Applied Evidence

It’s time to start asking all patients about intimate partner violence

J Fam Pract. 2019 April;68(3):152-154,156-161A

References

1. Campos-Outcalt D. USPSTF: What’s recommended, what’s not. J Fam Pract. 2014;63:265-269.

2. Black MC, Basile KC, Breiding MJ, et al. National Intimate Partner and Sexual Violence Survey: 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2011:113. www.cdc.gov/violenceprevention/pdf/NISVS_Report2010-a.pdf. Accessed February 20, 2019.

3. West CM. Partner abuse in ethnic minority and gay, lesbian, bisexual, and transgender populations. Partner Abuse. 2012;3:336-357.

4. Hines DA, Malley-Morrison K. Psychological effects of partner abuse against men: a neglected research area. Psychology of Men & Masculinities. 2001;2:75-85.

5. Houston E, McKirnan DJ. Intimate partner abuse among gay and bisexual men: risk correlates and health outcomes. J Urban Health. 2007;84:681-690.

6. Carvalho AF, Lewis RJ, Derlega VJ, et al. Internalized sexual minority stressors and same-sex intimate partner violence. J Fam Violence. 2011;26:501-509.

7. Nicholls TL, Pritchard MM, Reeves KA, et al. Risk assessment in intimate partner violence: a systematic review of contemporary approaches. Partner Abuse. 2013;4:76-168.

8. Intimate partner violence: definitions. Atlanta, GA: National Center for Injury Prevention and Control, Division of Violence Prevention, Centers for Disease Control and Prevention, August 22, 2017. www.cdc.gov/violenceprevention/intimatepartnerviolence/definitions.html. Accessed February 20, 2019.

9. Archer J. Sex differences in aggression between heterosexual partners: a meta-analytic review. Psychol Bull. 2000;126:651-680.

10. Baron RA, Richardson DR. Human Aggression. New York, NY: Springer Science+Business Media; 2004.

11. Breiding MJ, Basile KC, Smith SG, et al. Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 2.0. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2015.

12. Murphy CM, Eckhardt CI. Treating the Abusive Partner: An Individualized Cognitive-Behavioral Approach. New York, NY: Guilford Press; 2005.

13. Straus MA, Hamby SL, Boney-McCoy S, et al. The revised Conflict Tactics Scales (CTS2): development and preliminary psychometric data. J Fam Issues. 1996;17:283-316.

14. West CM. Partner abuse in ethnic minority and gay, lesbian, bisexual, and transgender populations. Partner Abuse. 2012;3:336-357.

15. Desmarais SL, Reeves KA, Nicholls TL, et al. Prevalence of physical violence in intimate relationships. Part 1: rates of male and female victimization. Partner Abuse. 2012;3:140-169.

16. Lawrence E, Orengo-Aguayo R, Langer A, et al. The impact and consequences of partner abuse on partners. Partner Abuse. 2012;3:406-428.

17. Langhinrichsen-Rohling J, Selwyn C, Rohling ML. Rates of bidirectional versus unidirectional intimate partner violence across samples, sexual orientations, and race/ethnicities: a comprehensive review. Partner Abuse. 2012;3:199-230.

18. Langhinrichsen-Rohling J, McCullars A, Misra TA. Motivations for men and women’s intimate partner violence perpetration: a comprehensive review. Partner Abuse. 2012;3:429-468.

19. Anderson CA, Bushman BJ. Human aggression. Annu Rev Psychol. 2002;53:27-51.

20. Straus MA, Gozjolko KL. “Intimate terrorism” and gender differences in injury of dating partners by male and female university students. J Fam Violence. 2014;29:51-65.

21. Ferraro KJ, Johnson JM. How women experience battering: the process of victimization. Soc Probl. 1983;30:325-339.

22. Sugg NK, Inui T. Primary care physicians’ response to domestic violence: opening Pandora’s box. JAMA. 1992;267:3157-3160.

23. Morgan KJ, Williamson E, Hester M, et al. Asking men about domestic violence and abuse in a family medicine context: help seeking and views on the general practitioner role. Aggress Violent Behav. 2014;19:637-642.

24. MacMillan HL, Wathen CN, Jamieson E, et al; McMaster Violence Against Women Research Group. Approaches to screening for intimate partner violence in health care settings: a randomized trial. JAMA. 2006;296:530-536.

25. Thompson RS, Rivara FP, Thompson DC, et al. Identification and management of domestic violence: a randomized trial. Am J Prev Med. 2000;19:253-263.

26. Ard KL, Makadon HJ. Addressing intimate partner violence in lesbian, gay, bisexual, and transgender patients. J Gen Intern Med. 2011;26:930-933.

27. Rabin RF, Jennings JM, Campbell JC, et al. Intimate partner violence screening tools: a systematic review. Am J Prev Med. 2009;36:439-445.e4.

28. Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009;99:280-295.

29. Sherin KM, Sinacore JM, Li XQ, et al. HITS: A short domestic violence screening tool for use in a family practice setting. Fam Med. 1998;30:508-512.

30. Peralta RL, Fleming MF. Screening for intimate partner violence in a primary care setting: the validity of “feeling safe at home” and prevalence results. J Am Board Fam Pract. 2003;16:525-532.

