There are several ways in which health center environments can both increase awareness of IPV and make survivors feel safe. Maintaining patient privacy can make patients feel more comfortable discussing sensitive information including IPV. Ways to maintain privacy includes keeping adequate space in intake lines, using white noise machines and always seeing patients alone for sensitive conversations. IPV posters, pamphlets and other materials raise awareness of IPV and convey to survivors that it is a safe place for them be and talk about their experience when they are ready.
Trauma is widespread. IPV is one source of trauma for many people, approximately 1 in 3. Other sources of trauma include witnessing violence, experiencing natural disaster, or being impacted by incarceration. Being trauma-informed means recognizing the prevalence and impact of trauma and taking steps in policies, practices and environment to avoid further harm and promote healing.
The following trauma and trauma-informed care resources can be used by both health systems and domestic violence programs to better serve survivors and all people who have experienced trauma:
- National Center for Trauma-Informed Care
- National Center on Domestic Violence, Trauma and Mental Health
- Adverse Childhood Experiences (ACEs)
- Agency for Healthcare Research and Quality (AHRQ)
Safety, confidentiality, mandatory reporting
Safety is of the utmost importance in any health system addressing IPV. Administrators should review their organization’s safety and security policies. Staff should be trained in these policies and know what to do in case of emergency or if, for example, a patient discloses that they are fearful of their abusive partner in the waiting room. How can front desk staff alert security if they are concerned about safety in the waiting room? How do intake staff respond to partners who refuse to let a patient see their doctor alone? Is there an exit separate from the waiting room that a patient can safely leave through? These types of security threats will likely be rare but planning ahead will make clinic environments safer for patients and staff.
Research supports routine IPV education with patients as an effective intervention at improving health and safety, and preventing violence. This routine education increases awareness about IPV, lets survivors know that the clinic is a safe place for them, can be shared with friends and family, and also preps patients for IPV screening or discussions with clinicians.
There are a number of ways in which clinicians can identify patients experiencing IPV. By creating a trauma-informed environment, and increasing awareness of IPV through posters, brochures and routine education, patients may feel more comfortable discussing their experiences of abuse with clinicians. Healthcare workers can learn more about the signs and symptoms of IPV, and practice targeted inquiry with patients. Clinicians can also integrate into their regular practice of talking to all patients about IPV, or more generally, how relationships affect health. This practice can include IPV screening tools. Whether or not survivors are ready to disclose when asked, routinely discussing IPV in a trauma-informed manner communicates to all patients that IPV is an important issue and that it is safe to their provider if and when they feel comfortable doing so.
Integrating abuse history into care
There are many ways in which clinicians can integrate patient abuse history into their care. Common IPV-related health issues such as unwanted pregnancies and sleep disturbances, can be treated more effectively with their abuse history in mind. For a patient who has experienced unwanted pregnancies due to reproductive coercion, providers may suggest a long-acting invisible form of birth control that cannot easily be tampered with, such as an intra-uterine device (IUD). Trauma interventions and referrals for counseling may be appropriate treatment for survivors experiencing insomnia in addition to or instead of standard sleep hygiene recommendations or medication.
Clinical documentation of an abuse history is important to efficient patient treatment and care coordination. There are significant safety considerations for documenting IPV in patient records so it is important to work closely with information technology (IT) teams and electronic health record (EHR) providers to ensure extra protections for IPV and other sensitive information.
Risk assessments and Safety planning
DV risk assessments can help assess the level of danger of homicide or serious re-assault by an abusive partner that a survivor is in. These assessments are often done with the assistance of a DV advocate but can be used in healthcare settings as well. Safety planning helps survivors figure out how they can increase their safety and prepare for the possibility of violence incidents. Safety plans are often made with the assistance of a domestic violence advocate, but can be used in the healthcare setting with appropriate IPV training.