Intimate Partner Violence (IPV) Awareness: ASK, ASSESS, REFER
April 3, 2015
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 . An additional study of adult female patients treated at the University of Kentucky Medical Center for facial trauma reported IPV rates of 5.5% .
More than 40% of murdered women are killed by a male partner . Half of all IPV-related homicide victims had presented to an ETC within 2 years of their death .
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 .
- Screen for IPV.
- Create a confidential environment.
- Ensure the patient is unaccompanied, whenever possible.
- "I need to conduct some additional screening in the adjoining room. We'll return shortly."
- "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."
- Close the door.
- Conduct the screening.
- Introduce the subject.
- "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?"
- Ask the question.
- "Have you been physically, sexually, or emotionally abused by an intimate partner?"
- Respect the patient's decision whether or not to disclose .
- Close the subject.
- "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."
- Address IPV—Counsel the patient.
- Provide validation and support.
- "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!"
- "I and everyone on my team are here to help you."
- De-stigmatize IPV/De-isolate the patient.
- "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."
- Assess patient safety.
- "Do you feel safe returning home today?"
- Assess child safety.
- "Have your children ever been injured or threatened? Do you fear that they might be?"
- Assess and respond to patient's wishes regarding actions to be taken.
- "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?"
- Address IPV—Offer referral/resources.
- Social work/counseling (see below)
- Law enforcement/Child protective Services
- Johnson County Family Crisis Center: 1-800-848-3206
- 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)
- 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 . More importantly, over 50% of those patients followed up with an outside case manager and over 25% reported resolution of violence at 1 year .
Reporting IPV to law enforcement is not currently mandatory in the state of Iowa. However, if child abuse is suspected, physician reporting is mandated.
ASK, ASSESS, REFER
- 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.
- Arosarena OA, Fritsch TA, Hsueh Y, et al. Maxillofacial injuries and violence against women. Arch Facial Plast Surg 2009;11:48-52.
- Family Violence Prevention Fund. The health care response to domestic violence: incidence and prevalence in an emergency department. JAMA 1996;273:1763-7.
- Davis JW. Domestic violence: the "rule of thumb": 2008 Western Trauma Association presidential address. J Trauma. 2008;65:969-74.
- 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