University of Iowa Health Care

Ophthalmology and Visual Sciences

EyeRounds.org

Intimate Partner Violence (IPV) Awareness: ASK, ASSESS, REFER

T.J. Clark MD, Erin M. Shriver, MD

April 3, 2015

Prevalence

In the University of Iowa Hospitals and Clinics Emergency Treatment Center (ETC)/eye clinic, 15% of orbital floor fractures in female patients are secondary to assault, with over half of these being intimate partner violence(IPV)-associated assault (7.6% overall) and 20% having no documented mechanism of injury [1].  An additional study of adult female patients treated at the University of Kentucky Medical Center for facial trauma reported IPV rates of 5.5% [2].

Importance

More than 40% of murdered women are killed by a male partner [3].  Half of all IPV-related homicide victims had presented to an ETC within 2 years of their death [4].

What to do

Screen ALL female patients presenting with facial/ocular trauma in the absence of a well-defined mechanism (e.g. motor vehicle collision).

How to do it

Modified from The Ophthalmologist's Pocket Guide to IPV [1].

  1. Screen for IPV.
    1. Create a confidential environment.
      1. Ensure the patient is unaccompanied, whenever possible.
        1. "I need to conduct some additional screening in the adjoining room.  We'll return shortly."
        2. "You'll have to excuse us.  It's standard for me to spend some time speaking to my patients privately.  You are welcome to take a seat in the waiting room."
      2. Close the door.
    2. Conduct the screening.
      1. Introduce the subject.
        1. "Because violence is so common and because there is help available, we now ask every patient about Intimate Partner Violence.  Is this something that is happening in your life?"
      2. Ask the question.
        1. "Have you been physically, sexually, or emotionally abused by an intimate partner?"
      3. Respect the patient's decision whether or not to disclose .
      4. Close the subject.
        1. "I understand that abuse is not a comfortable topic to discuss, but I'd rather risk offending you than miss an opportunity to provide you with information and resources that could potentially help you."
  2. Address IPV—Counsel the patient.
    1. Provide validation and support.
      1. "I'm very sorry to hear that you've been subjected to that kind of treatment.  I need you to know that this is NOT your fault!"
      2. "I and everyone on my team are here to help you."
    2. De-stigmatize IPV/De-isolate the patient.
      1. "Unfortunately, experiences like yours are not uncommon.  I want you to know that you are NOT alone in this and that there ARE resources available to you."
    3. Assess patient safety.
      1. "Do you feel safe returning home today?"
    4. Assess child safety.
      1. "Have your children ever been injured or threatened?  Do you fear that they might be?"
    5. Assess and respond to patient's wishes regarding actions to be taken.
      1. "I understand that you are in a very difficult position.  How can I help you?  Are there certain steps you would like me to help you take at this time?"
  3. Address IPV—Offer referral/resources.
    1. Social work/counseling (see below)
    2. Law enforcement/Child protective Services
    3. Psychiatry
    4. Johnson County Family Crisis Center: 1-800-848-3206
    5. National Domestic Violence Hotline (USA): 1-800-799-SAFE

Who to contact

Specific to Iowa

  • In the ETC: on-site social worker is available 24/7.
  • In the eye clinic:  Social work/counseling service available by phone at:  319-356-2207.
  • The Johnson County Family Crisis Center: (1-800-848-3206)

Nationally

  • National Domestic Abuse Hotline (1-800-799-SAFE)

Effectiveness of Intervention

Over 80% of women who screened positive for IPV in an urban ETC setting agreed to speak with an in-house patient advocate [5].  More importantly, over 50% of those patients followed up with an outside case manager and over 25% reported resolution of violence at 1 year [5].

Additional Information

Reporting IPV to law enforcement is not currently mandatory in the state of Iowa.  However, if child abuse is suspected, physician reporting is mandated.

Take-Home Point

ASK, ASSESS, REFER

References

  1. Clark TJ, Renner LM, Sobel RK, et al. Intimate partner violence: an underappreciated etiology of orbital floor fratures. Ophthal Plast Reconstr Surg 2014;30:508-11.
  2. Arosarena OA, Fritsch TA, Hsueh Y, et al. Maxillofacial injuries and violence against women. Arch Facial Plast Surg 2009;11:48-52.
  3. Family Violence Prevention Fund. The health care response to domestic violence: incidence and prevalence in an emergency department. JAMA 1996;273:1763-7.
  4. Davis JW. Domestic violence: the "rule of thumb": 2008 Western Trauma Association presidential address. J Trauma. 2008;65:969-74.
  5. Krasnoff M, Moscati R. Domestic violence screening and referral can be effective. Ann Emerg Med 2002;40:485-92.

Suggested Citation Format

Clark TJ, Shriver EM. Intimate Partner Violence (IPV) Awareness: ASK, ASSESS, REFER. April 3, 2015; Available from: http://EyeRounds.org/tutorials/IPV.htm

last updated: 04/03/2015
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