Family Medicine Providers

All forms of family violence are closely linked.

Studies estimate that in 30-60 percent of families in which there is adult IPV, children are also directly abused. Even when children are not directly abused, the exposure to adult IPV can be highly damaging to a child’s emotional, behavioral, and physical health. Childhood exposure to adult IPV can create developmental problems and inappropriate risk-taking behaviors that persist into adolescence and beyond.

The Adverse Childhood Experiences (ACE) Study demonstrates that this childhood exposure to adult IPV (and other traumatic childhood events) results in more risky health practices and poorer health for the exposed child as an adult. Intimate partner violence is often passed on from one generation to the next—affecting multiple family members and their health in long-lasting ways.

• Learn How to Address IPV and Childhood Exposure to IPV
• The Role of the Family Medicine Provider in Addressing IPV
• Screening Parents
• Caring for Pregnant Women
• Maintaining Safety and Confidentiality
• Inquiring about IPV with Men

Learn How to Address IPV and Childhood Exposure to IPV

1. Read the guidelines on how to address IPV in both adult and pediatric practices
2. Read our one-page “how to” address IPV sheets for family medicine providers
3. Follow the process on the Get Started page
4. Search on “domestic violence” on the American Academy of Family Physicians website
5. Place educational materials and posters in your practice

The Role of the Family Medicine Provider in Addressing IPV

The family medicine provider has a multi-faceted role in addressing IPV by:

1. Screening mothers and female guardians (and male guardians who are suspected of being victimized) for IPV victimization.
2. Screening mature middle childhood age children and all adolescents directly for exposure to adulthood IPV.
3. Screening adolescents (both boys and girls) for involvement in violent and abusive dating relationships.
4. Considering piloting a program of screening male patients for IPV victimization and perpetration.
5. Providing educational messages to all parents and children about the harmful effects of witnessing IPV on children.
6. Linking children and adults who have been exposed to IPV with appropriate treatment services.
   

Screening Parents

Family medicine providers have a unique, challenging, and high impact role to play in assisting families affected by intimate partner and family violence. Family medicine providers can screen parents for intimate partner violence and provide strong educational messages to parents about how childhood exposure to adult violence and abuse impacts children adversely in long-lasting ways. Family medicine providers also have a unique window into witnessing how various stressors are affecting all family members. Often, family medicine providers care for both the victim and the perpetrator within a couple experiencing IPV.

Caring for Pregnant Women

Family medicine providers also care for pregnant women who may begin experiencing IPV before, during, or after pregnancy. IPV has multiple adverse affects on pregnant women and newborns including an increased risk of hypertension and hospitalization of the pregnant woman, pre-term labor, low birth weight babies, and neonatal intensive care hospitalization. IPV is also associated with approximately a doubling of the STD rate. ACOG and CDC have prepared a slide show that addresses IPV in pregnancy that can be viewed on the CDC website. You can download our IPV and pregnancy brochures for use with your patients.

Maintaining Safety and Confidentiality

Family medicine providers face challenges to maintaining safety and confidentiality when addressing IPV as they care for so many couples and families. Some research suggests that it is safe to inquire about IPV victimization with women patients when both members of a couple are cared for in the same setting (provided that the female patient is screened in private and the results of the screening are kept completely confidential). Family practice providers must be aware that victims often feel guilty about their victimization while perpetrators of IPV often minimize, deny, and blame others for their violence. Guidelines and books can provide education regarding these dynamics.

Inquiring about IPV with Men

If family medicine providers embark upon inquiring about IPV with men, they should design the IPV program in such a way that it is clear that the program is “routine” and that a particular patient is not being screened for perpetration due to something revealed by their victimized partner. This will help protect the victimized partner, who also may be a patient in the family medicine practice, from retaliatory violence by the perpetrator patient. New pilot guidelines on addressing IPV with men and the accompanying review article may be helpful.