Doctors Share Tips to Support Survivors of Intimate Partner Violence During COVID-19

By Carolyn Crist

August 21, 2020

NEW YORK (Reuters Health) - Domestic-violence concerns have increased during the pandemic, and healthcare providers can offer several avenues of support, according to a group of women's- and adolescent-health doctors.

Doctors can check for privacy during telehealth visits, validate their patients' concerns and share resource lists, they write in Pediatrics.

"When the pandemic first began, community partners and intimate-partner-violence advocates started to see and hear safety concerns with survivors sheltering-in-place with abusive partners," said lead author Dr. Maya Ragavan of the University of Pittsburgh, in Pennsylvania.

Intimate-partner violence, which includes physical, sexual, emotional, financial and immigration-related abuse in a current or former relationship, can dramatically affect the health of the adults and children involved, she said.

"IPV itself is a pandemic, and compounded with the health, economic and structural challenges of COVID-19, creates unique challenges for families," she told Reuters Health by email. "While IPV can impact all families, structural inequities can cause unique challenges for marginalized communities."

Dr. Ragavan and her colleagues write about the ways that abusive partners may use the pandemic to control, frighten or manipulate others and use physical distancing to further isolate people. Typically, those who experience intimate-partner violence may seek escape through their workplace, activities outside of the home or trusted family and friends, but those options have been limited during the pandemic.

"Our team has heard stories from survivors about abusive partners taking their stimulus checks," she said. "Or turning off cellular or internet services, which may be the only way a family can communicate."

Dr. Ragavan and the co-authors recommend using a universal education approach, which emphasizes support, empowerment and resources for survivors.

They include several sample scripts that providers can use. For instance, doctor's offices can schedule appointments by describing telehealth options, asking whether the patient has a private place to speak and offering an in-person visit if the patient would like to speak privately or lacks internet access.

The authors also recommend against screening for abuse, which may limit resources to only those who disclose concerns, and instead provide resources to all families. Marginalized populations, in particular, may not want to share their concerns, so a universal approach can ensure privacy and equal access, they write.

Doctors' offices can also connect families with intimate partner violence agencies to discuss safety options. Local and national agencies have created texting lines, virtual chats and other resources to reach survivors during the pandemic.

"Digital interventions can reach survivors where they want to be reached. Designed correctly, digital resources are a safe and reliable way to deliver free, confidential, non-judgmental and safety-conscious support," said Chuka Nestor Emezue of the University of Missouri Sinclair School of Nursing, in Columbia. Emezue, who wasn't involved with the new article, researches intimate-partner violence and mobile health interventions.

"Apps can help survivors gauge how dangerous or potentially lethal their relationship may be," he told Reuters Health by email. "Beyond that, apps can help them design a safety plan suited to their situation."

Healthcare providers should also be aware of state-mandated reporting laws for child maltreatment, particularly if the state requires reports about child exposure to intimate-partner violence. On a report, doctors can provide details about co-occurring violence and child abuse to protect the survivor, the authors write.

"Children have been at home during the pandemic 24/7, and as much that they add stress to parents, they are now able to more easily observe IPV that might have occurred before the pandemic," said Dr. Catherine Kaukinen of the University of Central Florida, in Orlando. Dr. Kaukinen, who wasn't involved with this article, researches family violence.

Abusive parents may use children to control partners by threatening to take them outside or to high-risk places without a mask or by keeping them away from a parent who is an essential worker, Dr. Kaukinen said.

"COVID-19 is a compounding stressor for women and children already at risk for intimate partner violence and child abuse," she told Reuters Health by email. "All of the factors that heighten risk - stress of children and childcare responsibilities, male unemployment, financial insecurity, drinking - are compounded during this time."

SOURCE: https://bit.ly/31eHOJL Pediatrics, online August 20, 2020.

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