Preparing your practice to respond to survivors of intimate partner violence

pediatricianSummary:

  • Explanation of health impact and cost of domestic and intimate partner violence.
  • The Affordable Care Act recommends universal screening for intimate partner violence for women of child-bearing age to improve health and safety.
  • Domestic violence advocates and community-based organizations are prepared to support providers in delivering best practice care.

The Problem

Intimate partner violence (IPV) is defined as “physical violence, sexual violence, threats of physical or sexual violence, and psychological/ emotional violence. This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy” (CDC, 2010).

Prevalence: Nearly one in four women in the United States report experiencing violence by a current or former intimate partner at some point in her life. Vulnerable populations, such as youth, can be especially at risk for violence. 53% women aged 16-29 in family planning clinics reported physical or sexual violence from an intimate partner.1

Health effects: Exposure to IPV has significant adverse consequences for physical and mental health. 37% of all women who sought care in hospital emergency rooms for violence-related injuries were injured by a current or former partner.2 Women who have experienced domestic violence are 80% more likely to have a stroke, 70% more likely to have heart disease, 60% more likely to have asthma and 70% more likely to drink heavily than women who have not experienced IPV.3

Health cost: A 2009 study of more than 3,000 women from a large Pacific Northwest-based health plan found that healthcare costs for women suffering ongoing abuse were 42% higher than for women who were not abused. Healthcare costs remain higher even when the abuse is over. Women who suffered physical abuse five or more years earlier had healthcare costs that were 19% higher than women who were never abused.4

Clinical importance of addressing IPV: Since experiencing abuse contributes to factors such as smoking, substance abuse, and stress, interventions aimed at these problems will not succeed without addressing IPV. Healthcare settings have a central role in connecting women experiencing abuse to services that will reduce IPV: violence and promote positive health outcomes. Interventions as short as two minutes have been shown to be effective in clinical settings.5

The Solution

The U.S. Preventive Services Task Force recommends that clinicians universally “screen women of childbearing age for intimate partner violence.”6 Given the new policies in support of addressing IPV in healthcare settings, and the imperative in Oregon to achieve the Triple Aim, improving practice around serving survivors of IPV is a clinically recommended, evidence-based solution.

Why your practice?

    • Healthcare settings provide a unique opportunity for screening and intervention because of trusting relationships, confidentiality, and space away from the abusive partner.
    • A recent study found that 44% of survivors of domestic violence talked to someone about the abuse; 37% of those women talked to their healthcare provider.7 Women may present to their doctor before a social service provider or legal advocate.
    • In four different studies of survivors of abuse, patients reported that they would like their healthcare providers to ask them privately about IPV.8
    • Women in family planning clinics who received both assessment and counseling on IPV-specific harm reduction strategies were 60% more likely to end a relationship because it felt unhealthy or unsafe.9 Assessment for reproductive coercion during family planning clinic visits was associated with a 70% reduction in pregnancy coercion.10

How do I start?

      • Get training on tools to support screening and counseling for IPV and the effects of abuse on survivors. There are safety concerns when serving survivors. An uninformed intervention can cause potential harm. Learn more at www.healthcaresaboutipv.org.
      • Contact your local community-based organization or domestic violence advocate. Advocates have up-to-date resources to help support your patient to be safe and healthy. A domestic violence advocate can play a similar role to a community health worker or social worker in partnering with providers on patient support and care coordination.
      • Learn about promising practices in the field. Screening alone is not enough. When a patient discloses, support and harm reduction strategies must be implemented, and often a supported referral is needed. Oregon is home to many innovative pilots around partnership models for this supported referral. Learn more by calling the Oregon Coalition Against Domestic & Sexual Violence at (503) 230-1951.

        Get started today! Find your community-based program advocate online here.

1 Miller E, Decker MR, McCauley HL, Levenson R, Silverman JG. Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception April 2010 (Vol. 81, Issue 4, Pages 316-322, DOI: 10.1016/j.contraception.2009.12.004)

2 Rand, Michael R. 1997. Violence-related Injuries Treated in Hospital Emergency Departments. U.S. Department of Justice, Bureau of Justice Statistics. Washington, DC.

3 Adverse Health Conditions and Health Risk Behaviors Associated with Intimate Partner Violence, Morbidity and Mortality Weekly Report. February 2008. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/mmwr/PDF/wk/mm5705.pdf

4 Bonomi AE, Anderson ML, Rivara FP, Thompson RS. 2009. Health Care Utilization and Costs Associated with Physical and Nonphysical-Only Intimate Partner Violence. Health Services Research, 44(3): 1052-67.

5 Soeken, K., McFarlane, J., Parker, B. 1998. “The Abuse Assessment Screen. A Clinical Instrument to Measure Frequency, Severity and Perpetrator of Abuse Against Women.” Beyond Diagnosis: Intervention Strategies for Battered Women and Their Children. Thousand Oaks, CA: Sage.

6 Nelson HD, Bougatsos C, Blazina I. Screening Women for Intimate Partner Violence and Elderly and Vulnerable Adults for Abuse: Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 May. (Evidence Syntheses, No. 92.)

7 The Dorchester Community Roundtable Coordinated Community Response to Prevent Intimate Partner Violence. 2003.

RMC Research Corporation. Portsmouth, New Hampshire.

8 McCauley J, Yurk R, Jenckes M, Ford D. 1998. “Inside ‘Pandora’s Box’: Abused Women’s Experiences with

Clinicians and Health Services.” Archives of Internal Medicine. 13:549-555.

9 Miller E, Decker M, McCauley H, Tancredi D, Levenson R, Waldman J, Schoenwald P, Silverman J.A Family Planning Clinic Partner Violence Intervention To Reduce Risk Associated with Reproductive Coercion. Contraception – 01 September 2010 (10.1016/j.contraception.2010.07.013).

10 Ibid.

 

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