PEARR: Treating Abuse and Violence Victims, Step by Step

This member-only article appears in the December issue of Patient Safety Monitor Journal.

Holly Gibbs has been the director of Dignity Health’s Human Trafficking Response Program since 2015. She is also a survivor of child sex trafficking, recovered by law enforcement when she was 14. After her rescue, she was taken to an emergency department for assessment.
“What I remember most about this experience,” she says, “is that I was left alone in a room—I felt very isolated. The healthcare staff didn’t talk to me. I felt like they were disgusted by me, like I wasn’t worth their time. In reality, the staff probably didn’t know what to say to me.”

The Dignity Health system, HEAL Trafficking, and the Pacific Survivor Center teamed up to create a tool that could identify and care for victims/survivors of any form of abuse, neglect, or violence, including human trafficking. Together, they published the PEARR Tool, a suite of procedures to guide providers in providing assistance to possible abuse victims.

The worst thing a care provider can do when they suspect victimization, Gibbs says, is ignore the patient’s needs and concerns. “This is why we developed the PEARR Tool,” she says. “It offers step-by-step guidance for healthcare professionals to offer assistance to victim/survivors of violence. And it offers example statements to help get the conversation started. The best approach someone can take is one that prioritizes the potential victim’s wishes, safety, and well-being.”

Released in 2018, PEARR reflects principles of a trauma-informed and victim/patient-centered approach. It also provides additional instructions at various points where a conversation with a patient might come to an end.

The letters in PEARR stand for:
Provide privacy
Respect & Respond

1. Provide privacy
The first step is to provide a patient with a safe and private setting, she says. Ideally, that’s a private room with closed doors. And before discussing any sensitive topics, you need to explain your limits of confidentiality. That includes your legal requirements to report suspicions of abuse, neglect, or violence to internal staff and/or external agencies according to law or regulation. This will require that staff know their federal, state, local, and facility reporting requirements. (If you asked a random provider in your facility, would he or she know those requirements?)

There may be cases where the patient has a guest or companion that refuses to be separated from the patient—a potential sign of abuse. Staff will need to learn strategies on how to separate patients from their companions. PEARR states this should be done in a nonthreatening manner, such as:
Asking the companion to help fill out registration forms in the lobby
Say there’s a requirement or need for a private exam, such as a radiology or urine test

If staff are unable to begin a private conversation with a patient or have difficulty dealing with the companion once the private conversation ends, PEARR calls for additional steps:
Report safety concerns to appropriate personnel (e.g., nurse supervisor, patient safety, security officer)
Report risk factors or indicators as required or permitted by law/regulation
Continue health services in a victim-centric and trauma-informed manner

2. Educate
The next step is to educate the patient about abuse, neglect, or violence in a nonjudgmental and normalized manner. You don’t want the person to feel singled out for questioning. PEARR uses the following as an example conversation opener: “I educate all of my patients about [blank] because violence is so common in our society, and violence has a big impact on our health, safety, and well-being. Let’s review some information together.”

You can use a brochure or card to review information about abuse, neglect, or violence. That way, you can offer it to the patient after the conversation.

You should determine which types of abuse, neglect, or violence to talk about based on the risk factors at hand. A patient could be dealing with child abuse and neglect, domestic violence, sexual violence, human trafficking, or other problems that will require different information. PEARR offers several risk factor resources on its site.

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