Intimate Partner Violence Screening (IPV)

Intimate partner violence (IPV) is a pattern of behavior used to establish power and control over someone through fear and intimidation. It can include physical, sexual, emotional, or financial abuse. Nearly one out of three women experience IPV in their lifetime. Despite widespread recommendations for providers to screen women for IPV, screening rates remain low in healthcare settings.

There are many consequences of IPV. Among them, children that are exposed to IPV are at increased risk for abuse and neglect, mood and anxiety disorders, post-traumatic stress disorder, substance abuse, and school-related problems. Additionally, exposure to IPV during pregnancy is associated with late entry to prenatal care, lower infant birth weight, and is a leading cause of death during pregnancy. There is some evidence that screening in obstetrics clinics results in higher rates of identification when compared to emergency departments.

The Section of Public Health Pediatrics at Texas Children’s Hospital established a workgroup to assess IPV screening, identification, and referrals in the greater Houston community. Based on this assessment, the work group developed the following recommendations on how to improve IPV screening:

• Screen alone. Many of the participants said their abuser was with them when they were screened for IPV so they were unable to answer truthfully.
• Before you screen, tell patients what you will do if they respond “yes.” Some of the participants expressed fear of not knowing what would happen if they responded truthfully to the screen and suggested that they would be more likely to disclose if they knew what would happen next. In addition, many participants shared that they did not understand the legal system and were fearful of losing custody of their children if they disclosed.
• Providers should improve rapport. Many of the participants reported that they would be more likely to disclose if the providers had better rapport such as listening, making eye contact, and caring for the patient.
• More specific questions. Many of the participants were not aware they were in abusive relationships so they recommended asking specific and direct questions that included questions on non-physical abuse.
• Referral / follow-up. The referrals and follow-up from a positive disclosure must be tailored to the individual patient’s circumstance to decrease the risk of violence for the patient.