Essential Health Care Services Addressing Intimate Partner Violence (2024) / Chapter Skim
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5 Essential Health Care Services for Intimate Partner Violence ESSENTIAL HEALTH CARE SERVICES RELATED TO INTIMATE PARTNER VIOLENCE The committee defines health care services as care delivered in or referrable from a health care setting. Therefore, essential health care services related to intimate partner violence (IPV)
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124 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV The committee identified the following criteria for identifying essential health care services related to IPV: • Evidence-based health care services that address the most common and most serious health outcomes related to experiencing IPV; • Preventive services recommended by USPSTF and WPSI; and • Specific support services required to meet the basic safety and hous ing needs of people experiencing IPV. Essential Intimate Partner Violence–Related Health Care Services The many adverse health effects related to experiencing IPV do not occur in isolation.
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 125 Universal Screening and Education Screening in health care generally refers to delivering preventive health services that identify a condition or risk for a condition to patients without signs or symptoms of the condition being screened, as opposed to diagnosing patients with indications of the condition. Universal screening for IPV includes all patients, regardless of the presence of signs, symptoms, or health conditions related to IPV, to identify those with subclinical experiences of previous or ongoing IPV and those at risk for future IPV.
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126 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV TABLE 5-1 Validated Tools for Screening for IPV Sensitivity; Measure Components specificity Hurt/Insult/Threaten/ Four items (hurt, insult, threaten, scream) , 86%; 99% Scream tool (HITS)
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128 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Within the group of people receiving prenatal care, those who lived in rural districts and those who were covered through private insurance were less likely to be screened for IPV than those in urban areas and those covered through Medicaid (Kozhimannil et al., 2023)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 129 includes identifying and connecting the woman to resources consistent with her needs (Sabri et al., 2021)
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130 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV of the acute injuries associated with TBI, such as skull fracture, cervical fracture, and intracranial hemorrhage, require emergency medical care and may require surgical intervention (Galgano et al., 2017; Taylor et al., 2017)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 131 to IPV. Emergency medical care is required for severe gynecologic injuries and infections.
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132 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV her partner, which makes access to STI and HIV screening and treatment, including post-exposure prophylaxis, an urgent need (Gilmore et al., 2022)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 133 multimodal treatment. These include, but are not limited to, treatment of traumatic physical injuries, gynecologic and reproductive health care, mental health care, pharmacy/medication management, and primary care and specialty medical care.
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134 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV violence and safety, and referral to community-based resources. It is important to note that none of the interventions were conducted in a pediatric setting.
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Evaluation and treatment of IPV-related health conditions within the health system IPV Condition Evaluation Treatment/ UNIVERSAL Intervention IPV IPV Detection EDUCATION Referral Support IPV Screening Services Follow-up SOCIETY Access to COMMUNITY Health Care Partnership and Coordination HEALTH SYSTEM Community of IPV Services Support Services PATIENT Criminal Advocacy School-based Home-based Justice Programs Programs Programs System Support Housing Hotlines Community Programs and Support Based and Shelters Groups Organizations FIGURE 5-1 Access to essential health care services for those experiencing IPV. NOTES: Patients access health care services through multiple pathways, including treatment of recognized IPV-related health condi 1 tions (e.g., acute trauma from IPV assault)
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136 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV may also present with nonspecific complaints, such as recurrent headaches, poor sleep, abdominal pain, or fatigue (Miller et al., 2010)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 137 care systems have failed to adequately support patients included lacking adequate referrals or services, making the patient feel hopeless, and allowing the partner engaging in IPV to stay in the exam room (Duchesne et al., 2022)
