Intimate partner violence: Opening the door to a safer future

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doi:doi: 10.12788/jfp.0475

Behavioral Health

Intimate partner violence: Opening the door to a safer future

J Fam Pract. 2022 September;71(7):309-313 | doi: 10.12788/jfp.0475

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References

1. CDC. National Center for Injury Prevention and Control. Preventing intimate partner violence. 2021. Accessed June 27, 2022. www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html

2. CDC. Black MC, Basile KC, Breiding MJ, et al. The National Intimate Partner and Sexual Violence Survey: 2010 Summary Report. Accessed June 27, 2022. www.cdc.gov/violenceprevention/pdf/nisvs_executive_summary-a.pdf

3. Chen J, Walters ML, Gilbert LK, et al. Sexual violence, stalking, and intimate partner violence by sexual orientation, United States. Psychol Violence. 2020;10:110-119. doi:10.1037/vio0000252

4. Kofman YB, Garfin DR. Home is not always a haven: the domestic violence crisis amid the COVID-19 pandemic. Psychol Trauma. 2020;12:S199-S201. doi:10.1037/tra0000866

5. Lyons M, Brewer G. Experiences of intimate partner violence during lockdown and the COVID-19 pandemic. J Fam Violence. 2021:1-9. doi:10.1007/s10896-021-00260-x

6. Parrott DJ, Halmos MB, Stappenbeck CA, et al. Intimate partner aggression during the COVID-19 pandemic: associations with stress and heavy drinking. Psychol Violence. 2021;12:95-103. doi:10.1037/vio0000395

7. CDC. National Center for Injury Prevention and Control. Costs of intimate partner violence against women in the United States. 2003. Accessed June 27, 2022. www.cdc.gov/violenceprevention/pdf/ipvbook-a.pdf

8. US Preventive Services Task Force. Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: US Preventive Services Task Force final recommendation statement. JAMA. 2018;320:1678-1687. doi:10.1001/jama.2018.14741

9. Sprunger JG, Schumacher JA, Coffey SF, et al. It’s time to start asking all patients about intimate partner violence. J Fam Pract. 2019;68:152-161.

10. Chan CC, Chan YC, Au A, et al. Reliability and validity of the “Extended - Hurt, Insult, Threaten, Scream” (E-HITS) screening tool in detecting intimate partner violence in hospital emergency departments in Hong Kong. Hong Kong J Emerg Med. 2010;17:109-117. doi:10.1177/102490791001700202

11. Iverson KM, King MW, Gerber MR, et al. Accuracy of an intimate partner violence screening tool for female VHA patients: a replication and extension. J Trauma Stress. 2015;28:79-82. doi:10.1002/jts.21985

12. Sohal H, Eldridge S, Feder G. The sensitivity and specificity of four questions (HARK) to identify intimate partner violence: a diagnostic accuracy study in general practice. BMC Fam Pract. 2007;8:49. doi:10.1186/1471-2296-8-49

13. Sherin KM, Sinacore JM, Li X, et al. HITS: a short domestic violence screening tool for use in a family practice setting. Fam Med. 1998;30:508-512.

14. Rabin RF, Jennings JM, Campbell JC, et al. Intimate partner violence screening tools: a systematic review. Am J Prev Med. 2009;36:439-445.e4. doi:10.1016/j.amepre.2009.01.024

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16. Brown JB, Lent B, Schmidt G, et al. Application of the Woman Abuse Screening Tool (WAST) and WAST-short in the family practice setting. J Fam Pract. 2000;49:896-903.

17. Wathen CN, Jamieson E, MacMillan HL, MVAWRG. Who is identified by screening for intimate partner violence? Womens Health Issues. 2008;18:423-432. doi:10.1016/j.whi.2008.08.003

18. Hegarty K, O’Doherty L, Taft A, et al. Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial. Lancet. 2013;382:249-258. doi: 10.1016/S0140-6736(13)60052-5

19. Correa NP, Cain CM, Bertenthal M, et al. Women’s experiences of being screened for intimate partner violence in the health care setting. Nurs Womens Health. 2020;24:185-196. doi:10.1016/j.nwh.2020.04.002

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24. National Domestic Violence Hotline. Interactive guide to safety planning. Accessed August 22, 2022. https://www.thehotline.org/plan-for-safety/create-a-safety-plan/

Screen patients in private; this protocol can help. Given the sensitive nature of IPV and the potential danger some patients may be facing, it is important to screen patients in a safe and supportive environment.^19,20 Screening should be conducted by the primary care clinician, ideally when a trusting relationship already has been formed. Screen patients only when they are alone in a private room; avoid screening in public spaces such as clinic waiting rooms or in the vicinity of the patient’s partner or children older than age 2 years.^19,20

To provide all patients with an opportunity for private and safe IPV screening, clinics are encouraged to develop a clinic-wide policy whereby patients are routinely escorted to the exam room alone for the first portion of their visit, after which any accompanying individuals may be invited to join.²¹ Clinic staff can inform patients and accompanying individuals of this policy when they first arrive. Once in the exam room, and before the screening process begins, clearly state reporting requirements to ensure that patients can make an informed decision about whether to disclose IPV.¹⁹

Set a receptive tone. The manner in which clinicians discuss IPV with their patients is just as important as the setting. Demonstrating sensitivity and genuine concern for the patient’s safety and well-being may increase the patient’s comfort level throughout the screening process and may facilitate disclosures of IPV.^19,22 When screening patients for IPV, sit face to face rather than standing over them, maintain warm and open body language, and speak in a soft tone of voice.²²

Patients may feel more comfortable if you ask screening questions in a straightforward, nonjudgmental manner, as this helps to normalize the screening experience. We also recommend using behaviorally specific language (eg, “Do arguments [with your partner] ever result in hitting, kicking, or pushing?”¹⁶ or “How often does your partner scream or curse at you?”),¹³ as some patients who have experienced IPV will not label their experiences as “abuse” or “violence.” Not every patient who experiences IPV will be ready to disclose these events; however, maintaining a positive and supportive relationship during routine IPV screening and throughout the remainder of the medical visit may help facilitate future disclosures if, and when, a patient is ready to seek support.¹⁹

CRITICAL INTERVENTION ELEMENTS: EMPATHY AND SAFETY

A physician’s response to an IPV disclosure can have a lasting impact on the patient. We encourage family physicians to respond to IPV disclosures with empathy. Maintain eye contact and warm body language, validate the patient’s experiences (“I am sorry this happened to you,” “that must have been terrifying”), tell the patient that the violence was not their fault, and thank the patient for disclosing.²³

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