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Intimate Partner Violence and Abuse. Tintinalli’s Chapter 299. Introduction. defined as a pattern of assaultive, coercive behaviors that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats
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Intimate Partner Violence and Abuse Tintinalli’s Chapter 299
Introduction • defined as a pattern of assaultive, coercive behaviors that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats • About 30 to 60 percent of reported cases of spousal abuse also report child abuse • Perpetrators of violence, in particular severe violence, may be at risk for suicide, committing murder or suicide, or being murdered by a family member
Epidemiology • In 1999, a reported 671,110 women and girls older than 12 years experienced murder, rape, sexual assault, robbery, aggravated assault, and simple assault at the hands of an intimate • Risk factors for IPVA include female sex, age between 16 and 24 years, low income household, relationship status of separated rather than divorced or married, and children younger than 3 years in the home
Emergency Department • 5 million visits each year to the ED are made because of IPVA • 4 and 15 percent of women seen in EDs are there because of symptoms related to IPVA • 50 percent of women seen in EDs have experienced IPVA at some point in their lives
Identification • Injury patterns: fingernail scratches, bite marks, cigarette burns, bruises suggesting strangulation, and rope burns • Suicide attempts or presenting with vague complaints • Multiple ED visits or seeking treatment days out from the injury
Treatment • Inform the patient of the problem and provide support • ED Documentation: • description of the abuse in the victim's own words • Use a body map and photographs to supplement the written description • Safety Assessment: • High risk indicators of a potentially lethal situation include escalation in the frequency or severity of violence; the threat or actual use of weapons, in particular firearms; obsession with the victim; hostage taking; stalking; and homicide or suicide threats or attempts and evidence of violent behavior outside the home • Referral - National Domestic Violence Hotline: 1-800-799-SAFE (7233)
Legal Considerations • Most states have laws that require health care providers to report injuries resulting from firearms, knives, or other weapons • Twenty-three states have reporting requirements for injuries resulting from crimes • Duty to Care (screen patients for abuse) and Duty to Warn (potential victims should be warned if threats are made)
EDs should take the following steps to prepare for optimal IPVA response: • 1. Place multicultural, multilingual brochures and posters in examination rooms and other areas of the hospital that provide information about IPVA and its impact on victims and other family members and provide information about community-based programs that provide services to victims. • 2. Implement a routine screening protocol that addresses training of ED personnel, confidential interviewing, and appropriate interventions, including validation and referral. • 3. Establish an IPVA continuous quality improvement program that assesses adherence to recommended screening and intervention strategies. • 4. Form close relationships with hospital- and/or community-based IPVA experts to ensure appropriate referral practices. • 5. Establish a program in the ED and other hospital facilities that addresses IPVA.
