Documenting Intimate Partner Violence

One in four women in the United States reports experiencing violence by a current or former spouse or partner at some point in her life. Although women of all ages are at risk for domestic and sexual violence, those ranging from 20 to 24 years old (prime childbearing years), face the greatest risk of experiencing nonfatal intimate partner violence (IPV). Women subject to such violence face many health risks – they are more likely to have a stroke, heart disease, asthma, heave drinking habits, sexually transmitted disease, and miscarriages. The high prevalence and risks associated with IPV make perinatal IPV screening crucial.

Given these facts, it is important to analyze the best practices for domestic violence healthcare and referral. The American Medical Association (AMA) encourages primary healthcare providers to: routinely screen for IPV acknowledge the victim’s experience and assess the abuse for acute and chronic health effects document the abuse through detailed charting, body maps, and photos assess the risk for future injury or lethality and ascertain a level of safety review options and refer patients with a positive history of IPV to safety planning services

The AMA also recommends that all females aged 14 years and older should be routinely screened and that patients should be screened for IPV history at their first visit and abuse over the past year for each annual visit. Some questions that provide an effective look at a patients’ domestic violence history have been generated by The American College of Obstetricians and Gynecologists (ACOG):  Within the past year — or since you have been pregnant — have you been hit, slapped, kicked or otherwise physically hurt by someone?; Are you in a relationship with a person who threatens or physically hurts you?; and has anyone forced you to have sexual activities that made you feel uncomfortable?

Multiple sources and organizations such as AMA and ACOG have stressed the importance of proper screening practices. However, the extent to which these best practices are being followed paints a bleak picture. Although screened women have reported no harms of screening, studies have shown very little difference in observed IPV for screened and non-screened women after a period of 18 months. Current studies reveal that many hospitals do not have a universal screening policy or mandatory domestic violence training for staff in place. In addition, most institutions do not incorporate domestic violence screening into the clinical record and some sites often rely upon only one question for their screening protocol. The majority of clinical sites have inadequate information concerning a victim’s current and past abuse. Overall, studies have shown that relying on hospital staff to implement social work is ineffective and that screening for IPV is widely variable and often inadequate.

One study in particular discovered that less than 40% of the sites it examined had a mandatory universal screening policy for IPV in place and only one-third had mandated training on IPV for any of their staff. Furthermore, less than one-half of the examined task forces included physicians from the medical staff. Although the clinical settings under examination scored highly in the category for training being provided on IPV, many of the sites did not include this training in their mandatory orientation for new staff. When women were screened for abuse and a positive history of abuse was detected, the vast majority of sites had standard documentation to record cases of IPV. Nonetheless, in many cases, the documentation forms were lacking much in information about the abuse. For example, all the forms included information about the results of the screening and many documented injuries and recorded the referrals given to the victim; however, less than one quarter described the victim’s current or past abuse or contained the name of the perpetrator (Coben, 2005).

In conclusion, screening for domestic violence is quite prevalent. Nevertheless, screening effectiveness can be extremely low. Because education about IPV resources and referrals is frequently limited to identified victims, many women who need them do not receive them. Some clinical barriers that may be present in the way of effective screening and documentation of IPV include insufficient time the provider has to ask the questions, privacy of the screening, inadequate provider training to screen (perhaps some discomfort could be communicated to the patient), wording of the questions being asked, and the safety of the women being screened. There are several recommendations clinical settings can employ to their current screening and documentation procedures. Universal IPV resource education should be added to training about universal screening. Furthermore, healthcare settings could also provide women with information about seeking counseling and help regardless of whether they disclose IPV. Social workers could also aid in the screening procedure. Clinical settings must improve their screening and documentation procedures in order to aid in stopping the violent cycle of domestic violence.

References

  1. Coben, J.H., & Fisher, E.J. (2005). Evaluating the implementation of hospital-based domestic violence programs. Family Violence Prevention and Health Practice, 1(2), Retrieved from http://endabuse.org/health/ejournal/archive/1-2/Coben.pdf
  2. Kothari, C.L., Cerulli, C., Marcus, S., & Rhodes, K.V. (2009). Perinatal status and help seeking for intimate partner violence. Journal of Women, 18(10), 1639-1646.
  3. The American Congress of Obstetricians and Gynecologists. (2010). Screening tools–domestic violence. Retrieved from http://www.acog.org/departments/dept_notice.cfm?recno=17&bulletin=585
  4. The Family Violence Prevention Fund. (2002, September). National consensus guidelines on identifying and responding to domestic violence victimization in health care setting. Retrieved from http://www.stoprelationshipabuse.org/
  5. Tjaden, P., & Thoennes, N. (1998, November). Prevalence, incidence, and Consequences of Violence Against Women: Findings From the National Violence Against Women Survey. Retrieved from http://www.ncjrs.gov/pdffiles/172837.pdf

Written by The Triple Helix at Ohio State University

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