Michigan



Screening for Coercive Abortion, Intimate Partner Violence and Domestic Abuse: Guidance Tool for ScreeningCreating a Safe Environment Prior to Asking the Screening QuestionsCreating a safe environment for the patient to be able to discuss personal situations like coercion to abort, intimate partner violence, domestic abuse, or other forms of reproductive coercion is essential. Screening should occur in a private place, separate from any accompanying person and other patients. Conduct the screening while the patient is fully clothed, before any physical examination.Use direct, specific, easy to understand questions presented in a non-threatening, non-judgmental manner. If you cannot converse fluently in the patient’s primary language, use a professional interpreter or another health care provider who is fluent in that language. The patient’s family, friends, or children should not act as interpreters during the screening, as this may not be safe for the patient.Normalize the Screening ProcessYour patients will not feel singled out – and may feel more comfortable responding to your questions – if you explain that you ask every patient whether she is being coerced to have an abortion against her will or if she has experienced other forms of coercion or abuse. Explain that the patient can still have the abortion if she discloses coercion, if it is her choice. If the patient doesn’t want an abortion and wants to continue the pregnancy but is afraid of what will happen if she doesn’t, let her know that you can provide information about places where she can get help and support.Your patients may also feel more comfortable about speaking with you about coercion and safety if they understand that their answers to the screening questions are confidential. Explain the limits of confidentiality under the law and what would require you to report to law enforcement or to the Michigan Department of Health and Human Services (MDHHS). Explain that it is the care provider’s responsibility to make a report, not the patient’s. If the care provider reports, it does not mean that the patient will have to speak with the authorities if she doesn’t want to. Asking the Screening QuestionsTo help the client be comfortable in answering these screening questions and to build rapport with the client, the screening for coercion and intimate partner violence may be incorporated into the general discussion of her reasons for the visit and health history. Screening questions should be clear and direct, with open ended follow-up questions as appropriate. Below are suggested screening questions: Have you told any of the important people in your life that you are pregnant? If so, how did they respond?Has anyone forced or pressured you to come here today? Are you afraid of what someone might do if you don’t do what they want with the pregnancy?Has anyone threatened to hurt you– or make you feel unsafe – if you don’t have an abortion?Does the person who got you pregnant know you are here today?Has anyone tried to get you pregnant when you didn’t want to be?Has anyone messed with or made it difficult for you to use your birth control? Are you in a relationship with a person who threatens or physically hurts you?Do you feel you are in an unsafe living situation?Have you been hit, slapped, kicked or otherwise physically hurt by someone in the past year, or since you have been pregnant? Responding to Disclosures of Coercion and Other Forms of AbuseWhat to sayYou may be the first person your patient has been able to tell about coercion or other forms of abuse. Your response can have a profound influence on her future ability to reach out for support from other sources of assistance. If a patient discloses coercion to abort, or other forms of abuse, do not express shock or judgment. Rather, express support and affirmation for the patient. Without judgment, affirm that the patient has the right to make her own decisions and about whether to have an abortion procedure, and that you will respect her decision whatever it is. Examples of affirming, supportive statements include:“Thank you for telling me. I know it can be difficult to talk about what you have experienced.” “I am sorry this is happening to you. Nobody deserves to be treated this way.”“What happened to you is not your fault. There is help available.”The following statements would not helpful and should be avoided:“What did you do to make him hit you?”“If it were me, I wouldn’t put up with this.”“Why don’t you leave? Why do you stay with him?”“Why have you waited so long to talk about this?” “Have you tried marriage counseling? If you haven’t, you should.” (Marriage counseling is contra-indicated in cases involving coercive control of an intimate partner because the partners cannot participate on equal footing).Exploring Safety OptionsFor all patients who disclose coercion or other forms of abuse – whether or not they choose to proceed with the abortion – express your concerns about safety and explore their immediate concerns. Patients who choose not to have an abortion after screening for coercion may be at increased risk of danger. You might ask:What are you most concerned about right now in terms of your safety?Does the person you are afraid of have access to weapons? Is the person who is pressuring/harming you at the health facility now? Do you want to go home with that person?If the person is afraid to go home, you can ask: Is there somewhere safe to go? Can you stay with family or friends? Is there someone you would like to call?Do you need a shelter or safe place to stay?If the person is not afraid to go home, explore what protections she has be safe there. Are there supportive neighbors/family members/roommates to call?Does the abusive person have access to her? Assess the patient’s ability to think clearly and take action to protect herself from the abusive person.You can also assist a patient in protecting her safety and privacy by explaining what you will document, and how she can access it if she wants to provide it to another health care professional or use it in a court proceeding. To help a patient maintain the confidentiality of medical information that an abusive perpetrator might use against her, explore who else might be given access to it. Determine whether the patient wants law enforcement assistance, and if so, what kind of assistance. Does she need assistance to make a call to the police to accompany her back to her home or to another location? Does she want to file a police report? If you must make a report to law enforcement or MDHHS, let the patient know this. Also, discuss the timing of any report with the patient, or let her know when you will make the report, so that she has time to make plans for safety if necessary.State law requires documentation of the findings from the screening in the patient’s medical record, along with any referrals made in response to disclosures of coercion to abort or domestic violence. It may be helpful to use the patients’ own words to describe what happened. Use neutral language that describes specific behavior, avoiding judgments.Making ReferralsA list of referral resources is attached below. Many patients may need assistance to connect with these resources. You may:Offer the use of a private