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

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The Substance Abuse and Mental Health Services Administration of the US Department of Health and Human Services provides a useful online tool (https://findtreatment.samhsa.gov/) for locating local referrals that address behavioral health and substance-related concerns. The agency also provides a hotline (1-800-662-HELP [4357]) as an alternative resource for information and treatment referrals.

Safety planning can improve outcomes

For a patient who screens above low risk, safety planning with the patient is an important part of improving outcomes and can take several forms. Online resources, such as the Path to Safety interactive Web page (www.thehotline.org/help/path-to-safety/) maintained by The National Domestic Violence Hotline ([800]799-SAFE [7233]), provide information regarding important considerations for safety planning when:

living with an abusive partner
children are in the home
the patient is pregnant
pets are involved.

The Web site also provides information regarding legal options and resources related to IPV (eg, an order of protection) and steps for improving safety when leaving an abusive relationship. Patients at risk for IPV can explore the online tool and call the hotline.

For physicians who want to engage in provider-assisted safety planning, we’ve provided further guidance in the IPASSPRT screening script and safety plan (http://bit.ly/ipassprt) (TABLE 4).

Goal: Affirm patients’ strengths and reinforce hope

Psychological aggression is the most common form of relationship aggression; repeated denigration might leave a person with little confidence in their ability to change their relationship or seek out identified resources. That’s why it’s useful to inquire—with genuine curiosity—about a time in the past when the patient accomplished something challenging. The physician’s enthusiastic reflection on this achievement can be a means of highlighting the patient’s ability to accomplish a meaningful goal; of reinforcing their hope; and of eliciting important resources within and around the patient that can facilitate action on their safety plan. (See “IPV-related resources for physicians and patients.”)

SIDEBAR
IPV-related resources for physicians and patients

Intimate Partner Aggression Screening, Safety Planning, and Referral to Treatment (IPASSPRT) Project
› http://bit.ly/ipassprt
Online resource with tools designed by the authors, including an SBIRT-inspired script and safety plan template for IPV screening, safety planning, and referral

National Center for Injury Prevention and Control Division of Violence Prevention
› www.cdc.gov/violenceprevention/pdf/ipv-factsheet.pdf
Overview of IPV-related behavior, influence on health outcomes, people at risk of IPV, and sources of support, all in a format easily understood by patients

National Health Resource Center on Domestic Violence
› http://ipvhealth.org/
Includes guidance on connecting with IPV-related community resources; establishing such connections can facilitate warm handoffs and improve the likelihood that patients will follow through

Path to Safety, a service of The National Domestic Violence Hotline
› www.thehotline.org/help/path-to-safety/
Extensive primer on safety plans for patients intending to stay in (or leave) an abusive relationship; includes important considerations for children, pets, and pregnancy, as well as emotional safety and legal options

The National Domestic Violence Hotline
› (800) 799-SAFE (7233)

Substance Abuse and Mental Health Services Administration
› www.samhsa.gov/sbirt
Learning resources for the SBIRT protocol for substance abuse
› https://findtreatment.samhsa.gov/
Search engine and resources for locating local referrals
› (800) 662-HELP (4357)
Hotline for information and assistance with locating local treatment referral

IPV, intimate partner violence; SBIRT, screening, brief intervention, and referral to treatment.

Continue to: Closing the screen and making a referral