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Last Updated on January 29, 2022 by BVN

Katie Licari | Black Voice News

Dr. Candace Burton, an associate professor of nursing at UC Irvine, teaches her students and clinicians about the importance of screening and trauma-informed practices to help survivors of intimate partner violence access resources and improve medical outcomes. 

Burton said that screenings aren’t more widely used because doctors and medical providers feel uncomfortable and unequipped to deal with intimate partner violence. “Screening is giving your patients permission to tell you something terrible through asking,” said Burton.

Burton stressed that it’s important for health care providers to consistently ask screening questions as a way to build trust with a survivor dealing with trauma. In the classroom, she has her students recite “every patient, every time” to reinforce screenings as a habitual part of patient interactions. 

Intimate partner violence can have lasting effects long after physical signs of abuse heal. People who fight off an abusive partner may face criminal charges. Leaving an abusive relationship may mean a loss of stable housing. There can also be long-lasting physical health effects, ranging from depression to brain damage.

Traumatic brain injury (TBI) impacts how the brain works and can be caused by a physical force, like a punch in the face; a penetrating force, like a gunshot, or by cutting off oxygen to the brain through strangulation. Traumatic brain injuries can result in mild concussions to permanent disability and death. 

Intimate partner violence can have lasting effects long after physical signs of abuse heal. (source: m.facebook.com).

There is scarce research examining the long-term health implications of intimate partner violence. A 2002 study analyzed data from three Philadelphia hospital emergency departments. Research found 38% of IPV victims screened in one ER  were experiencing TBI injury; 30% of these patients reported losing consciousness at least once. The study concluded that there’s a need for increased screening for TBI in patients experiencing intimate partner violence. 

Intimate partner violence victims with TBI can experience dizziness, seizures and memory issues. A 2011 literature review from researchers at Johns Hopkins and the National Institute of Nursing Research, found that the length of an abusive relationship increased the likelihood and severity of negative health outcomes, including post-concussive syndrome (which is related to mild TBI), post-traumatic stress disorder and depression. 92% of intimate partner violence victims seeking services at crisis shelters were experiencing PTSD. 

The medical community can improve outcomes for survivors by routinely screening for violence and abuse during visits and providing trauma-informed care, said Burton. Trauma-informed care is founded on six principles

  • Safety: Ensure the patient feels physically and psychologically safe. 
  • Trustworthiness 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, have 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 competency: Recognizes and responds to the cultural, racial and social needs of survivors.

Shiuli,* who’s had several abusive partners, said becoming a mother was a pivotal moment in becoming a survivor. “What changed for me was my son,” said Shiuli. 

Shiuli is a night jasmine flower. | Photo by Pixahive.com

After giving birth, she was resting in bed in the recovery room. Her boyfriend began yelling and berating her. Several nurses in the ward were so alarmed with how he treated her, 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 connected her with resources to heal from the abuse. 

Shiuli’s experience at the hospital highlights the importance of screenings for intimate partner and domestic violence (which also includes the abuse of children) by clinicians. Despite the impact they can have, these screenings are not a universal standard in health care. 

Trauma-informed Pathways to Healing

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 health care workers stemming from COVID-19 has opened up conversations about trauma in patient care. 

The foundation of trauma-informed care is acknowledging that there is trauma to deal with and addressing it head on. Certain groups, particularly from marginalized communities, are more likely to have experienced trauma because of racial, social or cultural dynamics. “There is a greater likelihood if [the patient] is from a marginalized group that they have experienced intimate partner violence or abuse of some kind because predators tend to prey on people who are more vulnerable,” said Burton. 

For students and clinicians who don’t feel equipped to handle trauma or intimate partner violence, Burton encourages them to practice a “warm referral.” After a patient discloses a traumatic experience, such as intimate partner violence, the doctor makes the call for 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 as opposed to giving her the information to act on alone. 

Breaking the Cycle

The trauma-informed care program Shiuli’s social worker connected her with is provided by the Corona-Norco United Way. The organization serves northwest Riverside County, which includes the cities of Eastvale, Corona, Norco and unincorporated communities in the surrounding area. 

“Abuse is an actual choice. It is not a sickness or an illness,” said Dr. Alia Rodriguez, Corona-Norco United Way’s CEO. “Physical abuse is very painful and traumatic, but when the bruises and bones heal, there is still the mental gaslighting to deal with.” 

The organization offers a 12-week program tailored to each individual seeking assistance. It  includes peer-support groups, goal- setting for the future, career 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 domestic abuse survivors and their families, helped her recognize the red flags abusers tend to have. 

Corona-Norco United Way also offers programming for survivors’ children. Kids are taught how to cope with the violence they’ve been exposed to and may have also experienced first-hand. The focus is on learning how to healthily articulate and express emotions, how to avoid being a bully and how to avoid abusive partners when they’re older. 

People learn what is normal in a relationship from behaviors and dynamics in their parents’ relationships, said Rodriguez. “We are very passionate about breaking the cycle for kids,” she continued.

Shiuli said completing the program has helped her break the cycle of abuse for herself and for her now 1-year-old son. 

“I feel more inner strength because, when I look at my son everyday, I want better for [him],” Shiuli said. “My home shouldn’t be a battlefield. It should be peaceful, especially for a newborn. That was the strength I tapped into.” 

*Shiuli requested we use a pseudonym to protect her safety.

Editor’s note: The terms “intimate partner violence” and “domestic violence” have purposefully not been used interchangeably in this story, as there are nuanced differences between the two. Although not universally recognized as separate by law enforcement and other entities, intimate partner violence is committed within the confines of a romantic relationship. Domestic violence, however, includes abuse against both adults – significant others or other family members – and children.

Katie Licari

Katie Licari is a freelance journalist with Black Voice News. She has previously reported for CalMatters, the San Francisco Chronicle, and the LAIST. In 2019 she was a LA Press Club finalist in the New Feature Category. When she isn’t reporting she can be found gardening in her community garden plot.