Benefits of Domestic and Sexual Violence (DSV) Advocates in Health Care Settings
Oregon Coalition Against Domestic & Sexual Violence 2015 IPV & Healthcare Workgroup Product
Author: Myste French, MSW, Battered Persons’ Advocacy, Roseburg, Oregon
Domestic and sexual violence (DSV) have short and long-term impacts on survivors’ health. In addition to injuries sustained during violent episodes, abuse is linked to a number of adverse health effects including: depression, substance abuse, arthritis, chronic neck and back pain, migraines, problems seeing or speaking, sexually transmitted infections, and stomach ulcers1. The Affordable Care Act requires health plans to cover women’s preventative services including screening and counseling for interpersonal and domestic violence2.
Health Care Based DSV Advocacy
Establishing or strengthening a professional collaboration between DSV programs and health care organizations provides opportunities for advocates to work directly with victims identified in the health care setting. Advocates working in partnership with health care systems have unique opportunities to reach victims accessing primary care, women’s health, prenatal care, labor and delivery, urgent care, behavioral health, addictions treatment, dentistry and more.
The Role of the DSV Advocate
Advocates can offer patients safety planning, emergency shelter, housing resources, support groups, youth services, legal advocacy, and referrals which may be beyond a health care provider’s scope of practice. Within the health system an advocate might accompany a survivor to medical appointments, provide crisis counseling, facilitate on-site support groups, or even participate with the health care team in conducting DSV screening and assessment.
Through consultation, training, and technical assistance advocates can support providers in improving their skills and sensitivity in assessing and responding to DSV. Advocates should place particular emphasis on the importance of discussing the limits of confidentiality prior to screening for domestic or sexual violence. DSV Advocates can encourage providers to define success in terms of efforts to reduce isolation, options to improve survivor safety, and referrals to DSV advocacy.
Advocates can also support health care systems in creating an environment which enhances, rather than discourages the identification of abuse and its impacts on health; which prioritizes victim safety, confidentiality, integrity, and autonomy over their own life choices. DSV advocates may also provide health care facilities with posters, safety cards, screening tools, and other materials and products to enhance identification and response to violence.
On Site or Co-Located Advocacy Model
Advocates may have full time offices in a health care facility, be on site for specific days of the week when appointments can be made for patients, or may respond on site on an as needed basis. On site advocates work to integrate DSV awareness into the health care setting’s day-to-day operations including training health care providers to recognize the signs and symptoms of domestic violence, and how to talk to patients about what may be happening at home.
Advocates may also meet regularly with a multi-disciplinary task force in each facility, making sure the policies are supporting a proactive approach to domestic violence intervention3. Examples of policy-level improvements include: clinics establishing expectations of patient privacy during DSV screening; incorporating a screening tool into patients’ Electronic Medical Records; and requiring providers to receive domestic and sexual violence training.
Confidentiality, Mandatory Reporting, and Follow-Up
DSV advocates operate under the regulations of the Violence Against Women Act (VAWA 2013). As such, advocates are legally required to protect survivor’s confidentiality and are “prohibited from sharing personally identifying information about victims without informed, written, reasonably time-limited consent”4. In addition, DSV advocates are excluded from duty to report child abuse under Oregon Revised Statute 419B.005 and 419B.010. Unless an advocate’s status or licensure otherwise requires them to report, DSV advocates are not considered mandatory reporters.
Without a written release of information, advocates are unable to confirm whether they have followed-up with specific patients referred by providers. Alternatively, advocates could supply aggregate data on the number of referrals received from a given facility on a quarterly basis. Advocates partnering with health care facilities can also encourage providers to follow up with patients during their next visit, to determine if they were successful in accessing DSV services.
As a result of DSV advocacy and health care partnerships, DSV organizations may be invited to offer trainings to providers. These trainings endeavor to build on the skills of health care staff so that they understand the dynamics of DSV, are able and willing to assess for abuse, and can effectively respond to victims and their children. Training topics may include: Intimate Partner Violence and Health Outcomes; Confidentiality and Trauma-Informed Mandatory Reporting; and Screening and Intervention Tools for Intimate Partner Violence in Health Care Settings.
When a DSV organization is offering training to health care providers, advocates can play a vital role. Advocates partnering with health care should be aware of current research related to health and domestic violence, as well as existing tools available to support survivors. Allowing providers an opportunity to connect with an advocate during training can result in greater likelihood of providers making “warm” referrals to DSV advocacy organizations.
Support and Advocacy for Providers
The DSV advocate may also be presented with the opportunity to provide assistance directly to health care employees. Providers with a personal history of domestic or sexual violence might turn to the advocate as a resource, to consult with them regarding their own personal experience or concern over a friend or family member who is in an unsafe situation. Advocates are in a unique role and can extend their confidentiality practices to support survivors who are working within the health care system.
1 Coker, A., Smith, P., Bethea, L., King, M., McKeown, R. (2000). Physical Health Consequences of Physical and Psychological Intimate Partner Violence. Archives of Family Medicine, 9.
2 U.S. Department of Health and Human Services. Women’s Preventive Services: Required Health Plan Coverage Guidelines. Health Resources and Services Administration. http://www.hrsa.gov/womensguidelines. Accessed March 21, 2013.
3 Durborow, Nancy (2013). How to Create a Healthcare-based Domestic Violence/Sexual Assault Program. Futures Without Violence; National Health Resource Center on Domestic Violence. Accessed at: http://www.futureswithoutviolence.org/how-to-create-a-healthcare-based-domestic-violencesexual-assault-program/
4 Universal Grant Conditions: Nondisclosure of Confidential or Private Information. VAWA 2013 Section 3:42 U.S.C. 13935 (a)(20) & (b)(2)