1. Intimate Partner Violence Reporting Training UPDATE
***NOTE: Information may differ depending on regional jurisdiction and local hospital policies
Training UPDATE
THE CLINICAL SCENARIO
Ms. Kipp, a 29 year old woman presents to the fracture clinic with a fractured humerus. She has brought her two young children to the appointment with her. She discloses to the orthopaedic resident that the injury is the result of domestic violence perpetrated by her husband. In discussion with the resident Ms. Kipp swears that her husband has never hurt either of the children and does not believe that he ever would. The resident is unsure about whether or not to report this case to the police or children’s services and asks your advice.
What would you tell the resident?
THE FOCUS
THE FACTS
In Canada, the reporting requirements for physicians and other health care professionals (HCPs) regarding intimate partner violence (IPV) that does not involve children are relatively clear. It is a breach of confidentiality to report IPV without informed and voluntary consent from the victim.
KEY POINTS:
It is a breach of confidentiality to report IPV without informed and voluntary consent from the victim (written or documented verbal consent)
Actual or suspected child abuse must be reported to a child protection agency, not the police
WHEN DECIDING TO REPORT ABUSE, CONSIDER:
Has the child suffered physical harm from IPV?
Has the child been threatened with harm?
Has the child become directly involved in domestic disputes?
Is the parent unable to care for the child due to their physical or emotional condition as a direct result of IPV?
Is the pattern or degree of violence severe?
FOR FURTHER GUIDANCE, CONSIDER:
Consulting with a colleague
Contact your professional association or college to request guidance
Making a call to your local child protection service to discuss anonymously and request guidance about whether a report should be made
OUR RECOMMENDATIONS
For children, IPV within the home may constitute abuse, and actual or suspected child abuse must be reported to child protective services. If you are uncomfortable determining whether or not the IPV a patient discloses constitutes suspected or actual child abuse, you are not alone.
Part of the discomfort comes from the fact that determining whether or not a child is in need of protection can be a subjective decision that requires our professional judgement.
Ultimately, we must make a decision that we feel comfortable with personally, and that we can explain and defend if needed.
25% of HCPs report no continuing education on reporting of child abuse in the last 5 years
87% of HCPs report consulting with a colleague before reporting child abuse
FURTHER CONSIDERATIONS
You may want to consider letting a woman know upfront what you are required to report to child protective services so that she can make an informed decision about what to disclose. This information could be conveyed by making a general statement about the limits of confidentiality as part of your initial patient greeting. Discussing or notifying the mother prior to making a call to child protective services allows them to be prepared for follow-up from the agency and helps maintain trust in the patient-HCP relationship.