How can I effectively screen for domestic abuse in patients who may be reluctant to disclose their experiences?

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 ¹.

• 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 ¹. This is vital as disclosing in front of others, especially those who might share information with the perpetrator, increases risk ¹. Ensure the person feels safe, is given time and space to talk, and questions are asked in a kind, sensitive manner ¹. Listen closely, with empathy, and without judgement ¹. Reception areas should be arranged to ensure maximum privacy so that people cannot be overheard ³. Display information about support for those affected by domestic violence and abuse in waiting areas, including local and national helpline numbers ³. 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 ³. Healthcare professionals should be alert to features suggesting domestic abuse ².

• Use Sensitive Questioning:

  Ask open or direct questions about domestic abuse, depending on clinical judgement ¹. Many victims may not disclose unless directly questioned under safe and respectful conditions ¹.

  • 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?' ¹. Another approach is 'We know violence at home can be a problem, is there anyone who is hurting you?' ¹.
  • Direct questions can include: 'Do you feel safe at home?' or 'Does anyone make you feel afraid?' ¹. You might also ask, 'Do you feel safe in your relationship?' or 'Is there anything that worries you about your relationship?' ¹. 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?' ¹.

  Use gender-neutral terms such as 'partner/ex-partner' to encourage disclosure from all individuals, including LGBT victims ¹.

• 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 ¹. Emphasise confidentiality, as this reassurance can influence disclosure ¹. Information sharing without consent risks losing trust and endangering safety ¹. However, there are limits to confidentiality in exceptional circumstances, such as a risk of serious harm to a child or vulnerable adult ¹. 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 ¹,³. Ensure interpreting services are confidential ³.

• 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 ¹. Ongoing training and regular supervision for staff asking about domestic abuse are important to sustain good practice ³. Survivors are more likely to disclose if they have a trusting relationship with their healthcare professional ¹. Therefore, offer follow-up and continuity of care, viewing the conversation as the start of a process rather than a one-off event ¹.