Womens Transitional Living

Center

Intimate Partner Violence And

Health Training For Providers
 Objectives
An increased understanding of IPV and its effects on
patient health
An increased understanding of why and how to screen
and counsel patients for the occurrence of IPV in a
culturally sensitive manner
An increased understanding of how and where to
appropriately refer patients for IPV resources/services
An increased understanding of the limits of
confidentiality and mandatory reporting
Women experiencing IPV make up
12-23% of women in family medicine clinics

23% of women seeking prenatal care

25% of female suicide attempts*

14-35% of women seen in ERs

60% of mothers of abused children

*Starl, Evan, and Filtcraft, 1996

IPV IS A PRIMARY HEALTH CONCERN
According to the National 1 in 3 women
Violence Against Women
Survey, 2000
1 in 4 men
IPV caused 2,340 deaths in
2007. have experienced RAPE,
PHYSICAL VIOLENCE and/or
1,640 were females (70%) STALKING by an intimate
700 were males (30%) partner in their lifetime
WHAT IS INTIMATE PARTNER VIOLENCE?

A pattern of abusive behavior

that is used to gain and maintain
POWER and exert CONTROL
by one intimate partner over another.
INTIMATE PARTNER VIOLENCE

is LEARNED
and can lead to an intergenerational pattern of
abusive behavior that involves child and elder abuse
DOES NOT DISCRIMINATE
and is found in every race, culture, gender,
socioeconomic level, sexual orientation, religion, etc.
is NOT A ONE-TIME OCCURRENCE
has a complicated relationship with alcohol, drugs, and
stress
TYPES OF ABUSE
Emotional/Psychological
Physical
Verbal
Sexual
Financial
CYCLE OF VIOLENCE

The Cycle of Violence is a

pattern often experienced in
abusive relationships. In the
absence of effective
intervention, domestic
violence generally escalates
over time.
BARRIERS TO LEAVING
FEAR
LOVE, HOPE FOR CHANGE
DENIAL
IMMIGRATION STATUS
CULTURE, SOCIAL/FAMILY NORMS
FINANCIAL DEPENDENCE
LACK OF SUPPORT/OPTIONS
CHILDREN
HOW IPV PRESENTS IN VARIOUS MEDICAL SPECIALTIES

OB/GYN
PRIMARY CARE
EMERGENCY MEDICINE
OB/GYN
Symptoms & Scenarios

Pregnancy itself
Miscarriage
Vaginal bleeding (placental abruption)
Preterm labor
Decreased fetal movement
Still birth
PRIMARY CARE
Symptoms & Scenarios

Insomnia
Depression
Irritable bowel syndrome
Chronic pain
Multiple, frequent complaints
EMERGENCY MEDICINE
Symptoms & Scenarios

Injuries
Chest pain
Shortness of breath
Threatened abortion or miscarriage
Multiple frequent complaints not appropriate for
the ER
CHILDREN AND IPV
30-60% co-occurrence
IPV often precedes child maltreatment
Collateral victims
Exposure increases risk of emotional, physical,
sexual abuse by 6, 4.8, and 2.6 times respectively
RISKS TO CHILDREN

Anxiety Social function

Depression difficulties
Withdrawal Poor peer relationships
Somatic complaints Cruelty
Attention problems Bullying (aggressor and
Aggressive behavior victim)
PTSD Poor academic
performance
PROVIDER: BARRIERS TO SCREENING
Resource Barriers: Time constraints; lack of knowledge,
education or training
Personal Barriers: Personal discomfort with discussing topic of
IPV; concern for personal safety
Attitudes and perceptions: Not providers role to screen; there
are more pressing issues to address
Fears: Invading patients privacy; offending patients who were not
abused
Patient-related Barriers (from provider viewpoint): Language
barriers; difficult personalities to screen
HOW TO RESPOND
Routine Screening: Why Screen?
Cultural Competency
Appropriate Legal Reponses
Routine Screening: How to Screen
Respond with Referral Resources
ROUTINE SCREENING
Prevalence: IPV is one of the most common healthcare
issues seen
Educates Patients: on IPV as a health concern
Removes discriminatory practices
Dual Intervention: for both the victim and the
perpetrator
Positive Outcomes: May decrease serious injury/death
and/or child abuse
THINGS TO CONSIDER
Not presuming gender of the batterer
Stereotyping what a victim looks like
Religious beliefs
Social/familial pressures
Linguistic needs
WHAT DOES THE LAW REQUIRE?

