Intimate Partner Violence: A Call for Social Work Action

Abstract

Although it made a first appearance in the literature of psychiatry in the mid 1960s (Snell, Rosenwald, & Robey, 1964), domestic violence was not in the public eye until the Women's Movement of the 1970s when grassroots feminists brought it out of hiding. Since then, a proliferation of articles and journals has appeared in response to the issue, and a database (Violence and Abuse Abstracts) has been developed to catalog the quantity of research. Known over the years alternatively as domestic violence, battering, family violence, and spouse abuse, the Centers for Disease Control and Prevention (CDC) (2007) has called for a new designation: intimate partner violence (IPV). In response to that request, IPV is used throughout this article. The current article addresses the issue of routine screening of all women in emergency rooms, clinics, and primary care settings, and the role that social workers can play in the assessment, intervention, and referral process. We believe that social workers are in a unique position to help break down the barriers that currently prevent all women from receiving routine screening. In their multiple roles, social workers can train health care workers about the dynamics surrounding IPV; as practitioners they can conduct assessments and screenings in health care settings; as advocates they can provide support, resources, and referral information; as researchers they can evaluate existing programs and create new assessment tools; and as policymakers they can assist in the planning and development of the health care response to IPV. WHO BEARS THE BURDEN OF IPV? The CDC has defined IPV as violence occurring between current and former spouses or dating partners and includes not only physical and sexual abuse, but also threats and emotional abuse. During any given calendar year women experience approximately 4.8 million physical assaults and rapes, whereas men experience approximately 2.9 million assaults (Tjaden & Thoennes, 2000). Of the 1,544 deaths attributable to IPV in 2004, 75 percent were women and 25 percent were men. The cost of IPV is estimated at $8.3 billion a year, including medical care, mental health services, and lost productivity in the workplace (Tjaden & Thoennes, 2000). Clearly, IPV carries a substantial burden not only to the victim, in terms of physical and emotional costs, but also to society. Physical and Sexual Injury Physical injuries incurred by victims include bruises and cuts, as well as broken bones, head trauma and, in some cases, death. Trabold (2007) and Campbell, Sefl, and Ahrens (2003) noted that female victims of IPV are at 60 percent higher risk of developing health problems, including chronic pain, vaginal bleeding and infections, sexually transmitted diseases, headaches, and gastrointestinal problems. The National Institute of Justice and the Centers for Disease Control and Prevention (2000) estimate that approximately 480,000 visits per year are made to emergency rooms due to IPV. A correlate to women's physical and sexual abuse is the increased risk of using alcohol and marijuana as coping mechanisms. Emotional Abuse Mental health difficulties linked to IPV include anxiety disorders, depression, posttraumatic stress disorder, low self-esteem, poor body image, self-perceived poor health, and fear of intimacy, to name a few (Bergman & Brismar, 1991; McCauley & Kern, 1995; Naumann, Langford, Torres, Campbell, & Glass, 1999; Phelan, 2007). According to Briere and Jordan (2004), being a victim of IPV results in wide-ranging and complex symptoms often having an additive and cumulative effect. IPV IN HEALTH CARE SETTINGS Estimates of the size of the problem of IPV in health care settings range from 10 percent to 50 percent of all women presenting in emergency rooms or primary care settings (Duffy, McGrath, Becker, & Linakis, 1999; Eisenstat & Bancroft, 1999; Naumann et al. …