phone to call for helpMake a referral to a specific person at the program if possible or offer to call the program for the client.Provide a small information card with national hotline numbers. Many physicians who choose to do this give the card to all patients or place them in bathrooms where they are available in a private space. Provide information about how your patient can connect with local resourcesIn offering assistance, be sensitive to the fact that your patient most likely knows best what actions are in the best interests of her own safety. A patient should not feel forced to accept assistance or secretly place information in her purse, where an abuser might find it and escalate the level of violence. If you want to send a patient home with information about abuse or sources of assistance for abuse victims, make sure that it is safe for her to take it with her. If not, talk about other ways she can access the information. DocumentationState law requires documentation in the patient’s medical record that screening for coercion to abort was done, and any findings from the screening. Documentation must also include any referrals made in response to disclosures of coercion to abort or domestic violence. Documentation of abuse that a patient wishes to report is most helpful if you use the patient’s own words to describe what happened and avoid judgmental or conclusive statements. Use neutral language that describes specific behavior (e.g., “patient stated,” “patient chose not to call police,” or “patient reported her husband pushed her to the ground”). If the patient discloses visible injuries from abuse and wants documentation of them, offer to document these, photographically or otherwise.Referral Resources for PatientsIndividuals in immediate danger should call 911. National Domestic Violence Hotline: Call toll-free 24 hours a day anywhere in the U.S. Trained counselors provide confidential crisis intervention, support, information, and referrals to persons experiencing domestic violence, as well as to their families and friends. The hotline also links people to help in their area including shelters, counseling, legal advocacy and social assistance programs. Help is provided in English and Spanish with interpreters available for 139 more languages. All calls are confidential and anonymous. By telephone: 1-800-799-SAFE (7233) For individuals who are deaf: 1-800-787-3224 (TTY) / Video phone: 1-855-812-1001 (Monday to Friday, 12 PM – 8 PM EST). Individuals can also contact the hotline using Instant Messenger (DeafHotline) or email: deafhelp@ For the same services by live chat, visit: National Sexual Assault Hotline: Call toll-free 24 hours a day anywhere in the U.S. This service provides confidential counseling and support for individuals who have experienced sexual assault. The hotline automatically routes calls to the rape crisis center nearest the caller by reading the area code and prefix of the caller's phone number. By telephone: 1.800.656.HOPE (4673)Online hotline: Sexual Assault Hotline: Call toll-free 24 hours a day. This service provides confidential counseling and support for individuals who have experience sexual assault and abuse. The hotline provides crisis counseling and referrals. Callers may remain anonymous. By telephone: 1.855.VOICES4 (864-2374)Online: voices4Sexual assault / domestic violence victim service program serving the county where the survivor is located: [leave spaces blank to insert local contacts] For help finding a program in your location, visit domesticviolence (click on “find help near you”), or (click on “help”) National Sex Trafficking Hotline: 1-888-373-7888For victims of stalking and other crimes: National Center for Victims of Crime (Help for Crime Victims): . This organization provides a National Help Line, VictimConnect (), and can be reached by phone at 1--855-4VICTIM (1-855-484-2846) or by online chat. Assistance for members of Native American communities who have experienced domestic violence, sexual assault, or stalking can be found by contacting Uniting Three Fires Against Violence at (906) 253-9775. The Community Health and Research Center at the Arab Community Center for Economic and Social Services (ACCESS) offers a Victims of Crime Program that serves any victim of crime in the southeast Michigan community, including Wayne, Macomb and Oakland Counties. Services include counseling, psychiatric services, case management and legal advocacy for victims of domestic violence, child abuse, sexual abuse, rape, hate crimes, robbery, assault, theft, burglary, and survivors of homicide. Contact them at 313-216-2225 or node/329 The La Vida Partnership, a community program of the Community Health and Social Service Center (CHASS) in Detroit, is a domestic violence and sexual assault intervention and prevention program that provides linguistically and culturally appropriate services and resources targeted to Latino/a youth and families in Southwest Detroit and Southeast Michigan. Information about this organization is found online at: assistance: Michigan Legal Help - - is for people who are handling their legal problems without a lawyer. It helps users learn about their legal problems and get ready for court. The site provides many Do-It-Yourself tools to help create court forms. It does not give legal advice, and it is not a substitute for having a lawyer. Users can, however, search the website for a lawyer, community services, or a Self-Help Center near their locations. The website covers a variety of legal issues that include: personal protection orders, divorce, child custody, child support, paternity, name changes, eviction, landlord/tenant, leases, and public assistance.Pregnancy Support Services: Michigan Local Public Health Departments: Each local public health department provides pregnancy support services including: WIC (Women, Infants and Children), referral for prenatal care, home visiting, assistance with Medicaid enrollment, immunizations and ongoing maternal and infant health services. Contact information for Michigan local health departments can be accessed on the Michigan Department of Health and Human Services (MDHHS) website: Michigan 2-1-1: Michigan residents can call 211 for a wide range of local social services and community organizations that aid those in need. Regional call centers throughout the State of Michigan connect callers with local basic resources such as temporary housing, food banks, clothing, help with utilities, support groups, and many more. Michigan Adoption Resource Exchange (MARE): Provides a listing and interactive agency map to help Michigan residents find a licensed adoption agency located near them. MARE also provides information and resources for individuals and families interested in adoption. Safe Delivery Information: Michigan law allows a parent to safely surrender a newborn child no more than 72 hours old to an employee who is inside and on duty at any hospital, fire department, police station, or by calling 911. This program is a safe, legal and anonymous alternative to abandonment of a newborn. The program releases the newborn for placement with an adoptive family. Safe Delivery Hotline: 866-733-7733. For more information see: ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download