October is Domestic Violence Awareness Month. In the last several blogs, we have covered topics focusing on patients who may have high-risk issues. Depending on where you are located in the U.S., your patients may still be working remotely, are unable to see friends and family, and there may be limited services available if they are in need. Add to this, patients who have lost their jobs or have had pay reductions as a result of COVID-19, or the stress of having to home school children while juggling work. These issues can add significant stress within a home. Patients may also live with an abusive partner/spouse, parent, or child that they are unable to leave due to circumstances, fear, limited resources, or financial limitations. This can place patients at significant risk.
Domestic violence affects many individuals in the U.S. Nearly ½ of all women and men in the U.S. have experienced psychological aggression by an intimate partner. There has been a rise in intimate partner violence following the COVID-19 pandemic, and a study found that victims delayed reaching out to health care services until the late stages of the abuse cycle. Additionally, the number of people who have contacted domestic violence hotlines have increased. Some cities, however, are seeing a decrease in calls of up to 50%, and it is believed that this is due to victims being in close proximity in the home with their abuser., 
As part of ongoing assessment and treatment, Allied Healthcare Professionals (AHPs) should assess if a patient or a loved one within the home is a victim of domestic violence. It is important to inquire if a patient feels safe by asking open ended questions. AHPs should look for bruising or other signs of abuse. Ensure that you thoroughly document in the patient’s medical record documenting objective observations, and patient quotes. The patient may not be forthcoming in disclosing the issue, either in front of the suspected abuser or in private. It is important to document a description of visible observations, despite patient reporting.
If abuse is suspected, adequately assess the situation with the patient in a safe manner. Keep in mind, however, that the abuser could be in the background of the session and may be able to overhear. It is important to ask questions in a way that the abuser is not alerted. Pay attention to the patient’s affect and use of code words or phrases such as she/he might order a pizza later. If the information provided is off topic, the patient may be at risk. Have a process in place to notify law enforcement, when indicated and mandated.
Given the COVID-19 pandemic, some of you may still be providing telehealth, may have transitioned to in-person, or provide a combination of the two. It can be difficult to know if a person is experiencing domestic violence, and if she/he is engaging in treatment via video or phone, it can be even more so. When engaging in telehealth with patients, be mindful that you may have to take immediate action to contact authorities if an incident occurs. Violent incidents can occur over video, take a recent case that occurred where a child’s mother was shot and killed by her father while the 10-year-old was engaged in a Zoom classroom session. Although this incident was not specific to telehealth, it highlights issues that could potentially occur when you are providing telehealth. In a situation such as this, it is critical to contact authorities to report what you observed and for the safety of the others in the home.
This was mentioned in a previous Blog, but it bears repeating. As many people remain confined to their homes, a hand signal is being used by domestic violence victims to alert those, on the other end of the screen, that they may be in danger. The “Signal for Help” initiative was launched by the Women’s Funding Network during the COVID-19 pandemic and has been circulated on Twitter and Tik Tok. It is important that AHPs are aware of this signal and, when used, seek help for the patient. If you are unaware of this signal, the resource below will bring you to an article where the video is embedded and demonstrates the signal.
During this time, it may be difficult for victims of abuse to access services or shelters. Shelters may be closed or not accepting new individuals and programs may be limited. This can create additional challenges to obtain assistance for patients. Should you need resources, there are a number of national services available and are included at the end of this Blog.
Be aware that some states may have regulations requiring professionals to report domestic violence to local authorities or state agencies. Additionally, reporting obligations also may exist if children, elders, or disabled persons live within a home where domestic violence occurs. It is important that you are aware of your state specific obligations if you become aware of domestic violence.
Finally, it is important to seek guidance should you need it. Safety is paramount. If you have time, i.e., the situation does not put the patient or others at imminent risk, seek advice from a risk management professional or an attorney.
Here are a number of national services that may be helpful:
National Domestic Violence Hotline: 1-800-799-7233 or text LOVEIS to 22522
Crisis Text Line: text HOME to 741741
National Parent Hotline: 1-855-427-2736
 Mozes, A., Study Finds Rise in Domestic Violence During COVID, WebMD, https://www.webmd.com/lung/news/20200818/radiology-study-suggests-horrifying-rise-in-domestic-violence-during-pandemic#1, Aug. 18, 2020; Gosangi, B., M.D., Park, H., M.D., et. al., Exacerbation of Physical Intimate Partner Violence during COVID-19 Lockdown, Radiology, https://pubs.rsna.org/doi/10.1148/radiol.2020202866, Aug. 13, 2020
 Evans, M., M.D., M.P.H., Lindauer, M., J.D., and Farrell, M., M.D., A Pandemic within a Pandemic — Intimate Partner Violence during COVID-19, JAMA, https://www.nejm.org/doi/full/10.1056/NEJMp2024046, Sept. 16, 2020
Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM
Healthcare Practice and Risk Management Innovation Officer
Trust Risk Management Services, Inc.
NOTE: This information is provided as a risk management resource and is not legal advice or an individualized personal consultation. At the time this resource was prepared, all information was as current and accurate as possible; however, regulations, laws, or prevailing professional practice standards may have changed since the posting or recording of this resource. Accordingly, it is your responsibility to confirm whether regulatory or legal issues that are relevant to you have since been updated and/or to consult with your professional advisors or legal counsel for timely guidance specific to your situation. As with all professional use of material, please explicitly cite The Trust as the source if you reproduce or distribute any portion of these resources. Reproduction or distribution of this resource without the express written permission of The Trust is strictly prohibited.