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In the ninth of our 16 blogs for 16 days, Professor Paul Coulthard, Dean of Dental School at Barts and The London School of Medicine and Dentistry, talks about the role that dentist can play in identification and referral.

INTRODUCTION

The face is a common target in assault and consequently dental professionals have a part to play in identifying domestic violence and abuse in patients that present to them. The role of the dental team is to identify domestic violence and refer their patient for specialist help.

Many dentists and dental care professionals do not however consider that this is their responsibility because they assume that the patients GP or social services or the police will be doing something. We know that other services may not have been approached and even if they have, it is better for the individual to be asked on numerous occasions rather than not asked at all. 

THE DENTAL ENVIRONMENT

Some dentists may think that this role is more appropriate for the general medical practitioner rather than themselves, not recognising the importance of their own role and the opportunities that general dental practice provides. A large proportion of the population attend their dentist on a regular basis who do not need to attend their GP. Also, GPs receive minimal training in oral health and dental injury and may not detect dental aspects of abuse.

It is useful to take advantage of working in the dental environment, which is likely to be considered less stigmatising than some other statutory services, to create an opportunity for the patient to disclose domestic violence and ask for help. Patients are often unaccompanied during examination and treatment sessions as part of routine practice and somembers of the dental team are in a unique and advantageous position to undertake enquiry about domestic violence and abuse. 

Asking about domestic violence

The dental professional should be confident and supportive in their approach, expressing concern as necessary. The appropriate time to ask is probably as part of taking the social history. Later, when examining the patient, if injuries are found that do not appear to be consistent with the stated aetiology, then the dental professional should explain this concern to the patient.

All dental care professionals in contact with patients should be aware of the risks of domestic violence and alert to the possible indicators which include frequently missed appointments, injuries inconsistent with explanations of accidental causation, evidence of multiple injuries and if the woman or man appears frightened or excessively anxious.

If the dentist and team only focus on treating injuries, without asking about their cause, then they will be doing little to help the patient experiencing domestic violence. If there are signs suggesting that a patient may be experiencing domestic violence, then the dentist or dental care professional should ask direct and specific questions, and try to obtain evidence, if possible photographic.

Questions 

Before asking direct questions, the dental professional should begin with some indirect ones to help establish a relationship with the patient and develop empathy. Examples include: ‘Is everything alright at home?’ or ‘Are you ever afraid at home?’

It may be helpful to explain why the questions are being asked by explaining, “I am sorry if someone has already asked you about this, and I don’t wish to cause you any offence, but we know that throughout the country 1 in 4 women experiences violence at some time during their life and so we are asking all women about this issue.’ 

If responding to dental or facial injury then it may be helpful to suggest, ‘Your partner seems very concerned and anxious about you. Sometimes people react like that when they feel guilty, was he responsible for your injuries?’ 

REFERRAL

The purpose of identification of domestic violence is referral on to the appropriate agency and so this process must be considered prior to enquiry. The referral to agencies providing direct help can be done by providing leaflets and cards with contact details to take away.  The dental team should have access to the appropriate information, and be responsible for ensuring that such information is widely available for patients, relatives and friends of women experiencing domestic violence. 

Displaying posters in the waiting room with a contact telephone is also useful. It provides a signal to encourage patients to disclose their domestic violence experience.

TRAINING FOR DENTISTS AND DENTAL CARE PROFESSIONALS

Many dental professionals lack the fundamental knowledge about domestic violence as well as the necessary skills to identify and discuss violence with women. Training should involve working alongside key voluntary sector agencies as well as different professional groups involved in responding to violence. Dental professionals also need to understand the issues around confidentiality and child safeguarding and record keeping. 

We have been undertaking some research to look at an intervention to educate, and hopefully change the behaviour of dentists and members of their team, so that they are informed and confident to ask patients about domestic violence when they present to them with injury potentially as a consequence of DVA. They are also connected to local agencies for effective referral. 

IN SUMMARY

Dentists and dental care professionals should be aware of how domestic violence impacts on dentistry. They should be confident in the identification of domestic violence when a patient presents routine dental care in addition to when they present with dental or facial injury. The identification of individuals experiencing domestic violence is the first step towards ensuring appropriate care.  Dentists should be prepared to refer the patient to the appropriate agencies that can offer direct help.

Inadequate training prevents professionals identifying and responding appropriately to domestic violence. 

