Domestic violence is one of the leading contributors to chronic health care problems in women, and prolonged exposure to violence is the principal predictor of morbidity and mortality.1 This month, DVCC360 explores the health impact of domestic violence and strategies that local communities can embrace to respond more effectively.
Aside from the immediate trauma caused by an individual assault, emerging research has shown that domestic violence both contributes to chronic health problems and limits the ability of victims to successfully manage their health care needs. Women who have been physically or psychologically abused by an intimate partner are at increased risk of being treated for arthritis, migraines, sexually transmitted diseases, stomach ulcers, and spastic colon.2 A perpetrator’s control of the victim’s access to, and compliance with, health protocols, makes optimal management of these illnesses exponentially more difficult. As a result, domestic violence victims are less likely to engage in important preventative health care behaviors and more likely to participate in injurious health behaviors, such as smoking, alcohol abuse and substance abuse.3
The long term health consequences of domestic violence reach far beyond the individual victim. The economic magnitude is significant. Each year, the costs of intimate partner rape, physical assault, and stalking exceed $5.8 billion.4 This includes almost $1 billion in lost productivity for daily work responsibilities in non-fatal IPV cases.5 Current research indicates that hospital-based domestic violence intervention will reduce health care costs by at least 20 percent.6 It is therefore in every community’s interest to explore how to effectively implement such intervention.
According to the Family Violence Prevention Fund, responses to intimate partner victims are most efficient and effective when coordinated in a multi-disciplinary manner and in collaboration with domestic violence advocates so that no single provider is responsible for the entire intervention.7 This principle applies equally to creating an effective response to the health care needs of victims. Across the country, Medical Advocacy Projects created by local domestic violence advocates are leading these efforts. Locally, the DVCC’s Medical Advocacy Project, led by Susan Delaney, has made impressive advancements through partnerships with organizations such as Stamford Hospital and the Masters Entry Into Nursing (MEIN) Program at the University of Connecticut’s School of Nursing. Through research, advocacy, and training, these partnerships are changing the entire face of the health care response to victims of domestic violence in Stamford.
Currently, in its third year, the Medical Advocacy Project (MAP) is designed to promote early identification of victims through universal screening at the point of entry to the health care system; provide on-site advocacy to victims in hospitals, clinics, and medical offices; and implement a comprehensive training program for physicians, nurses and other healthcare professionals. In close consultation with experts in the field, such as Dr. Isabel Butrymowicz, the Clinical Research Project Manager at the Yale University School of Medicine, MAP has created a training program for effectively assessing, responding, documenting and making appropriate referrals on domestic violence cases. To date, over 1,200 doctors, nurses, and affiliated staff at Stamford Hospital have received this training. Moreover, in an effort to continue improving their overall response to domestic violence victims, Stamford Hospital has worked closely with Delaney and the Medical Advocacy Project to implement a cutting edge intake and assessment protocol, designed to more effectively screen for and refer patients who have experienced or are currently experiencing domestic violence. “The education and training available through our local Medical Advocacy Project provides medical professionals with the necessary tools to appropriately asses and refer victims of domestic violence,” says Delaney. “Our goal is to enable providers to go beyond merely treating presenting injuries and instead play a critical role in addressing root causes.”
In addition to MAP’s systemic advocacy with the staff at Stamford Hospital, the project also responds to crisis calls from health care settings 24 hours a day, 7 days a week, providing on-site advocacy for victims of domestic violence. Countless victims have been impacted by the capacity of the program. In one such case, a victim of domestic violence had been severely beaten and required a lengthy hospital stay. Her stay would have been prolonged by weeks had it not been for MAP. The project collaborated with hospital staff and successfully procured the necessary pain management equipment that the patient required to complete her recovery at home. The project was thus able to ensure that the victim’s recovery was as comfortable as possible and ease her concerns about how a lengthy hospital stay could affect her financial ability to move on safely and independently from her batterer.
The Medical Advocacy Project recognizes the basic fact that victims of domestic violence cannot possibly focus on their own health care when they are consumed with worry about their physical safety and that of their children. In one recent case, a safe house resident confided that she had not had a routine preventative health care screening in more than fifteen years. To more effectively address the health care needs of women who come into our safe houses in particular, MAP has partnered with Dr. Donna Clemmens, PhD, RN, of the University of Connecticut’s School of Nursing, and the Masters Entry Into Nursing (MEIN) Program to create a ground-breaking response. Through in-house health fairs and clinics, the MEIN program not only addresses the immediate health needs of residents and provides information critical to each family’s long term health care needs, including information on nutrition and the developmental needs of their children, it also collects data which is then used to enhance the types of screenings and health care services available. This partnership is so innovative that, in March 2012, Clemmens and Delaney were invited to the National Conference on Health & Domestic Violence, held in San Francisco, to present their work. As the program continues to collect data, their goal is to develop a targeted approach to addressing the health care needs of women and children in safe house settings that can serve as a model across communities.
The health care setting is undeniably a primary point of entry for victims of domestic violence, and battered women report that one of the most important aspects of their interactions with a physician is being listened to about the abuse. Even if a patient chooses not to initially disclose, the provider’s initial inquiry can often increase the likelihood of a future disclosure.8 Therefore, it is crucial that all doctors, nurses and affiliated medical professionals receive comprehensive training and begin to build internal protocols that facilitate their ability to identify domestic violence, connect victims to critical community resources, and respond appropriately to their concerns. While communities across the country have historically struggled to do so, programs with expertise in creating effective health care responses, such as the DVCC’s Medical Advocacy Project, welcome the opportunity to assist individuals and organizations throughout our seven towns as they work to enhance these capabilities, and we urge all of our partners to reach out and learn more.
For additional reading about the impact of domestic violence on the health of victims and strategies to creating an effective community response, the DVCC’s Medical Advocacy Project recommends:
“National Consensus Guidelines: On Identifying and Responding to Domestic Violence Victimization in Health Care Settings,” published by the Family Violence Prevention Fund, San Francisco (CA) (February 2004), available at: http://www.futureswithoutviolence.org/userfiles/file/Consensus.pdf.
- Chamberlain, L. at pg. 1, Assessment for Lifetime Exposure to Violence as a Pathway to Prevention, National Online Resource Center for Violence Against Women, VAWnet.org (2011), available at: http://www.vawnet.org/applied-research-papers/print-document.php?doc_id=301.
- Coker, A., et. al, at pg. 9, “Physical Health Consequences of Physical and Psychological Intimate Partner Violence.” Archives of Family Medicine (2000).
- “National Consensus Guidelines: On Identifying and Responding to Domestic Violence Victimization in Health Care Settings,” at pg. 5, The Family Violence Education Fund, San Francisco, CA (revised February 2004).
- National Center for Injury Prevention and Control. Costs of Intimate Partner Violence Against Women in the United States, pg. 2. Atlanta (GA): Centers for Disease Control and Prevention (2003).
- Id. at pg. 2.
- Futures Without Violence. The Facts on Health Care and Domestic Violence. Available at: http://www.futureswithoutviolence.org/userfiles/file/Children_and_Families/HealthCare.pdf.
- “National Consensus Guidelines: On Identifying and Responding to Domestic Violence Victimization in Health Care Settings,” at pg. 11, The Family Violence Education Fund, San Francisco, CA (revised February 2004).
- Id. at pg. 6.