By Catherine Cerulli, JD, PhD, Professor of Psychiatry, University of Rochester
Sometimes as a health care professional, we have to walk into other’s darkness with an acute injury, a chronic health condition, or a new diagnosis.
We are called to help others through our work as health care providers. However, an issue that isn’t familiar to us can sometimes be overwhelming.
During COVID, health care providers were pushed to the brink with providing life-saving care and seeing their patients face difficult social determinants of health such as:
- lost jobs
- insecure health care benefits
- lack of child care.
One issue that surfaced in the public’s eye during COVID was the increase in domestic violence reporting in some communities. In particular, some systems reported increased child abuse as well as intimate partner violence (IPV), which occurs between people married, formerly married, dating, formerly dating, or who may have had a casual date or intimate experience.
Growing Impact of Intimate Partner Violence
Nationally, household surveys reveal IPV is more common than we know and affects millions of people globally. The Centers for Disease Control reports 1 in 4 women and 1 in 10 men experienced sexual, physical, or stalking by an intimate partner during their lifetimes. Psychological abuse also impacts millions of people each year. What that means is that out of 100 women patients a provider sees, 1 in 4 likely have had some type of IPV lifetime experience.
This isn’t just true for adults, as IPV deeply impacts adolescents, with 16 million people in the United States reporting their abuse experiences occurred before they were 18 years old.
Actionable Steps to Combat IPV
How can we take on IPV for the public health crisis it is? How can we feel prepared to walk into someone’s darkness? We provide medication guidance, pre-surgical counseling, and post-op planning, but we are not always prepared to address other issues patients face.
To help providers respond to IPV, The Joint Commission issued Standard PC 01.02.09 which requires organizations to use written criteria to identify patients who may be victims of:
- physical assault
- sexual assault
- sexual molestation
- domestic abuse
- elder or child abuse and neglect.
Further, the standard requires providers to report cases of possible abuse and neglect to external agencies, in accordance with laws and regulations. But we don’t just want to be prepared to report it – we want to address it. To this end, The Joint Commission published Quick Safety Issue 63: Addressing Intimate Partner Violence and Helping to Protect Patients.
Screening & Safety
We must consider patient’s safety as well as that of any children when taking steps to intervene. When you ask a patient the screening questions, be sure the patient is alone. If the patient is accompanied, don’t make assumptions regarding the visitor’s identity. Get the patient alone by being creative – perhaps walk them down the hall for an “assessment” or something to that effect. Once you have asked the screening questions in compliance with The Joint Commission and your local organization’s policies, you can move into an assessment and referral.
Be aware of your organizations screening policies regarding IPV and your organization’s noted expert. Who is your on-call go-to person? Have that number on speed dial. If you are unable to reach someone internally, know the local 24/7 emergency domestic violence hotline number. A patient may be willing to talk to an anonymous provider but not call the police. If you don’t have a local IPV provider, access the National Domestic Violence Hotline, 1-800-799-7233, which also provides excellent language translation services.
You are not alone on this journey of screening, assessing, and referring patients who are experiencing IPV. There are myriad resources such as:
- World Health Organization’s Violence Against Women Fact Sheet
- Futures Without Violence National Health Resource Center on Domestic Violence toolkit
- Bright Futures, a national health promotion and prevention initiative by the American Academy of Pediatrics
There may be a committee at your organization where you can encourage training, Grand Rounds, interdisciplinary case conferencing approaches or tips embedded within your electronic medical record workspace.
Together, with organizational and community partners, we can respond to, reduce, and prevent IPV. That is how we begin to break the cycle of violence.
Catherine Cerulli, JD, PhD, has established a unique, scientifically based career path that seeks to combine legal, public health, and mental health perspectives to enhance the human rights and well-being of people marginalized due to economic, safety, health, and legal concerns. As a Professor of Psychiatry at the University of Rochester Medical Center (URMC) and the Director of the Laboratory of Interpersonal Violence and Victimization, she has promoted research in diverse criminal justice, community, and health settings, and in 2016 cofound an innovative medical-law program that integrates health, legal, and advocacy services for victims of intimate partner violence (IPV). Dr. Cerulli also directs the UR Susan B. Anthony Center, which focuses on translating science regarding social determinants of health into practice. Dr. Cerulli, a licensed attorney, has worked directly with IPV victims since 1983 - as a counselor, advocate, attorney, and researcher. She forges collaborative community studies in partnership with survivors as investigators and advisors, guided by principles of community-based participatory research. Dr. Cerulli has worked in Russia, China, Mongolia, the Greater Mekong region, and most recently, in India. NIH Fogarty International Center, the World Health Organization, and the Fulbright Specialist Program have funded her international portfolio. As a national and international leader and trainer, Dr. Cerulli speaks directly to the need for agencies to ground their service programs in scientifically developed evidence and to rigorously evaluate the real-world impacts of their initiatives.