The Affordable Care Act, which comes into effect this month, paves the way for increased screening for intimate partner violence in the health care setting. While there are some health systems that are screening routinely, there are some that have not integrated this piece into their practice. After working in this field for years and having the benefits of prevention and screening drilled into my head while working on my Masters in Public Health, I was struggling to understand why health care providers would hesitate in screening for intimate partner and sexual violence. A recent article published in the journal Women & Health identified the main perceived barriers identified by health care service providers.
“Barriers to Screening for Intimate Partner Violence” identifies five categories of perceived concerns: personal barriers, resource barriers, perceptions and attitudes, fears, and patient related barriers. It is essential for advocates and educators to address these perceived barriers with service providers in their areas. The authors state,
Failure to diagnose IPV and intervene may have detrimental outcomes, as 44 percent of domestic violence-related homicide victims had presented to an emergency department within two years of their deaths (Davis, 2008).
The Affordable Care Act has created an opportunity for sexual assault and intimate partner violence fields to approach health care service providers with education and resources to help them feel more comfortable addressing violence with their patients. Health care providers may not know what signs to look for or how to address a patient who is exhibiting signs of trauma (emotional or physical). The social norms and rape myths that we try to dismantle in community outreach presentations may be present in health care settings, leading a service provider to resist a comprehensive screening or intervention of any sort. Additionally, providers may not know what resources exist for a survivor outside of the health care setting. Helping service providers to have a deeper understanding of the comprehensive services offered at a rape crisis or shelter based program may help the service provider feel more at ease when broaching the subject with a patient. Service providers may have also experienced their own trauma, making is challenging to remain neutral during the course of a screening. As advocates, we need to let service providers know that we are able to support them as well as their patients.
Here are some helpful resources to use when service as a resource for health care providers:
Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings, designed by the Centers for Disease Control
American Congress of Obstetricians and Gynecologists Resource Guide
“Barriers to Screening for Intimate Partner Violence”
Sheila Sprague, PhD, Kim Madden, MSc, Nicole Simunovic, MSc, Katelyn Godin BSc, Ngan K. Pham, and Mohit Bhandari, MD, PhD, FRCSC.
Women & Health, 52: 587-605, 2012.
Background: Health care providers play a vital role in the detection of intimate partner violence among their patients. Despite the recommendations for routine intimate partner violence screening in various medical settings, health care providers do not routinely screen for intimate partner violence. The authors wanted to identify barriers to intimate partner violence screening and improve the understanding of intimate partner violence screening barriers among different health care providers. Methods: The authors conducted a systematic review to examine health care providers’ perceived barriers to screening for intimate partner violence. By grouping the studies into two time periods, based on date of publication, they examined differences in the reported barriers to intimate partner violence screening over time. Results: The authors included a total of 22 studies in this review from all examined sources. Five categories of intimate partner violence screening barriers were identified: personal barriers, resource barriers, perceptions and attitudes, fears, and patient-related barriers. The most frequently reported barriers included personal discomfort with the issue, lack of knowledge, and time constraints. Provider-related barriers were reported more often than patient-related barriers. Conclusions: Barriers to screening for intimate partner violence are numerous among health care providers of various medical specialties. Increased education and training regarding intimate partner violence is necessary to address perceptions and attitudes to remove barriers that hinder intimate partner violence screening by health care providers.