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After the assessment, an intervention strategy can be developed (see FlG. 111-2). These cases are complicated, and they require a muLtidis-ciplinary approach (eg, physicians, nurses, social workers, lawyers, police, and psychiatrists).
First, the health professional must consider whether interventions have been implemented in the past. Information about previous interventions (eg, court orders of protection) and the reasons they failed should be obtained to avoid the same approach.
The health professional must decide whether emergency intervention, which usually involves emergency medical attention and law enforcement, is required. Circumstances that dictate such intervention include the urgent need for medical or psychiatric attention and life-threatening mistreatment.
In all cases, interventions may include medical assistance; education (eg, teaching victims about abuse and available options and helping them devise safety plans); psychologic support (eg, individual psychotherapy and support groups); law enforcement and legal intervention (eg, arrest of the abuser and orders of protection and advocacy on behalf of the victim in the criminal justice system); and alternative housing (ranging from sheltered senior housing to nursing home placement). Because counseling the victim usually requires many sessions, the health professional should anticipate incremental progress, not a short-term resolution.
With a competent victim, the health care provider presents options, and the victim decides how to proceed. With a judgmentally impaired victim, the multidisciplinary team should make most decisions. Decisions need to be based on the severity of the violence, the lifestyle choice history of the person, and the legal ramifications. The aim should be to implement the least restrictive plan. Often, there is no single correct decision, and each case must be carefully followed up.
In most states, reporting is mandatory when abuse occurs in the home. In all states, it is mandatory when abuse occurs in an institution. State laws vary as to which agency receives these reports. Thus, health care workers should become familiar with the mandatory reporting laws in their state and the available protective service resources.

Tags: TREATMENT

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