Excerpts of this DV support guideline is listed below according to each clinical question.
Evidence and justification for each recommendation are presented in Chapter 7.
I Organizing support
1 Healthcare provider as support
CQ (Clinical Question) 1: Is educational intervention necessary for healthcare providers?
2 Support in healthcare system
CQ2: Should support in healthcare system be accessible for DV victims?
II. DV screening
1. Asking about DV experience: DV screening CQ3: Is DV screening necessary at perinatal care?
CQ4: Should the target for screening be focused on women with particular signs of DV?
CQ5: What are the appropriate settings for DV screening?
Educational intervention about DV is necessary for healthcare providers (“A” recommendation).
Support in healthcare system should be made visible and accessible to DV victims (“C”
recommendation).
DV screening should be implemented at perinatal care (“B” recommendation).
DV screening should not focus only on women with particular risk factors, signs, or symptoms (“D” recommendation).
CQ6: What kind of attitudes should healthcare providers take towards DV victims?
CQ7: What are the DV screening tools known to be effective?
CQ8: How should DV screeing be conducted?
CQ9: What is the appropriate timing and frequency for DV screening?
2. Identifying the risk factors
CQ10: What are the appropriate indice as the risk factors?
3. Identifying the clinical symptoms
CQ11: Should miscarriage and elective abortion be considered as clinical symptoms of DV?
DV screening should be done more than once (“C” recommendation).
DV screening should take place during pregnancy but may also be considered after childbirth (“C” recommendation).
Alcohol abuse, drug abuse, unemployment of the partner as well as experience of childbirth may be indicative of DV risk (“C” recommendation).
DV screening should be done in a place where privacy of the woman is secured, and without the presence of her family, husband or intimate partners (“A” recommendation).
‘Abuse Assessment Screen’ (AAS), ‘Partner Violence Screen’ (PVS), and ‘Violence Against Women Screen’ (VAWS) are known to be effective. Any one of these tools should be used for screening (“B” recommendation).
DV screening should be conducted with self-administered questionnaires (“B” recommendation).
Healthcare providers should respect the women and always be empathic and supportive (“A”
recommendation).
CQ12: What kind of physical injuries are to be considered as clinical symptoms of DV?
CQ13: What conditional changes in pregnant women need special attention?
CQ14: What psychological conditions of pregnant women require attention?
CQ15: Should delayed presentation to prenantal care be considered as a clinical symptom of DV?
CQ16: Can past DV experience be considered as a clinical symptom of DV?
CQ17: Can newborn with low birth weight be a clinical symptom of DV?
CQ18: Should fetal distress and death be considered as clinical symptoms of DV?
Miscarriage and elective abortion of DV and the women experienced either of them more than once must be paid special attention (“A” recommendation).
PTSD and depression may be indicative of DV and need special attention (“B”
recommendation). Similarly, fear of sexual intercourse and decreased sexual desire may require special attention (“C” recommendation).
Special attention should be paid, when women in pregnancy seek delayed prenatal care (“B” recommendation).
Physical injuries on head, neck and face should be taken special notice when identifying clinical symptoms of DV.
Anomally in weight changes of pregnant women (i.e. excessive weight gain or loss) may need special attention (“C” recommendation).
Past DV experience may be consieread as a clinical symptom of DV.
Newborn with low birthweight can be an important clinical symptom of DV (“A”
recommendation).
IV. Does the woman consent to assistance?
CQ19: Is consent of the woman required before discussing DV with her?
CQ20: Should decision of the woman be confirmed before support is offered?
V. Safety assessment
CQ21: Should safety of the women and children be assessed?
CQ22: What is a scale to be used for the risk assessment?
VI. Safety planning
CQ23: Should referrals be made to police or DV support centers?
CQ24: Is safety planning necessary to ensure the safety of the woman?
Fetal distress and death must be paid special attention as important clinical symptoms of DV (“A” recommendation).
Consent of the woman must be obtained before discussing her DV experience (“A”
recommendation).
The woman must be asked if she is willing to seek support (“A” recommendation).
Safety of the women and children (including the fetus) should be assessed (“B”
recommendation).
For assessment of the risk of DV, ‘Danger Assessment Scale’ (DAS) should be used (“B”
recommendation).
If the woman and children are at high risk of their life, they should be referred to police or DV support centers with her consent (“A” recommendation).
VII. Providing information on useful social resources
CQ25: Is it necessary to provide the women with information on social resources and with support for utilizing them?
CQ26: What kind of discretion must be used when providing information for the women?
VIII. Follow up and documentation
CQ27: How long should the woman be followed up?
CQ28: What cautions should be taken with the documentation of DV?
Safety planning must is necessary for ensuring the safety of the woman, and support for the planning must be offered (“A” recommendation).
Support including the information must be given for women to make effective use of the available social resources (“A” recommendation).
Information must be provided for the woman while ensuring her safety, e.g. in a manner the abuser would not notice (“A” recommendation).
Long term follow up of the woman may be necessary through the perinatal period and postpartum (“B” recommendation).
Words and quotes of the woman should be recoreded only with her consent. The information must be stored with care and under no circumstance be disclosed to anyone but the woman. Healthcare providers should be aware of necessary cautions for handling the information (“A” recommendation).