To effectively screen for domestic abuse in patients who may be reluctant to disclose their experiences, it is crucial to create a safe and private environment and use sensitive questioning techniques NICE CKS.
- Create a Safe and Private Environment:
Always allow the person to make a disclosure alone in private, ensuring no third parties are present, including children, partners, relatives, or friends NICE CKS. This is vital as disclosing in front of others, especially those who might share information with the perpetrator, increases risk NICE CKS. Ensure the person feels safe, is given time and space to talk, and questions are asked in a kind, sensitive manner NICE CKS. Listen closely, with empathy, and without judgement NICE CKS. Reception areas should be arranged to ensure maximum privacy so that people cannot be overheard NICE. Display information about support for those affected by domestic violence and abuse in waiting areas, including local and national helpline numbers NICE. This information should be available in various formats and languages, and discreet methods like pens or key rings with helpline numbers can also be used NICE. Healthcare professionals should be alert to features suggesting domestic abuse NICE CG110.
- Use Sensitive Questioning:
Ask open or direct questions about domestic abuse, depending on clinical judgement NICE CKS. Many victims may not disclose unless directly questioned under safe and respectful conditions NICE CKS.
- Open questions can include: 'How are things at home?' or 'Sometimes symptoms can be triggered by stressful events in our relationships, has anything like that happened to you?' NICE CKS. Another approach is 'We know violence at home can be a problem, is there anyone who is hurting you?' NICE CKS.
- Direct questions can include: 'Do you feel safe at home?' or 'Does anyone make you feel afraid?' NICE CKS. You might also ask, 'Do you feel safe in your relationship?' or 'Is there anything that worries you about your relationship?' NICE CKS. For injuries, consider asking, 'These injuries are more than I would expect following a fall, I'm wondering if someone else might have hurt you?' NICE CKS.
Use gender-neutral terms such as 'partner/ex-partner' to encourage disclosure from all individuals, including LGBT victims NICE CKS.
- Ensure Confidentiality and Professional Interpretation:
Advise the person that any discussion is confidential and that information will be shared only with their consent, subject to practice policy on adult and child safeguarding NICE CKS. Emphasise confidentiality, as this reassurance can influence disclosure NICE CKS. Information sharing without consent risks losing trust and endangering safety NICE CKS. However, there are limits to confidentiality in exceptional circumstances, such as a risk of serious harm to a child or vulnerable adult NICE CKS. If a professional interpreter is needed, use a professional service rather than the person's child, relative, or friend, as there is a significant risk that people experiencing domestic abuse may be less likely to disclose with someone they know in the room NICE CKS,NICE. Ensure interpreting services are confidential NICE.
- Staff Training and Follow-up:
All healthcare staff should be trained to recognise possible signs of domestic abuse, enquire sensitively and safely, understand patient confidentiality, and know how to respond to a disclosure NICE CKS. Ongoing training and regular supervision for staff asking about domestic abuse are important to sustain good practice NICE. Survivors are more likely to disclose if they have a trusting relationship with their healthcare professional NICE CKS. Therefore, offer follow-up and continuity of care, viewing the conversation as the start of a process rather than a one-off event NICE CKS.