Safety Planning in the Pediatric Setting Saint Louis University Department of Psychology and University Pediatrics Family Safety Project

Intimate Partner Violence (IPV) The alternatives and options available to women affected by IPV are complex: –Remaining in the relationship does not indicate endorsement of violence –Nor does leaving guarantee safety of women and their children Physicians play a critical role in society's coordinated response to support children and their families

Pediatrician’s Role Physicians should –Assess degree of risk (i.e., frequency, duration, presence of firearms, drug use) –Provide resources and ways to reduce certain risks –Focus on HARM REDUCTION

Risk Assessment Is the woman afraid to go home? Has there been an increase in frequency/severity of violence? Have there been threats of homicide or suicide? Have there been threats to the children? Is there a gun present?

Safety Planning Focus: to reduce harm and increase safety of women and children within violent homes Planning for safety involves aspects of protection during acute episode, as well as issues surrounding staying or leaving relationship

Protection Strategies Limit access to weapons (e.g., hide guns, remove bullets) Stay away from the kitchen or enclosed spaces (e.g., closets) if violence is expected Instruct children to go to a “safe place” Try to move towards an open door or phone Call 911 or flee to predetermined safe place

Staying Strategies Maintain social support and independent income (if possible) Hide extra set of keys Store money in a separate (perhaps secret) location Secure copies of legal/financial papers –e.g., credit card, license, property titles, and custody papers Play “bartender” if drinking is associated with violence

Leaving Strategies Obtain an order of protection and provide copies to school/work Cancel shared credit cards/banking accounts Change regular travel habits Change locks/secure windows Obtain an unlisted phone number Move to undisclosed place

Making Children Safer Make sure children hear frequently that they are not responsible for violence Encourage them to leave the scene of violence Tell children where to go for safety Teach children how to call 911 and practice giving their address/phone number

Systemic Issues Because child abuse and IPV can frequently co-occur, the involvement of DFS may be warranted Though pediatricians are not mandated to report IPV, child abuse must be reported

National Resources National Resource Center on Domestic Violence ( ) Nationwide Hotline ( HOPE) National Domestic Violence Hotline ( SAFE)

State/Local Resources Alternatives to Living in Violent Environments Missouri Coalition Against Domestic Violence Women’s Support and Community Services

State/Local Resources Legal Advocates for Abused Women Crisis Nursery for children Women’ Resource Center

RADAR R: Routinely ask female patients A: Ask direct questions D: Document your findings A: Assess safety R: Review options and referrals

To Learn More…. American Academy of Pediatrics Continuing Medical Education online American Medical Association – Domestic Violence Resources ( ) American College of Emergency Physicians – ( American Bar Association – Resources on Safety Planning