model clearly shows how this could lead to sustaining an abusive relationship despite IPV: When a relationship provides social standing or contributes to an adolescent’s self-concept, there is already important investment, and the alternatives are developmentally unacceptable (Bouchard et al., 2020) . Teens and preteens experience IPV in the form of dating violence, which is unfortunately common among adolescent couples: Abusive and/or controlling behaviors occur in as many as 20% to 50% of all teen dating relationships, while physical and sexual dating violence occur in roughly 10% (Baiden et al., 2021; Basile et al., 2020; Hinduja & Patchin, 2021) . Teen dating violence may be physical, sexual, psychological, or emotional and includes stalking and technologically based, or “cyber,” abuse (National Adults One reason to focus on IPV during adulthood is that this is often the stage during which individuals establish long- term, committed relationships, resulting in cohabitation and/or marriage. As already addressed, adult women are the most often-reported victims of IPV. In fact, much of what is known about IPV comes from research conducted in this population, but adults of any gender and in any romantic or partnered relationship may experience IPV. More research Older Adults Importantly, IPV is not confined to teens or adults under the age of 65 years. It can occur at all ages. Studies have shown that individuals who experience IPV early in life are also more likely to experience abuse later in life than are those with no history of IPV (Walker & Wamser-Nanney, 2022) . IPV in the older adult population can take many forms. It may proceed from an abusive relationship that began earlier in life (Cations et al., 2021) , be related to historical forms of abuse such as child maltreatment or past IPV (Herrenkohl et al., 2020) , or occur in the context of a new relationship between older adults (Schreiber & Salivar, 2021) . Age Identifying and Addressing Intimate Partner Violence Screening prompts for IPV and SA are now built into many clinical documentation systems as part of regulatory requirements, but these are only effective if the provider makes the choice to use them. Some find this uncomfortable and feel they lack the skills to assess for IPV and SA or lack the resources to intervene when screening results in positive findings (Burton & Carlyle, 2020) . Therefore, providers must be educated about both the process and approach in order to be effective in screening and assessment for abuse. It is worth noting, as well, that when patients and clients disclose
Center for Injury Prevention and Control Division of Violence Prevention, 2023) . The Youth Risk Behavior Surveillance System (YRBS) indicates that approximately 10% of high school students reported physical victimization and 10% reported sexual victimization by a dating partner in the previous year—figures that have held steady for a number of years (Baiden et al., 2021; Basile et al., 2020) . At the same time, nearly one in three adolescents involved in dating relationships report an experience of digital or cyber dating abuse within the past year (Hinduja & Patchin, 2021) . Teens who are victims of dating violence are more likely than unaffected teens to experience adverse health outcomes such as anxiety, depression, substance use, unhealthy weight control, and risky sexual behaviors (Pengpid & Peltzer, 2020) . is needed to understand whether there are differences in IPV outcomes (i.e., perpetrator and victim experiences and health outcomes) among those in same-sex/gender or polyamorous relationships. Further, IPV during pregnancy is a particular concern among women of reproductive age and clinicians must be aware of how this can affect health and gestation (Burton & Carlyle, 2020) . should never preclude the clinician from considering IPV and performing screening during every encounter (Burton & Carlyle, 2020) . It is also worth noting that IPV among older adults is often considered a subset of elder/vulnerable adult abuse, particularly when the victim is experiencing cognitive impairments, physical impairments, or other factors that make him or her vulnerable (US Department of Health & Human Services Adminstration for Community Living, 2023) . As such, these instances may be subject to mandatory reporting laws. Mandatory reporting of IPV in older adults and other populations is discussed later in this course. IPV and/or SA, it is often to a healthcare provider and in response to screening (Dichter et al., 2021; Spangaro et al., 2021) . Nurses remain the most trusted group among the healthcare professions (Levine, 2023) and are thus in a position of great potential to assist survivors of IPV and/ or SA in the healthcare setting. Survivors are frequently in contact with providers in a variety of settings (see Table 3), and opportunities to screen for and intervene in cases of IPV should not be missed.
Table 3: Recognizing Possible Signs of Intimate Partner Violence Setting Signs of Intimate Partner Violence Emergency department Assorted acute injuries; pain from previous injuries; multiple visits with vague complaints; psychosocial issues Counseling offices Victims and perpetrators may present for couple’s counseling or as individuals seeking therapy for reasons other than IPV. Additionally, pastoral counseling may be sought by victims and perpetrators. Refusal to meet individually may be a sign of controlling behavior.
Prenatal and obstetric clinics and practices
Increased incidence of abuse during pregnancy; missed appointments; late entry into the prenatal care system
Mental health setting
Symptoms of anxiety, depression; substance abuse; suicide attempts
Schools
Child-centered systems will often be the first place of IPV disclosure, driven sometimes by a child’s behavioral clues (e.g., regressed or internalized or externalized behavior) Behavioral clues or other stress-related conditions reflective of witnessing violence; mother presenting with black eyes and bruises in different stages of healing
Pediatrician’s offices
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