Primary Care–Based Interventions for Intimate Partner Violence

Bair-Merritt, Megan; Lewis‐O’Connor, Annie; Goel, Swati; Amato, Paula; Ismailji, Tasneem; Jelley, Martina J.; Lenahan, Patricia; Cronholm, Peter F.

doi:10.1016/j.amepre.2013.10.001

Cited by 161 publications

(139 citation statements)

References 38 publications

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“…Such post-disclosure interventions have significantly enhanced social service usage in non-VA settings. 40 Elevated rates of IPV among women identifying as lesbian or bisexual are consistent with national surveillance data. 19 It is important to note that non-heterosexual sexual orientation does not necessarily indicate perpetration of IPV by a samesex partner, as bisexual and lesbian women may have experienced IPV from male partners.…”

Section: Discussionsupporting

confidence: 67%

Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care

et al. 2016

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OBJECTIVES:The objectives of this study were to identify the prevalence of past-year intimate partner violence (IPV) among women Veterans utilizing Veterans Health Administration (VHA) primary care, and to document associated demographic, military, and primary care characteristics. DESIGN: This was a retrospective cohort design, where participants completed a telephone survey in 2012 (84% participation rate); responses were linked to VHA administrative data for utilization in the year prior to the survey. PARTICIPANTS: A national stratified random sample of 6,287 women Veteran VHA primary care users participated in the study. MAIN MEASURES: Past-year IPV was assessed using the HARK screening tool. Self-report items and scales assessed demographic and military characteristics. Primary care characteristics were assessed via selfreport and VHA administrative data. KEY RESULTS: The prevalence of past-year IPV among women Veterans was 18.5% (se = 0.5%), with higher rates (22.2% -25.5%) among women up to age 55. Other demographic correlates included indicators of economic hardship, lesbian or bisexual orientation, and being a parent/ guardian of a child less than 18 years old. Military correlates included service during Vietnam to post-Vietnam eras, less than 10 years of service, and experiences of Military Sexual Trauma (MST). Most (77.3%, se = 1.2%) women who experienced IPV identified a VHA provider as their usual provider. Compared with women who did not report past-year IPV, women who reported IPV had more primary care visits, yet experienced lower continuity of care across providers. CONCLUSIONS: The high prevalence of past-year IPV among women beyond childbearing years, the majority of whom primarily rely on VHA as a source of health care, reinforces the importance of screening all women for IPV in VHA primary care settings. Key considerations for service implementation include sensitivity with respect to sexual orientation, race/ethnicity, and other aspects of diversity, as well as care coordination and linkages with social services and MST-related care.

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Section: Discussionsupporting

confidence: 67%

Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care

et al. 2016

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“…17,18 Discussion of ARA during a clinical encounter may enhance adolescents' ability to address such abuse. The School Health Center Healthy Adolescent Relationships Program (SHARP) is a provider-delivered intervention implemented within routine SHC visits.…”

Section: What This Study Addsmentioning

confidence: 99%

A School Health Center Intervention for Abusive Adolescent Relationships: A Cluster RCT

