Intimate Partner Violence: Compassionate Care, Effective Assessment _ _______________________________
Encourage your patient to call a local or national hotline for further information. Provide a private, safe space for your patient to make those calls if at all possible. Such a call in no way commits the patient to a course of action, but can better inform and empower them. Give your patient brochures or written resources only if they feel it is safe for them to have. Numbers and contact information can be programmed into personal phones under “Code Names” to avoid identification. Some perpetrators go through their partner’s belongings, including technological devices, and finding information on IPV could be perceived as the partner attempting to leave and put them at increased risk of violence.
fuse jealousy with love. They may willingly give up passcodes and private electronic information under the pressure of an abusive partner. Lack of experience and perspective regarding healthy relationships can also affect the power dynamics in the relationship, especially if the teen’s partner is significantly older. All of these factors make teens more vulnerable to being controlled. Striving for independence, battered teens may be especially reluctant to seek help from authority figures such as health care providers. Clinicians should reassure teens about the confidential and supportive nature of the doctor-patient relationship. Doctors should screen adolescents for abuse as described below, remem- bering that the abuser may be a parent, another family member, boyfriend, or girlfriend. The teen’s knowledge and behavior around violence, coercion, alcohol, drugs, and sexual activity needs to be assessed. An abused teen particularly needs to be told that the abuse is not their fault and that help is available (see the list of resources at the end of this document). VIOLENCE IN LESBIAN, GAY, BISEXUAL, TRANSGENDER, AND OTHER GENDER AND SEXUAL MINORITY (GSM) RELATIONSHIPS IPV in GSM relationships appears to be as common, or possibly more common, than in heterosexual relationships [37]. - [39] Many GSM individuals do not feel comfortable disclosing their sexual orientation to healthcare providers, and are likely to be even more reluctant to disclose abuse. GSM individuals who do disclose their sexual orientation are still rarely asked about IPV. Barriers to inquiry include gender-related myths, for example, that men cannot be victims of abuse, or that same-sex relationships are inherently “equal” because parties are of the same gender [37; 40]. Additional obstacles specific to GSM survivors include homophobia and transphobia and resulting discrimination in society and among healthcare providers as well as social consequences of revealing one’s sexual orientation, such as loss of children and other family relationships, employment, or community standing. Shelter space and support services may not be available specifically for battered gay men, transgender, and gender nonconforming individuals. Lesbian and bisexual women have the option of going to more traditional domestic violence programs that accept women, but many of these programs may not be suitable for or sensi- tive to members of the GSM community. Transgender and gender-nonconforming individuals face particular barriers in getting help because providers, and the public in general, often understand even less about gender identity and expression than they do about sexual orientation. Healthcare providers should therefore approach screening, diagnosis, and treatment with special sensitivity to the difficult issues that abused GSM patients may face.
SPECIFIC IPV ISSUES OR PATIENT POPULATIONS
PREGNANCY IPV may be associated with: • Restricted access to contraception. • Unintended or coerced pregnancy, as well as rapid repeat pregnancy. • Delayed or unreliable access to prenatal care. • Spontaneous, elective, or coerced abortions. • Antepartum hemorrhage. • Premature labor. • Increased risk of maternal injury, substance abuse, and poor nutrition. Violence during pregnancy is a serious medical and public health problem, with the majority of published studies in the U.S. reporting prevalence rates between 4% - 8% [34; 35]. IPV against pregnant women is more prevalent than preeclampsia, gestational diabetes, and placenta previa, all of which are routinely screened for in prenatal care. In addition, homicide is the most common cause of pregnancy-associated maternal death [36]. Prenatal visits provide access to and continuity of care for pregnant women and thus represent an excellent opportunity for clinicians to assess for and intervene in IPV. Patients should be routinely screened for new or ongoing abuse during each prenatal visit. Women are more often physically abused in the year before pregnancy and even if the abuse stops or decreases during pregnancy, it usually starts again postpartum [34]. Thus, it is important to ask about abuse before, during, and after pregnancy. ADOLESCENT DATING VIOLENCE Adolescents may suffer from an array of abusive behaviors, rang- ing from verbal and emotional abuse, to physical abuse, rape, and even homicide. Some teens are battered by people with whom they are dating, while others may be abused by parents or other caregivers. Teens in dating relationships often con-
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