Safety Interventions in Domestic Violence in Primary Care Peer Review
Fact Sheet and Resource
Nearly 1 in 6 significant women in the U.S. take been abused by a partner.
Women who feel intimate partner violence prior to and during pregnancy are at increased risk of low maternal weight gains, infections, high blood pressure level and are more likely to deliver pre-term or low birth weight babies.
Women who received prenatal counseling for IPV had fewer recurrent episodes of IPV during and postal service pregnancy, also as better nascence outcomes such every bit lower rates of preterm birth and low nascency weight.
U.S. Preventive Services Chore Force (USPSTF) Course: B
USPSTF Recommendation:
Screen women of childbearing historic period for intimate partner violence (IPV), such as domestic violence (DV), and provide or refer women who screen positive to intervention services. This recommendation applies to women who do not have signs or symptoms of abuse.1
Intimate Partner Violence - Provider Fact Sail 
PDF - 77.96 KB
- Why is this important?
- How frequently is this preventive service being provided?
- What are the best screening practices identified in the literature?
- What are the best interventions identified in the literature?
- What barriers exist for providers?
- What are some provider-driven ideas to address these barriers?
- What does the Affordable Care Deed cover?
- What does Medicaid cover?
- References
For More than Data
- Provider Implementation Tools
- Other Resource
Why is this of import?
According to the CDC, it is estimated that roughly 1.v 1000000 women are raped and/or physically assaulted each year in the United States.2
Intimate partner violence (IPV) affects every bit many as 324,000 pregnant women each twelvemonth.3
Physical violence perpetrated by intimate partners is as well oftentimes accompanied by emotionally abusive and decision-making behavior.four Although women of all ages may feel IPV, it is nigh prevalent among women of reproductive age and contributes to gynecologic disorders, pregnancy complications, unintended pregnancy, and sexually transmitted infections.5
Due to underreporting and lack of recognition, IPV may occur more commonly amid pregnant women than conditions for which they are currently being screened (i.e. gestational diabetes, preeclampsia, etc.). IPV can have direct and indirect impacts on fetal wellness, such as spontaneous abortion and maternal stress, which in plough can induce alcohol or drug use or smoking. These behaviors are associated with poor outcomes like low birth weight, fetal alcohol syndrome, and others. Three studies have also constitute possible associations between IPV and unintended pregnancies.
Enquiry has plant that IPV rates are highest in families with young children, which supports intervention during the pre and perinatal periods.6 Screening is effective in the early detection and effectiveness of interventions to increase the condom of abused women.7
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How often is this preventive service being provided?
Ninety-half-dozen percent of women receive prenatal care, which can consist of 12-13 prenatal visits. As such, it tin exist an important window of opportunity to screen.viii Although screening for IPV is recommended by the USPSTF, studies have shown very low screening rates ranging from 1.5%- 12% in chief care settings.9
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What are the best screening practices identified in the literature?
American Congress of Obstetricians and Gynecologists (ACOG), in line with the U.Due south. United states of america Section of Health and Human Services (HHS) and Institute of Medicine (IOM), recommends that IPV screening and counseling should be a cadre part of women's preventive health visits and at periodic intervals, including obstetric care (at starting time prenatal visit, at least once per trimester, and at the postpartum checkup, as disclosure may not occur at the outset attempt). Providers should as well offering ongoing support, and review available prevention and referral options.10
All of the screening tools evaluated by the USPSTF are directed at patients and tin can be self-administered or used in a clinician interview format. The 6 tools that showed the nearly sensitivity and specificity were:11
- HITS (Hurt, Insult, Threaten, Scream) [PDF]
- OVAT (Ingoing Violence Cess Tool) [PDF]
- STaT (Slapped, Things and Threaten) [PDF]
- HARK (Humiliation, Afraid, Rape, Kick)
- CTQ–SF (Modified Childhood Trauma Questionnaire–Short Grade)
- WAST (Woman Abuse Screen Tool) [PDF]
Other screening tools for significant women include 4 Ps 12 and the Abuse Assessment Screen [PDF]. CDC has compiled a comprehensive list of screening instruments [PDF] that have been tested on various patient populations.
Studies have shown that patient self–administered or computerized screenings are every bit effective as clinician interviewing in terms of disclosure, comfort, and fourth dimension spent screening.13
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What are the best interventions identified in the literature?
