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I am a provider who has been assigned to train all the other providers about how to address IPV victimization. Do you have any advice for what type of training works best? I probably won’t be given much time to train each group of providers and want to do the best job possible. What if I only have 50 minutes?
There remains controversy over “screening” for IPV but there are numerous studies that show without inquiry most IPV “cases” remain hidden. Patients are very unlikely to spontaneously disclose IPV victimization or perpetration in the healthcare setting. So, if providers want to address IPV they must actually ASK patients questions about IPV. Providers have many barriers to addressing IPV—from personal experience with violence to lack of experience, lack of training, fear of offending patients, fear of not being able to handle patient disclosure, burn out and disillusionment, concerns about time management, and more.
An effective training must provide very practical tools and tips, showing providers “how to” address IPV in the context of your particular setting. An effective training must also provide hope—demonstrating to providers that providing support to an isolated, abused patient is ultimately deeply rewarding for both the patient and provider. Ideally, training should be interactive in some way—either through question and answer periods, “role playing”, or practical case work done in pairs or groups.
Summary of steps re training:
- Educate yourself—by following the process outlined in the “Get started” section.
- Develop a partnership or connection to a supportive community based IPV advocacy organization/shelter—preferably one that could serve as a major referral source for your patients. Invite this agency to help you with the training.
- Practice asking all your patients (or, at least, your women patients) about IPV so you can speak from experience and vouch for how “do-able” addressing IPV is, even in a busy practice.
- Share survivor stories at the beginning and throughout the training by reading survivor stories, sharing histories and quotes from patients, showing a video, or having a survivor speak.
- Remind the audience at the beginning of the training that providers are not immune to IPV and that the training is also applicable to all of us and our friends, family, and colleagues. (I’ve never done a training in which there are not survivors of violence/IPV amongst the staff).
- Give the providers sample questions to use with patients. You can use mnemonics such as HITS, a screening tool like the Abuse Assessment Screen, or a simple question like, “Has your partner ever hit you, hurt you, or threatened you?” No short screening tool addresses all forms of IPV including current and past emotional, physical, and sexual abuse—so, in practical terms, I advocate “finding your own voice” with non-judgmental, direct, behaviorally based questions like: “Has your current partner ever hit, hurt or threatened you?, Has your partner ever forced you to do something sexual you didn’t want to do? Has this ever happened with a past partner?” Click here to learn about available screening tools.
- Explain how to respond to a “yes” answer or disclosure—making sure that providers understand that their compassionate listening and emotional/verbal support as well as the provision of a hotline/crisis number are the most important interventions. See the Family Violence Prevention Fund guidelines.
- If there is time to incorporate “role playing” or practice cases into the training this will increase the likelihood that providers will try addressing IPV during clinical practice.
- Provide reference materials including the one-page “how to” sheet, local resource phone numbers, the healthy relationship checklist, and the safety brochure.
If you only have 50 minutes or little time to prepare consider showing the “Screen to End Abuse” video/CD-ROM and then taking questions for 20 minutes. This works very well!
In our clinic we have been screening women for victimization for a few years now. We all feel fairly comfortable handling disclosures of IPV, and accessing local agencies to assist our patients. Over the years we have also discovered that many of our gay male patients are also being victimized by their partners. We also feel that IPV will never be reduced if we don’t start helping patients who are perpetrating violence get help with their violent, abusive behavior.
We would like to start figuring out how to talk to men about IPV victimization and perpetration—but are not sure how to do this safely. Do you have any advice?
There is far less empiric study of screening men (than there is for screening women) for IPV victimization. There is also far less empiric study of screening male (or female) patients for IPV perpetration. Thus, we have little published experience to guide us. Many experts agree that screening men for both victimization and perpetration requires that providers be quite experienced in understanding the dynamics of IPV and the tendency of perpetrators of IPV to minimize, deny, and hide their abusive behaviors. Perpetrators of IPV will often portray themselves as victims, whereas victims often feel shame and guilt. IPV victimization (of both women and men) has been associated in many studies with poor health. Now, there is growing evidence that IPV perpetration is associated with poorer health and higher sexual risk behaviors.
Different approaches and programs for screening men for victimization and perpetration (or for screening all patients for both victimization and perpetration) have not been studied for efficacy or safety. One could imagine, though, that in some settings providers may design programs to screen patients for ANY IPV in their intimate relationship(s) and then refer the patients to someone who has the time and skill to sort out whether the patient is primarily being victimized or is primarily perpetrating IPV. At some point, though, all of the providers caring for a particular patient need to understand the patient’s role in the IPV in order to advocate effectively for the patient to develop healthier relationships. The provider needs to support and empower victims and hold perpetrators accountable for their behavior.
If you are going to begin a program to screen men for IPV victimization and perpetration I suggest that you:
- Read this review article on addressing IPV with men.
- Read these pilot guidelines on screening men for IPV victimization and perpetration.
- Read this one-page screening sheet.
- Read Why Does He Do That? Inside the Minds of Angry and Controlling Men by Lundy Bancroft.
- Speak to your local legal counsel about how to respond to patients who present an imminent threat to another person (what are your 5150 procedures? What are the laws in your state regarding a patient’s threat of harm to another person?).
- Establish contact with a batterer’s treatment program that can accept your patients, or at least, find out which programs are in your area and how to refer to them.
- Establish contact with programs that will treat gay men who are victimized by their partners.
- If possible establish contact with any programs that might be willing to assist heterosexual men victimized by a female partner (or will, at least, provide phone counseling).
- Consider establishing a continuous quality improvement monitoring project that includes safe, anonymous ways for patients to provide you feedback on your programs (especially so that victimized patients can let you know if your addressing IPV with perpetrators has affected them adversely in any way).
I work in a pediatric setting. We are not currently screening for IPV. I am really concerned that so many of the child abuse patients and, also, other children are witnessing their parents’ IPV. How do I convince the pediatricians I work with to address parental IPV? Do you know of any resources for pediatricians addressing IPV?
The American Academy of Pediatrics has stated that “the abuse of women is a pediatric issue”. For many abused women, the only healthcare provider they interact with will be their child’s pediatrician as their partner may actively bar them from seeking their own healthcare. Thus, pediatricians play a crucial role in addressing adult IPV. Pediatricians are also in a position to supportively educate parents about the effects of exposure to adult IPV on child development in general and on the health and well-being of a particular child. Children who are exposed to IPV hear, see, and are aware of more than their parents/guardians realize. Children exposed to IPV are dramatically affected by this exposure—which affects their neurologic, emotional, behavioral, and physical development. Children exposed to IPV have more behavioral, emotional, and physical problems.
Children who are exposed to adult IPV may also be directly abused. Studies find that between 30-60% of cases in which there is parental IPV there is child abuse also and vice versa.
We also now know that experiencing traumatic events as a child (including witnessing IPV) results in increased high risk behaviors and increased physical and mental health problems as an adult. So, the entire life course for a child can be dramatically influenced by exposure to adult IPV as a child.
Anecdotally, victimized parents consistently report that the realization of how deeply damaging their unhealthy relationship is for their children is one of the most motivating factors in seeking greater safety and assistance. There is some evidence from projects such as "Fathering after Violence" that even perpetrators of IPV find motivation to change through education about the adverse effects their violent, abusive behavior has on their children.
Steps to take: