RADAR
Wanda Filer. 1992‚ 1996‚ 1999‚ 2004
شیوه نامه "رادار"
Remember to ask routinely about partner violence in your own practice.
Ask directly about violence with such questions as‚ “At any time‚ has a partner hit‚ kicked‚ or otherwise hurt or frightened you?” Interview your patient in private at all times.
Document information about “suspected domestic violence” or “partner violence” in the patient’s office.
Assess your patient’s safety. Is it safe for her to return home? Find out if any weapons are kept in the house‚ if the children are in danger‚ and if the violence is escalating.
Review options with your patient. Know about the types of referral options (e.g.‚ shelters‚ support groups‚ legal advocates).
Note. There is another version of the RADAR screening tool (called RADAR/SA) that also assesses for sexual assault with the following question: “Have you ever been sexually assaulted or involved in sexual acts against your will?”
RADAR for Men: A Domestic Violence Intervention
R=Routine inquiry
A=Always ask
D=Document findings
A=Assess safety and lethality
R=Respond
R= Routine inquiry of all male patients 14 and older
Some patients will not volunteer information concerning the presence of DV‚ but will talk freely about it when asked. Asking your male patients about domestic violence should be a routine part of medical care‚ whether the patient appears to be involved in DV or not. We expect health care providers to ask their male patients at a first visit and on a yearly basis.
In addition to routine inquiry‚ providers should ask about DV whenever patients present with risk factors such as substance abuse; PTSD; financial stressors such as job loss or foreclosure; unexplained bruises or injuries; or depression. Abuse may increase during pregnancy; partners of pregnant women should be asked about DV.
A=Always ask
Below are several questions you might ask your patient to assess his involvement in a violent relationship. You may also want to notify the patient of exceptions to confidentiality. Specifically‚ if children are being harmed‚ you will have to involve the appropriate authority in your municipality; and if your questions discover an imminent risk to your patient or someone else‚ you will have to involve the police.
Providers have their own personal style‚ and this will affect how you ask your patients. The exact wording is not that important; what is important is that you ask. Patients report being more comfortable with health care providers who ask in a non-judgmental fashion and who appear to be genuinely interested in their well-being.
· “Are you in a relationship in which you are being hurt or threatened?”
· “Have you ever used any kind of physical force against your partner?”
· “Has your partner ever pushed‚ grabbed‚ slapped‚ choked‚ or hit you?”
· “Have you ever done that to her/him?”
· “Has your partner ever forced you to have sex or perform sexual acts which you did not want to do?”
· “Have you done that to her/him?”
Some providers and patients are more comfortable with questions that assess the nature of the relationship first.
· “How would you characterize your relationship with your partner?”
· “All people argue. How do you and your partner handle disagreements or fights?”
· “Do your fights ever become physical?”
If a patient admits to DV‚ it may be difficult to determine whether the patient is primarily the victim or the perpetrator. Your response and advice are based to a great extent on the balance of power and control in the relationship. The following questions may help to further define the patient’s role in the relationship.
· “Does your partner put you down or make you feel bad about yourself?”
· “Do you do that to her/him?”
· “Are you afraid of your partner?” “Is he/she afraid of you?”
· “Has your partner stopped you from going places or seeing people?”
· “Have you done that to her/him?”
· “Who controls financial decisions in your relationship?”
· “Do you share decisions over financial matters?”
· “Has your partner threatened to call immigration and have you deported?”
· “Have you done that to her/him?”
If the patient answers “Yes” to either being a perpetrator or victim of DV‚ see what to do under the “Respond” section below‚ and then continue with the following steps.
D=Document findings
Document in the chart that you asked about DV‚ and what the patient said. If the patient denies DV‚ it is important to document that you asked‚ as this is widely becoming a standard of care. If the patient admits to being involved in DV‚ document his story. Use quotation marks to document exact words. Note what injuries‚ if any‚ you observed. State your assessment of the potential for future violence including threats made. Describe safety and follow-up plans including your next scheduled appointment. Document that you asked about safety of children in the home.
A=Assess for safety and lethality
We can never totally predict who will do harm to their partner‚ but there are some questions you can ask to help assess the current situation.
· If your patient acknowledges being a victim of domestic violence:
· Is it safe for him to go home today?
· Is he being stalked?
· Has there been an increase in the frequency or severity of violence?
· Are there weapons easily accessible to the perpetrator?
· Have there been threats of homicide or suicide to him‚ the children‚ and/or pets?
If your patient admits to being a perpetrator:
· Has there been an increase in the frequency or severity of violence?
