Family violence and sexual assault

Adult violence items test privacy, language after disclosure, and evidence rules that do not override consent. Child maltreatment reporting is in Paediatric skin, ENT, and safeguarding. Elder maltreatment is in Elder abuse and polypharmacy. Legal reporting mechanics also sit in Client rights, restraints, and reporting.

Intimate partner violence: screen, respond, do not trap

Intimate partner violence is a pattern of physical, sexual, psychological, or economic control. Injuries that do not match the story, delay in seeking care, a partner who answers every question, and a client who looks to the partner before speaking are cues. Screen in private. If the partner refuses to step out, that itself is data; get help from security or another staff member rather than forcing a confrontation that isolates the client further in that moment.

After a disclosure, the therapeutic response is belief and options, not an interrogation. “Thank you for telling me. You did not cause this. You have choices, and I can help you look at them.” Avoid “why do you stay,” “what did you do,” and cheerleading that they must leave tonight. Leaving is often the highest-risk period because control is threatened. A rushed ultimatum can send the client back without a bag, documents, or a plan, and can escalate lethality. Your job is a safety plan they own: a packed bag if it is safe to hide one, important documents, a code word with a friend, hotline numbers memorized or hidden, and where to go if they decide. They may decline every resource today. Document the offer and stay available. That is not failure. Forcing a competent adult into a shelter against their will is.

Sexual assault: care first, kit only with consent

After sexual assault the priorities are safety, injuries, pregnancy and infection risk, and then evidence if the client wants it. Speak in private. Do not make them repeat the story to every staff member. A SANE or trained examiner collects the kit when available; your job is consent, chain of custody as trained, and not destroying evidence by accident.

1. Stabilize life threats and obvious injuries. Assault does not pause ABCs.
2. Ask before you have them bathe, change clothes, brush teeth, or eat and drink if a kit may still be wanted.
3. Explain the kit: what it is, that it is optional, that they can stop any step, and that medical treatment is not a trade for evidence.
4. Consent is timed and specific. An unconscious client does not get a kit “while we have the chance” unless law and policy in the stem say otherwise; default is wait for consent.
5. Preserve clothing in paper as taught, label, and hand off per protocol. Do not put wet evidence in plastic that grows mold as the stem frames it.

Prophylaxis for pregnancy and STIs, hepatitis/HIV pathways, and tetanus follow orders and the client’s consent. Offer advocacy and a support person. Documentation is factual: what you saw, what they said in their words, what care they accepted or declined. The distractor that looks tidy is showering them for dignity before they have decided about a kit, or telling them they “have to” complete evidence to get prophylaxis. They do not.

Priority map