31. Capaldi DM, Knoble NB, Shortt JW, et al. A systematic review of risk factors for intimate partner violence. Partner Abuse. 2012;3:231-280.

32. Brownridge DA, Taillieu TL, Tyler KA, et al. Pregnancy and intimate partner violence: risk factors, severity, and health effects. Violence Against Women. 2011;17:858-881.

33. Messing JT, Campbell JC, Snider C. Validation and adaptation of the danger assessment-5: a brief intimate partner violence risk assessment. J Adv Nurs. 2017;73:3220-3230.

34. Grigsby N, Hartman BR. The Barriers Model: an integrated strategy for intervention with battered women. Psychotherapy: Theory, Research, Practice, Training. 1997;34:485-497.

35. Moyers TB, Rollnick S. A motivational interviewing perspective on resistance in psychotherapy. J Clin Psychol. 2002;58:185-193.

36. Belfrage H, Strand S, Storey JE, et al. Assessment and management of risk for intimate partner violence by police officers using the Spousal Assault Risk Assessment Guide. Law Hum Behav. 2012;36:60-67.

37. McCloskey LA, Lichter E, Williams C, et al. Assessing intimate partner violence in health care settings leads to women’s receipt of interventions and improved health. Publ Health Rep. 2006;121:435-444.

38. Eckhardt CI, Murphy CM, Whitaker DJ, et al. The effectiveness of intervention programs for perpetrators and victims of intimate partner violence. Partner Abuse. 2013;4:196-231.

39. Trabold N, McMahon J, Alsobrooks S, et al. A systematic review of intimate partner violence interventions: state of the field and implications for practitioners. Trauma Violence Abuse. January 2018:1524838018767934.

40. Kraanen FL, Vedel E, Scholing A, et al. The comparative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) and substance abuse treatment alone: a randomized controlled trial. BMC Psychiatry. 2013;13:189.

These tools can facilitate screening for IPV

Physicians might have reservations asking about IPV because of 1) concern whether there is sufficient time during an office visit to interview, screen, and refer, 2) feelings of powerlessness to stop violence by or toward a patient, and 3) general discomfort with the topic.²²Additionally, mandated reporting laws regarding IPV vary by state, making it crucial to know one’s own state laws on this issue to protect the safety of the patient and those around them.

Screening increases the likelihood of engaging the patient in supportive services, thus decreasing the isolation that is typical of abuse.

Research has shown that some patients prefer that their health care providers ask about relationship violence directly²³; others are more willing to acknowledge IPV if asked using a paper-and-pencil measure, rather than face-to-face questions.²⁴ Either way, screening increases the likelihood of engaging the patient in supportive services, thus decreasing the isolation that is typical of abuse.²⁵ Based on this research, screening that utilizes face-valid items embedded within paperwork completed in the waiting room is recommended as an important first step toward identifying and helping patients who are experiencing IPV. Even under these conditions, however, heterosexual men and sexual minorities might be less willing than heterosexual women to admit experiencing IPV.^26,27

A brief vignette that depicts how quickly the screening and referral process can be applied is presented in “IPV screening and referral: A real-world vignette." The vignette is a de-identified composite of heterosexual men experiencing IPV whom we have counseled.

SIDEBAR
IPV screening and referral: A real-world vignette

Physician: Before we wrap up: I noticed on your screening that you have been hurt and threatened a fair amount in the past year. Would it be OK if we spoke about that more?

Patient: My wife is emotional. Sometimes she gets really stressed out and just starts screaming and punching me. That’s just how she is.

Physician: Do you ever feel concerned for your safety?

Patient: Not really. She’s smaller than me and I can generally calm her down. I keep the guns locked up, so she can’t grab those any more. Mostly she just screams at me.

Physician: This may or may not fit with your perception but, based on what you are reporting, your relationship is what is called “at risk”—meaning you are at risk for having your physical or mental health negatively impacted. This actually happens to a lot of men, and there’s a brochure I can give you that has a lot more information about the risks and consequences of being hurt or threatened by a partner. Would you be willing to take a look at it?

Patient: I guess so.

Physician: OK. I’ll have the nurse bring you that brochure, and we can talk more about it next time you come in for an appointment. Would it be OK if we get you back in here 6 months from now?

Patient: Yeah, that could work.

Physician: Great. Let’s do that. Don’t hesitate to give me a call if your situation changes in any way in the meantime.

One model that provides a useful framework for IPV assessment is the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, which was developed to facilitate assessment of, and referral for, substance abuse—another heavily stigmatized health care problem. The SBIRT approach for substance abuse screening is associated with significant reduction in alcohol and drug abuse 6 months postintervention, as well as improvements in well-being, mental health, and functioning across gender, race and ethnicity, and age.²⁸

IPASSPRT. Inspired by the SBIRT model for substance abuse, we created the Intimate Partner Aggression Screening, Safety Planning, and Referral to Treatment, or IPASSPRT (spoken as “i-passport”) project to provide tools that make IPV screening and referral accessible to a range of health care providers. These tools include a script and safety plan that guide providers through screening, safety planning, and referral in a manner that is collaborative and grounded in the spirit of motivational interviewing. We have made these tools available on the Web for ease of distribution (http://bit.ly/ipassprt; open by linking through “IPASSPRT-Script”).

Continue to: The IPASSPRT script appears lengthy...