Many thanks to Dr. Lucia Agudelo for her Grand Rounds presentation this week titled Beyond Intimate Partner Violence (IPV) Screening. Dr. Agudelo, who did professional work in this field before entering medical school, shared the high prevalence of IPV in the US, presented us with new framework of how to approach IPV conversations with our patients, and encouraged us to rethink our goal when we screen for IPV--from one of disclosure to one of support.
I do encourage you to watch a recording of Dr. Agudelo's presentation, available HERE.
For those of you who prefer a written summary. .
IPV is a pattern of assaultive and coercive behaviors that can include physical injury, psychological abuse, sexual assault, progressive isolation, intimidation and threats. It is aimed at establishing power and control of one partner over the other.
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| https://www.theduluthmodel.org/wheels/ |
In the US, an average of 20 people experience IPV every minute, which equates to more than 20 million abuse victims annually.
~1 in 5 women and 1in 7 men report having experienced severe physical violence from an intimate partner in their lifetime
~1 in 5 women and 1 in 12 men have experienced contact sexual violence by an intimate partner
IPV has wide ranging effects on physical and mental health and can exacerbate a huge range of medical problems-- everything from asthma and diabetes to depression/anxiety to unplanned pregnancy to menopause symptoms, to GI disorders and fibromyalgia.
Dr. Agudelo reminded us to consider IPV on our ddx when we are seeing patients with uncontrolled chronic conditions that don't seem to be able to get under control with standard therapies. This may include someone with high blood pressures or difficult to control blood sugars or even chronic pain. For more information on this, check out the 2019 NEJM article on IPV
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| https://www.nejm.org/doi/full/10.1056/NEJMra1807166 |
IPV has unsurprising wide ranging impacts on children, including physical injuries and child abuse, fear, depression and anxiety, sleep disturbances, eating disorders, and even impact on early brain development.
Dr. Agudelo introduced us to an evidence-based intervention to address domestic and sexual abuse in health settings called CUES. This methodology has been designed and created to offer support to men and women who are experiencing violence and connect them with help and support if they need/want it.
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| https://www.futureswithoutviolence.org/wp-content/uploads/CUES-graphic-Final.pdf |
C: CONFIDENTIALITY
- know your state's reporting requirements
- always see patients alone for a part of every visit so you can bring up safety
- use professional interpretation (not family/friends) if you cannot speak the patient's language
UE: UNIVERSAL EDUCATION AND EMPOWERMENT
- give patient TWO Safety cards (see graphic)
- "I am giving these cards to all my patients to be sure they know how relationships can impact health"
- Make sure you let the patient know you are a SAFE person to talk to
- Giving cards to EVERYONE (and not just those you suspect are at risk) makes it more likely that people who need the information will get the information
S: SUPPORT
- though disclosure is not the primary goal, you need to be ready to support someone if/when they do disclose
- be ready to make warm handoff to local support agencies with experience with IPV
- offer care plans that take IPV into account
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| https://www.dangerassessment.org/ |
Dr. Agudelo finished the presentation by encouraging us to hold our institutions of employment accountable to visible and concrete IPV safety-- including posters on the walls and signs in clinic rooms and bathrooms that denote safety and offer resources, the availability of safety cards and/or safety plans, easy access to resources (numbers, internet sites) for those who may be experiencing IPV and need help. How doe the clinic or hospital where you work ensure that patients know their rights and that this is a safe place?
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