Intimate Partner Violence - KU School of...
Transcript of Intimate Partner Violence - KU School of...
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
Intimate Partner Violence
KUSM‐Wichita Family Medicine Residency at Wesley Family Medicine
Amanda Steventon, MDApril 11, 2014
Case presentation
• New patient, 30 yo G4P3– Recently relocated from Oklahoma
– Reveals she has not yet told her partner about the move
– Worried about the delivery and presence of partner
– Bruising noted
http://www.health2fit.com/tag/pregnancy/
1
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
Objectives
• Name the types of intimate partner violence (IPV) and review the prevalence of IPV
• Explain when to screen for IPV based on patients displaying signs of IPV
• Discuss the management of patients with current IPV and with a history of IPV
Case Presentation
• At Delivery– Partner is present
– Appears reconciliation occurred
• At 6 week postpartum visit– Tearful, angry
– Relationship has dissolved again
http://www.growingyourbaby.com/wp‐content/uploads/2009/07/3605161_blog1.jpg
2
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
Case presentation
• At 1 yo well child
– Reconciliation occurred
– Angry and depressed
• In hospital
– Fearful of his presence
– Depressed
Types of Abuse
• Physical
– aggression
• Sexual
– coercion
• Psychological
– control
Feder, G. et al. An Evidence‐Based Response to Intimate Partner Violence.http://narconon.ca/blog/drug‐addiction/resolving‐family‐drug‐abuse‐narconon.html , http://topnews.net.nz/content/231371‐abuse‐link‐be‐reconsidered‐acc , http://www.dailyrecord.co.uk/news/scottish‐news/police‐vow‐action‐domestic‐abuse‐1709371
3
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
Intimate Partner Violence
• 29% of women will experience IPV
– Black non‐Hispanic
– Young, unmarried
– Low income
– Addiction
– Pregnancy
• 10% of men will experience IPV
– Alaska native
– Black non‐Hispanic
– Young
– Same sex partner
Intimate Partner Violence: Consequences. Eggertston,Laura. New WHO guidelines on intimate‐partner violence. An overview of Intimate Partner Violence in the United States‐ 2010 findings. National Center for Injury Prevention and Control, Division of Violence Prevention. Accessed March 2014. Kimberg, Leigh. Addressing Intimate Partner Violence with Male Patients: A Review and Introduction of Pilot Guidelins. Gottlieb, Amy. Intimate partner violence: a clinical review of screening and intervention.
Intimate Partner Violence
• Cost of IPV more than 8.3 billion
• 38% of murders due to IPV
http://www.jamescounselling.co.uk/abuse‐counselling/
4
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
Identifying Signs of IPV
• Anxiety
• Depression
• Suicidality
• Sleep disorders
• Unexplained GI symptoms
• Unexplained reproductive system symptoms
• Unexplained injuries
• Using healthcare services often
Eggertston,Laura. New WHO guidelines on intimate‐partner violence. Gottlieb, Amy. Intimate partner violence: a clinical review of screening and intervention.
To Screen or Not to Screen?
• World Health Organization (WHO) 2013– recommends against routine screening
• United States Preventive Services Task Force (USPSTF) 2013 – B recommendation for routine screening
• Women of childbearing age• Aids in reduction of violence and adverse outcomes
– B recommendation to refer women who screen positive– No recommendations for men, women older than
childbearing age– Insufficient evidence for elderly/vulnerable adult screening
Feder, G. et al. An Evidence‐Based Response to Intimate Partner Violence. Bair‐Merritt, Mary, et al. Primary Care‐Based Interventions for Intimate Partner Violence, A Systematic Review. Moyer, Virginia. Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults: U.S. Preventive Services Task Force Recommendation Statement.
