The following is an important article:

JAMA. 2012 Aug 15;308(7):681-9. doi: 10.1001/jama.2012.6434.

Effect of screening for partner violence on women's quality of life: a randomized controlled trial.

Klevens J, Kee R, Trick W, Garcia D, Angulo FR, Jones R, Sadowski LS.

In fact, screening for DV without building some form of therapeutic alliance with the affected individual, be she a mother in a pediatric clinic with her child or an adult patient seeking care for herself is perhaps for the affected individual more risky than beneficial. Risky, in terms of both lack of trust that a report to authorities might be made or that the partner might find out that she has disclosed but also risky in terms of letting down psychological defenses that maintain her psychic equilibrium in the face of the chronic threat. That being said, as a clinician working primarily with mothers, infants, and young children, tell-tale signs in the mother's and/or child's reactions to inquiry about family functioning and observations of disturbances of the mother-child relationship can lead to an understanding of suffering that supports the formation of the alliance and to disclosure and safety-planning. Many primary-care professionals may not feel comfortable with what might be disclosed and hence there is a collusion with the avoidance of the affected individual. Thus reflective supervision of medical staff with a mental health perspective can improve the professionals' ability to engage adults affected by domestic violence.

You may find the following two papers of use to you.

ROSE, D., TREVILLION, K., WOODALL, A., MORGAN, C., FEDER, G. & HOWARD, L. 2011. Barriers and facilitators of disclosures of domestic violence by mental health service users: Qualitative study. The British Journal of Psychiatry, 198, 189-194

FEDER, G., AGNEW DAVIES, R., BAIRD, K., DUNNE, D., ELDRIDGE, S., GRIFFITHS, C., GREGORY, A., HOWELL, A., JOHNSON, M., RAMSAY, J., RUTTERFORD, C. & SHARP, D. 2011. Identification and Referral to Improve Safety (IRIS) of women experiencing domestic violence with a primary care training and support programme : a cluster randomised controlled trial. Lancet, The, 378, 1788-1795

I'm not too sure that the issue is specifically around visual, clinical or verbal barriers, as I agree with Daniel above that trust is the biggest issue, and usually that is person rather than environment dependent. However, there has been some work completed that suggested that the indirect nature of the approach taken by victims may result in help not being offered.

WILLIAMS, S. L. & MICKELSON, K. D. 2008. A paradox of support seeking and rejection among the stigmatized. Personal Relationships, 15, 493-509

In terms of issues surrounding disclosure for domestic violence, one of the best models I have seen is

BEAULAURIER, R. L., SEFF, L. R. & NEWMAN, F. L. 2008. Barriers to help-seeking for older women who experience intimate partner violence: a descriptive model. Journal Of Women & Aging, 20, 231-248

It may be that you could use a combination of the resources above mapped onto the patient journey you have in mind which might suggest specific aspects of your question for further work.

I hope this gives you a start, and would be interested to hear what you discover.

Hi both, thank-you for the insights. I was just assisting a Nurse Practitioner with a piece of research she is doing in this area. I have put together a bibliography for it. She is doing a PhD on this topic. When it becomes available I will send a link. In the meantime, this is the bibliography:

1999. Domestic violence in patients visiting general practitioners--prevalence, phenomenology, and association with psychopathology. S Afr Med J, 89, 635-40.

2004. Pilot educational outreach project on partner violence. Prev Med, 39, 536-42.

2007. What do abused women expect from their family physicians? A qualitative study among women in shelter homes. Women Health, 45, 105-19.

2011. Intimate partner violence. Am Fam Physician, 83, 1165-72.

AHMAD, F., HOGG-JOHNSON, S., STEWART, D. E., SKINNER, H. A., GLAZIER, R. H. & LEVINSON, W. 2009. Computer-assisted screening for intimate partner violence and control: a randomized trial. Annals of Internal Medicine, 151, 93-102.

