Healthcare Resource Hub
This resource hub is intended for healthcare providers or anyone working in a clinic or hospital setting. The hub provides information about the warning signs and forms of relationship abuse, how it impacts health, how to work with patients experiencing abuse, how to assess for relationship abuse, and how to respond if a patient discloses abuse. It was created by a Violence Free Minnesota staff member, a sociology & family violence prevention student, and an occupational therapy doctoral student.
Relationship abuse is a pervasive public health issue that can impact anyone regardless of gender identity, religion, sexual orientation, race, ethnicity, or ability. Relationship abuse involves a pattern of behavior used by one partner to maintain power and control over the author. “Partner” may include a current or former romantic or sexual partner or a current or former spouse. It can include financial, sexual, physical, emotional, and/or reproductive abuse, as well as spiritual abuse and digital abuse.
Because of its prevalence and wide-ranging impacts, healthcare providers will interact with many patients experiencing relationship abuse across the course of their careers and across departments and specializations, from the Emergency Department, behavioral health services, neurology, obstetrics and gynecology, to neurology, prenatal and postnatal care, pain management, sexual health, and more.
The gender-neutral version of the Power and Control Wheel, is a tool that visually depicts the tactics an abusive partner may use to maintain power and control over the victim/survivor.
While relationship abuse impacts all communities, it has a disproportionate impact on individuals of color, individuals with disabilities, LGBTQ+ individuals, and women. Relationship abuse is upheld and reinforced by systems of oppression, including racism, ableism, misogyny, homophobia, transphobia, and sexism. These systems of oppression lead to the silencing of victim/survivors from these communities, denial of support services, barriers to accessing services, the criminalization of survival, and short- and long-term housing and food insecurity.
Warning Signs and Impacts of Relationship Abuse
Providers should be aware of the potential warning signs and impacts of relationship abuse. Warning signs and impacts may be physical, emotional, financial, and/or sexual/reproductive. Relationship abuse can also impact a patient’s behavioral health. It is important to note that individual symptoms such as headaches, depression, or substance use are not necessarily always indicative of relationship abuse. Rather, many symptoms and signs together may present a clearer picture of potential abuse.
It is important to consider the possibility of a trauma history for patients presenting with substance use, anxiety, depression, PTSD, and/or suicidal ideation. Abusive partners may also attempt to impede or sabotage a victim/survivor’s recovery from substance use and/or mental health concerns. These tactics are called substance use coercion and mental health coercion. The impacts of abuse are not just physical and often span a range of dimensions within a victim/survivor’s life.
Relationship abuse screening rates are generally low. Healthcare providers also tend to report many barriers to assessing patients for relationship abuse, including lack of time, discomfort and lack of knowledge, personal safety concerns, and concerns about mandatory reporting. However, patients generally report that they would consider disclosing experiences of abuse if providers were to ask them directly and respectfully. Patients who received expressions of support and concern from healthcare providers when experiencing abuse also report that this support was critical to understanding that they deserved to be safe and healthy in their relationships (Renner et al., 2019).
It is important to consider transitioning from relationship abuse screening models to universal education, an evidence-based practice developed by practitioners and researchers through Futures Without Violence. Universal education is an evidence-based intervention method that involves providing education and resources on relationship abuse to every patient at every visit (as safely allows). Universal education is meant to prompt non-structured, supportive conversations about healthy and unhealthy relationships that allow power to be shared between provider and patient. This is different from screening, which relies on a positive disclosure by the patient in order for the provider to share relationship abuse resources. However, if a patient is with their partner or the partner refuses to leave, it will not be safe to provide universal education.
CUES, the evidence-based intervention developed by Futures Without Violence healthcare and relationship abuse experts, advocates for the use of universal education through information about confidentiality, universal education, empowerment, and support.
Safety cards for various populations and in various languages, which are used to facilitate the CUES method, can be found here. These safety cards provide information about healthy and unhealthy relationships, parenting, self-care, and resources for relationship abuse.
During a pandemic, assessing patients for relationship abuse can be even more difficult. During telehealth visits, patients may be at home with an abusive partner monitoring the conversation, monitoring their device, or in the next room or within hearing distance. It may simply not be safe for a patient to disclose abuse during a telehealth visit. It will not always be safe for providers to initiate conversations about relationships during a telehealth visit. The patient’s safety should always be prioritized.
Documentation and Coding
Documentation of relationship abuse is important because it helps providers consider the effects of abuse over time and issue appropriate clinical recommendations. Additionally, proper documentation and coding can facilitate provider reimbursement for offering such necessary services, which may increase the likelihood of providers integrating universal education into their practice. Privacy is essential to coding and documentation of relationship abuse. Providers and administrators should work together with patients to determine what is safe to document, as well as consult with domestic violence experts for best practice guidance.
Referrals and Resources
If a patient discloses abuse, making a warm referral to a domestic violence agency if the patient desires can be helpful. Advocates are trained professionals who work to support and emphasize the victim/survivor’s safety and individuality, serving as a bridge between the victim/survivor and the system. They aim to be a source of empowerment and to make options more readily accessible. Advocates can provide safety planning and risk assessments, connect survivors to housing, mental health and substance use support, financial and food assistance, guide survivors through the legal system, navigate employment processes, and more.
When making a referral to an advocate, it is helpful to personalize the referral - letting the patient know what kinds of services the advocate/their agency provides, what languages are spoken at the agency, whether transportation is provided, how to enter the program, whether it is a shelter, what some of the advocates’ names are, etc. Personalizing the referral can show the patient that you are knowledgeable about the agency, which can increase their trust in that agency.
Many Minnesota-specific resources are available for patients experiencing abuse.
Minnesota’s statewide domestic and sexual violence crisis line can be reached by phone call at 1.866.223.1111 or text at 612.399.9995.