Bear witness from randomized trials back up a variety of interventions for women of childbearing historic period, including counseling, dwelling visits, and mentoring support. Depending on the blazon of intervention, these services may be provided by clinicians, nurses, social workers, not–clinician mentors, or customs workers. Counseling generally includes information on safety behaviors and community resources. In addition to counseling, home visits may include emotional support, education on trouble–solving strategies, and parenting back up.14
A systematic review that evaluated the benefits of IPV interventions in master health settings showed that 76% of interventions resulted in at least 1 statistically meaning benefit – reductions of violence, improvement of physical and emotional health, safety promoting behaviors, utilize of IPV customs based resource. It also highlighted the following domains of successful interventions: focusing on self–efficacy and empowerment, focusing on admission to IPV resources, and brief not–physician interventions (collaborative multidisciplinary care teams).fifteen
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What barriers exist for providers?
- Time constraints
- Discomfort with the topic
- Fearfulness of offending the patient or partner
- Need for privacy
- Perceived lack of power to change the problem, and
- A misconception regarding patient population'south take chances of exposure to IPVsixteen
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What are some provider-driven ideas to address these barriers?
- Massachusetts Medical Community's "Use your RADAR" approach provides a thorough stride–by–step resource in how to have an constructive conversation about IPV with patients and develop appropriate referral networks to ensure continuity of care for patients who screen positive.
- Providers can play a significant part: creating and maintaining trust relationships with patients and being supportive is key to women disclosing sensitive information. Providers can inform a patient that IPV is prevalent and has serious health consequences, which is better than just providing data on resources, but may non exist better than doing nothing.
- Many women do not feel comfortable disclosing IPV; by providing pedagogy and resources, she tin still receive the information and employ it when it is near appropriate for her. Also, discussing safe and salubrious relationships is of import and can prevent serious abuse from occurring after.
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What does the Affordable Care Act comprehend?
All Marketplace plans and many other plans must cover domestic and interpersonal violence screening and counseling for all women without charging a copayment or coinsurance. This is truthful even if the patient has non met their yearly deductible. This applies only when these services are delivered past a network provider.17
The Centers for Medicare and Medicaid Services (CMS) besides provides data about the Coverage of Preventive Services.
HealthCare.gov provides lists of preventive intendance benefits for all adults and those specific to women.
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What does Medicaid cover?
Each state has its own programme for Medicaid coverage. To observe out more about Medicaid and CHIP eligibility and coverage in your state, delight visit Medicaid.gov.
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For more than information
Provider Implementation Tools
Intimate Partner Violence During Pregnancy, A Guide for Clinicians
The American College of Obstetricians and Gynecologists (ACOG)/Centers for Disease Control and Prevention (CDC) screen show on intimate partner violence during pregnancy is a training tool for clinicians to increase understanding of the important role they can play in identifying, preventing, and reducing intimate partner violence.
Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings [PDF] is a compilation of existing tools for assessing intimate partner violence (IPV) and sexual violence (SV) victimization in clinical/healthcare settings. This document should serve equally a guide to aid in the selection of assessment instruments for use in wellness care settings to identify victims requiring boosted services. The identification tin can assist practitioners make appropriate referrals for both victims and perpetrators.
Futures Without Violence provides alphabetize of health and domestic violence related materials, including Affordable Care Deed guidelines for screening and a guide for Addressing Intimate Partner Violence in Obstetric, Gynecologic and Reproductive Wellness Intendance Settings.
Health Cares Near IPV: Intimate Partner Violence Screening and Counseling Toolkit offers providers, health plan administrators, domestic violence advocates and others, the tools to implement the recommendations and identify and back up patients facing abuse.
Maryland Department of Health and Mental Hygiene, IPV Information for Healthcare Providers [PDF] includes a guide for providers, a sample cess tool, and methods to best dialogue with patients.
The Danger Cess helps to make up one's mind the level of danger an abused woman has of being killed by her intimate partner.
The National Wellness Collaborative on Violence and Abuse listing of recommended Preventive Medicine Service Codes [PDF] to Tape Screening and Brief Counseling of Domestic and Interpersonal Violence (updated September 2013).
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Other Resource
How the Affordable Care Human activity benefits survivors of domestic violence [PDF] provides information on The Affordable Intendance Deed & Women'south Health from the HHS Administration for Children and Families (ACF) Sectionalisation of Family Violence Prevention and Services (December 2013).
Health Resource and Services Administration (HRSA) Intimate Partner Violence and Perinatal Depression website provides a comprehensive approach for community-based programs to address intimate partner violence and perinatal depression.
March of Dimes Abuse During Pregnancy: A Protocol for Prevention and Intervention [PPT]
CDC Intimate Partner Violence website provides a diversity of information including definitions and data, risk and protective factors, consequences, prevention strategies, and additional resources.
CDC Violence and Reproductive Health website provides background information on key activities related to violence and reproductive health. Federal and other programs are highlighted as they may be important to public health professionals concerned nearly preventing violence that is associated with pregnancy-related illness, injury, and death.
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Source: https://www.ahrq.gov/ncepcr/tools/healthier-pregnancy/fact-sheets/partner-violence.html