Sunday, October 12, 2008

Intimate Partner Violence Challenges Intervention And Solutions: Part 2 Universal Screening

This is the second in a series of posts about what I learned at the all-day workshop sponsored by the Mayo Clinic Intimate Partner Violence Education and Prevention Committee.

The second session given by Marcia Britain DNP, RN, CNP and by Dale Nasby MS, RN, CNS was titled Universal Screening in the Medical Setting.

They began by doing a poll on whether different statements related to domestic violence were myths or facts. Since this was a motivated audience who likely already knew the basics about domestic violence, the audience consensus matched the reality of domestic violence.

One of the statements was, "Middle and upper class women do not get battered as frequently as poor women." This is a myth which can cause medical staff who don't work with poor patients to incorrectly assume they don't need to do any screening for domestic violence.

The presenters made it clear that intimate partner violence (IPV) is a health care issue. One in 5 female patients have been victims of IPV and this victimization has both immediate and long term health consequences.

Each year there are 73,000 hospitalizations and 1,500 deaths due to IPV. What caught my eye wasn't this number, but the fact that many who have significant injuries do not go to the ER or the doctor to have that trauma or injury treated.

Since IPV usually includes emotional or psychological abuse, those victims who aren't directly blocked from getting treatment may feel too ashamed to seek treatment since they would have to explain how the injury happened. Most abusers are careful to make their victims feel responsible for their violent actions.

However, while women often don't get care for IPV injuries, they do frequently seek care for other medical conditions which may or may not be related to the abuse.

The rate of depression in women who had experienced IPV was twice that of the general population. Victims of IPV can exhibit antisocial behavior which can serve as an additional barrier.

This reminds me of medical advice I've heard repeatedly about the importance of having your doctor know all relevant information so that any treatment is appropriate and safe. I don't remember which session it was mentioned in but one speaker talked about a doctor doing blood tests trying to find medical reasons for why a woman, who was in fact an IPV victim, bruised easily. In domestic violence, it is the health care professionals who need to consider how they can increase the chances that they are working with complete information.

There is not yet any research which shows direct evidence that screening for IPV leads to decreased disability or premature death. Currently the rate of of health care screening for IPV is about 10%.

Universal screening was defined as, "Inquiry about domestic violence with all women whether or not symptoms or signs are present and whether or not the provider suspects abuse has occurred."

Those who do IPV screening should be educated about the related issues, has been trained in how to ask about abuse, how to intervene when abuse is disclosed and is authorized to update the patient's medical record. Barriers to screening by health care personnel include fear of an affirmative response and a feeling that IPV victims won't respond to help.

There is no golden standard for universal screening, however a common question that gets asked, "Do you feel safe at home?" isn't an effective screening tool. 43% of those who said yes were experiencing IPV and only 8.8% of women experiencing IPV did not feel safe at home.

A health care provider who is perceived as caring and compassionate is more likely to get a disclosure if the screening is done in private and they are offered follow-up care.

The AAS (Abuse Assessment Screen) is now down to 2 questions:

Have you ever been hit, slapped, kicked, or otherwise physically hurt by your male partner?

Have you ever been forced to have sexual activities?

If the answer is yes, health care personnel were urged to consider additional screening such as the danger assessment developed by Jacquelyn C. Campbell Phd, RN, FAAN.

A positive response needs followup which may need to include a safety plan depending on the results of the danger assessment.

Unfortunately, sometimes health care personnel don't read the responses to waiting room screening questions. That could lead a patient to believe that health care providers either don't care or aren't a resource which can provide effective referrals.

Here's part 1, if you missed it.

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