Studies show that intimate partner violence (IPV) affects the physical and mental health of victims and the children who witness it. Because IPV is widespread and the consequences, acute and chronic, are serious, health care organizations have encouraged providers to identify patients experiencing IPV and refer them to local resources. To date a number of screening tools have been validated, but research is limited on how provider identification impacts the health and quality of life of IPV victims. Several best practice guidelines have been developed to guide providers in the identification and management of IPV. Research demonstrates that training alone is insufficient to ensure that providers screen for IPV. Rather, system wide approaches that incorporate prompts about screening, formal training with tool kits, referral resources and routine consultation, and timely feedback with providers on the initiative or program have been the most successful.
Health Impact
IPV victims use more health care resources than persons who are not abused. Health care costs for victims are almost 50% higher than those of nonvictims. Much of this is nonemergent care. In the primary care office, 11% to 22% of women are currently experiencing physical violence by an intimate partner. In fact, almost half (47%) of the victims who were murdered by their intimate partners were seen in the health care setting for general health or mental health issues during the year prior to their deaths. In addition to injuries, studies show that chronic health conditions, such as migraine headaches, chronic pain, and irritable bowel syndrome are common among victims of IPV. A recent study by the Harvard School of Public Health demonstrates that physical violence compromises a woman’s health during pregnancy, her likelihood of carrying a child to term, and the fetal development and health of her newborn. Mental health diagnoses such as depression, substance abuse, anxiety, and posttraumatic stress disorder occur up to four times more often in victims compared to persons who are not abused.
Health Care Response
Since 1992 professional health care organizations, such as the American Medical Association (AMA), American Academy of Family Physicians, American College of Obstetrics and Gynecology (ACOG), American College of Physicians, and American Nurses Association, have encouraged health providers to identify and treat IPV victims. Recognizing the impact of witnessing IPV on children, the American Academy of Pediatrics encouraged pediatricians to screen during well-child visits and when children presented with symptoms or problems often associated with IPV exposure (e.g., behavior problems, depression, and chronic pain complaints). In 1992, the Joint Commission on Healthcare Organization Accreditation introduced standards that hospitals and their associated clinics must adhere to regarding the identification and management of patients living with IPV as part of accreditation.
The AMA, ACOG, the Family Violence Prevention Fund, and others have developed best practice guidelines that endorse screening all women for IPV during well-woman exams and when women present with “red flag” signs and symptoms, such as injuries, chronic conditions, depression, or pregnancy concerns. Always keeping in mind victim privacy and confidentiality, providers are encouraged to respond by (a) validating the victim’s experience, (b) affirming no one deserves to be abused, (c) assessing support and safety, (d) sharing IPV resources, and (e) scheduling follow-up appointments.
Recognizing that an intimate relationship is abusive and attaining behavior change is a process, and health providers are encouraged to respect the victim’s timeline and decisions in coping with the abusive relationship. In most states, it is not mandatory to report IPV to authorities, unless a weapon is used or severe injury occurs.
Current Research
Evidence-based reviews neither support nor negate the value of these efforts in the health care setting, but call for further research as much evidence is anecdotal in nature. Rebuttals to these reviews encourage efforts to identify signs of IPV in patients, due to the prevalence and impact of IPV, in order to produce comprehensive and quality care. Failing to identify signs of IPV means the provider may miss an important dimension of the patient’s situation and associated stressors that are contributing to the patient’s health condition. For example, treating migraines without identifying IPV may result in a reduced benefit to the overall health and function of a patient. Conversely, treating headaches and discussing safety and available options would be more comprehensive.
Qualitative research shows that victims want to be asked about IPV, even if they do not disclose immediately. Victims report wanting hope and knowing that support and options are available. A number of validated screening tools exist. Recent work by Harriet MacMillan demonstrates that women prefer self completed (computer, audiotape, or written) to faceto-face questioning about IPV. All formats identify similar rates of IPV.
