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The Importance of Screening

In 2013, Forbes Magazine reported on the cost of intimate partner violence…

Forbes Magazine

“In the U.S., 24 percent of adult women and 14 percent of adult men have been physically assaulted by a partner at some point in their lives. It is the most common cause of injury for women ages 18 to 44. And it leads to an increased incidence of chronic disease: Abused women are 70 percent more likely to have heart disease, 80 percent more likely to experience a stroke and 60 percent more likely to develop asthma.

Nearly a quarter of employed women report that domestic violence has affected their work performance at some point in their lives. Each year, an estimated 8 million days of paid work is lost in the U.S. because of domestic violence.

Domestic violence costs $8.3 billion in expenses annually: a combination of higher medical costs ($5.8 billion) and lost productivity ($2.5 billion).”

How Is Intimate Partner Violence a Health Issue?

Physical Effects

  • Acute or immediate physical injuries such as bruises, abrasions, lacerations, punctures, burns and bites, as well as fractures and broken bones or teeth
  • More serious injuries, which can lead to disabilities, including injuries to the head (TBI), eyes , ears, chest and abdomen
  • Gastrointestinal conditions, long term health problems and poor health status, including chronic pain syndromes
  • Death, including femicide and AIDS related death

Sexual and Reproductive Effects

  • Unintended/unwanted pregnancies
  • Abortion/unsafe abortion
  • STI’s, including HIV
  • Pregnancy complications/miscarriage
  • Vaginal bleeding or infections
  • Chronic pelvic infection
  • UTI
  • Fistula
  • Painful sexual intercourse
  • Sexual dysfunction

Mental Effects

  • Depression
  • Sleeping and eating disorders
  • Stress and anxiety disorders
  • Self-harm and suicide attempts
  • Poor self-esteem

Behavioral Effects

  • Harmful alcohol and substance use
  • Multiple sexual partners
  • Choosing abusive partners in later life
  • Lower rates of contraceptive and condom use

Why Screen for Abuse?

According to The Joint Commission:

  • All patients must be screened for abuse/neglect/sexual molestation and rape
  • Staff are to be trained how to screen
  • Staff members are able to make appropriate referrals for victims of abuse/neglect

The Affordable Care Act states:

  • Interpersonal violence screening and counseling will be covered by insurance for all adolescent and adult women
  • Reimbursement to providers for screening/intervention

Who is Required to Screen for Abuse?

  • Physicians
  • Nurses
  • Social workers or patient advocates

How to Screen for Abuse Guidelines

Here are some guidelines to think about when you are assessing a patient for abuse:

  • Everyone regardless of age should be routinely screened at each outpatient visit and emergency department visit.
  • Screening should be done in the individuals primary language with an interpreter who is not a friend or family member.
  • All patients should be screened for prior incidents of domestic violence.
  • Care providers should be aware of cultural issues and factors that influence the patient’s perception of abuse.
  • Screenings should be done face-to-face when the patient is alone and in a confidential, private setting.
  • Patients should be asked straightforward questions and asked to provide a medical and social history.
  • The care provider should be nonjudgmental to maintain communication with the patient.
  • Go from general to specific
  • Validate the experience

Determining what to ask, when to ask and how to ask can be a challenge depending on your work environment. For example, it might be difficult to find a private place to have a conversation if you work in the Emergency Department, or your clinic may be extremely busy and you may feel you do not have time to assess appropriately. We at the Beacon Program understand and are here to assist you and your staff. Once you have assessed or determined that there are concerns of abuse:

  • Ask the patient if they would like to talk to someone who is knowledgeable about intimate partner violence
  • State that the services is free and confidential (and optional if working with competent adult)
  • If the patient agrees to talk with Beacon, just give us a call at 984-974-0470, page us for more emergent consults (inpatient medical center only), place an order via EPIC or EPIC chat (Beacon adult)
  • If the patient does not want to talk to anyone right then, feel free to give them a Beacon Brochure and contact information for their County’s domestic violence agency if safe to do so.