Intimate partner violence (IPV) is defined by the Centers for Disease Control and Prevention (CDC) as “abuse or aggression that occurs in a romantic relationship,” and this refers to both current and former intimate partnerships. IPV includes physical and sexual violence, reproductive coercion, stalking, psychological aggression, and financial abuse/exploitation. It’s estimated that 41% of female-identifying individuals and 26% of male-identifying individuals experience IPV at some point during their lives. Notably, IPV can affect people of all genders and sexual orientations, with higher rates of IPV reported among bisexual and transgender individuals. Additional vulnerable populations include adolescents, older individuals, Black, Latinx, and People of Color (BIPOC), immigrants, people living with disabilities, people living on lower incomes, people in the military, people living with substance use disorders, and pregnant individuals.
IPV can have serious physical and mental health consequences for victims, including physical trauma (e.g., bruises, fractures, head trauma), chronic physical and mental health conditions (e.g., chronic pain, sexual health problems, anxiety, depression, post-traumatic stress disorder), poor pregnancy outcomes, societal and economic effects (e.g., social isolation, financial instability, difficulty finding employment or housing), and even death. It can also impact children who witness or experience violence in their homes, leading to behavioral and emotional problems, poor academic performance, and increased risk of future violence. Health care providers play a key role in screening for IPV and connecting people to resources. Here’s what you need to know:
When should I screen for IPV?
The American College of Obstetricians and Gynecologists recommends screening for IPV during all new patient visits, annual preventive visits, initial prenatal visits, as well as during each trimester of pregnancy and at postpartum checkup(s). The American Academy of Pediatrics recommends screening parents for IPV at early and regular intervals, which can be incorporated into the anticipatory guidance aspect of well-child checks. Non-specific signs that may prompt IPV screening include depression, anxiety, substance use, failure to keep medical appointments, requests for repeat pregnancy tests when the patient does not wish to be pregnant, new or recurrent sexually transmitted infections (STIs), or frequent clinical visits for nebulous concerns.
How should I screen for IPV?
There are several validated screening tools that can be used to assess for IPV, including:
- Hurt/Insult/Threaten/Scream (HITS)
- Partner Violence Screen (PVS)
- Woman Abuse Screening Tool (WAST)
- OVAT (Ongoing Violence Assessment Tool
- Abuse Assessment Scree
- STaT (Slapped, Things, and Threaten
- Humiliation, Afraid, Rape, Kick (HARK)
Importantly, research demonstrates that self-administered or computerized screenings are as effective as clinician interviewing.
It’s essential to consider the potential risks and benefits of screening for IPV. While screening can help identify patients experiencing violence, it can also put them at increased risk if their abuser is present or if the screening results are not kept confidential. Thus, it’s critical to ensure that screening is conducted in a safe and supportive environment and that appropriate resources are provided.
What are examples of best practices for implementation and intervention?
Kaiser Permanente Northern California (KPNC) has developed a comprehensive “systems model” approach that involves screening all patients for IPV at regular intervals using a standardized screening tool. The screening tool is embedded in the electronic medical record and can be administered by any member of the health care team, including medical assistants, nurses, and clinical providers.
If a patient screens positive for IPV, the health care team follows a standardized protocol for assessment, intervention, and referral. This includes a comprehensive assessment of the patient’s safety, including risk for future violence. Patients who disclose IPV are provided with information about safety planning, legal resources, and counseling services, and are referred to local advocacy organizations for additional support.
This model also includes a focus on community partnerships and collaboration to address IPV as a public health issue. KPNC works closely with local advocacy organizations and community partners to provide support and resources to patients and families affected by IPV and to promote community-level prevention efforts.
Another implementation and intervention approach includes CUES (Confidentiality, Universal Education + Empowerment, and Support), an initiative of Futures Without Violence. The CUES approach is based on a trauma-informed, patient-centered model of care and focuses on building strong, supportive relationships between health care providers and patients. The approach is organized around the following key steps:
- Confidentiality: Providers should ensure confidentiality by seeing patients alone for at least part of the clinical visit (and asking partners or others to step out of the room prior to screening for IPV). This can also help to build a strong, trusting relationship with the patient, which includes creating a safe and supportive environment where patients feel comfortable disclosing their experiences with IPV.
- Universal Education + Empowerment: Providers can share two safety cards with patients that help to discuss relationships and how relationships affect health. This evidence-based approach also encourages patients to share a safety card with a friend or family member.
- Support: Though disclosure of IPV is not necessarily the goal of this approach, it will likely occur in many instances (and over time). Providers can offer information about safety planning, legal advocacy, and counseling, and help patients to develop a personalized safety plan that meets their individual needs and circumstances. Providers should also offer ongoing support, which may include regular check-ins to ensure that the patient is safe and receiving appropriate care, as well as referrals to additional services as needed.
Additional interventions may include home visits, which can involve emotional support, education on problem-solving strategies, and parenting support, as well as a strong focus on self-efficacy and empowerment.
Am I mandated to report IPV?
Health care providers should be aware of the mandatory reporting laws in their states and how they apply to cases of IPV. Some states have mandatory reporting laws for all cases of suspected IPV, while others only require reporting in certain circumstances, such as when a child is involved or when the victim is elderly or disabled. Some states may also have reporting exemptions in cases where reporting could put the victim in danger or jeopardize their privacy.
To balance the need to comply with reporting laws, as well as the need to prioritize the safety of their patients, providers should make patients aware of reporting requirements prior to screening. This may include explaining the potential consequences of reporting and helping patients to understand their options for seeking help and support.
Health care providers play a critical role in identifying and responding to IPV, and there are several evidence-based screening instruments and intervention approaches available. Addressing IPV requires a comprehensive and multidisciplinary approach, and by working collaboratively to provide compassionate and effective care to patients who have experienced IPV, we can promote healing, recovery, and resilience for those affected by this epidemic.
- National Domestic Violence Hotline: 1-800-799-SAFE (7233)
- National Sexual Assault Hotline: 1-800-656-HOPE (4673)
- Love Is Respect Hotline: 1-866-331-9474
- Futures Without Violence: National Health Resource Center on Domestic Violence
- National Coalition Against Domestic Violence
- National Network to End Domestic Violence
- National Resource Center on Domestic Violence
- U.S. Department of Justice Office on Violence Against Women
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