5
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
Barriers
• Lack of training
– Only 10% are screening routinely
• Competing time demands
• Limited access to referral resources
• Low confidence of effectiveness
• Harm to doctor‐patient relationship
McCall‐Hosenfeld, et al. “I Just Keep My Antennae Out”: How Rural Primary Care Physicians Respond to Intimate Partner Violence. Gottlieb, Amy. Intimate partner violence: a clinical review of screening and intervention.
http://www.w3.org/2010/Talks/ij‐ltgroups‐20101103/barriers
Caring for Patients of IPV
• First line support
– Provide access to information of resources
– Identify the scope and severity of IPV
• Treat accompanying mental health issues
– Appropriate interventions
• Validation/Empathy
Feder, G. et al. An Evidence‐Based Response to Intimate Partner Violence.
6
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
Caring for Patients of Current IPV
• Danger assessment
• Safety planning
• Referral
• Follow up planning
• Documentation
McCall‐Hosenfeld, et al. “I Just Keep My Antennae Out”: How Rural Primary Care Physicians Respond to Intimate Partner Violence. Bair‐Merritt, Mary, et al. Primary Care‐Based Interventions for Intimate Partner Violence, A Systematic Review. Gottlieb, Amy. Intimate partner violence: a clinical review of screening and intervention.
http://www.hotpeachpages.net/canada/air/medbook/23.html
Caring for Patients with Prior IPV
• Post‐Traumatic Stress Disorder– Cognitive Behavioral Therapy (CBT)
– Eye movement desensitization and reprocessing therapy (EMDR)
• Address comorbid mental health issues
Eggertston,Laura. New WHO guidelines on intimate‐partner violence.
http://www.psychologist‐nh.com/cognitive‐behavioral‐therapy‐cbt/
7
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
Special Populations of IPV
Pediatric
• Identification
– PCPs have difficulty in identification
– Psychosocial affects
– 30‐60% of families with IPV child will be abused
http://www.dailymail.co.uk/news/article‐2004878/Unmarried‐parents‐6‐times‐likely‐split‐time‐child‐5.html
Klassen, Brian, et al. Pediatric Symptom Checklist Ratings by Mothers with a Recent History of Intimate Partner Violence: A Primary Care Study. Stiles, Melissa. Witnessing Domestic Violence: The Effect on Children. Am Fam Physician. Kimberg, Leigh. Addressing Intimate Partner Violence with Male Patients: A Review and Introduction of Pilot Guidelins.
Pediatric
• Screening
– Study in Michigan
• Pediatric Symptom Checklist (PSC) behavioral screen
• Management
– Education
– Referral
– Follow up
Klassen, Brian, et al. Pediatric Symptom Checklist Ratings by Mothers with a Recent History of Intimate Partner Violence: A Primary Care Study. Stiles, Melissa. Witnessing Domestic Violence: The Effect on Children. Am Fam Physician. Kimberg, Leigh. Addressing Intimate Partner Violence with Male Patients: A Review and Introduction of Pilot Guidelins.
8
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
Resources• National Domestic Violence Hotline:
– 1‐800‐799‐SAFE
• IPV Screening and Counseling Toolkit– www.futureswithoutviolence.org
• IPV Delphi Instrument for hospital based programs– www.ahrq.gov
• National Crime Prevention Counsel– http://www.ncpc.org/topics/violent‐crime‐and‐personal‐safety
• CDC resources– http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/
resources.html
Shavers, Clarissa. Intimate Partner Violence, A guide for primary care providers. The Nurse Practitioner Dec 2013; 38 (12): 39‐44.