Research on what types of interventions impact the health and welfare of victims is limited. Studies show that discussing safety behaviors with a nurse helped women adopt more of the behaviors. Victims also need help with obtaining orders of protection, which decrease the occurrences of abusive incidents. Postshelter advocacy and counseling have been found to improve women’s scores on quality of life, social supports, depression, and self-esteem as well as to elevate self-worth scores for children. Onsite advocacy services improve provider screening and referral rates.
Specialized Training for Health Care Providers
Despite the encouragement of professional organizations, less than 10% of health providers routinely inquire about IPV. Training alone does not increase screening rates. However, specialized training based on models for behavior change with built-in reinforcement, such as feedback on screening, chart prompts, newsletters, and periodic updates on patient outcomes, improves rates of inquiry. System wide approaches, like those instituted at Woman Kind in Minnesota and Kaiser Permanente in California with specialized training and victim interventions, have brought about improved outcomes and comprehensive system change. Support from system administration and health leaders, who make IPV management a priority, allocate resources, ensure training of staff, and deliver necessary health system supports, is essential for success. Collaboration with local advocacy services is also imperative.
Future Opportunities
With more research, there are many opportunities to improve the care of victims within the health care setting. IPV impacts the physical and mental health of victims, perpetrators, and children. More research on how to assist all members of the family and identifying and implementing public health prevention efforts are important goals for future work.
Bibliography:
- AMA Council on Scientific Affairs. (2005, June). Report 7 of the Council on Scientific Affairs (A-05): Diagnosis and management of family violence. Chicago: American Medical Association.
- American College of Obstetrics and Gynecology (ACOG). (1999). Domestic violence: Educational bulletin. Washington, DC: Author.
- American College of Physicians. (1986, March 3). Domestic violence. Position paper presented to the American College of Physicians, Philadelphia.
- Committee on Child Abuse and Neglect, American Academy of Pediatrics. (1998). The role of pediatricians in recognizing and intervening on behalf of abused women. Pediatrics, 101, 1091–1092.
- Flitcraft, A. H., Hadley, S. M., Hendricks-Matthews, M. K., McLeer, S. V., & Warshaw, C. (1992). American Medical Association diagnostic and treatment guidelines for domestic violence.
- Chicago: American Medical Association. Institute of Medicine. (2002). Confronting chronic neglect: The education and training of health professionals on family violence.
- Washington, DC: National Academy Press. MacMillan, H. L., et al. (2006). Approaches to screening for intimate partner violence in health care settings. Journal of the American Medical Association, 296(5), 530–536.
- Nelson, H. D., Nygren, P., McInerney, Y., & Klein, J. (2004). Screening women and elderly adults for family and intimate partner violence: A review of the evidence for the U.S. preventive services task force. Annals of Internal Medicine, 140, 382–386.
- Ramsay, J., Richardson, J., Carter, Y., Davidson, L., & Feder, G. (2002). Should health professionals screen women for domestic violence? Systematic review. British Medical Journal, 325, 314–318.
- Silverman, J. G., Decker, M. R., Reed, E., & Raj, A. (2006). Intimate partner violence victimization prior to and during pregnancy among women residing in 26 U.S. states: Associations with maternal and neonatal health. American Journal of Obstetrics and Gynecology, 195(1), 140–148.
- Wathen, C., & MacMillan, H. (2003). Interventions for violence against women: Scientific review. Journal of the American Medical Association, 289(5), 589–600.
This example Health Care Response to Intimate Partner Violence Essay is published for educational and informational purposes only. If you need a custom essay or research paper on this topic please use our writing services. EssayEmpire.com offers reliable custom essay writing services that can help you to receive high grades and impress your professors with the quality of each essay or research paper you hand in.
See also:
ORDER HIGH QUALITY CUSTOM PAPER
Always on-time
Plagiarism-Free
100% Confidentiality
Special offer!
