San Francisco's response to domestic violence has been strengthened by recent institutional changes within the health care community. For example, San Francisco General Hospital has developed and implemented changes in its policies for addressing domestic violence. As a pilot site for the FUND's health care project, a multidisciplinary team from the hospital received resource materials, technical assistance and training from the FUND. The team, which included administrators, doctors, nurses, social workers, and a local domestic violence advocate, used these as a basis to formulate a response policy for the hospital and to develop a packet of materials for staff to use in responding to domestic violence cases. The emergency room was the first hospital department to train staff and adopt the new protocol. All emergency room staff, including paramedics, nurses, doctors, social workers, interpreters, clerks and security officers, have been trained in the new procedures. Training and use of these protocol are beginning to occur in eight other hospital departments as well.
Public health clinics in San Francisco are also beginning to develop domestic violence policies using the FUND's materials as a starting point. However, there are several differences between the services provided by public health clinics and emergency rooms, which may influence the features of the public health clinic's protocol. While the emergency room usually sees only the victim of domestic violence, both battered women and their batterers may seek care from public health clinics. Also, the emergency room typically sees the victim only one-time and the victims usually have specific injuries caused by domestic violence. Public health clinics, on the other hand, provide primary care for a wider range of conditions related to abuse such as depression, abdominal pains, chronic headaches, or other stress-related disorders. Public health clinic staff must take these differences into account in developing their protocol. However, like San Francisco General Hospital, the public health clinics have assembled multidisciplinary teams to develop the protocol which will assign different responsibilities to various staff within the clinic.
The San Francisco Family Violence Council has developed county-recommended domestic violence protocol and training guidelines which have been endorsed by the major city leadership and health organizations. These protocol and guidelines will be distributed to all hospitals, clinics and physicians in the San Francisco community in October 1996.