Department heading

In the model phase, the Fulda Protection Outpatient Clinic primarily reached women as victims of partner violence and offered them an additional care service. The data of the case documentations show that the possibility of patient-assigned documentation makes sense especially for women who have experienced partner violence, as it offers the possibility to file a report at a later point in time (within the applicable time limits). In Fulda, there is also obviously a need for case management for victims of interpersonal violence, especially partner violence, which is also covered by the Protection Outpatient Clinic and which goes beyond the documentation of the consequences of injuries that can be used in court.

In the model phase, the Fulda Outpatient Clinic only reached a small proportion of victims of interpersonal violence whose injuries are to be documented. It seems to be perceived only to a limited extent as a place for documenting injuries in the context of violence in the community (violence in public spaces) that can be used in court. The target group of elderly people in need of care as victims of violence is currently not reached. An alternative care service exists for children.

During the pilot phase, it was not possible to satisfactorily sensitise health care providers to the issue of violence and to optimise the relief of health care providers in their tasks in the context of violence through the protective outpatient clinic. Applications for victim compensation only played a minor role in the outpatient protection clinic.

The data of the Fulda Protection Outpatient Clinic do not allow any conclusions to be drawn about the incidence of violence in the region; no conclusions for population-based interventions for the prevention of violence can be drawn from the data. Nevertheless, the Protection Outpatient Clinic should carry out a standardised (annual) evaluation of its cases, which would provide information on the number of cases, the form of violence and constellation of violence, the form of contacting the Protection Outpatient Clinic, the services provided by the Protection Outpatient Clinic and connections to criminal charges.

Recommendations for the transfer of the model to other regions can be derived from the experiences of the pilot phase. In principle, the ÖGD is suitable as a provider for a protective outpatient clinic. The disadvantages associated with this (relative remoteness from care and no 24-hour on-call service) could be better compensated by institutional cooperation, e.g. with emergency rooms. When deciding on a sponsorship, questions of existing competences and experience, access to patients of the health care system and financing options should be decisive.

From the point of view of qualifications, the protective outpatient clinic involves hybrid activities which, on the one hand, are not specifically trained in any occupational group and, on the other hand, do not require the full range of existing competences of individual occupational groups. A stronger orientation of the professional spectrum towards the practices of health care could possibly help to improve acceptance there. In the necessary further qualification, the focus is on observation and supervised activity as well as systematic self-study. Legal questions should be discussed with the regional public prosecutor's office.

Spatial requirements are a large examination room, sanitary facilities, a small waiting room, offices and an evidence room behind a security gate. Registration and a second waiting area, as well as a meeting room, can be located in front of the lock. A pleasant and relaxing atmosphere is important.

For a standardised procedure, courses of action could be developed that correspond to the legal situation. A discharge interview is followed, if there are no reasons for exclusion, by a physical examination, photographic documentation and later a detailed description. Indications of unclear findings or inadequately treated injuries require contact with the health care provider. Supplementary evidence is archived and preserved. This is followed by a risk analysis and referral to the further help system. Finally, it is discussed how to proceed with the documentation. Special procedures are necessary in the case of sexualised violence (specialist medical examination), in the case of children as victims of violence (determination of the personal degree of maturity, consent of the parents, anonymous counselling by the youth welfare office, commissioning by the youth welfare office and the police) and in the case of persons in need of care who are not capable of giving consent (consent care).

Active, regional networking and public relations work are central prerequisites for the success of the project.