Initial Considerations for culturally competent screening
Proper use of an interpreter can facilitate the disclosure of violence or the potential for violence in the lives on non-English speaking patients. Using the patient’s family members, friends, or partner to interpret when asking about domestic violence puts the patient’s safety at risk.
Interview patients alone
Providers should be aware that patients may not feel comfortable disclosing abuse for many reasons. These include:
Fear of authority
Fears related to being an undocumented alien
Lack of familiarity with the medical and/or legal system
General unease in the medical setting
Cultural/religious norms about disclosing abuse to people outside of the family or community of origin
Culturally Sensitive Screening and Risk Assessment
Framing the Questions
Using open-ended questions is crucial to cultural sensitivity. In order to work effectively with any battered woman, we must ask open-ended questions rather than read the abuse victim a list of things we can do for her.
Many women minimize abuse as a survival mechanism and will volunteer more information if they receive culturally sensitive encouragement.
When asked broad questions, almost all women will describe what they need and fear from their own cultural perspective.
Review confidentiality.
Asking the Questions
In the U.S., it is against the law for your partner to threaten, hit, kick, or punch you. Does this ever happen to you? I will not tell your partner or any member of your family or friends what you are telling me.
General Questions: “Do you ever feel unsafe at home?”; “Have you ever felt afraid of your partner?”; “Has anyone at home hit you or tried to control you?”; “What are your concerns about your partner’s reaction?”
Planning for safety, offering support, and making referrals
“I’m glad you told me. We see many patients in similar situations. We can help.”
“What are your safety needs, fears, and concerns while you continue to live with your partner?”
“Do you have a safety plan?”
“What are the means your partner might use to continue controlling your life?”
“Do you know where you could get help if you or someone you know was being hurt by a partner?
“Would you like more information about domestic violence?
“There are safe places to go if you are experiencing violence at home. Would you be interested in talking to someone about going to a safe place?
Types of Abuse and Tactics Abusers May Use That May be Unique to Women from other Cultures:
Convincing her that if she seeks help for the violence, he will get custody of their children (men are given legal control over the children in many countries.)
Convincing her that his violence actions against her are not criminal unless they occur in public.
Threatening to have someone harm her family members in her home country.
Threatening to do or say something that will shame her family or cause them to “lose face”.
Isolating her from friends and family; Being the only person through whom she can communicate in English; Not allowing her to meet with social workers or other support persons; Not allowing her to meet with people who speak her language or who are from her community, culture, or country.
Threatening to report her to INS if she is undocumented or threatening to sabotage the documentation process.
Domestic Violence as a Crime
In a victim’s native country, domestic violence may be legal, and in many countries people are fearful of the police and other authorities.
The victim may believe that she cannot receive help. In her home country, it may be that the person with the most money and the strongest political connections wins – usually the man.
Religious Beliefs and cultural expectations
In many cultures, women are responsible for keeping the family unit intact. She may be blamed for family disintegration, and shunned by friends and family members for talking about the abuse.
