Safety Planning in the Pediatric Setting

1. Safety Planning in the Pediatric Setting Saint Louis University Department of Psychology and University Pediatrics Family Safety Project

2. Intimate Partner Violence (IPV) • The alternatives and options available to women affected by IPV are complex: • Remaining in the relationship does not indicate endorsement of violence • Nor does leaving guarantee safety of women and their children • Physicians play a critical role in society's coordinated response to support children and their families

3. Pediatrician’s Role • Physicians should • Assess degree of risk (i.e., frequency, duration, presence of firearms, drug use) • Provide resources and ways to reduce certain risks • Focus on HARM REDUCTION

4. Risk Assessment • Is the woman afraid to go home? • Has there been an increase in frequency/severity of violence? • Have there been threats of homicide or suicide? • Have there been threats to the children? • Is there a gun present?

5. Safety Planning • Focus: to reduce harm and increase safety of women and children within violent homes • Planning for safety involves aspects of protection during acute episode, as well as issues surrounding staying or leaving relationship

6. Protection Strategies • Limit access to weapons (e.g., hide guns, remove bullets) • Stay away from the kitchen or enclosed spaces (e.g., closets) if violence is expected • Instruct children to go to a “safe place” • Try to move towards an open door or phone • Call 911 or flee to predetermined safe place

7. Staying Strategies • Maintain social support and independent income (if possible) • Hide extra set of keys • Store money in a separate (perhaps secret) location • Secure copies of legal/financial papers • e.g., credit card, license, property titles, and custody papers • Play “bartender” if drinking is associated with violence

8. Leaving Strategies • Obtain an order of protection and provide copies to school/work • Cancel shared credit cards/banking accounts • Change regular travel habits • Change locks/secure windows • Obtain an unlisted phone number • Move to undisclosed place

9. Making Children Safer • Make sure children hear frequently that they are not responsible for violence • Encourage them to leave the scene of violence • Tell children where to go for safety • Teach children how to call 911 and practice giving their address/phone number

10. Systemic Issues • Because child abuse and IPV can frequently co-occur, the involvement of DFS may be warranted • Though pediatricians are not mandated to report IPV, child abuse must be reported

11. National Resources • National Resource Center on Domestic Violence (800-537-2238) • Nationwide Hotline (800-656-HOPE) • National Domestic Violence Hotline (800-799-SAFE)

12. State/Local Resources • Alternatives to Living in Violent Environments 314-993-2777 • Missouri Coalition Against Domestic Violence 573-634-4151 • Women’s Support and Community Services 314-531-2003

13. State/Local Resources • Legal Advocates for Abused Women 800-527-1460 • Crisis Nursery for children 314-768-3201 • Women’ Resource Center 314-726-6665

14. RADAR • R: Routinely ask female patients • A: Ask direct questions • D: Document your findings • A: Assess safety • R: Review options and referrals

15. To Learn More…. • American Academy of Pediatrics http://endabuse.org/programs/healthcare/files/Pediatric.pdf • Continuing Medical Education online www.medscape.com/viewprogram/2777_pnt • American Medical Association – Domestic Violence Resources (312-464-5066) http://www.ama-assn.org/ama/pub/category/3242.html • American College of Emergency Physicians – (www.acep.org) • American Bar Association – Resources on Safety Planning http://www.abanet.org/domviol/home.html