Sexual Violence and Intimate Partner Violence
Providers should be prepared to use a traumainformed approach to discuss sexual violence and intimate partner violence (IPV) during routine clinical visits.203, 204 ACOG and AAP recommend that universal education about IPV be offered to all patients at least annually.
Universal education is the clinical strategy used to educate all patients on healthy and unhealthy relationships and the health consequences of IPV. This approach differs from screening in that it advocates for all patients to be given information on the health impact of IPV regardless of whether or not they disclose current or past experiences of violence, thus reaching more people who may choose not to disclose. Universal education can be coupled with direct inquiry and an offer for a warm referral and available resources for IPV—as needed and when a patient discloses violence in response to use of CUES (description below) or other screening. Before discussing sexual violence and IPV, providers should understand their state reporting requirements, make a plan to see the patient alone, and disclose the limits of their confidentiality.205 When a person discloses sexual violence or IPV, the provider should convey empathy, validation, and nonjudgmental care. It is important to connect patients to additional services they may need, including forensic nursing care, housing, legal advocacy, and support groups.
Futures Without Violence developed the CUES intervention to improve care for persons experiencing intimate partner violence.206 This intervention focuses on a team-based approach to addressing IPV, with the following key elements:
| C | Confidentiality. Always see the patient alone for at least part of the visit, and disclose your limits of confidentiality before discussing IPV. |
| UE | Universal Education + Empowerment. Use safety cards to talk with all patients about healthy and unhealthy relationships and the health effects of violence. Always give at least two cards to each patient so they can share with caregivers, loved ones, friends, and family. |
| S | Support. Disclosure is not the goal, but it will happen. Discuss a person-centered care plan to encourage harm reduction. Make a warm referral to a domestic or sexual violence advocacy organization, and document the disclosure in order to follow up at the next visit. |
RHNTC, in partnership with Futures Without Violence, developed a health-care-staff-facing video series illustrating how to apply different components of the CUES intervention in response to IPV.