Healthcare provider speaks compassionately with young female patient showing possible signs of domestic violence

Assessing and Caring for Victims of Intimate Partner Violence

Social scientists and healthcare professionals define intimate partner violence (IPV) as any behavior that occurs within an intimate relationship that causes physical, psychological, or sexual harm to a partner within the relationship. These behaviors are perpetrated by a person who is, was, or wishes to be in a relationship with the victim and aims to gain control over them.  

IPV occurs in women and men regardless of their economic status, gender, age, ethnicity, sexual orientation, religion, or educational background. It can occur in both heterosexual or same-sex relationships with a higher prevalence in low-income, under-educated, rural, and pregnant populations. 

Recommended course: Intimate Partner Violence Compassionate Care, Effective Assessment 

How many men and women are victims of intimate partner violence? 

According to the Centers for Disease Control and Prevention (CDC), one in three women and one in four men in the United States have experienced severe physical violence at some point in their lifetime. Between 2003 and 2012, law enforcement records tied 15% of all violent crimes to IPV. Although experts estimate that intimate partners abuse 10 million men and women annually, the true incidence of IPV is unknown, as many victims are afraid to seek appropriate care. 

Barriers preventing effective, compassionate care 

Healthcare providers are an essential resource in providing empathic, compassionate care to vulnerable populations for which IPV screening can have a huge impact. Despite this, many barriers exist preventing effective and safe screening for those currently experiencing or at risk of IPV.  

Potential barriers preventing effective screening and care include a lack of time, a lack of a private screening area, or a lack of appropriate knowledge of the resources and screening questionnaires available in their community. Without proper policies and protocols, the identification of potential victims of IPV can be difficult and pose a barrier to early intervention.  

The fear of retaliation by the aggressor is an important factor preventing many victims from seeking help. Handouts and pamphlets can place a patient at risk of escalating violence if their partner finds the documents. To overcome this barrier, technology (e.g. QR codes) and posters in private bathrooms help provide discreet screening opportunities. However, these tools are limited by the literacy level and lack of knowledge of the patient as to the implications of answering yes to the screening questions.   

Screening tools to identify potential victims of intimate partner violence

According to the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, healthcare providers should screen for IPV at frequent, regular intervals. One of several available validated tools can perform these screenings. 

  • Hurt, Insult, Threaten, and Scream (HITS) is a four-question screening tool published in 1998. Experts throughout the years have validated the questionnaire as a self-administered or clinician-administered screening tool. Each question is rated on a 5-point scale. With a range of 4 to 20 points, 10 points and 11 points are used as cut-offs to identify victimized female and male patients, respectively.  
  • Women Abuse Screening Tool (WAST) is a seven-question screening tool. It is also available as the WAST-Short questionnaire, which consists of only two questions. Women who answer affirmatively to the two questions on the WAST-Short screening tool are high-risk individuals. Ultimately, these women should be assessed on different factors such as previous abuse, severity of abuse, need for legal services, and provided information about community resources. 

Studies have identified self-administered and clinician-administered screening tools as equally effective in detecting IPV. Additionally, recent studies have assessed computer-assisted screenings in the healthcare setting, noting this method increases opportunities to discuss IPV and increase the detection of IPV safely and confidentially.  

Interviewing techniques in situations involving suspected IPV 

Identifying, preventing, and intervening are important roles of physicians when encountering patient situations involving suspected IPV. Research involving survivors of IPV confirms that survivors welcome a clinician’s questioning and screening, as long as the clinician questions them in a nonjudgmental, respectful manner. Effective physician interviewing should use a patient-centered framework to identify and address IPV including these four components:  

  • Awareness 
  • Identification 
  • Intervention 
  • Prevention 

Physicians should pay attention to the role violence can play in health-related conditions. Incorporating questions on violence into a routine patient history can help identify IPV and build the patient-physician relationship. Beginning with broad, less threatening questions regarding victimization can reduce defensive responses and ease the transition into more specific questioning.  

The use of screening tools can help identify IPV in clinical settings and alert clinicians that further evaluation may be required. When conducted in a safe and secure environment, the potential to disclose possible abuse increases.  

The SOS-DoC framework can guide a physician when caring for victims of intimate partner violence. This framework includes: 

  • S: Offering support and assessing safety 
  • O: Discussing options including safety plans and follow-up 
  • S: Validating strengths of the survivor 
  • Do: Documenting observations, injuries, and treatment plans 
  • C: Offering follow-up and accessing barriers to their access 

Effective strategies for IPV prevention lack clinical support, but simple strategies like pamphlets and posters to help educate patients on IPV and healthy relationships. Education can help patients identify potential abuse and improve outcomes. 

Key elements of a safety plan for victims of intimate partner violence

Effective safety planning utilizes strategies to enhance a victim’s self-awareness of situations involving IPV-related risk factors. It empowers them with the necessary skills to seek safety. Recognizing that survivors of IPV may be unable or unwilling to leave an abusive relationship, safety planning provides survivors with knowledge of options and behaviors to help enhance their safety and minimize harm.  

Developing a safety plan for those in an abusive relationship 

  • Develop a support network. Discussing abuse can be embarrassing for the survivor. Identifying someone they trust and can count on in a crisis is essential to staying safe and recovering.  
  • Know safe places. Identifying local domestic violence shelters or a family member’s house and a safe route to these locations enables a survivor to remove themselves from potentially dangerous situations. 
  • Create a code word. Develop a code word with children or a support network member that signifies the need to leave the area or identifies a survivor’s need for help. 
  • Pack an emergency bag. Having an emergency bag packed and ready will help save time and provide essential items during the first few days. 
  • Have an escape. Avoid one-entry rooms such as bathrooms or bedrooms where a survivor can become trapped. Stay close to doors and windows for easy exit. 

Actionable elements of a safety plan 

  • Open a personal savings account. Survivors should establish a savings account in their name and contribute to it as much as possible.  
  • Copy important documents. Make copies of important documents such as a social security card and birth certificate and place them in your escape bag or store them at a relative’s house. 
  • Pack an emergency bag. Keeping an emergency bag available with cash, spare keys, license, credit cards, and important documents and phone numbers is essential for survival. 
  • Escape route. Develop an escape plan including where to go and the route and commit it to memory. 

As physicians, screening and effective care can significantly impact the lives of our IPV patients. Staying current on the evolving literature and adopting effective techniques can help not only improve your care but save a life in the meantime.