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138 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV complexity of IPV in the context of acute care; beliefs that IPV was a social not medical issue and outside their scope; frustration and powerlessness when patients returned to violent environments; lack of training, infrastructure, and support services; working in under-resourced environments; and personal stereotypes and biases about IPV. Many of these issues were also described in studies of barriers to effective IPV interventions in other settings (Rivas et al., 2019)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 139 not disclose their experiences to clinicians. Examples of such communitybased services include: • Advocacy programs, which help people experiencing IPV navigate the legal system or access supports such as housing, education, counseling, financial planning, and job placement (Shorey et al., 2014)
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140 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Domestic Violence Advocacy Programs Many community-based domestic violence advocacy programs serve individuals and families experiencing IPV. These programs often use an empowerment model with a gendered approach by contextualizing IPV within gender oppression (Kasturirangan, 2008)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 141 School- and College-Based Health Centers An estimated 6.3 million students have received services from a schoolbased health center (SBHC) , most of which are located in underserved, low-resource neighborhoods (Love et al., 2019)
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142 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV • Develop partnerships to raise awareness about IPV within HRSA and the U.S. Department of Health and Human Services (HHS)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 143 services, the OPA and the Centers for Disease Control and Prevention (CDC) developed the Quality Family Planning Services Recommendations, which provide clinical recommendations for family planning and related services (Gavin et al., 2017)
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144 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Telehealth can have a role in providing IPV care when privacy and safety are assured. A recent systematic review of trials comparing interventions for IPV services using telehealth versus usual care showed similar outcomes for each group.
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 145 App-Based Interventions for Identifying Risk and Connecting to Resources App-based interventions are emerging as an important strategy for addressing IPV. A longitudinal study of an app-based screening and safety planning program, MyPlan, found it to be effective for improving safety behaviors and reducing IPV among young adults over time (Glass et al., 2022)
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146 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV range of services, such as advocacy, shelter, and legal protection (Shorey et al., 2014)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 147 during pretest counseling for HIV and domestic violence risk assessment is required during post-test counseling of HIV-infected individuals (NYSDOH, 2013)
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148 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Veterans Administration Intimate Partner Violence Program The Veterans Health Administration (VHA) began formally encouraging IPV screening in Veterans Affairs (VA)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 149 at several VHA facilities (Iverson et al., 2022)
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150 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV which assesses the woman's risk for intimate partner homicide; options available to the woman; safety planning information that is consistent with the context and level of danger; community-specific IPV resources; and national hotline information (Sharps et al., 2016)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 151 TABLE 5-2 Continued Risk or Protective Factors* Strategy Approach • Low self-esteem Disrupt the • Early childhood • Depression and suicide attempts developmental home visitation • Aggressive or delinquent behavior as a pathway toward • Preschool youth partner violence enrichment with • Heavy alcohol and drug use family engagement • History of physical and emotional • Parenting skills abuse in childhood and family relationship programs • Treatment for at-risk children, youth, and families • Strong social support networks and Create protective • Improve school stable, positive relationships with others environments climate and safety • Neighborhood collective efficacy • Improve • Coordination of resources and services organizational among community agencies policies and • High rates of violence and crime workplace climate • Easy access to drugs and alcohol • Modify the • Weak community sanctions against IPV physical and social • Weak health, educational, economic, environments of and social policies or laws neighborhoods • Low education or income Strengthen economic • Strengthen • Societal income inequality supports for families household financial security • Strengthen work– family supports • Communities with access to medical Support survivors to • Victim-centered care and mental health services increase safety and services • Communities with access to economic lessen harms • Housing programs and financial help • First responder • Communities with access to safe, stable and civil legal housing protections • Patient-centered approaches • Treatment and support for survivors of IPV *
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152 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV treatment for at-risk children, youth, and families. Strategies for creating protective environments, including schools, work, and neighborhoods, could reduce IPV risk related to established risk factors.
