Abstract

Family and intimate partner violence and abuse (FIPV) is a critical public health problem with repercussions for mental and physical health. FIPV exposure also is associated with social difficulties such as low socioeconomic status, legal issues, poor access to employment and education, housing instability, and difficulty meeting other basic needs. As a biopsychosocial problem, one discipline alone cannot adequately address FIPV. While individuals who experience FIPV traditionally seek respite, care and safety through domestic violence shelters, social services or courts, they also often present to health care settings. Building on the medical-legal partnership model with critical input from a community advisory board of individuals with lived experiences of FIPV, we implemented a person-centered approach in the health care context to cohesively integrate legal, safety, social, psychological and physical health needs and concerns. The purpose of this paper is to describe the Healing through Health, Education, Advocacy and Law (HEAL) Collaborative for individuals who have experienced psychological abuse, physical abuse, sexual abuse, or neglect related to child maltreatment, intimate partner violence, and/or elder abuse, and review our real-world challenges and successes. We describe our interprofessional team collaboration and our pragmatic biopsychosocial framework for bringing together: professional and stakeholder perspectives; psychological, medical, legal, and personal perspectives; and clinical, evidence-based, and educational perspectives. There is no doubt that creating a program with biopsychosocial components like HEAL requires professionals appreciating each other's contributions and the need to begin working from a common goal. Furthermore, such a program could not be successful without the contributions of individuals with the lived experience we seek to treat, coupled with the external health care clinicians' input. We describe lessons learned to date in an effort to ease the burden for those seeking to implement such a program. Lessons include HEAL's more recent clinical adaptions to serve patients both in-person and via telehealth in the wake of COVID-19.

Highlights

  • Individuals experiencing family and intimate partner violence (FIPV), defined as child maltreatment, intimate partner violence, and elder abuse [1], frequently interact with the health care system for needs both directly and indirectly related to their abuse [2,3,4]

  • FIPV is associated with increased risk for complex social needs, such as food, unstable housing, homelessness, legal difficulties, and unstable employment [8,9,10], all factors that affect individuals’ mental and physical health but access to health care

  • Health care clinicians often do not ask about victimization [13, 14], while many patients do not disclose FIPV without specific inquiry [15]

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Summary

Introduction

Individuals experiencing family and intimate partner violence (FIPV), defined as child maltreatment, intimate partner violence, and elder abuse [1], frequently interact with the health care system for needs both directly and indirectly related to their abuse [2,3,4]. Health care clinicians often do not ask about victimization [13, 14], while many patients do not disclose FIPV without specific inquiry [15]. Reasons why patients may not share their FIPV experiences with their health care clinicians include believing it is irrelevant, disclosing it is embarrassing, or past negative experiences when sharing it with other health professionals (e.g., being told to leave their partner when that was not what they wanted). Examples include invasive physical exams that trigger memories of sexual assault or being evaluated for FIPV in the presence of the person who abused them, which may result in the perpetuation of abuse or cause the individual to cease seeking care altogether [16]

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