________________________________ Intimate Partner Violence: Compassionate Care, Effective Assessment
VIOLENCE IN DIVERSE CULTURES AND IMMIGRANT POPULATIONS
The success of safety planning can be compromised by ongoing drug use, and the success of addiction recovery can be impeded by continued violence. Therefore, healthcare providers should always carefully assess for IPV where there is evidence of sub- stance abuse, and screen for substance abuse where there is evidence for IPV. In addition, providers should weigh carefully the risks and benefits of prescribing controlled substances for symptom relief in patients with chemical dependence, particularly opioid pain medications [41]. SEXUAL ASSAULT AND IPV According to the National Intimate Partner and Sexual Vio- lence Survey (NISVS), the lifetime incidence of rape is 19.3% for women and 1.7% for men [42]. Patient responses to sexual assault can vary from visible distress to calm composure. Some survivors of recent rape have difficulty trusting hospital person- nel and the evidence collection process. Thus, sensitivity and patience are critical when examining or referring a patient to the emergency department. Clinicians trained in empathetic evidence collection such as Sexual Assault Nurse Examiners can be invaluable collaborators. In addition to collecting physical evidence in cases of recent sexual assault, healthcare providers can offer validation, support, and appropriate refer- rals for sexual assault counseling. Clinicians should be mindful of asking questions that might sound victim-blaming or judgmental, such as “why were you wearing that?” or “why didn’t you report this to the police?” Instead encourage contact with a local rape crisis center and appropriate therapeutic and community services, even if an assault took place months or years ago. Supportive approaches such as these can be fundamental to the recovery and reintegra- tion process for survivors of sexual assault. Strategies providers can use to assess patients for sexual violence are discussed further at the end of this monograph. HUMAN TRAFFICKING Human trafficking is associated with significant physical and psychological harm including the risk for IPV [43]. The abuses suffered by people who are trafficked include many forms of physical violence or abuse (e.g., beating, burning, rape, confine- ment) as well as many psychologically damaging tactics such as threats to themselves or their family members, blackmail, extortion, lies about the person’s rights, and confiscation of vital identity documents [43]. Healthcare professionals are uniquely positioned to identify and intervene on behalf of trafficking victims. Outside of law enforcement, healthcare settings are among the few places where the lives of human trafficking victims may intersect with the rest of society, if only for brief periods [44]. In a study of 98 sex trafficking survivors, 88% had at least one encounter with a healthcare provider while they were being trafficked, with 63% of these encounters happening in an emergency department [45].
IPV is prevalent in every culture and segment of society. Immi- grants and members of minority cultures, however, face extra hurdles as they attempt to access available services to protect themselves, their children, and other dependents. Patients of different cultures may hold belief systems and traditions that make it harder for them to perceive their own danger, understand their right to live in safety, know their legal rights and options, or even speak to anyone about their situation. Survivors whose native language is not English may find it difficult to communicate with healthcare providers, advocacy services, and law enforcement personnel. They may also harbor legitimate fears of becoming homeless, losing their children, or deportation, if their abuse is revealed. These patients may not trust the health care system, and thus suffer in silence and be at risk. Healthcare providers who are sensitive to the potential barriers and problems that immigrants and members of diverse cultures face can better establish trusting relation- ships with their patients, which is critical for uncovering and dealing with IPV. SUBSTANCE ABUSE Substance abuse is often associated with violence. Perpetrators are more likely to use or abuse alcohol and other substances, and, in addition, patients who abuse alcohol and other drugs are more likely to become victims. Further, survivors of partner violence are more likely to abuse alcohol and to receive multiple prescriptions for tranquilizers, sedatives, and opioid analgesics to treat the pain or distress of present or past abuse [9]. With rising rates of opioid abuse, physicians should consider increas- ing screening of violence in their patient population. Although most abused individuals are neither dependent on alcohol nor involved with other drugs, those who are addicted are often doubly stigmatized. They may be labeled as sexually promiscuous, unfit as parents, unworthy as partners, have low self-control or willpower, or being just plain “crazy.” They are more likely to be blamed for the violence in their lives, further impeding efforts to resolve issues and regain health. Intervention goals for chemically dependent abused patients include sobriety as well as safety. For some, addiction treat- ment may be a necessary first step, but intervention for the violence should not be neglected. For others, achieving safety may be necessary before participating in an addiction recovery program. Becoming sober may threaten an abuser’s sense of control, and place the survivor at risk for increased violence. Ideally, both issues are treated together. Addiction or intoxi- cation, although maladaptive, may serve as coping strategies for the victimized individual. Sobriety in the absence of safety and resiliency-oriented support may unmask previously undiagnosed mental health issues for marginally functioning abused patients.
17
MDFL0627
Powered by FlippingBook