Precontemplation: the patient-victim does not see the relationship as abusive | Ask about IPV when there is an injury; ask how injury occurred | Ask about IPV at the annual examination |
| Ask during pregnancy | Ask during each trimester of pregnancy |
| Ask routinely (annual examination) and when warning symptoms and illnesses are present* | Ask when warning symptoms and illnesses are present* |
| Have and make pamphlets available. Do not spend time reviewing them in detail | Ask at well-child examination and if abuse is suspected (child abuse, failure to thrive, behavior problems, school problems, ADHD/hyperactivity, depression, teen risk-taking behaviors, worried parent) |
| Educate about the impact of IPV on the physical and mental health of the victim and her children | Make pamphlets with safety plan information available in the office. |
| Document suspicions about IPV | Assess safety.† If any risk factors are present, share concerns with the patient-victim or follow mandated reporting guidelines |
Early contemplation: the patient-victim sees the relationship as abusive, but may choose not to share this with the physician | Ask about IPV as above despite nondisclosure—women want to be screened | Ask as above |
| Listen and watch for clues (hints or evidence of abuse) Victims are observing whether physician is willing to discuss abuse | Assess safety.† If any risk factors are present share concerns with the patient-victim or follow mandated reporting guidelines |
| Discuss observations about the abuser’s controlling behavior—if physicians observe abuse, discuss concerns in private with the patient-victim | Make pamphlets with safety plan information available in the office |
| Have and make pamphlets available. Do not spend time reviewing them in detail | |
| Educate about the impact of IPV on the physical and mental health of the victim and her children | |
| Document suspicions about IPV | |
| Document subjective and objective findings | |
Late contemplation: the patient-victim sees the relationship as abusive and is weighing the pros and cons of making a change | Ask as above | Ask as above |
| Affirm abuse is occurring and that no one deserves to be abused | Assess safety.† If any risk factors are present share concerns with the patient-victim or follow mandated reporting guidelines |
| Educate about the impact of IPV on the physical and mental health of the victim and her children | Consider reviewing safety plan‡ with the patient-victim, educate staff about IPV and have them review safety plan, or refer the patient to IPV agency |
| Review local IPV crisis numbers with the patient-victim | |
| Offer to have the patient telephone the crisis number from a private room in the office | |
| Make referrals for counseling to a counselor knowledgeable about IPV for the patient or her children | |
| Document subjective and objective findings | |