Domestic Violence DTW

  1. Definitions
  2. Key Points
    1. Prevalence
    2. Course
    3. Effects
    4. Know Your State Laws
  3. Assessment
    1. Before assessing, discuss confidentiality
    2. Who and how often to assess (see table)
    3. Asking about intimate partner violence
    4. How to assess
    5. What to ask
  4. Management
    1. Responding to disclosure of intimate partner violence by parent
      1. Support the victim
      2. Provide information on intimate partner violence
      3. What to say to the child who has witnessed intimate partner violence
      4. For adolescents who are victims of violence
      5. Assess and address safety issues (see Safety Plan for Adult Victims Living With Their Abusers and Safety Instructions)
      6. Referrals for adult parents and adolescents
      7. Referrals for children
    2. Responding to child disclosure of intimate partner violence
    3. Reporting requirements for child abuse and intimate partner violence
    4. Documentation
    5. What to do if a patient says "no" or will not discuss abuse
  5. Appendix
    1. Who and How Often to Assess
  6. Citations


Key Points

Latest research on Domestic Violence




Know Your State Laws

Latest research on Domestic Violence


Before assessing, discuss confidentiality[note]

Who and how often to assess (see table)

Asking about intimate partner violence

How to assess

What to ask[note]


Responding to disclosure of intimate partner violence by parent

Support the victim

  • Express concern for the patient's or parent's safety.
  • If the victim is comfortable, encourage her/him to talk about what has happened.
  • Listen without making judgments.
  • Tell victims that they are not alone and that you and other people can help them.
  • Tell her/him that the violence is not their fault, s/he does not deserve to be abused and that only her/his abuser can stop the abuse, and that there is no excuse for intimate partner violence.
  • Make sure s/he knows that there is help available and that there are people s/he can turn to for support.
  • Remind the victim that you are a resource, should s/he need further assistance.
  • Inform the attending parent or adolescent of any reporting laws and requirements.

Provide information on intimate partner violence

  • Intimate partner violence is common (among all social strata, educational levels and ethnic groups).
  • Most violence continues for a long time and often gets more frequent and more severe.
  • Violence happens in all kinds of relationships - including teen relationships and lesbian and gay relationships.
  • Violence in the home can harm all family members including children, both physically and emotionally
  • There are resources for families, and this clinic/practice/provider can help find them.
  • Intimate partner violence affects victim health and the health of the family.

What to say to the child who has witnessed intimate partner violence

  • If a parent discloses intimate partner violence, the provider with the parent's permission can specifically acknowledge the disclosure with the child by saying:
    • "What are your worries about the fighting at home?"
    • "I am concerned about the safety of people in your home and I am glad your mother told me about this."
    • "What is going on in your house is not your fault."
    • "You are not responsible for solving these problems. I am going to work with your mother (father, caretaker, etc.) to try to make things better."
  • The way in which the provider discusses these issues with children will vary by their age and level of cognitive development.
    • For a four-year-old, it is probably sufficient to provide simple acknowledgment and reassurance about safety.
    • For an eight-year-old, it may be appropriate to add more specific reassurances about what steps the parent is taking to handle the situation.
    • For an older child or an adolescent, it may be important to offer the opportunity to talk about their perspectives of the situation at home.

For adolescents who are victims of violence

  • Address the health issues by obtaining a complete history.
  • If possible, conduct a complete, unclothed, physical exam. Look for - and document - evidence of current or previous injuries and of sexual abuse.
  • Ask about medical and psychological effects resulting from abuse, such as chronic pain, worsening of existing medical conditions, psychological distress, anxiety, sleeping and eating disorders, miscarriages or substance abuse.
  • Schedule a follow-up appointment, encourage your patient to return and make other appropriate referrals.
  • Encourage the patient to talk to his/her parents or trusted adult about dating violence.
  • For severe violence, inform adolescents that you must inform their parents or guardian to keep them safe. In this case, you may need to inform state protective service if the caretaker will not protect the child.

Assess and address safety issues[note] (see Safety Plan for Adult Victims Living With Their Abusers and Safety Instructions)

  • Ask her/him about her/his immediate plans. Is s/he going home to the person who hurt her/him? Does s/he have a friend or relative s/he can talk to? If s/he is going to leave, where is s/he going to go?
  • Depending on the amount of time the clinician has, the following issues can be pursued to assess current danger:
    • What happened during the latest incident? Is the abuse increasing in frequency or severity?
    • Were weapons involved?
    • Have there been prior incidents?
    • Have you sought any kind of assistance for previous battering? Have you ever left before?
    • Has the abuser ever threatened or physically injured the children?
  • Assess for suicidal ideation and risk of homicide
    • Have you ever considered, threatened or attempted suicide?
    • What injuries did you sustain during the worst incident of violence?
    • Has the violence increased in frequency and/or severity?
    • Has the abuser ever threatened to kill you? Do you believe s/he is capable of killing you? Has the abuser used a weapon or threatened you with a weapon before?
    • Are you planning to leave/divorce him in the near future?
    • Are there firearms or other weapons in the house?
  • Help parents think about safety issues for their children. For example:
    • Do the kids usually get involved when a violent incident occurs?
    • What do they do when violence erupts?
    • Do you talk with them about it? What do you say?
    • Children should be taught that their job in a violent situation is to stay safe, not to protect their parents or stop the fighting. They should be taught now to call 911(where age appropriate).
  • Help the victim think about options and their implications.
  • Inquire about the possibility of referring a victim to appropriate services from a battered women's shelter or support network and/or other culturally relevant agency such as a community center, church or other organization serving the victim's community.

