Add screening for violence by intimate partners
Intimate partner violence (IPV) and reproductive and sexual coercion disproportionately affect women.1
According to the Family Violence Prevention Fund (now Futures Without Violence), intimate partner violence (IPV) "is a pattern of assaultive behavior and coercive behavior that may include physical injury, psychological abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation, and reproductive coercion. [Such] types of behavior are perpetrated by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent, and is aimed at establishing control of one partner over the other."2
Check the following statistics:
- About one in four women has been physically and/or sexually assaulted by a current/former partner.3
- Nearly half (45.9%) of women experiencing physical abuse in a relationship also disclose forced sex by their intimate partner.4
- In one sample, one in four women reported lifetime coerced sex; among women reporting coerced sex, more than one-third were 15 years old or younger at the time of their first coerced sexual experience.5
The Affordable Care Act (ACA) offers coverage for screening and counseling for interpersonal and domestic violence without requiring a copayment, coinsurance, or deductible. The Department of Health and Human Services has adopted guidelines for women's preventive health services to help ensure that women can receive these services.
More emphasis for IPV screening came in 2013, when the U.S. Preventive Services Task Force released a recommendation stating that "clinicians screen women of childbearing age for intimate partner violence (IPV) such as domestic violence and provide or refer women who screen positive to intervention services."6
Jacquelyn Campbell, PhD, RN, FAAN, professor and Anna D. Wolf Chair in the Johns Hopkins University School of Nursing in Baltimore, is a national leader in research and advocacy in the intimate partner violence field. She says that those who have been working to improve the healthcare system response to women who are abused by partners are "extremely excited" that the Affordable Care Act provides for routine screening for IPV to be covered by insurance as part of the "well woman" visit.
"Without knowledge of current or recent IPV, providers cannot accurately diagnose and adequately treat health problems such as chronic pain, insomnia, or depression," notes Campbell. "IPV is a risk factor that increases the chances of a women experiencing those health problems; by knowing about IPV and helping the woman figure out how to get safer and be put in touch with experts that can help with that, the provider can help prevent or lessen the severity of these health conditions and others like them that are associated with violence."
The "well woman visit" is part of the new emphasis on preventive healthcare to help decrease the high costs of healthcare for severe, debilitating chronic conditions later, notes Campbell. With ACA coverage in place for IPV screening, there have been renewed calls to routinely screen for IPV in other health settings such as prenatal care, emergency departments, and urgent care, Campbell notes. (To get up to speed on IPV screening, use the online Health Cares about IPV Screening Toolkit developed by Futures Without Violence. It offers tools to address domestic and sexual violence and strategies for forging partnerships with violence programs. Go to http://bit.ly/1gzEpoQ.)
Family planning providers, who treat young women of reproductive age, need to familiarize themselves with intimate partner violence. College-age women (ages 18-25) are at high risk for dating violence, but they tend to seek services such as domestic violence advocacy programs at rates lower than older adults. It is estimated that one of five college females will experience some form of IPV during her college career.5
Young women are more likely than older women to look to their peers or to technology as a forum for accessing information about dating violence and safety resources, such as a dating violence hotline, says Nancy Glass, PhD, MPH, RN, FAAN, a professor in the Baltimore-based Johns Hopkins University School of Nursing and associate director of the Johns Hopkins Center for Global Health. A smart phone application, One Love MyPlan, can be downloaded for free using iTunes or Google Android and is password protected. (Go to the One Love Foundation website, http://bit.ly/MOFz6E, for links.)
MyPlan is a safety decision aid for young women who are concerned about a partner's controlling behavior and/or are experiencing physical/sexual violence or threats of violence in a dating or intimate relationship. It assists young women in assesing the danger in their abusive relationship, says Glass. It also helps set priorities for safety.
"Based on the young woman's assessment and safety priorities, a safety plan is provided with suggested safety strategies personalized to her level of danger and highest priorities for safety," states Glass. "These personalized strategies are then linked to national and state-level community advocacy, health, legal, and/or police resources depending on danger level and safety priorities."
Once a young woman uses MyPlan, she can receive information by calling or chatting anonymously with a trained advocate. The safety plan also might provide suggestions for safely reaching out to friends, family, college administrators, or other trusted people for help and support, says Glass. The woman, using her secured password, can access MyPlan once downloaded to the smartphone, anytime. As dating relationships are dynamic, she might want to revise her danger assessment and safety priorities resulting in an updated personalized safety plan and/or learn about new strategies for safety, she explains.
Young women are likely to look to their peers for accessing safety resources, and peers report not having confidence in providing the support requested. Another feature of MyPlan is that friends - male or female - who are concerned about a friend's safety in a dating relationship can download MyPlan app to their smartphone. The friend's component of the MyPlan app will step the friend through a process to assess the danger in their friend's relationship and set priorities for safety, says Glass. The assessment and safety priorities will be used to develop a personalized plan with strategies to provide support and help to their friend.
"For example, the safety plan may provide examples of how to safely and respectfully bring up the concerns they have about the friend's partner and relationship," explains Glass. "The plan may include national and state advocacy resources that they can use to learn more about dating violence, [or] seek advice on how to support their friend and/or provide to their friend, such as dating violence hotline or campus support groups."
The MyPlan app can be accessed, once downloaded, at any time by the friends using their passwords, if they want to revise the assessment and safety priorities and receive an updated safety plan to use to support their friends, notes Glass.
"The MyPlan app is not a replacement for seeking resources and support through trained service providers, such as advocates, healthcare providers, college/university administrators," states Glass. "MyPlan is a resource that can help young women and their friends as they are struggling with understanding what is happening in the relationship and learn that there are resources and options for support/help to increase safety . They are not alone."
- Chamberlain L, Levenson R. Addressing Intimate Partner Violence, Reproductive And Sexual Coercion: A Guide For Obstetric, Gynecologic And Reproductive Health Care Settings. Third edition. Washington, DC: American College of Obstetricians and Gynecologists; San Francisco (CA): Futures Without Violence; 2013.
- Family Violence Prevention Fund. Reproductive Health and Partner Violence Guidelines: An Integrated Response to Intimate Partner Violence and Reproductive Coercion. San Francisco: Family Violence Prevention Fund; 2010.
- Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.
- Campbell JC, Soeken KL. Forced sex and intimate partner violence: effects on women's risk and women's health. Violence Against Women 1999; 4:1017-1035.
- Stockman JK, Campbell JC, Celentano DD. Sexual violence and HIV risk behaviors among a national representative sample of heterosexual American women: the importance of sexual coercion. JAIDS 2010; 53(1):136-143.
- Krebs CP, Linquist CH, Warner TD, et al. College women's experiences with physically forced, alcohol- or other drug-enabled, and drug-facilitated sexual assault before and since entering college. J Am Coll Health 2009; 57(6):639-647.
- Moyer VA; U.S. Preventive Services Task Force. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013; 158(6):478-486.