Professor Paul Coulthard is Dean of Dental School at Barts and The London School of Medicine and Dentistry.

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AVA
AVA
AVA

AVA is an expert, groundbreaking and independent charity working across the UK.

Their vision is a world without gender based violence and abuse. They aim to  inspire innovation and collaboration and encourage and enable direct service providers to help end gender based violence and abuse particularly against women and girls.AVA’s work is focused around those areas where they can make the best contribution to ending violence and abuse. They do this by making sure that survivors get the help and support they need in the here and now, through providing innovative training that has a proven direct impact on the professional practice of people supporting survivors of violence and abuse

developing a range of toolkits, e-learning and other material that supports professionals to provide effective and appropriate support to survivors of violence and abuse

using our influence and networks to ensure survivors voices are heard. We work closely with AVA in many areas including the Pathfinder project

https://avaproject.org.uk

SafeLives
SafeLives
SafeLives

SafeLives are a national charity dedicated to ending domestic abuse, for good. We combine insight from services, survivors and statistics to support people to become safe, well and rebuild their lives. Since 2005, SafeLives has worked with organisations across the country to transform the response to domestic abuse, with over 60,000 victims at highest risk of murder or serious harm now receiving co-ordinated support annually. SafeLives are members of the Pathfinder consortium.

http://www.safelives.org.uk/about-us

IMKAAN
IMKAAN
IMKAAN

Imkaan is a UK-based, Black feminist organisation. We are the only national second-tier women’s organisation dedicated to addressing violence against Black and minoritised women and girls i.e. women and girls which are defined in policy terms as Black and ‘Minority Ethnic’ (BME). The organisation holds nearly two decades of experience of working around issues such as domestic violence, forced marriage and ‘honour-based’ violence.

They work at local, national and international level, and in partnership with a range of organisations, to improve policy and practice responses to Black and minoritised women and girls. Imkaan works with it’s members to represent the expertise and perspectives of frontline, specialist and dedicated Black and minoritised women’s organisations that work to prevent and respond to violence against women and girls. Imkaan delivers a unique package of support which includes: quality assurance; accredited training and peer education; sustainability support to frontline Black and minoritised organisations; and facilitation of space for community engagement and development. They are a part of the Pathfinder Consortium.

https://www.imkaan.org.uk

The University of Bristol CAPC
The University of Bristol CAPC
The University of Bristol CAPC

The Centre for Academic Primary Care (CAPC) is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research.  It is part of Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.

A dedicated team of researchers at the Centre work on domestic abuse projects and IRISi is a co-collaborator and partner on some of these projects including ReProvide, HERA and DRiDVA.

The Health Foundation
The Health Foundation
The Health Foundation

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. The Health Foundation’s Exploring Social Franchising programme aims to generate a deeper understanding of the potential of social franchising models for scaling effective health and social care interventions within the NHS.

We are one of four project teams participating in the programme to develop a social franchise to enable the sustainable spread of our intervention, the IRIS Programme. We receive funding and support from the Health Foundation, including technical expertise on social franchising, and attend programme learning events. The Health Foundation has also commissioned a programme-wide evaluation to support understanding of the use of social franchising in the UK health and care system. We and our franchisees will support the evaluation through co-designing data collection requirements, providing access to data as requested, hosting site visits and attending learning events.

https://www.health.org.uk

STADV
STADV
STADV

Standing Together Against Domestic Violence is a UK charity bringing communities together to end domestic abuse. They bring local services together to keep people safe

Most public services weren’t designed with domestic abuse in mind, and they often struggle to keep people safe. Poor communication and gaps between services put survivors at risk.

STADV aim to end domestic abuse by changing the way that local services respond to it. They do this through an approach that they pioneered, called the Coordinated Community Response. The Coordinated Community Response brings services together to ensure local systems truly keep survivors safe, hold abusers to account, and prevent domestic abuse.

Their model of a coordinated local partnership to tackle and ultimately prevent domestic violence is now widely accepted as best practice. They are also a part of the Pathfinder consortium.

http://www.standingtogether.org.uk

Spring Impact
Spring Impact
Spring Impact

Spring Impact is a not-for-profit social enterprise born out of the frustration of seeing social organisations constantly reinventing the wheel and wasting scarce resources. Spring Impact uses a combination of tested commercial and social principles and extensive practical expertise to support organisations to identify, design and implement the right social replication model to scale their social impact.

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