PL-7. Identification and Intervention With Women Victims of Abuse in the Health Care System

Women who have experienced sexual and/or physical violence have been found to have significantly compromised physical and mental health. Controlled research from the US and other countries has shown an increased risk for injury, chronic pain, gynecological problems, chronic irritable bowel syndrome and a compromised immune system from both childhood and adult physical and sexual assault, particularly family violence (child and wife abuse). Abused women also have an increased risk for depression and post-traumatic stress disorder. Reproductive health problems related to intimate partner violence include increased unintended pregnancy, adolescent pregnancy, abuse during pregnancy, sexually transmitted diseases, urinary tract infection, and lowered birthweight in infants. Because of the high rates of trauma history and significant health effects, North American health care systems are beginning to screen for intimate partner violence and sexual assault routinely in health care systems and provide interventions for abused women. The majority of women in US emergency departments and managed care health settings say they approve of routine screening for intimate partner violence in health care settings. Screening can be achieved with a brief 4 question Abuse Assessment Screen which has been tested in many health care settings. Questions regarding the woman’s health need to include issues around intimate partner violence, sexual abuse, and address lethality assessment issues. The Danger Assessment is one tool that is used to assess the dangerousness of the woman’s situation. Documentation of the injuries should include photographs, a body map for injury history, and other written documentation that can be used for court proceedings. When abuse is identified, appropriate interventions need to be used. These include principles of empowerment, referrals to shelters or other domestic violence resources, safety planning, and long-term follow up by the health care giver. A brief health care intervention has been shown to increase women’s use of safety behaviors and decrease their experience of both physical and emotional violence from a partner. Other health care policy suggestions include addressing violence in prenatal and post-partum care, mental health care settings, and in HIV prevention programs.