Referrals for adult parents and adolescents

  • Help your patient find culturally appropriate support from a hospital or community-based social worker or advocate who can help the victim with:
    • Emergency shelter or permanent housing
    • Emergency financial assistance or transportation
    • Counseling and/or support groups for victims and their children
    • Child care, visitation centers
    • Legal assistance
    • Mental health and substance abuse treatment
    • Social services
    • Batterer intervention programs
    • Independent living centers
    • Couples treatment and mediation are not usually recommended
  • When possible, refer patients to organizations that reflect their cultural background or address their special needs such as organizations with multiple language capacity and those who specialize in working with teen, disabled or LGBT (lesbian, gay, bisexual, or transgender) clients.
  • WAllow her/him to use your phone to make calls. If you don't have information about intimate partner violence programs in your area, call the National Domestic Violence Hotline at 800-799-SAFE (800-799-7233 or TDD: 800-787-3224).

Referrals for children

  • Children react to witnessing intimate partner violence in many different ways. The family's capacity to support these children also varies, as do their beliefs or ways of seeking help. If the parent is concerned about her child, options for help should be discussed, including a counseling referral, mental health assessment or other support services (such as Big Brother/Big Sister). A referral would be strongly recommended in the following circumstances:
    • If the child has witnessed severe violence resulting in injury or hospitalization of either the child, sibling or parent.
    • If the child's symptoms have persisted for more than three months.
    • If there has been a change in behavior or an increase in aggression or depression.
    • If the caretaker is unable to be emotionally attuned to the child's needs.
    • If the violence has resulted in the death of a parent.

Responding to child disclosure of intimate partner violence

Reporting requirements for child abuse and intimate partner violence


What to do if a patient says "no" or will not discuss abuse


Who and How Often to Assess

Newborn Caregiver At postpartum visit
New Patient Caregiver & Adolescent At first visit
Well Child:
Child Caregiver At 2, 6 and 12 months, then yearly
Adolescent Adolescent Yearly
Prenatal Adolescent Mother Once per trimester
Mental Health Caregiver & Adolescent At initial visit
Emergency Caregiver & Adolescent At every visit
Other Visits Caregiver & Adolescent Whenever there are physical or behavioral indicators or chronic somatic complaints


  1. Groves, B.M, Augustyn, M, Lee, D, Sawires, P (2004). Identifying and Responding to Domestic Violence: Consensus Recommendations for Child and Adolescent Health.
  2. Barkan, H., Farley, M., Minkof, J. (2000). Mammography Screening and Domestic Violence. .
  3. Christian C, Scribano P, Seidl T, Pinto-Martin J (1997). Pediatric injury resulting from family violence. .
  4. Coker, A., Smith, P., Bethea, L., King, M., McKeown, R. (2000). Physical Health Consequences of Physical and Psychological Intimate Partner Violence. .
  5. Danielson, K., Moffit, T., Caspi, A., Silva, P. (1998). Comorbidty Between Abuse of an Adult and DSM-III-R Mental Disorders: Evidence From an Epidemiological Study. .
  6. Dearwater, S.R., Coben, J.H., Campbell J.C., Nah, G., Glass, N., McLoughlin, E., et al. (1998). Prevalence of intimate partner abuse in women treated at community hospital emergency departments. .
  7. Edleson, J.L. (1999). The overlap between child maltreatment and woman battering.
  8. Gelles, R.J., Harrop, J.W. (1989). Violence, battering, and psychological distress among women. .
  9. Housekamp, B.M., Foy, D. (1991). The assessment of posttraumatic stress disorder in battered women. .
  10. (2000). Healthy Steps Interactive Multimedia Training and Resource Kit. .
  11. Jaffe, P., Sudermann, M. (1995). Understanding Partner Violence: Prevalence, Causes, Consequences, and Solutions. Families in Focus Services, Vol. II.
  12. Kilpatrick, K.I., Litt, M., Williams L. (1997). Post-traumatic stress disorder in child witnesses to domestic violence. .
  13. Lieberman, A., Von Horn, P., Grandison, C., Pekarsky, J. (1997). Mental health assessment of infants, toddlers and preschoolers in a service program and a treatment outcome research program. .
  14. McCauley, J., Kern, D.E., Kolodner, K., Dill, L., Schroeder, A.F., DeChant, H.K., et al. (1995). DThe 'battering syndrome': prevalence and clinical characteristics of domestic violence in primary care internal medicine practices. .
  15. National Institute of Justice and Centers for Disease Control and Prevention (1998). Prevalence, Incidence, and Consequences of Violence Against Women: Findings from the National Violence Against Women Survey.
  16. Rossman R. (1998). Children Exposed to Marital Violence: Theory, Research, and Applied Issues.
  17. Spaccarelli, S., Coatsworth, J.D., Bowden, B.S. (1995). Exposure to serious family violence among incarcerated boys: Its association with violent offending and potential mediating variables.. .
  18. Stark, E., Flitcraft, A. (1995). Killing the beast within: Woman battering and female suicidality. .
  19. U.S. Department of Justice (1998). Violence by Intimates: Analysis of Data on Crimes by Current or Former Spouses, Boyfriends, and Girlfriends.
  20. Wolfe, D.A., Wekerle, C., Reitzel, D., Gough, R. (1995). Ending the Cycle of Violence: Community Responses to Children of Battered Women.


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