Jessamin Cipollina, MA
March 10, 2020
Intimate Partner Violence (IPV) is defined as any physical and sexual violence, stalking, or psychological harm by a current or former partner. The CDC identifies IPV as a “serious, preventable public health problem” that affects millions of people in the U.S. every year and can result in many negative health consequences including anxiety, substance abuse, and traumatic brain injury. Recent statistics show that about 1 in 4 women and 1 in 10 men have experienced some form of IPV in their lifetime, many of whom report experiences before the age of 18. IPV affects both men and women at any age and can result in lifelong emotional, physical and fiscal trauma to survivors and their families, not to mention the lasting oral health consequences that can severely impact overall health and quality of life.
According to a report from the Health Resources and Services Administration (HRSA), approximately 75% of injuries from IPV occur around the head, neck and mouth. This can result in serious injuries to the mouth and teeth. Ongoing physical abuse from a partner such as slapping or hitting across the face can lead to serious head trauma and brain injury, including broken jaw, facial and mouth lacerations, loosening of teeth and traumatic evulsion of teeth. Primary care physicians, nurse practitioners, midwives, nurses, physician assistants, dentists and dental hygienists are a few of many clinicians who are well-positioned to identify signs of IPV and take initial action to address abuse. But clinicians and staff may not be aware of what to look for in patients or what questions to include in screening protocol.
Examples of Clinical Signs of IPV
Obvious
- Broken teeth
- Fractured jaw
- Cuts
- Facial bruising
- Bite marks
- Bruises on neck
- Wrist, arm or ankle strains
- Patches of missing hair
Subtle
- Headaches
- Depression
- Fatigue
- Lack of eye contact
- ER trips for vague reasons
- Self-inflicted cuts
- Hidden cuts
- Passive interaction
- Eating disorders
The findings of recent studies demonstrate a need for IPV competencies to be integrated in oral health care and increased self-efficacy among all health professions in IPV screening. IPV screenings and know-how are especially important in primary care practice, urgent care and ER settings that are frequented by men and women who have sustained injuries from physical abuse. Several studies report that many health professionals, particularly dentists and dental assistants, do not receive education or training in identifying and approaching IPV in their offices. As such, continuing education in identifying signs of abuse is warranted. These findings also reveal some reluctance among oral health professionals to screen due to lack of expertise in detecting IPV. They recommend promoting adoption of IPV screenings in dental offices. Mandatory reporting of abuse is required in many states, but practitioners may not be equipped with adequate resources to report abuse as well as refer their patients to safe services if they are in imminent danger.
HRSA’s Strategy to Address Intimate Partner Violence includes four Priorities for addressing and raising awareness of IPV in clinical settings. This initiative aims to increase IPV knowledge within the health care workforce and increase access to IPV-informed health services, with the ultimate goal of earlier intervention and prevention of IPV. In addition to the primary care workforce, HRSA purports that practitioners and office staff also are perfectly poised to recognize both obvious and subtle indicators of IPV and should be aware of screening questions and methods that can be used with patients to assess their safety.
Sample Screening Questions
- “Since your last visit, I see that you have two broken teeth. How did that happen?”
- “I notice you have a bruise on your jaw. How did that happen?”
- “You seem upset/distracted today. Is there anything you would like to talk about with me?”
- “You mentioned that things have been stressful at home. Can you tell me more about what has been going on?”
HRSA also describes several trauma-informed practices that can be adopted by health professionals and staff to make their clinic a safe space, as well as “activating” clinic environments to promote IPV education and practices.
Trauma-Informed Practices for Health Professionals
- Schedule longer appointments to get a patient acclimated to procedures in mouth
- Provide a consultation room in the dental offices to further engage with patient
- Identify a “quiet room” in the dental office where procedures can be done
- Ask assessment questions using an open-ended and non-judgmental manner that encourage patient disclosure
- Allocate a portion of the visit to just involve your patient, excluding visitors
- Provide interpreters for your patients
- Offer patients immediate and private access to an advocate in person or over the phone
- Develop a list of referral resources at the ready for patients that need immediate attention
- Familiarize yourself with the IPV reporting requirements in your state
- LISTEN to your patients
- Evaluate your attitudes and beliefs about IPV
- Decide that you aren’t here to diagnose or treat IPV, but to create an opportunity for patients to share these and other experiences that may impact their overall health
There is a compelling need to integrate IPV competencies into oral health clinical education and practice! This clinical issue exemplifies the importance of interprofessional education and practice that includes collaboration between and among clinicians from different professions to effectively address IPV as a population health problem. It is the responsibility of health care professionals to ensure that their clinical setting has safe spaces and that productive, thoughtful conversations about IPV and related trauma topics can take place. IPV is one of many national public health concerns that can have irrevocable effects on oral health and overall health. Studies demonstrate that practitioners need to make progress in acquiring the competencies and resources necessary to identify signs of IPV and address them in clinical practice settings.
Resources for Patients and Practitioners
National Domestic Violence Hotline
thehotline.org
1-800-799-SAFE (1-800-799-7233)
Provides information on identifying domestic abuse, 24-hour helpline and online live chat for immediate support and referrals
Safe Horizon
safehorizon.org
1-800-621-HOPE (1-800-621-4673)
Advocacy organization with 24-hour helpline and online live chat, including resources for safety and support
National Coalition Against Domestic Violence (NCADV)
ncadv.org
Provides resources for domestic violence victims and their families to find immediate aid and plan for a safe future
Sources:
- Centers for Disease Control and Prevention. Intimate Partner Violence. Updated March 1, 2020.
- Health Resources and Services Administration, Office of Women’s Health. The HRSA Strategy to Address Intimate Partner Violence. Rockville, Maryland: 2017.
- Health Resources and Services Administration, Office of Women’s Health, Office of Planning, Analysis and Evaluation, & Bureau of Primary Health Care. Lunch and Learn: Intimate Partner Violence and Oral Health. Presentation. April 4, 2018.
- Harris CM, Boyd L, Rainchuso L et al. Oral health care providers’ knowledge and attitudes about intimate partner violence. J Dent Hyg. 2016;90(5);283-96.
- Lemich SA, Freudenthal JJ, Neill K et al. Dental hygienists’ readiness to screen for intimate partner violence in the state of Texas. J Dent Hyg. 2018;92(3);47-55.
- Parish CL, Pereya MR, Abel SN et al. Intimate partner violence screening in the dental setting: results of a nationally representative survey. J Am Dent Assoc. 2018;149(2);112-21.