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[实施亲密伴侣暴力预防多学科网络]

[Implementing a pluridisciplinary network of intimate partner violence prevention].

作者信息

Bazex H, Thomas A, Combalbert N, Lignon S

机构信息

Direction de la recherche CIRAP, ENAP, association Previos, 440, avenue Michel-Serres, BP 28, 47916 Agen cedex 9, France.

出版信息

Encephale. 2010 Feb;36(1):62-8. doi: 10.1016/j.encep.2008.11.004. Epub 2009 Mar 6.

Abstract

INTRODUCTION

The victims of a spouse's violence have a high risk of developing mental and physical health symptoms. The efforts aimed at preventing the consequences of domestic violence are encouraged by the current literature as well as the national and international recommendations. They highlight the fact that intervention and treatment programs have more or less failed.

BACKGROUND

This publication introduces the main stages of the implementation of a network, the main goals of which are to improve the knowledge and professional practices aimed at the victims of domestic violence, and to enhance the continuation and quality of health and social care (screening, assessment and addressing). After relating the developments and the methodology of the victims' consultations carried out, we will show how such a network device enables one to exceed the usual practice limits. First, we point out certain specificities pertaining to postimmediate psychological care (psychological debriefing) of victims of intimate partner violence.

METHODOLOGY

After presenting a specific methodology of assessment of the global situation of the victim, three illustrations of the specific consequences of domestic violence will be made, in order to highlight the interest of collaborating between professionals who are used to tackling this issue. First, is the way to empower women and help them to avoid assaults and thus prevent victimisation. The overall goal of this specific intervention is to teach women that they can end the cycle of perpetuating of intimate partner violence by learning safety factors, such as what to do if more violence occurs and where and how to seek assistance if it were to recur. Second, is to prevent the consequences of domestic violence on a child's development. It is based on the fact that children who witness domestic violence are negatively affected, as children who witness abuse are likely to experience a number of psychological symptoms. So the network proposes preventive measures and specific addressing to reduce the impact of violence. The third example relates to the high proportion of sexual assault among the nature of violence women suffer from. Victims of marital rape experience significant levels of negative mental and physical health symptoms. Network professionals have improved the screening of sexual assault in order to propose to the victims specific addressing, in terms of gynaecologic and psychological care.

DISCUSSION

As a consequence, we deal with the professional and deontological positioning that the medical professionals have towards this device. The network device aims at going beyond the limits of the usual care, both through a pooling of knowledge and multidisciplinary practices. The establishment of common models of intervention (working groups), also suggests a best practice in relation to complex issues: the establishment of a network is a means of establishing the link between professionals. However, professionals in a network should routinely question their practice and ethics and to avoid "confusion of roles" - the risk of multidisciplinary and standard practices. Differences and professional specialisation are essential components of a care offer tailored to the clinical complexity of victims of domestic violence. It now appears necessary to assess the impact of this care at the social, health and psychological levels of victims of domestic violence.

摘要

引言

遭受配偶暴力的受害者出现身心健康症状的风险很高。当前的文献以及国家和国际建议都鼓励采取措施预防家庭暴力的后果。这些措施强调了干预和治疗方案或多或少都存在失败的情况。

背景

本出版物介绍了一个网络实施的主要阶段,该网络的主要目标是提高针对家庭暴力受害者的知识水平和专业实践能力,并加强健康和社会护理(筛查、评估和应对)的持续性和质量。在讲述了受害者咨询的进展和方法之后,我们将展示这样一个网络装置如何能够突破常规做法的限制。首先,我们指出亲密伴侣暴力受害者即时心理护理(心理疏导)的某些特殊性。

方法

在介绍了评估受害者整体状况的具体方法之后,将给出家庭暴力具体后果的三个实例,以突出习惯于处理这一问题的专业人员之间合作的益处。首先,是增强妇女权能并帮助她们避免遭受攻击从而预防受害的方法。这一具体干预措施的总体目标是教导妇女,她们可以通过学习安全因素来结束亲密伴侣暴力的持续循环,比如如果再次发生暴力该怎么做,以及如果暴力再次发生在哪里以及如何寻求帮助。其次,是预防家庭暴力对儿童发展的影响。这基于目睹家庭暴力的儿童会受到负面影响这一事实,因为目睹虐待的儿童可能会出现一些心理症状。因此,该网络提出了预防措施和具体应对方法以减少暴力的影响。第三个例子涉及妇女所遭受的暴力性质中性侵犯的比例很高。婚内强奸的受害者会出现严重的负面身心健康症状。网络专业人员改进了性侵犯筛查,以便在妇科和心理护理方面为受害者提供具体的应对方法。

讨论

因此,我们探讨了医疗专业人员对这一装置的专业和道义定位。该网络装置旨在通过知识汇集和多学科实践突破常规护理的限制。建立共同的干预模式(工作组)也暗示了针对复杂问题的最佳实践:建立网络是在专业人员之间建立联系的一种方式。然而,网络中的专业人员应该经常审视自己的实践和道德规范,避免“角色混淆”——多学科和标准化实践的风险。差异和专业分工是根据家庭暴力受害者的临床复杂性提供个性化护理的重要组成部分。现在看来有必要评估这种护理对家庭暴力受害者在社会、健康和心理层面的影响。

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