9
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
Resources• Wichita
– Harbor House• http://catholicdioceseofwichita.org/family‐stabilization/harbor‐house
– YWCA Crisis Center• http://www.ywcaofwichita.org/womens_crisis_center/what_we_do/
• Dodge City– Crisis Center
• http://crisiscenterdc‐com.doodlekit.com/home/family_first_center
• Liberal – Liberal Domestic Violence Center
• http://www.larcdvs.org/
• Salina– Ashby House
• http://www.ashbyhouse.org/
– Domestic Violence Center of Central Kansas• http://www.dvack.org/
• Garden City– Family Crisis Center
• http://www.familycrisisservices.com/index.html
• Hays– Options, Domestic and Sexual Violence Services
• http://www.help4abuse.org/
• Pittsburg– Safehouse Crisis Center
• https://www.facebook.com/pages/Safehouse‐Crisis‐Center‐Inc/291161577593249
• Emporia– Plumb Place
• http://www.plumbplace.org/
– Shiloh House• http://www.shilohhomeofhope.org/
10
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
Screening Tools
• Hurt, Insult, Threaten, Scream (HITS)– http://www.fpnotebook.com/Prevent/Exam/SfScrnFrIntmtPrtnrVlnc.htm
• Ongoing Abuse Screen/Ongoing Violence Assessment Tool (OAS/OVAT)– http://www.cdc.gov/ncipc/pub‐res/images/ipvandsvscreening.pdf
• Slapped, Threatened, and Throw (STaT)– http://www.cdc.gov/ncipc/pub‐res/images/ipvandsvscreening.pdf
• Humiliation, Afraid, Rape, Kick (HARK)– http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034562/table/T1/
• Modified Childhood Trauma Questionnaire (CTQ‐SF)• Woman Abuse Screen Tool (WAST)
– http://www.fpnotebook.com/Prevent/Exam/SfScrnFrIntmtPrtnrVlnc.htm
Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults: Recommendation Statement. Am Fam Physician. 2013 Apr 15;87(8):online.
11
Intimate Partner ViolenceAmanda Steventon, MD
4/11/2014
References• Feder, G. et al. An Evidence‐Based Response to Intimate Partner Violence. JAMA August 7, 2013; 310 (5) 479‐480. • Intimate Partner Violence: Consequences. CDC.gov, March 2014;
http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/consequences.html• Eggertston,Laura. New WHO guidelines on intimate‐partner violence. CMAJ 2013. DOI:10.1503/cmaj.109‐4609• McCall‐Hosenfeld, Jennifer, et al. “I Just Keep My Antennae Out”: How Rural Primary Care Physicians Respond to
Intimate Partner Violence. Journal Of Interpersonal Violence, 14 Jan 2014 DOI: 10.1177/08862560513517299; 1‐25. • Bair‐Merritt, Mary, et al. Primary Care‐Based Interventions for Intimate Partner Violence, A Systematic Review. Am J
Prev Med 2014; 46 (2):188‐194.• Shavers, Clarissa. Intimate Partner Violence, A guide for primary care providers. The Nurse Practitioner Dec 2013; 38
(12): 39‐44.• Klassen, Brian, et al. Pediatric Symptom Checklist Ratings by Mothers with a Recent History of Intimate Partner
Violence: A Primary Care Study. J Clin Psychol Med Setting (2013) 20:473‐477. DOI 10.1007/s10880‐012‐9354‐8. • Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults: Recommendation Statement.
Am Fam Physician. 2013 Apr 15;87(8):online. • Stiles, Melissa. Witnessing Domestic Violence: The Effect on Children. Am Fam Physician. 2002 Dec 1;66(11):2052‐
2067.• An overview of Intimate Partner Violence in the United States‐ 2010 findings. National Center for Injury Prevention
and Control, Division of Violence Prevention. Accessed March 2014. http://www.cdc.gov/violenceprevention/pdf/ipv‐nisvs‐factsheet‐v5‐a.pdf
• Kimberg, Leigh. Addressing Intimate Partner Violence with Male Patients: A Review and Introduction of Pilot Guidelins. J Gen Intern Med 2008 Oct 2, 23 (12):2071‐8.
• Gottlieb, Amy. Intimate partner violence: a clinical review of screening and intervention. Women‘s Health, 2008; 4 (5):529‐39.
• Cronholm,Peter, et al. Intimate Partner Violence. Am Fam Physician. 2011 May 15; 83 (10) 1165‐1172.• Moyer, Virginia. Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults: U.S. Preventive
Services Task Force Recommendation Statement. Annals of Internal Medicine, 2013 March 19; 158(6)478‐487.• Chamberlain, Linda, et al. The Impact of Perceived Barriers on Primary Care Physicians‘ Screening Practices for
Female Partner Abuse. Women and Health, 2008 Oct 21. 35:2‐3, 55‐69.
12