it (this is not something you should publicise). Examples of these are lipsalves and phone screen cleaners
REMEMBER immediate threat to life or safety call the police 999
Non urgent police reporting 101
Or police Scotland anonymous website report

Question 22

What else can you do for patients to try help combat domestic abuse?

Answer 22

Put cards in the toilets and posters in waiting areas to let patients know you are able and willing to talk about domestic abuse - this is very useful if they are not ready to disclose
Have your staff wear ASC badges
Allow patients to use the phone in the surgery or pharmacy to contact agencies if they need to
Link with domestic abuse agencies and have their materials available. They can help you let the community know that you are trained and willing to help
Develop a protocol to allow you to get people on their own if partners are present and to alert others to the issue. You may want to have code words that you use (can also use the excuse of needing the x-ray machine to get people out of the room)

Question 23

What is not expected from a dentist in regards to domestic abuse?

Answer 23

It is not your role to provide specific advice about if, how or when to leave the home
If a victim decides to leave this has been shown to be the most dangerous time for them and the time when the abuse often escalates
Provision of advise about leaving is best left to the professional organisations who deal with domestic violence
You should provide the contact details for these organisations