BRADBURY-JONES, C., DUNCAN, F., KROLL, T., MOY, M. & TAYLOR, J. 2011. Improving the health care of women living with domestic abuse. Nursing Standard, 25, 35-40.

CORBALLY, M. A. 2001. Factors affecting nurses' attitudes towards the screening and care of battered women in Dublin A&E departments: a literature review. Accident & Emergency Nursing, 9, 27-37.

FLURY, M., NYBERG, E. & RIECHER-RÖSSLER, A. 2010. Domestic violence against women: Definitions, epidemiology, risk factors and consequences. Swiss Medical Weekly, 140, w13099-w13099.

GRUNFELD, A. F., RITMILLER, S., MACKAY, K., COWAN, L. & HOTCH, D. 1994. Detecting domestic violence against women in the emergency department: a nursing triage model. Journal Of Emergency Nursing: JEN: Official Publication Of The Emergency Department Nurses Association, 20, 271-274.

GUTMANIS, I., BEYNON, C., TUTTY, L., WATHEN, C. N. & MACMILLAN, H. L. 2007. Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses. BMC Public Health, 7, 12-12.

HEGARTY, K. & O'DOHERTY, L. 2011. Intimate partner violence - identification and response in general practice. Australian Family Physician, 40, 852-856.

HEWITT, L. N., BHAVSAR, P. & PHELAN, H. A. 2011. The secrets women keep: intimate partner violence screening in the female trauma patient. Journal of Trauma, 70, 320-323.

LIEBSCHUTZ, J., BATTAGLIA, T., FINLEY, E. & AVERBUCH, T. 2008a. Disclosing intimate partner violence to health care clinicians - what a difference the setting makes: a qualitative study. BMC Public Health, 8, 229-229.

LIEBSCHUTZ, J., BATTAGLIA, T., FINLEY, E. & AVERBUCH, T. 2008b. Disclosing intimate partner violence to health care clinicians - what a difference the setting makes: a qualitative study. BMC Public Health, 8, 229-229.

MORSE, D. S., LAFLEUR, R., FOGARTY, C. T., MITTAL, M. & CERULLI, C. 2012. "They told me to leave": how health care providers address intimate partner violence. Journal of the American Board of Family Medicine, 25, 333-342.

RAMSAY, J., RUTTERFORD, C., GREGORY, A., DUNNE, D., ELDRIDGE, S., SHARP, D. & FEDER, G. 2012. Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians. British Journal of General Practice, 62, 647-655.

RICKERT, V. I., DAVISON, L. L., BREITBART, V., JONES, K., PALMETTO, N. P., ROTTENBERG, L., TANENHAUS, J. & STEVENS, L. 2009. A randomized trial of screening for relationship violence in young women. Journal of Adolescent Health, 45, 163-170.

SOGLIN, L. F., BAUCHAT, J., SOGLIN, D. F. & MARTIN, G. J. 2009. Detection of intimate partner violence in a general medicine practice. Journal of Interpersonal Violence, 24, 338-348.

SPRAGUE, S., MADDEN, K., SIMUNOVIC, N., GODIN, K., PHAM, N. K., BHANDARI, M. & GOSLINGS, J. C. 2012. Barriers to Screening for Intimate Partner Violence. Women & Health, 52, 587-605.

SVAVARSDOTTIR, E. K. & ORLYGSDOTTIR, B. 2009. Identifying abuse among women: use of clinical guidelines by nurses and midwives. Journal Of Advanced Nursing, 65, 779-788.

TAN, E., O'DOHERTY, L. & HEGARTY, K. 2012. GPs' communication skills - a study into women's comfort to disclose intimate partner violence. Australian Family Physician, 41, 513-517.

TREVILLION, K. 2011. Domestic violence: responding to the needs of patients. Nursing Standard, 25, 48-56.

Dear Daniel and Jeanettte, the author has now published her Thesis.

I thought you might be interested in it. It is openly accessible in our repository, available at http://www.lenus.ie/hse/handle/10147/316150