Since 1995, California state law

CALIFORNIA requires that health care
STATE LAW providers routinely screen for
IPV and that health care
(AB890): organizations train clinicians on
detection and treatment
because
Those experiencing IPV often
SCREENING AND seek medical care instead of
TRAINING contacting law enforcement
Most women have regular
contact with health care,
providing multiple opportunities
for learning about resources
MANDATED REPORTING - IPV
CALIFORNIA STATE LAW (PENAL CODE 11160): REPORTING

You are required to report if:

There is PHYSICAL injury you know or reasonably believe was caused by

abuse, assault, or a firearm, and you are treating that injury
You are the treating provider
Use form Cal EMA 2-920
Must notify local law enforcement as soon as possible
Hard copy must be filed (usually by fax) within 48 hours

No report is required if:

You learn of prior abuse
You learn of current abuse, but are not treating a wound or physical injury
OTHER MANDATED REPORTING
MEDICAL PROFESSIONALS ARE ALSO
REQUIRED TO REPORT CHILD ABUSE
OR ELDER ABUSE:

The Child Abuse and Neglect Reporting Act

(Penal Code 11164-11174.3)
Elder Abuse (California Welf. & Inst. Code
15630-15632)
IPV SCREENING TOOLS &
DANGER/LETHALITY ASSESSMENTS
IPV SCREENING TOOLS assist in making a general
determination if there is abuse occurring in an intimate
partner relationship.
DANGER ASSESSMENTS assist with providing a more
in-depth snapshot as to the level of danger involved in an
intimate partner relationship.
From these types of assessments, a service provider can
determine an ideal safety action plan and provide congruent and
relevant resources.
*Any concerns stemming from an intimate partner screening tool
would warrant an appropriate referral to a domestic violence advocate.
DANGER ASSESSMENT
Assesses for instances that increase victims
danger level, such as:
Previous threat with a weapon
Gun access
Estrangement/stalking
Victim having left for another partner
Forces sex/abuse during pregnancy
Perpetrators stepchild in home
Unemployment
How to screen: RADAR
ROUTINELY SCREEN: women and men

ADVISE OF LIMITS OF CONFIDENTIALITY & ASK: direct

questions in a non-judgmental manner

DOCUMENT: what happened, use patients own words, describe all

injuries in detail

ASSESS: patient safety

RESPOND: review options and refer

ADVISE & ASK
Screening must occur in private
Disclose limits of confidentiality (i.e., mandatory
reporting)
Use the patients language of choice
Laminated cards with questions and yes or
no answers are good options to consider
ADVISE OF LIMITS OF CONFIDENTIALITY

I want to advise you that I am a mandatory reporter of

domestic violence, child abuse, and elder abuse. If I learn
or believe an injury I'm treating is caused by abuse, I am
required to report this. If you tell me that children were
present during domestic violence, I am also required to
report this. Do you have any questions about this?"
RESPOND
Domestic Violence Hotlines
211 OC
Local Community Resources 211OC.org/dv
Counseling Services
Legal Advocacy
Housing
Medical Services
Womens Transitional Living Center
Residential Programs
Emergency Shelter
Supportive Services
Individual & Group
Counseling, Case
Management
Legal Advocacy 24 Hour Hotline:
Restraining Orders, Custody,
Immigration Services 877-531-5522
Community Education
LOVE@wtlc.org
Personal Empowerment
Program, Trainings,
Community Engagement