Steps and Strategies

Routinely inquire about current and past violence

• Ask even if physical indicators are absent
  
• Use private setting/space
  

Ask direct questions

• Validate and be non-judgmental
  
• Use culturally/linguistically appropriate language

Document findings

• Include any description of incident
  
• Use body map
  
• File reports when required under law

Assess safety

• Escalating frequency/severity of violence
  
• Threats of homicide/suicide
  
• Weapons used or available

Review options and referrals

• Become familiar with variety of resources
  
• Let the patient decide what is the safest option

Framing Questions:

• "Because violence is so common in many people's lives, I've begun to ask all of my patients about it"
  
  
• "I am concerned that your symptoms may have been caused by someone hurting you"
  
  
• "I don't know if this is (or ever has been a problem for you, but many of the patients I see are dealing with abusive relationships. Some are too afraid or uncomfortable to bring it up themselves, so I've started asking about it routinely.

Direct Verbal Questions:

• "Are you in a relationship with a person who physically hurts or threatens you?"
  
• "Did someone cause these injuries? Was it your partner/husband?"
  
• "Has your partner or ex-partner ever hit or physically hurt you?"
  
• "Do you (or did you ever) fell controlled or isolated by your partner?"
  
• "Do you ever feel afraid of your partner? Do you feel you are in danger?"
  
• "Is it safe for you to go home?"
  
• "Has your partner ever forced you to have sex when you didn't want to? Has your partner ever refused to practice safe sex?"
  
• "Has any of this happened to you in previous relationships?"