hen you think about the role healthcare has in helping people who experience intimate partner violence (IPV) or domestic violence (DV), you might think about providing care for someone after an injury. That’s important, but at University of Utah Health we also believe that our providers can play a role in preventing and putting a stop to IPV. 

The statistics on domestic violence are staggering: 

• 1 in 3 women will experience IPV in their lifetime 

• 42% of homicides in the U.S. since the year 2000 were related to domestic violence 

• Men were the perpetrators in 88% of DV-related murders 

• Children witness 22% of domestic violence homicides 

• Women of all ages, races, and socioeconomic status can experience IPV 

While the numbers alone are shocking, perhaps more devastating is that these are not just statistics. These are people (mostly women) whose lives are dramatically changed, and in some cases tragically ended, because of the violence they experience. The Utah Department of Health (UDOH) reported that a child who witnesses IPV is more likely to experience childhood trauma and poor health outcomes throughout their lives, and is more likely to experience IPV as an adult. 

Domestic violence takes many forms 

The UDOH offers grants for primary prevention of domestic violence and we wanted to find out how we could alter the focus from predominately reactionary to the inclusion of primary prevention for healthcare professionals. We surveyed providers and staff and found that most had no training or very limited training in this area. 

As a result, the Trauma and Injury Prevention team with the support of the Office of Network Development and Telehealth (ONDT) education now works to train staff and providers on how to understand, identify, and take the necessary steps to intervene with someone experiencing intimate partner violence. We educate providers on how to identify the signs of IPV and help in a safe and appropriate way. We have screening tools in our emergency department to help identify patients who are victims. 

Beyond these tools, we also educate providers and staff to understand the signs of IPV that might not be as obvious as a bruise or an injury. Domestic violence can take many forms and providers or staff must be able to recognize them: 

• Physical violence 

• Emotional or psychological abuse 

• Control and isolation 

• Financial control 

• Verbal abuse (coercion, threats) 

• Sexual violence 

IPV prevention practices 

Discussing IPV with a patient can be uncomfortable. Some providers or staff may see signs of abuse or just feel like something is not right, but either they don’t know how to bring it up, or they doubt their suspicions. To break through that discomfort, our staff need to be equipped with the right tools, strategies, and training which include skills on communication.

Build a relationship of trust. 

The first step in being able to talk to patients about these sensitive and difficult topics is to build trust. That requires having a relationship with your patient and communicating with them effectively. It’s also important to be up front about the IPV screening and let them know before they answer that if they tell you about abuse you will have to report it. This gives them the power and the choice to disclose it or not. (Laws for adults are different than children; if you suspect child abuse you must report it. For adults you only have to report if you know it is occurring.) 

Use open ended questions. 

Rather than asking “Are you being abused?” “Are you safe?” or “Are you in a healthy relationship?” it’s better to ask open-ended questions. 

• What is your home like? 

• How's your relationship? 

• What do you view as being comfortable and healthy? 

Open-ended questions allow you to start a conversation so providers can pick up on small cues or indicators of potential abuse. In some cases, a person may not realize that they are in an abusive relationship and would answer “no” to the question. Or they might feel safe right now and answer “yes,” leading you to think they are safe all the time. Open-ended questions leave more room for nuance and discussion to determine someone’s risk level. 

Know risk and protective factors. 

Risk factors increase the risk they will experience IPV. These include things like: 

• Past history of violent relationships 

• Witnessing IPV as a child 

• Childhood trauma 

• Substance abuse 

Protective factors can reduce someone’s risk, even if they have some of those risk factors. Things like strong social connections, emotional and family support, problem-solving skills, and financial resources can all be protective factors. However, it’s important not to overstate protective factors or assume that because someone has them they could not be a victim of IPV. For example, having a lot of money doesn’t automatically mean someone cannot be abused.  

Pay attention to chronic health issues. 

Chronic health issues could also be a sign of a problem, even if they are not the typical signs you might expect from someone who is physically abused (like bruises or broken bones). Chronic headaches, abdominal pain, and other similar issues could be the result of high levels of stress from living in a constant state of “fight or flight.” 

How to prevent Intimate Partner Violence 

One of the most important things we can do to reduce IPV is to change the cultural norms that allow it to continue. 

• Engaging men in the conversation. Most men are not abusers, but most perpetrators of abuse are men. It’s important to have discussions with men and boys about how they can spot red flags in the men they know who could become abusive and intervene or speak out against it, or how to support women who disclose abuse. 

• Creating an open and inclusive environment for people to talk about it. People should not feel ashamed to seek help for IPV. The more open we are about it, the more empowered someone feels to get the help they need. 

• Setting common goals and clear expectations. When everyone understands how to identify IPV and their role in preventing it, we can make big strides as healthcare providers. 

The best thing we can do in health care to stop IPV is be more proactive and less reactionary. There are very few primary prevention programs out there now, so the more we can work on creating awareness, the more steps we can take to help end domestic violence. At U of U Health, we want to be at the forefront in that effort.