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Katherine Beall, Ashley Beutel, Megan Gerwitz, Alivia Guthrie, Kira Jaroslawsky, & Chelsea Stewart

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Partner violence is not only a prevalent issue in the United States but a widespread global health issue as well affecting both men and women. Every day healthcare providers may treat or have seen a patient that has experienced intimate partner violence with or without knowing for certain. The literature review on these appalling global cases expresses that this can occur in all types of communities and subgroups. Identifying patients suffering from this tragedy can be difficult. Health care providers need to implement a better approach to avoid missing intimate partner violence victims. Physical and mental abuse causes a significantly horrendous toll on an individual, impoverished communities can be more susceptible to partner violence but that may not always be the case. The current health care delivery model for partner violence comprises environmentally safe screening and counseling. A strategy to further minimize this global health issue relates to an interprofessional quality improvement implementation regarding the check-in process at a healthcare office at all patient visits. Reducing this global health issue and decreasing the error of missing these victims is the goal.

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The CDC (2021) defines intimate partner violence as abuse or aggression that occurs in a romantic relationship. “Intimate partner” refers to both current and former spouses and dating partners. It includes physical violence, sexual violence, stalking, and psychological aggression.

Partner Violence in the United States is a common problem that affects 10 million people a year (Huecker et al., 2022). In the United States 1:4 women and 1:9 men are victims of domestic violence.

Partner violence is a public health problem and at some point, all healthcare professionals will evaluate or treat a patient who is a victim of partner violence. While it can be difficult to identify, healthcare professionals are the first ones to interact with these patients so being able to recognize it and make the appropriate referral is essential.

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Per CDC (2021), intimate partner violence starts early and continues throughout one's life. Certain individuals and communities are at a higher risk to experience violence due to specific living, social, structural, and employment conditions (CDC, 2021). The CDC (2021) explains that about 11 million women and 5 million men report sexual, physical, or stalking by an intimate partner in their lifetime, and that the first experience was before the age of 18. 35% of women and 11% of men experience some sort of physical injury from inmate partner violence (CDC, 2021).

There are many unhealthy medical outcomes that can result from IPV, and can affect the body physically and mentally in a negative way. Survivors may experience PTSD, mental health concerns, and be at a higher risk to engage in smoking, drinking, and risky sexual behaviors (CDC, 2021). Groups who have been marginalized, such as people from racial and ethnic minority groups, are at higher risk for worse consequences (CDC, 2021).

Certain risk factors include communities with high rates of poverty, unemployment rates, and crime (CDC, 2021). Relationship factors include controlling, aggressive partners, or increase in stress (CDC, 2021).

The cost burden related to intimate partner violence can be direct and non-direct. The cost for injuries related to intimate partner violence, lost productivity from paid work, criminal justice, and others was $3.6 trillion (CDC, 2021).
"The cost of IPV over a victim’s lifetime was $103,767 for women and $23,414 for men" (CDC, 2021).

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Offender Relationship to Victim (ICJIA, 2018)

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Summary of USPSTF Recommendations for IPV Screening

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The QI intervention is a screening tool incorporated into an office check-in procedure.

Sivarajasingam (2021) states that reliable screening for domestic abuse leads to a reduction in abuse prevalence in a community.

Hawkins et. al.(2014) shows that with the use of technology, clinics can screen for domestic abuse while activating social services when a person screens positive for at risk.  This activation of social services decreases the delay to aid and led to a reduction of redundant domestic abuse cases (Hawkins et. al, 2014).

Creating a screening questionnaire for domestic abuse as part of the technology check-in process for clinics, that would then activate social services when needed, would lead to a reduction of domestic violence in the community.

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American Family Physician (AFP). (2019, May 5). Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: recommendation statement. https://www.aafp.org/pubs/afp/issues/2019/0515/od1.html#:~:text=Several%20screening%20instruments%20can%20be,Abuse%20Screening%20Tool%20(WAST).

Center for Disease Control and Prevention (2021, November 2). Fast Facts: Preventing Intimate Partner Violence.

https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html

Centers for Disease Control and Prevention. (2021, November 2). Risk and protective factors|intimate partner violence|violence prevention|injury Center|CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/intimatepartnerviolence/riskprotectivefactors.html

Hawkins, J. W., Pearce, C. W., Skeith, J., Dimitruk, B., & Roche, R. (2009). Using technology to expedite screening and intervention for domestic abuse and neglect. Public Health Nursing, 26(1), 58–69. https://doi.org/10.1111/j.1525-1446.2008.00754.x

