The Welfare Soul of I.N.P.S. (Istituto Nazionale di Previdenza Sociale) in Support of Women Victims of Violence in 8-Step Guide and in Project of a New Medical-Legal Activity based on Forensic Trauma Criteria

Mini Review

Following up on a previous publication [1], the project presented here aims to improve understanding and support for victims of gender violence, including the minors involved.

To the economic-administrative measures already adopted by Italian social security institute named I.N.P.S. (Istituto Nazionale della Previdenza Sociale)-such as cultural change, “freedom income”, regulations on ISEE (Equivalent Economic Situation Indicator) and “inclusion allowance”-described in the “8-step Guide”, the hypothesis of an integrated intervention is added. It is based on traumatological forensic investigations conducted by medical-legal units of I.N.P.S. with the aim of providing qualified technical and healthcare support.

The approach is supported by numerous studies [2-4] that highlight the importance of forensic research, data collection and multidisciplinary collaboration; specifically, literature confirms usefulness of service since all forensic medicine service can be a reliable source of statistical data and forensic research is useful for identifying predictive factors of homicides; and again, Lancet magazine published a contribution on usefulness of interventions prevent or respond to violence: while Ministry of Health has expressed its opinion on the need to strengthen research and research capacity for evaluation of interventions against violence and strengthen response of health sector.

Based on sources and guidelines [5,6] that already regulate care pathways in healthcare facilities, the project proposes a system applicable at both an operational and instrumental level. This system involves specialized and multidisciplinary staff (medical-legal examiners, psychologists, social workers) of medical-legal units of I.N.P.S, operating in a context free of the pressures linked to the emergencies of local and hospital structures.

Specialist Activity Would be Divided into Three Main Phases:

1. Assessment phase: involves a diagnostic assessment through an in-depth anamnestic investigation, aimed at reconstructing the dynamics and the harmful modalities, also useful for differential diagnosis. A detailed body inspection follows, supported by the use of body diagrams and photographic surveys.

2. Evaluation phase: focuses on analysis of disabling states resulting from trauma, following guidelines outlined by Guidelines expressed by I.N.P.S. Superior Medical Commission. This phase involves the establishment of medical Commissions, which may include specialist figures in accordance with new Disability Delegation Law no. 227/2021 (Implementation decree no. 62/2024).

3. Support phase: activity can provide assistance to Judicial Authorities and contribute to statistical-epidemiological studies, thus supporting work of National Observatory on gender violence.

Given the delicacy of investigation and characteristics of phenomenon, adequate professional training of medico-legal healthcare professional will be recommended, in relation to anamnestic methodology, adequate evaluation of outcomes with correct identification of means, methods and times of production of traumas; in fact, Ministerial Decree of 2017, in Italy, specifies the need for professional training.

Confirming that this project represents a significant advancement towards a more robust and specialized support and verification system for victims of gender violence, with the aim of improving effectiveness of protection and assistance measures currently in place, the Guarantee Committee (Comitato Unico di Garanzia) of I.N.P.S., with its President, Maria Giovanna De Vivo, enthusiastically welcomed the doctors’ project, including it in the positive action plan envisaged for the three-year period 2025/2027, providing, within “I.N.P.S. for all” project, implementation of awareness and information, activities aimed at preventing violence against women, improvement of the policy in favor of women victims of violence through agreements for job placement of women, and also concrete implementation of presented pilot project starting at Avellino medical legal units, under the name of “The Legal Medical Center alongside women victims of violence”.

References

• Picciocchi E (2024) The contribution of the Italian Institute of Social Security (INPS) to the protection of female victims of abuse with a 7-Step Guide. Further hypothesis of a traumatological forensic health medico-legal assessment. E Minerva Forensic Medicine.
• Y Mellouki, L Sellami, L Saker, N Belkhadja, Y Zerairia, F Kaious, et al., (2023) The epidemiological and medico-legal characteristics of violent deaths and spousal homicides through a population of women autopsied within the Forensic Medicine Department of the University Hospital of Annaba. BMC Women's Health.
• Loraine J Bacchus, Manuela Colombini, Isabelle Pearson, Anik Gevers, Heidi Stöckl, et al., (2024) Interventions that prevent or respond to intimate partner violence against women and violence against children: a systematic review. Loraine J Bacchus et all. Lancet Public Health.
• (2014) Informativa OMS violenza contro le donne. Ministero della Salute.
• (2013) Manuale per operatori sanitari su violenza di genere. Procedura unica interaziendale. OMS.
• (2017) Linee guida nazionali per le Aziende sanitarie e le Aziende ospedaliere in tema di soccorso e assistenza socio-sanitaria alle donne vittime di violenza. Decreto del Consiglio dei Ministri.