August 14, 2020
How PAs Can Provide Compassionate Care to Survivors of Interpersonal Violence
Forensic Examiner and PA Katherine Thompson Shares Tips and Resources
July 24, 2020
By Divya Williams
Identifying and managing survivors of interpersonal violence (IPV) can seem intimidating, but with advice from an experienced colleague, PAs can feel empowered to provide quality care in these situations.
AAPA enlisted Katherine Thompson, PA-C, to respond to Huddle’s Ask Me session on IPV and forensic medicine. Thompson has been practicing in emergency medicine and urgent care for four years and has worked as a forensic examiner for the same amount of time. She also runs a small business dedicated to improving empowerment and education around IPV.
“Forensic medicine for IPV encompasses the medicolegal investigation and exam of survivors of sexual assault, human trafficking, domestic violence, child abuse (sexual and non), elder abuse, workplace violence, non-fatal strangulation, and even other violent crimes, like gunshot wounds, attempted kidnappings – the list goes on,” Thompson said.
“I firmly believe that we as healthcare providers have the capacity and the ability to do an excellent job of identifying and managing survivors of IPV in our care settings (and we’re ALL exposed to survivors, whether we know it or not),” Thompson said. “But we often feel anxious, scared, or personally disempowered to do so.” Read about what Thompson had to share with her PA colleagues, and head to Huddle to see the whole conversation.
Knowing the basics of trauma-informed care (TIC) can make a world of difference for patients, Thompson said. Here are a few statistics she shared in the discussion:
- Approximately 1 in 3 women and 1 in 4 men will experience domestic violence in their lifetime; and 1 in 3 women and 1 in 8 men will experience sexual assault in their lifetime. So this is something that the majority of our population experiences at some point.
- 92% of survivors will disclose to someone at some point; 48% of those people will disclose to medical professionals first; the great majority of those who disclose to medical professionals report negative reactions.
- Negative reactions to first disclosure (usually defined as unsympathetic, paternalistic, patronizing, victim-blaming, etc.) appear to set the tone for the survivor in all future reactions and increase the rates and severity of PTSD, depression, and anxiety.
To guide clinicians as they work to mitigate these staggering statistics, Thompson points to the “4 Rs” which sum up the basics of TIC:
Realize the widespread impact of trauma. Trauma is linked to every chronic disease state, so the care of trauma should be included in every facet of medicine. I ask every single patient every single time I see them whether they’ve experienced trauma in their life. And last piece of advice about that: you aren’t scarring them by asking them in a sympathetic but direct way: I ask everyone this question because trauma has such a wide-ranging effect on our lives and our medical health: ‘Have you ever experienced trauma in your life? This could include, but isn’t limited to, domestic violence, sexual assault, child abuse, or something else?’
Recognize signs and symptoms of trauma. There is no “correct” response to trauma. Beyond PTSD and depression – chronic pain syndromes, body image difficulty, substance abuse problems, anger management, risk-taking behavior, the list goes on.
Respond by fully integrating knowledge about trauma into all policies, procedures, and practices (including continuing education!) often the most overwhelming step, but important, because it helps cut down on “Pandora’s Box Syndrome”, the fear of providers that once they crack that box open, they’ll never be able to close it. Know your local resources, regional resources, hospital system / clinic system response…or make one if you don’t have it! And I’m happy to help you understand how to go about that.
Seek to actively avoid retraumatization. Lack thereof is often accomplished through the above 3 steps.
Thompson said she recognizes that this only covers the basics and recommends the following resources for further reading:
- The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
- Trauma Treatment Toolbox
- Trauma-Informed Practices with Children and Adolescents (can’t forget our pediatric friends dealing with ACEs – I’ve got some great tips on interviewing children about difficult topics!)
- Trauma Informed Care in Medicine: Fam Community Health Vol. 38, No. 3, pp. 216–226
Establishing systems and processes
Thompson is enthusiastic about helping providers and support staff create systems and processes to help lessen the anxiety around discussing these topics with patients. “Kaiser has an excellent pillar-based system established in Northern California that I think is a really excellent system-wide approach to detecting and managing victims across their spectrum of care,” Thompson said. “I like the pillar-based system because it’s modular and can be established in pieces, as opposed to needing to be rolled out perfectly in one fell swoop.” Thompson advises that the first and most important step is a needs assessment. “Where are you succeeding? Where are you needing to improve? This can be accomplished through research, chart audits, interviewing patients, etc.”
In addition to an initial visit, follow-up is an integral part of a survivor’s care, and a step that is often not reached. “Follow-up is a consistent conversation amongst those who work in IPV – follow-up rates are traditionally low, even when appointments are scheduled at the time of the initial exam.”
Thompson refers healthcare providers to the Family Justice Center model, where the survivor can return to the same location for counseling/social services, follow-up medical exams and treatment, and/or follow-up visits with law enforcement.
“I think that supporting a survivor’s overall health and well-being, which would include access to social work, is a crucial part of the process,” Thompson said. “Where I work now, this is a crucial ‘pillar’ to our institutional support – we are in the process of developing a system-wide response to IPV, and one of the built-in triggers/Best Practice Advisories that we are implementing is an automatic trigger to social work and behavioral health anytime we’re inputting an ICD 10 code/information that indicates either a current or history of IPV.”
For workplaces that don’t already have social work or a community organization providing advocacy during and after the forensic exam, Thompson advises looking to community resources like RAINN (Rape, Abuse, Incest National Network) and the National Domestic Violence Hotline – both maintain lists of resources in communities. She also recommends reaching out to regional organizations to help your practice form this kind of network.
To see other information Thompson shared in this Ask Me session, head over to Huddle. And if you’re interested in engaging in the next discussion, keep an eye out for the next Ask Me session and drop by Huddle to ask your own questions!
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