Huecker, M.R., King, K.C., & Jordan, G.A. (2022) Domestic Violence. Statpearls

https://www.ncbi.nlm.nih.gov/books/NBK499891/

Sivarajasingam, V. (2021, April 1). Routine screening for domestic abuse. British Journal of General Practice. Retrieved July 14, 2022, from https://bjgp.org/content/71/705/173

Stapleton, S. J., Bradford, J. Y., Horigan, A., Barnason, S., Foley, A., Johnson, M., Kaiser, J., Killian, M., MacPherson-Dias, R., Proehl, J. A., Reeve, N. E., Slivinski, A., Valdez, A. M., Vanhoy, M. A., Zaleski, M. E., Gillespie, G., Bishop-Royse, J., Wolf, L., Delao, A., … Administrative Staff. (2019). Clinical practice guideline: intimate partner violence. Journal of Emergency Nursing, 45(2), 1–191. https://doi.org/10.1016/j.jen.2019.01.016

United States Preventative Services Task Force (USPSTF). (2018, October 23). Intimate partner violence, elder abuse, and abuse of vulnerable adults: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/intimate-partner-violence-and-abuse-of-elderly-and-vulnerable-adults-screening

Waalen, J., Goodwin, M. M., Spitz, A. M., Petersen, R., & Saltzman, L. E. (2020). Screening for intimate partner violence by health care providers: Barriers and interventions. American Journal of Preventative Medicine, 19(4), 230-237. https://www.doi.org/10.1016/s0749-3797(00)00229-4.

Yonfa, E., Fasol, M., Cueva, & Zavgorodniaya, A., (2021). Intimate Partner Violence, A literature Review. The Open Psychology Journal. DOI: 10.2174/1874350102114010011

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Literature Supporting the Significance of the Issue

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Literature Supporting the Significance of the Issue

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Intimate partner Violence is a global health issue, women and minority patient populations are especially vulnerable (Yonfa, et al., 2021). IPV does not discriminate and it can be influenced by cultural, socioeconomic, and educational factors, adverse child experiences are also known to contribute to IPV (CDC, 2021).
Approximately 35 percent of women worldwide have experienced some form of violence in their lifetime (CDC, 2021).
One study suggests that IPV appears to happen less often to married women in comparison to divorced or separated women in most countries (Yonfa et al., 2021).  Researchers in the Yonfa et al study also suggest that “childhood victimization and domestic violence are highly correlated” (2021).
In the clinical practice guideline, there was strong evidence present in their own review of the literature, this included how different screening types among intimate partner violence victims were preferred over others (Stapleton et al., 2019). Several studies found and reviewed by Stapleton et al. found that many of the studies had results relating to the notion that patients who are interviewed face to face and utilized a computer screening tool are more likely to disclose their personal experience with abuse (2019).
The literature review revealed that prevention is the primary target of research, finding ways to reduce and prevent IPV by promoting healthy, respectful, and non violent relationships for individuals, families and communities (CDC, 2021). Prevention is targeted through educational initiatives such as social emotional learning programs for youth, family based programs that teach safe and healthy relationship skills,  community outreach clubs, digital screening tools, and increased awareness on IPV warning signs all lead to early detection and prevention (CDC, 2021). Decreasing the stigma surrounding IPV and providing supports to victims that do come forward creates a protective environment fostering healing and recovery. Preventing IPV is a global health issue that requires unique targeted interventions and improved policies to protect victims and restore lives.

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Effective solutions from healthcare professionals and healthcare systems are required to address the health issues brought on by intimate partner violence. The United States Preventative Services Task Force (USPSTF, 2018) and multiple national healthcare organizations endorse screening and counseling for partner violence. Therefore, the healthcare delivery system must integrate screening and counseling in a safe and efficient manner.

The current USPSTF recommendation is to screen women of
reproductive age for partner violence and provide or refer women with positive screenings to the appropriate support services; however, there are no recommendations or guidelines for when and how often to screen for IVP (AFP, 2019; USPSTF, 2018). Moreover, studies show extremely low screening test engagement in primary care settings, with screening rates ranging from approximately 1.5% to 12% (Waalen et al., 2020).

The USPSTF (2018) does not list any recommendations for screening elderly or vulnerable adults, stating that there is no reliable screening tool in the primary care setting to screen this population in the absence of physical and identifiable signs of abuse. Additionally, there are no recommendations or guidelines for screening male and nonbinary patients.

The USPSTF (2018) recommends the following tests in screening for IVP: Humiliation, Afraid, Rape, Kick (HARK); Hurt/Insult/Threaten/Scream (HITS); Extended-Hurt/Insult/Threaten/Scream (E-HITS); Partner Violence Screen (PVS); and Woman Abuse Screening Tool (WAST).

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Clinical Practice Guideline_ Intimate Partner Violence