Intimate Partner Violence and Reproductive Coercion Intervention in a Health Care Setting

Meghan Benson, MPH, CHESDirector of Community Education

[email protected] ext. 1

Intimate Partner Violence & Reproductive Coercion Intervention in a Health Care Setting

Safe Healthy Strong 2014Health Care Provider TrackAugust 8, 2014

UW-Milwaukee Zilber School of Public Health

mailto:[email protected]

Copyright © 2013. Planned Parenthood of Wisconsin, Inc.

Conflict of InterestStatement

I have received no support or commercial funding for this presentation, or for any products mentioned herein.

AboutPLANNED PARENTHOOD

Copyright © 2014 Planned Parenthood of Wisconsin, Inc.

Annual reproductive health exams Birth control (including EC & condoms) Cancer screening STI testing & treatment HIV testing & risk-reduction education Pregnancy testing & all-options education NEW! Online appointment scheduling – www.ppwi.org Abortion services (Appleton, Madison & Milwaukee) Referrals for other health & social services Education & training Organizing & advocacy

http://www.ppwi.org/

Objectives

Explain the prevalence of intimate partner and sexual violence in family planning and other reproductive health care settings

Describe reproductive coercion as intimate partner violence (IPV)

List important knowledge, skills, and resources need to effectively screen for IPV

Describe a brief, brochure-based IPV intervention found to be effective in health care settings

Demonstrating competency in normalizing healthy relationships, screening for IPV, and making referrals for IPV


First, a few quick conversations…

Language is important – victim vs. survivor?

Trigger warning

Please practice self-care


Importance of Partnerships

Health care providers and sexual assault (SA) and intimate partner violence (IPV)/domestic violence (DV) service providers play different and unique roles in prevention and intervention Increased collaboration will only improve

health outcomes Cross-referrals


We’ve come a long way, but we need to do more.

In addition to intervention (especially once serious injury occurs), prevention and early intervention are necessary

In addition to criminal justice, other approaches – including broader community and population interventions – are needed

In addition to interventions in ER and urgent care, other health care settings can be utilized

In addition to addressing the needs of women and children, the needs of men and LGBTQ+ individuals, who are victims and survivors


Prevalence of Interpersonal Violence

1 in 3 women will experience sexual or physical violence in her lifetime

1 in 5 women will be sexually assaulted with half reporting being raped by a partner

1 in 4 women will experience intimate partner violence In a family planning setting (e.g. Title X health center) –

more than 1 in 2 women will experience intimate partner violence

Disparities in these rates exist among women of color, LGBTQ+ individuals, those who have been incarcerated, and other marginalized groups


The impact of IPV – beyond black eyes and broken bones…

Long-term health consequences Outcomes related to sexual and reproductive

health IPV increased the risk of unintended pregnancy Pregnancy also increase the risk of IPV Tobacco use – 42% of women experience IPV could not stop

smoking, compared to 15% of women not experiencing IPV Breastfeeding – 35-52% less likely to breastfeed & 41-

71% more likely to cease breastfeeding by 4 weeks postpartum

Postpartum depression – 5X more likely to experience Homicide is the second leading cause of injury-related

deaths among pregnant women


The importance of health care providers!

Women who talked to their health care provider about IPV 4X more likely to use an intervention 2.6X more likely to exit the relationship

SA & IPV/DV service providers also have a unique opportunity to ensure victims and survivors access health care 17% of women experiencing IPV report a partner

has prevented them from accessing health care services compared to only 2% of women who do not report IPV


Reproductive Coercion

Interfering with birth control methods

Coercing a partner to have unprotected sex

Controlling pregnancy outcomes


Reproductive Coercion

Health care providers are key!

Providing a discreet method of birth control

“Warm referrals” for SA and IPV services


Your Own Experience

Has a health care provider ever screened you for SA or IPV/DV? Reproductive coercion?

How was the screening done? Form Discussion with provider

Were you alone? Especially in the context of prenatal care


Umm…

“Has your partner ever hit, punched, kicked, slapped, pushed, shoved, or choked you?”

“Do you feel safe at home?”


Barriers for Health Care Providers

Scope of work Comfort level What to do after disclosure? Frustration Limited time


Addressing Barriers

SA & IPV/DV screening as a standard of care

Training & resources On-site services & “warm referrals” Focus on the goal of intervention –

education and support Brief, simple, and integrated

interventions are available


Brief, Brochure-Based Intervention


Futures Without Violence


www.futureswithoutviolence.org

http://www.futureswithoutviolence.org/

http://www.futureswithoutviolence.org/

First, do no harm.

Screen patients alone Screen patients in the language they will

understand Only used a trained medical interpreter Do not use family members or friends to translate

Before screening, review the limits of confidentiality Mandated reporting for minors

Reports required by law are allowed under HIPAA However, you violate HIPAA if you report something not

mandated by law


Example Discussion


Before we get started, I want you to know that everything you say to me is confidential, meaning I won’t talk to anyone else about what you tell me UNLESS you tell me that someone is hurting you, you are planning to hurt

yourself, or you are planning on hurting someone else.

Screening as a Standard of Care

How often should you ask about SA and IPV/DV? At least annually With each new partner Multiple, repeat visits for pregnancy tests,

EC, STI tests, etc… can be clinical indicators to assess more frequently


Screening as a Standard of Care

When should you ask about SA and IPV/DV? During any sexual and reproductive health care

visits Pregnancy test Birth control STI/HIV tests Initial & annual visits Abortions

Where should you provide education? In a private setting Alone


Elements of Intervention

4 Cs Confidentiality Conversation

Normalizing the activity – “We talk about this with [or we show this to] all our patients.”

Card Review the safety card Offer harm reduction strategies

Connect “Warm referral” to SA or IPV/DV service provider


• In groups of 3 – one provider, one patient, and one observer – practice introducing the Did You Know Your Relationship Affects Your Health? brochure

Practice!


Panel 1

Starts by addressing healthy relationships Positive behaviors are considered first Normalizes conversations about healthy

relationships Supports those already in healthy

relationships


Panel 2

Begins addressing specific unhealthy relationship behaviors Reproductive coercion Sexual assault Controlling behaviors


Panel 3

Further explores unhealthy and abusive relationship behaviors Fear of partner Protective behaviors/self-management

strategies Physical violence


Panel 4

Harm reduction approaches “Invisible” contraception Safety planning to include EC

NOT harm elimination For patients unable to leave an

abusive relationship


Panel 6 & 7

Provides additional support and resources

Opportunity to connect a patient with a SA or IPV/DV advocate1. On-site advocate2. “Warm referrals” 3. Phone number, addresses, and websites for

local SA and IPV/DV service providers


• In groups of 3 – one provider, one patient, and one observer – practice using the Did You Know Your Relationship Affects Your Health? brochure to:• Normalize healthy relationships• Explore unhealthy relationship behaviors• Assess for reproductive coercion and other forms

of physical violence• Provide harm reduction strategies and referrals,

as appropriate

Practice!


Comments, questions, thoughts, or ideas?


Intimate Partner Violence and Reproductive Coercion Intervention in a Health Care Setting

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