Impacting nearly 12 million people a year, domestic violence (DV) and intimate partner violence (IPV) is a likely reality for the next woman or man who comes to a rural healthcare facility. From the “do’s and don’ts” of screening to the “do’s and don’ts” when violence is disclosed, rural providers need to be prepared to meet the challenges of this ongoing public health crisis. 

According to the National Domestic Violence Hotline, domestic violence (DV) is also referred to as intimate partner violence (IPV) and several other phrases that describe behaviors of one partner to maintain power and control over another. The Hotline offers plain language definitions and examples of DV and IPV, which include not only physical, emotional, and sexual abuse, but also sexual and reproductive coercion and financial and digital abuse.

First Steps in Addressing Rural DV/IPV: Awareness and Screening

Dr. DeShana Collett is a practicing physician assistant (PA) and an Associate Professor at the University of Kentucky (UK) College of Health Sciences. Because DV is so common and rural resources so scarce, Collett said she wants their PA graduates to be aware of the condition’s complexities and comfortable with possible interventions.

“I believe the first step in decreasing violence is awareness and tying in the proof that domestic violence-associated trauma impacts overall health and well-being,” she said. “I would say it is an effortless task to weave in the education of IPV as a health condition because of its commonality. We know that patient care skills applied during encounters with DV and IPV patients will also be similar to many other health conditions that our students will encounter.”

With more than a decade of teaching comes the experience of integrating DV into standard curriculum, Collett said. She tells students that screening for DV should actually start with the moment the patient walks through a clinic door, sits in the waiting room, and looks around at posters on the wall or educational messages in a clinic room.

“Building on an ‘everywhere and everyone’ philosophy, I tell my students that awareness is important for the receptionists, the medical assistants, and nursing staff,” she said. “We all have multiple opportunities to screen and be aware because the problem is everywhere. It takes all of us to educate and win the fight to end violence and I remind them, it’s not just women, it’s men, it’s adolescents, and geriatrics as well.”

Advocacy organizations said that healthcare providers should feel free to reach out to their community resources and proactively build organization-to-organization and person–to-person relationships so they are not alone in trying to care for these patients, especially in emergent situations.

Maren Woods is Program Director for Praxis International’s Rural Advocacy and Interagency Responses to Violence Against Women, a technical assistance program for grant-funded communities working on violence issues. She said in their work with hundreds of rural advocacy programs, a walk-through is one approach they’ve heard about that seems to help build these types of relationships.

“A clinic walk-through is where a domestic violence advocate can go through the clinic on a mock visit, Woods said. “Feedback can be given on what’s in the waiting room, the exam room, how the clinic team might respond to different patient scenarios. It’s sort of a ‘meet and greet,’ where the advocate can give their lens to safety, information, and protocols. And it builds partnerships between the community’s non-clinical and clinical teams.”

DV and IPV in Rural Settings: The Differences

Collett said because nearly 25 percent of their program’s graduates who stay in Kentucky will practice in a rural county, she has to prepare students for dealing with DV in that setting. That starts with acknowledging the list of factors studied long ago found to be associated with DV in rural areas including geographic isolation, transportation limits, and patriarchal attitudes regarding gender roles, religious beliefs, and the issues about small community confidentiality that extend to law enforcement teams, criminal justice, and the community’s healthcare providers. With these factors in mind, she said she reminds students to still just start with being patient-centered.

“I believe there’s not a ‘rural approach’ to screening,” she says. “It’s more important to stay patient-centered. I tell students the most important thing they need to do is make it clear to their patients that a rural clinic can be a safe place when they’re ready to talk to someone.

Original article printed in The Rural Monitor