Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

It’s time to address the shadow pandemic of intimate partner violence

Gabriele Ruzgas, Elsa Nico, Katherine Thompson, Nicole Zolman, and Shikha Jain, MD
Conditions
December 17, 2020
Share
Tweet
Share

As the coronavirus pandemic continues to surge through the nation, a concerning “shadow pandemic” is quietly growing as well. Many cities and states, including Chicago, are reinstituting stay-at-home advisories and orders to protect communities from COVID-19. Unfortunately, an unintended consequence has been the increase in intimate partner violence (IPV). With the tightening of stay-at-home regulations, the health care system cannot overlook those suffering behind closed doors.

IPV includes physical violence, sexual violence, emotional abuse, and stalking. IPV can affect anyone and is one of the leading causes of homicide in women. During the COVID-19 pandemic, homes have become an even more dangerous place for individuals experiencing IPV. They have to spend the whole day at home with little access to outside support or childcare services, and stressors in the home are exacerbated due to social isolation, compact living situations, economic hardships, and unemployment. The pandemic’s impact on IPV also differentially impacts vulnerable populations such as minority women, undocumented immigrants, and those with mental health conditions.

Early data from the COVID-19 pandemic related to IPV is difficult to assess due to under-reporting to law enforcement agencies, under-utilization of existing social services, and the challenge of collecting self-report data during a global pandemic. To interpret the pandemic’s impact on IPV, data has been gathered by looking at call traffic to various domestic violence hotlines globally. For instance, calls to a domestic violence hotline in the U.K. increased by 25 percent within the first week of stay-at-home measures, and similarly, a Vancouver crisis line experienced a 300 percent increase in calls during the pandemic.

In Chicago, the Chicago Police Department has seen a 13 percent increase in domestic violence-related service calls since the pandemic started, compared to the same time last year. From March 21 to April 22, 2019, the Illinois Domestic Violence Hotline received five text messages, while in 2020, during the same time frame, the number was 118, an increase of over 2,000-percent. This massive increase in text messages likely represents changes due to stay-at-home orders in which people were less able to safely make a phone call. Now, more than ever, it is essential to have effective and timely IPV screening and intervention.

Oftentimes, the doctor’s office serves as a first-line screening for IPV. The American Medical Association (AMA) recommends that all medical centers develop a clear IPV screening policy. Throughout training, physicians are taught to create a safe screening environment, identify physical signs of abuse, engage in sensitive, empathetic, and non-judgmental conversation, and provide additional resources for help. Patients are asked, “Do you feel safe at home?” at visits in hopes of identifying patients that might benefit from additional care, counseling, or referrals.

However, the transition to primarily telehealth visits during the pandemic has disturbed this process. It may be hard to evaluate physical signs of abuse through a webcam and nearly impossible through a phone. Additionally, it is difficult for a physician to ensure a safe space for screening in a telehealth environment. In the clinic, health care workers can ensure a completely private conversation, whereas via telehealth, the same cannot be said — while they may ask about privacy at the start of the encounter, the perpetrator may be nearby and simply out of frame.

Specific actions can be taken to mitigate the risks to potential IPV patients in telehealth settings. Hand signals or a “safe word” can be established ahead of time to indicate when it’s safe to talk or if resources and support are requested. Using yes or no questions on a phone call can help limit the amount of information a patient reveals and assess whether it is safe for the conversation to continue. An alternate approach is for physicians to provide universal domestic violence resources to every patient, whether they disclose IPV. In either case, it would be essential that the resources given to the patient are hidden, such as the phone number of a shelter being listed as a pharmacy.

Kaiser Permanente’s Family Violence Prevention Program, established in 1998, demonstrates an effective model for addressing IPV in the health care setting. This model stands on four pillars: 1) establish a supportive environment, 2) inquire and refer, 3) provide on-site resources, and 4) connect with community groups. Health care providers can reference Futures Without Violence’s comprehensive resource guide on the “CUES” intervention for the first two pillars – Confidentiality, Universal Education, and Support. On-site resources, like a telepsychiatry program, can provide a seamless transition from identifying IPV in telehealth screens to connecting survivors with licensed therapists. Finally, partnering with community groups or non-profits like the Family Justice Center Alliance provides people with legal advice, including virtual resources, and shelter arrangements. Health care practitioners should also be aware of universal safe words and hand signals, like tucking the thumb and wrapping the other fingers around it, as signs for help. All health care centers should establish similar programs and train their providers on IPV telehealth screening, especially those serving vulnerable patient populations.

While some may argue that these various measures place an extra burden on physicians, that is all the more reason for health care systems to establish a uniform set of guidelines for IPV screening via telehealth. The truth is that many of these measures are already in use, just not on a large enough scale for all patients and providers to know they exist. Therefore, it is critical that all health centers select an appropriate action plan and disseminate it to their health professionals and actively provide education and ensure implementation.

As the nation continues to stay at home to prevent the spread of COVID-19, we must not neglect the subsequent rise in IPV. Health centers should implement telehealth screening protocols for IPV to mitigate this rise. Telehealth visits will likely persist for the foreseeable future. Health care systems have the capacity to save lives from both the virus and IPV — the time to address the shadow pandemic is now.

Gabriele Ruzgas, Elsa Nico, Katherine Thompson, and Nicole Zolman are medical students. Shikha Jain is a hematology-oncology physician who blogs at her self-titled site, Dr. Shikha Jain.  She can be reached on Twitter @ShikhaJainMD.

Image credit: Shutterstock.com

Prev

Utilize a baseline test to uncover COVID brain fog

December 17, 2020 Kevin 0
…
Next

When it comes to weight stigma in children and teens, let’s meet in the middle

December 17, 2020 Kevin 0
…

ADVERTISEMENT

Tagged as: COVID, Infectious Disease, Public Health & Policy

Post navigation

< Previous Post
Utilize a baseline test to uncover COVID brain fog
Next Post >
When it comes to weight stigma in children and teens, let’s meet in the middle

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

Related Posts

  • It’s time to seriously study gun violence

    Michael B. Bagg
  • How the COVID-19 pandemic highlights the need for social media training in medical education 

    Oscar Chen, Sera Choi, and Clara Seong
  • Doctors: It’s time to unionize

    Thomas D. Guastavino, MD
  • Finding happiness in the time of COVID

    Anonymous
  • Gun violence in America is a national emergency

    Hussain Lalani, MD and Justin Lowenthal 
  • A medical student’s reflection on time, the scarcest resource

    Natasha Abadilla

More in Conditions

  • Financing cancer or fighting it: the real cost of tobacco

    Dr. Bhavin P. Vadodariya
  • 5 cancer myths that could delay your diagnosis or treatment

    Joseph Alvarnas, MD
  • When bleeding disorders meet IVF: Navigating von Willebrand disease in fertility treatment

    Oluyemisi Famuyiwa, MD
  • What one diagnosis can change: the movement to make dining safer

    Lianne Mandelbaum, PT
  • How kindness in disguise is holding women back in academic medicine

    Sylk Sotto, EdD, MPS, MBA
  • Measles is back: Why vaccination is more vital than ever

    American College of Physicians
  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech
    • How blockchain could rescue nursing home patients from deadly miscommunication

      Adwait Chafale | Tech
    • When service doesn’t mean another certification

      Maureen Gibbons, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech
    • How blockchain could rescue nursing home patients from deadly miscommunication

      Adwait Chafale | Tech
    • When service doesn’t mean another certification

      Maureen Gibbons, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...