Katie Licari | black voice news
Dr. Candace Burton, associate professor of nursing at UC Irvine, teaches her students and clinicians the importance of screening and trauma-informed practices to help survivors of domestic violence access resources and improve medical results.
Burton said screenings aren’t being used more widely because doctors and healthcare providers feel uncomfortable and ill-equipped to deal with domestic violence. “Screening gives your patients permission to tell you something terrible by asking them,” Burton said.
Burton stressed that it’s important for healthcare providers to consistently ask screening questions to build trust with a survivor dealing with trauma. In class, she asks her students to recite “every patient, every time” to reinforce screenings as a regular part of patient interactions.
Intimate partner violence can have lasting effects long after the physical signs of violence have healed. People who fight an abusive partner can face criminal charges. Leaving an abusive relationship can mean the loss of stable housing. There can also be lasting effects on physical health, ranging from depression to brain damage.
Traumatic brain injury (TBI) impacts brain function and can be caused by physical force, such as being punched in the face; a penetrating force, such as a gunshot, or by cutting off oxygen to the brain by strangulation. Traumatic brain injuries can result in mild concussions that can lead to permanent disability and death.
There is little research examining the long-term health implications of intimate partner violence. A 2002 study analyzed data from three Philadelphia hospital emergency departments. Research found that 38% of domestic violence victims seen in an emergency room suffered from head trauma; 30% of these patients reported losing consciousness at least once. The study concluded that there is a need to increase screening for TBI in patients who are victims of domestic violence.
Victims of domestic violence with TBI may experience dizziness, seizures, and memory problems. A 2011 literature review by researchers from Johns Hopkins and the National Institute of Nursing Research found that the duration of an abusive relationship increased the likelihood and severity of negative health outcomes, including post-death syndrome. concussion (which is related to mild TBI), after – traumatic stress disorder and depression. 92% of victims of intimate partner violence seeking services in emergency shelters had PTSD.
The medical community can improve outcomes for survivors by regularly screening for violence and abuse during visits and providing trauma-informed care, Burton said. Trauma-informed care is based on six principles:
- Security: Ensure that the patient feels physically and psychologically safe.
- Reliability and transparency: Organizational decisions are made transparently to foster trust.
- Peer support: Connecting with other survivors establishes safety and builds trust.
- Collaboration: Everyone in an organization, including non-medical and non-therapist staff, has a role to play in ensuring a therapeutic environment.
- Empowerment and choice: Trauma survivors, who have often been disempowered, are empowered through goal setting and decision making.
- Cultural competence: Recognizes and responds to the cultural, racial and social needs of survivors.
Shiuli,* who has had multiple abusive partners, said becoming a mother was a pivotal moment by becoming a survivor. “What changed for me was my son,” Shiuli said.
After giving birth, she was resting in her bed in the recovery room. Her boyfriend started yelling and scolding her. Several nurses on the ward were so alarmed by the way he was treating her that they called a social worker. The call changed the trajectory of Shiuli’s life. She left her abusive boyfriend and moved in with relatives. Her social worker put her in touch with resources to recover from the abuse.
Shiuli’s experience at the hospital highlights the importance of screenings for intimate partner and domestic violence (which also includes child abuse) by clinicians. Despite the impact they can have, these screenings are not a universal standard of healthcare.
Trauma-informed healing pathways
Trauma-informed care improves outcomes for survivors of trauma and intimate partner violence. According to Burton, interest in implementing trauma-informed practices has increased during the pandemic. The trauma and burnout of healthcare workers resulting from COVID-19 has opened up conversations about trauma in patient care.
The foundation of trauma-informed care is recognizing that there is is trauma to manage and face it head on. Certain groups, especially from marginalized communities, are more likely to have experienced trauma due to racial, social or cultural dynamics. “There is a better chance if [the patient] is part of a marginalized group that they have experienced violence or abuse from their intimate partner, as predators tend to prey on the most vulnerable people,” Burton said.
For students and clinicians who don’t feel equipped to deal with trauma or domestic violence, Burton encourages them to practice “warm orientation.” After a patient discloses a traumatic experience, such as intimate partner violence, the physician enlists resources and support with their patient. A warm referral is similar to what Shiuli’s nurses did for her when they called a social worker on her behalf instead of giving her the information to act on on her own.
Break the cycle
The trauma-informed care program Shiuli’s social worker connected her to is provided by Corona-Norco United Way. The organization serves northwest Riverside County, which includes the towns of Eastvale, Corona, Norco and surrounding unincorporated communities.
“Violence is a real choice. It’s not a disease or illness,” said Dr. Alia Rodriguez, CEO of Corona-Norco United Way. “The physical abuse is very painful and traumatic, but when the bruises and the bones heal, there’s still the mental lighting to deal with.”
The organization offers a 12-week program adapted to each person who asks for help. It includes peer support groups, setting goals for the future, career counseling services and help enrolling in government assistance programs. For Shiuli, learning about intimate partner violence was critical to her recovery. The program, which is available to victims of domestic violence and their families, has helped her recognize the red flags abusers tend to have.
Corona-Norco United Way also offers programs for children of survivors. Children learn to cope with the violence they have been exposed to and may also have experienced first-hand. The focus is on learning the healthy way to articulate and express emotions, how to avoid being a bully, and how to avoid abusive partners when older.
People learn what’s normal in a relationship from their parents’ behaviors and relationship dynamics, Rodriguez said. “We’re very passionate about breaking the cycle for kids,” she continued.
Shiuli said ending the program helped her break the cycle of violence for herself and her now one-year-old son.
“I feel more inner strength because when I look at my son every day, I want more for him. [him]”Shiuli said. “My home shouldn’t be a battlefield. It should be peaceful, especially for a newborn baby. That’s the strength I drew on.
*Shiuli has requested that we use a pseudonym to protect her safety.
Editor’s Note: The terms “intimate partner violence” and “domestic violence” have deliberately not been used interchangeably in this story, as there are nuanced differences between the two. Although not universally recognized as distinct by law enforcement and other entities, intimate partner violence is committed within the confines of a romantic relationship. Domestic violence, however, includes abuse against adults – significant others or other family members – and children.