Feel Prepared: Not Scared! Domestic Violence and Human Trafficking Education in the Ambulatory Care Office

Healthcare workers are often the first to suspect or aid in helping men or women who are in trouble. Domestic violence (referred to as intimate partner violence) and human trafficking (known as “modern slavery”) are decisions by others to create control and inequity in a relationship. Domestic violence can be psychological, emotional, sexual, and financial abuse. One in five women experience a form of abuse, while one in seven men experience physical violence and one in 12 men experience sexual violence. In the United States, abuse victims lose a total of 8.0 million days of paid work each year. The cost over a lifetime related to abuse is $103,767 per woman and $23,414 per man according to a CDC study in 2021. One in 15 children are exposed to domestic violence, and 90 % of those children are eyewitnesses to that violence.
Human trafficking (forced labor, commercial sexual acts, and involuntary labor to pay debt) affects almost 21 million people worldwide according to statistics from 2017. One million children are trafficked for commercial sexual exploitation. Victims are double victimized when domestic violence and human trafficking are combined. Although certain communities experience inequities, domestic violence and human trafficking affects all races, economic, and educational levels.
Ambulatory care staff members are prepared to respond quickly to emergencies such as chest pain and breathing difficulty. However, staff are often unprepared to care for a victim of domestic violence or human trafficking when patients present in the office setting. Workflows, education, and resources are more available in the acute care setting but not in the ambulatory care setting. Lack of training in the ambulatory care setting prevents delay of care for possible violent situations.
A recent domestic abuse situation in our clinic involved a patient who was threatened with injury by her intimate partner. When the patient and partner arrived together, the patient privately stated that she required assistance. The team safely accompanied the patient out the back door into a waiting taxi. The partner was escorted out of the office by a public safety officer.
A successful outcome was evident; however, the situation was chaotic. Staff struggled to address the situation confidently. Multiple phone calls were made attempting to find the appropriate resources. The need for training and education was apparent. Understanding that the non-vulnerable adult must consent to report and choose his or her own safety choices may create legal and ethical conflicts in staff. The use of a quick reference guide with key points taken from the facility policies can boost the confidence of the staff encountering these situations.
This poster presentation displays the educational tool developed for ambulatory care staff. An extensive literature search regarding domestic violence and human trafficking revealed research related to definitions, signs of recognition, the cycle of the abuser, and safety plans. However, there was a lack of research on strategies to manage these situations. This tool demonstrates the collaboration of multidisciplinary staff members and leaders from agencies, emergency departments, legal counsel, and nursing colleagues to protect our patients.