· Is your patient tracking his partner’s behavior without his/her knowledge?
· Are there weapons easily accessible to him?
· Has there been prior contact with the police? Is there a Protection From Abuse Order?
· Are issues such as substance abuse‚ depression‚ or mental illness exacerbating his behavior?
· Should you consider contacting the victim?
It is important to identify whether there are children in the home and whether or not the children are being harmed. If you have evidence that the children are being harmed‚ you have a moral and legal obligation to involve the appropriate agency in your municipality.
If your patient discloses intent to imminently harm a named victim‚ you may have a duty to warn that person. Case law in California established that the provider who has reason to believe that someone may be at risk for injury from his/her client has a duty to initiate contact with that person to warn the victim. It is important for sites to develop and implement policies that reflect existing statutes‚ protect victims of DV‚ and protect patient confidentiality.
R=Respond
A general statement should first be made: “Being in a violent relationship affects the health and well-being‚ of you‚ your partner‚ your children and your community. This kind of stress can worsen illness‚ and depression‚ and increase substance abuse and absence from work. This is hard‚ complicated and will take time to work out.”
If your patient is a victim of DV‚ you can respond as follows:
Encourage him to talk about it:
“Would you like to talk about what has happened to you? Would you like some help?”
Validate his experience and emphasize the risk of violence to his and his families’ health and well-being.
“Many people feel that only women are victims of domestic violence‚ but we know that it can happen to anyone‚ including men. No one deserves to be treated this way.”
“If you’re being hurt‚ your kids are being hurt‚ too.”
If the patient does not need immediate assistance‚ offer information about resources in the community.
“I can put you in touch with someone who can help you.”
Acknowledge that change is a process‚ and follow the situation over time:
“I am glad you told me about this‚ and I want to help you to stay healthy and safe. Let’s make sure we bring this up at the next visit.”
If your patient acknowledges being a perpetrator of DV‚ you can respond as follows:
Positively reinforce the patient’s telling you about this‚ and reframe the issue as a health issue.
“I am glad you told me about this. I’d like to spend some time talking about this because I am concerned about your health and safety. Do you feel that this behavior is affecting your health in any way?”
Make it clear that you do not condone this behavior.
“I strongly believe that violence is not an acceptable way to resolve disputes. The behavior you describe is dangerous and illegal.”
Remind the patient of the consequences of his abusive behavior.
“This situation puts at risk everything you care about - your health‚ the health of your partner and children‚ your freedom‚ your job. You must stop the violence and stay away from your family if you have an urge to use force. You could be arrested and convicted for hurting your partner. Also‚ your kids are learning from your behavior.”
Offer hope that the patient can change his behavior and offer appropriate referrals.
“You can do something about this. Are you interested in help to change your behavior?
Do you have friends or family you can turn to for help with this? Can your faith help you? I know some community programs for men that can help.”
Recognize that change is a process‚ and follow the pattern of behavior over time.
“Again‚ I am glad you told me about this. I want to help you to stay healthy and safe.
Let’s make sure we bring this up at the next visit.”
شرح سایت روان سنجی: نام این ابزار بگرفته از پنج فعالیتی است که پزشک در بررسی و شناسایی خشونت شریک زندگی باید به کار گیرد.
· به یاد داشتن پرسش معمولی درباره خشونت، مانند: وجود زدن، لگد، یا هر گونه آسیب یا ایجاد وحشت بدون محدودیت زمانی
· پرسش مستقیم درباره خشونت
· مستندسازی اطلاعات در بازه خشونت خانگی مشکوک و یا خشونت شریک محل مراجع
· سنجش ایمنی مراجع، آیا او در بازگشت به خانه ایمن است؟ اگر در خانه سلاح هست و اگر در خانه کودک هست و اگر خشونت فزاینده است.
· بازبینی پاسخ ها با بیمار، درباره آگاهی او از گزینه های گونه های مراجعه مانند: پناهگاه، گروه های حامی و یا وکیل
چگونگی دستیابی
منبع و ماخذ
نخستین لینک، فهرستی از 50 خشونت خانگی را ارائه می کند.
Alpert EJ. (Ed.) (2004). Partner violence: How to recognize and treat victims of abuse‚ Fourth Edition. Waltham‚ MA: Massachusetts Medical Society.
Alpert EJ. (1995). Violence in intimate relationships and the practicing internist: New “disease” or new agenda? Annals of Internal Medicine‚ 123‚ 774-81
dJaeger JR. (2004). RADAR for Men [teaching protocol]. Philadelphia‚ PA: Institute for Safe Families.