Supporting Intimate Partner Violence Survivors and Their Children During the COVID-19 Pandemic
Year: 2020
Type: article
Abstract: The patient was well appearing but congested. Through gown, gloves, goggles, and a mask, I asked the mom if there was anyone at home who could help bulb suction. “He’ll never help,” she said. As tears dripped down her cheek, she described struggles with a partner who was controlling and disinterested in co-parenting, who took her money and tried to destroy her credit. She wanted him to leave, but the pandemic happened, and child care was limited. She had to keep working, and he was watching her children. She felt exhausted, saying, “Being here, in clinic, is like a break for me.” She shared that her partner has never physically abused her or injured her children. She felt safe taking resources about a local intimate partner violence (IPV) agency and was open to a follow-up visit.IPV, which includes physical, emotional, sexual, financial, or immigration-related abuse by a former or current partner, is a pervasive public health epidemic, with myriad child health impacts.1–3 During the coronavirus disease 2019 (COVID-19) pandemic, physical distancing, school and child care closures, and unemployment are contributing to additional stressors within households, associated with worsening IPV. Whereas empirical data on IPV and COVID-19 is nascent, emerging work, with data from Los Angeles and Indianapolis, reveals an increase in IPV reports in March to April 2020 compared with January to March 2020.4 Pediatric clinicians have a vital role in connecting adult caregivers with supports and resources to mitigate the consequences of IPV for both survivors and their children.COVID-19 may be used to control, frighten, or manipulate IPV survivors. Although physical distancing is critical to reduce virus transmission, abusive partners may use this time to further isolate IPV survivors. IPV survivors often seek respite from violent relationships through their workplace and activities with trusted family and friends, which is challenging in the current climate. Abusers may also shut off phones or Internet service as a form of control, further compounding isolation. Physical distancing may limit a survivor’s access to support groups and individual counseling. For example, at the time of writing this article, an IPV agency in our community has seen a decrease in helpline calls, likely because individuals experiencing IPV do not feel safe calling for support while sheltering-in-place with abusive partners. Abusive partners may also withhold health insurance, information about COVID-19, and protective equipment (eg, hand sanitizer).Children exposed to IPV may experience similar isolation and stress. Like their parents, children have less access to their usual sources of support, particularly trusted adults, such as teachers, after-school workers, and coaches. Children may also become victims of violence themselves; Hamby et al5 found that >50% of children exposed to IPV also experienced child maltreatment. The lay press has written that reports to Child Protective Services have decreased across the country. This is less likely reflecting a reduction in abuse, but rather decreased interactions between children and their adult supports, many of whom are mandated reporters.Marginalized families experiencing IPV, such as those living in poverty, those identifying as racial and ethnic minorities or immigrants, or those who have limited English proficiency, face unique challenges. The pandemic’s economic ramifications disproportionately affect those living in poverty, and the impacts of poverty and IPV often compound one another.6 Additionally, emerging research reveals racial and ethnic disparities in COVID-19 testing, morbidity, and mortality.7 Pediatric clinical teams should be aware of how overlapping stressors and structural inequities faced by IPV survivors from marginalized communities are amplified during this pandemic.The rapid switch to telehealth during this pandemic may provide creative solutions for IPV survivors for whom clinical visits are inaccessible, for example, if abusive partners are withholding transportation or preventing their partner from leaving the home. However, telehealth also creates safety and privacy concerns. Abusive partners may monitor communication used through telehealth in multiple ways, including listening in during calls and video visits; reading texts; impersonating IPV survivors through texts, e-mails, or patient portal messages; changing patient portal passwords; and accessing e-mails. Telehealth may also be less accessible if an abusive partner has shut off data plans or Internet service.We offer recommendations to support IPV survivors and their children during the current pandemic and in the foreseeable future, as more health care is delivered virtually. Table 1 provides sample scripts that pediatric clinical teams (nurses, health care clinicians, medical assistants, etc) can tailor for their setting. We focus on parents and caregivers; recommendations for adolescents experiencing violence are available elsewhere.8When a visit is being scheduled, front desk staff should describe telehealth and assess whether the parent can speak privately. An in-person visit should be provided as an option. At the start of a telehealth visit, the medical assistant or clinician should assess for privacy. If not in a private location, the clinician can ask if there is another time to talk or if they can move to another location. Clinicians should be aware of limited privacy and avoid asking sensitive questions directly. Finally, clinical teams should advocate for telehealth platforms with built-in privacy features, such as chat and “quick exit” functions.Screening for IPV and other adversities may be dangerous via telehealth, especially because privacy cannot be guaranteed. With the Confidentiality, Universal Education and Empowerment, and Support (CUES) framework,9 adapted for a virtual setting, the clinician begins by offering parents positive reinforcement during these challenging times and then provides education and resources about IPV, which can be shared with friends or family. Unlike screening, which confers resources only to those who disclose, CUES promotes parent-clinician relationship building by deprioritizing disclosure and providing resources to all families. Marginalized populations, many of whom have experienced historical trauma from the medical establishment and may not wish to disclose stressors, are disproportionately impacted by this pandemic. Therefore, providing universal education and resources helps to ensure privacy and promote health equity. Clinicians may choose to use CUES for IPV specifically or embed this approach to address overlapping health-related social needs, such as food insecurity, unemployment, and child care. Resources should also include supports for children, including behavioral health, virtual support groups, and strategies for parents to mitigate child stress symptoms.Although disclosure is not the goal with the CUES framework, clinicians should be prepared to safely support IPV survivors who disclose through telehealth. Validation of the experience alone is healing. If the parent is no longer in a private location, the clinician can communicate using chat functions or suggest potentially private locations, such as going for a walk, speaking in the bathroom, or using headphones so the perpetrator cannot hear the conversation. Because IPV survivors know best how to keep themselves safe, clinicians should follow their lead in terms of further discussion. Clinicians can offer options for support, such as connecting the survivor with an IPV advocate in the moment (a “warm referral”), offering an in-person follow-up visit, and providing suggestions on storing resources (such as helpline numbers) safely.Mandated reporting may be particularly challenging in situations in which a clinician is concerned about co-occurring IPV and child maltreatment, especially during a telehealth visit. Clinicians should be aware of state-mandated reporting laws, including if their state requires reporting for child exposure to IPV.10 When filing a mandated report, clinicians should clearly state the concern for co-occurring IPV and child abuse to protect the safety of the IPV survivor. Whenever possible, clinicians can call Child Protective Services with the IPV survivor (a “warm handoff”) to include them as part of the mandated reporting process. Clinicians can also connect families with IPV agencies to discuss safety options.IPV agencies are developing innovative ways to connect with clients virtually. For example, in our community, Women’s Center and Shelter of Greater Pittsburgh has moved shelter residents who are immunocompromised to safe off-site locations, is displaying information about their services at supermarkets and other stores deemed essential, and has created a texting line, which may be more confidential than a phone call. The National Domestic Violence Hotline (https://www.thehotline.org/) is using virtual chat groups, and Futures Without Violence, a national violence prevention organization, has compiled a list of resources for IPV survivors during the pandemic (https://www.futureswithoutviolence.org/get-updates-information-covid-19/).As pediatric clinical teams support families during this unprecedented time, we must be aware of the compounding stress and challenges faced by IPV survivors and their children. Developing creative solutions and collaborative partnerships to support IPV survivors and their children during the COVID-19 pandemic is crucial to protecting the well-being of the families we serve and promoting health equity.We thank Lisa James and Rebecca Levenson for their critique of this article.
Source: PEDIATRICS
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: bronze
Awards: G3537838402, G9000288328
OpenAlex ID: W3050197591