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 153 2015; Moynihan et al., 2015)
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154 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Firearm Violence Prevention Women are more likely to be shot and killed by a male intimate partner than they are to be killed by a stranger (Sorenson, 2017; Sorenson and Schut, 2018)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 155 protective environments (Finnie et al., 2022; Niolon et al., 2019)
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156 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV General feelings of social disconnectedness and hopelessness can also serve as barriers for Black women with IPV experiences who also have had a history of involvement with the legal system (Gutowski et al., 2023)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 157 engaging in IPV use to control and intimidate their partners, concern for the safety of pets can be a barrier to disclosure and care seeking. Access to shelters that allow women experiencing IPV to bring their pets can reduce this barrier (Campbell and Glass, 2009; Collins et al., 2018)
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158 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV FIGURE 5-3 Health Resources and Services Administration (HRSA) Primary Care Health Professional Shortage Area Map.
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 159 Maternity Care Professionals The March of Dimes categorizes maternity care deserts as counties that have no hospitals or birth centers offering obstetric care and no obstetricians/gynecologists (OB-GYNs) or certified nurse midwives providing deliveries (Brigance et al., 2022)
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160 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Sexual and Reproductive Health Care Professionals In some regions there are major shortages and gaps in the availability and distribution of clinicians providing the full range of sexual and reproductive health care. Contraception is a fundamental element of women's health care, and federal law20 requires full coverage of contraceptives for those with private insurance or Medicaid.
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 161 experiencing IPV. Pregnancy testing and abortion services are essential for those who experience sexual IPV and reproductive coercion (Grace and Anderson, 2018)
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162 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV 315 advocates from 119 sexual assault crisis centers across 44 states about emergency department preparedness to care for people who experience sexual assault found that the presence of a SANE was associated with an increased likelihood of availability of post-discharge resources (Chalmers et al., 2023)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 163 FIGURE 5-5 Health Resources and Services Administration (HRSA) Mental Health Professional Shortage Area Map.
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164 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Adolescent Care Professionals Accessibility to comprehensive adolescent care remains a major barrier for youth across the country, especially those who are immigrants, are uninsured, live in a rural area, or live in a neighborhood with a concentrated disadvantage. Even with federal and state insurance coverage for minors, including increases in receipt of care with the Patient Protection and Affordable Care Act (ACA)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 165 Confidentiality and Privacy Requirements Privacy and confidentiality requirements present challenges for integrated service models in a steady state context. For example, medical–legal partnerships, which "address the health-harming social and legal needs of patients and communities by integrating the expertise of health care, public health, and legal professionals," face legal impediments to sharing data among members of interprofessional care teams (Mantel and Knake, 2018, p.
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166 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV abortion counseling and referral and disqualify family planning sites that provide abortion services (Frederiksen et al., 2021)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 167 federal funding. Research has found that Medicaid enrollment grew during the PHE partly because of this policy (Benitez and Dubay, 2022; Mandal et al., 2022)
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168 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Required Coverage for Services Federal and state governments ensure or restrict access to health care through various means. One approach is to require health plans to cover certain types of services, such as preventive care.
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 169 Out-of-Pocket Expenses While preventive services are covered without cost sharing, the health consequences of IPV can be severe, and many people who experience IPV have significant care needs beyond preventive services. As a result, many face substantial out-of-pocket expenses.
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170 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV or abortion. HIPAA39 does allow patients to request that explanation of benefits statements are kept confidential, but enforcement has been uneven (English and Lewis, 2016)
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 171 Adjognon, O
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172 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Brown, R
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 173 Coker, A
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174 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Ford-Gilboe, M., C Varcoe, K
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 175 Gilmore, A
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176 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Hahn, C
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 177 Iverson, K
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178 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Kozhimannil, K
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 179 Markman, H
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180 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Miller, E., S Goldstein, H
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 181 North Carolina Department of Health and Human Services. Healthy opportunities.
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182 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Ragavan, M
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 183 Scheer, J
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184 ESSENTIAL HEALTH CARE SERVICES ADDRESSING IPV Sutton, A., H Beech, B
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ESSENTIAL HEALTH CARE SERVICES FOR IPV 185 Wagner, A
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