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Toolkit Overview - Cook County Department of Public Health

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Another sample IPV policy for healthcare providers titled “Community <strong>Public</strong> <strong>Health</strong> Services<br />

Domestic Violence Protocol,” is currently used by San Francisco’s <strong>Department</strong> <strong>of</strong> <strong>Public</strong> <strong>Health</strong>.<br />

This protocol provides a definition <strong>of</strong> DV and guiding principles for healthcare providers, as well<br />

as protocols for the following activities:<br />

• Screening<br />

• Assessment<br />

• Intervention<br />

• Documentation<br />

• Mandatory Report <strong>of</strong> Injury<br />

• Continuity <strong>of</strong> Care<br />

Appendices include:<br />

A. Staff Roles and Responsibilities<br />

B. Symptoms and Signs <strong>of</strong> Domestic Violence<br />

C. Approaches for Interviewing the Patient<br />

D. Safety Assessment and Planning<br />

E. Injury Location Record (Body Map)<br />

F. Consent to Photograph/Receipt <strong>of</strong> Evidence<br />

G. Summary <strong>of</strong> California Reporting Law (adapt by inserting Illinois’ Reporting Laws here)<br />

H. Report <strong>of</strong> Injuries by a Firearm or Assaultive or Abusive COnduct<br />

I. Common Questions about Mandatory Reporting<br />

J. DV Contact Form<br />

K. Community Resources<br />

L. <strong>Health</strong> Commission Resolution on Universal Screening<br />

M. Acknowledgements<br />

N. Signatory Page<br />

The "Community <strong>Public</strong> <strong>Health</strong> Services Domestic Violence Protocol" can be viewed in its<br />

entirety at:http://endabuse.org/userfiles/file/<strong>Health</strong>Care/CommunityServices.pdf and Future<br />

Without Violence states “no permission is needed to use or adapt this document at healthcare<br />

facilities,<br />

“Warm Springs <strong>Health</strong> and Wellness Center Guidelines for Clinical Assessment and Intervention<br />

on Domestic Violence”is another sample IPV protocol for the medical setting from the FWV<br />

at:http://www.endabuse.org/userfiles/file/<strong>Health</strong>Care/ClinicalAssessment.pdf

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