et al. 2015

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BACKGROUND AND OBJECTIVES: Few evidence-based interventions address adolescent relationship abuse in clinical settings. This cluster randomized controlled trial tested the effectiveness of a brief relationship abuse education and counseling intervention in school health centers (SHCs). METHODS:In 2012-2013, 11 SHCs (10 clusters) were randomized to intervention (SHC providers received training to implement) or standard-of-care control condition. Among 1062 eligible students ages 14 to 19 years at 8 SHCs who continued participation after randomization, 1011 completed computer-assisted surveys before a clinic visit; 939 completed surveys 3 months later (93% retention).RESULTS: Intervention versus control adjusted mean differences (95% confidence interval) on changes in primary outcomes were not statistically significant: recognition of abuse = 0.10 (20.02 to 0.22); intentions to intervene = 0.03 (20.09 to 0.15); and knowledge of resources = 0.18 (20.06 to 0.42). Intervention participants had improved recognition of sexual coercion compared with controls (adjusted mean difference = 0.10 [0.01 to 0.18]). In exploratory analyses adjusting for intensity of intervention uptake, intervention effects were significant for increased knowledge of relationship abuse resources and self-efficacy to use harm reduction behaviors. Among participants reporting relationship abuse at baseline, intervention participants were less likely to report such abuse at follow-up (mean risk difference = 20.17 [20.21 to 20.12]). Adolescents in intervention clinics who reported ever being in an unhealthy relationship were more likely to report disclosing this during the SHC visit (adjusted odds ratio = 2.77 [1.29 to 5.95]).CONCLUSIONS: This is the first evidence of the potential benefit of a SHC intervention to address abusive relationships among adolescents.WHAT'S KNOWN ON THIS SUBJECT: Adolescent relationship abuse (ARA) is prevalent in confidential clinic settings such as school health centers (SHCs) and is associated with poor health outcomes. No evidence-based interventions target reduction of ARA in the SHC setting.

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“…These are just some of the reasons that research about screening and interventions for IPV is complex and challenging. 18 The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) supports more detailed diagnostic codes for IPV exposure and suspected or confirmed IPV, and robust EHRs (with careful attention to confidentiality) should promote the capture of more specific IPV diagnostic and treatment data.…”

Section: Ipv Screening and Interventionsmentioning

confidence: 99%

“…[5][6][7][8][9][10] Research indicates that screening and counseling for IPV can identify survivors and, in some cases, increase safety, reduce abuse, and improve clinical and social outcomes. [11][12][13][14][15][16][17][18][19] Possible harms or unintended consequences of clinical assessment have been raised and considered in research trials, but thus far no evidence of such harm has emerged. [19][20][21] Barriers for implementation of IPV screening and counseling are myriad, including clinician concerns about time; limited incentives for screening 22 ; either nonexistent or poorly implemented policies to guide clinicians and practices in conducting screening; lack of knowledge and confidence about how to support a patient who discloses IPV, [23][24][25][26][27] which may reflect lack of reliable intervention services 28 ; and inadequate crosssector collaborations with victim service advocates.…”

Section: Introductionmentioning

confidence: 99%

Integrating Intimate Partner Violence Assessment and Intervention into Healthcare in the United States: A Systems Approach

Miller

McCaw

Humphreys

et al. 2015

Journal of Women's Health

152

116

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The Institute of Medicine, United States Preventive Services Task Force (USPSTF), and national healthcare organizations recommend screening and counseling for intimate partner violence (IPV) within the US healthcare setting. The Affordable Care Act includes screening and brief counseling for IPV as part of required free preventive services for women. Thus, IPV screening and counseling must be implemented safely and effectively throughout the healthcare delivery system. Health professional education is one strategy for increasing screening and counseling in healthcare settings, but studies on improving screening and counseling for other health conditions highlight the critical role of making changes within the healthcare delivery system to drive desired improvements in clinician screening practices and health outcomes.This article outlines a systems approach to the implementation of IPV screening and counseling, with a focus on integrated health and advocacy service delivery to support identification and interventions, use of electronic health record (EHR) tools, and cross-sector partnerships. Practice and policy recommendations include (1) ensuring staff and clinician training in effective, client-centered IPV assessment that connects patients to support and services regardless of disclosure; (2) supporting enhancement of EHRs to prompt appropriate clinical care for IPV and facilitate capturing more detailed and standardized IPV data; and (3) integrating IPV care into quality and meaningful use measures. Research directions include studies across various health settings and populations, development of quality measures and patient-centered outcomes, and tests of multilevel approaches to improve the uptake and consistent implementation of evidence-informed IPV screening and counseling guidelines.

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Primary Care–Based Interventions for Intimate Partner Violence

Cited by 161 publications

References 38 publications

Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care

Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care

A School Health Center Intervention for Abusive Adolescent Relationships: A Cluster RCT

Integrating Intimate Partner Violence Assessment and Intervention into Healthcare in the United States: A Systems Approach

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