Essential Health Care Services Addressing Intimate Partner Violence (2024)

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Essential Health Care Services Addressing Intimate Partner Violence Susan J. Curry, and Crystal J. Bell, Editors Committee on Sustaining Essential Health Care Services Related to Intimate Partner Violence During Public Health Emergencies Board on Health Care Services Health and Medicine Division PREPUBLICATION COPY—Uncorrected Proofs Consensus Study Report 

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW, Washington, DC 20001 This activity was supported by a contract between the National Academy of Sciences and the Health Resources and Services Administration of the U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/27425 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2024 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Essential health care services addressing intimate partner violence. Washington, DC: The National Academies Press. https://doi.org/10.17226/27425. PREPUBLICATION COPY—Uncorrected Proofs 

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COMMITTEE ON THE SUSTAINING ESSENTIAL HEALTH CARE SERVICES RELATED TO INTIMATE PARTNER VIOLENCE DURING PUBLIC HEALTH EMERGENCIES SUSAN J. CURRY (Chair), Dean and Distinguished Professor in the Department of Health Management and Policy of the University of Iowa College of Public Health SUE ANNE BELL, Assistant Professor at the University of Michigan School of Nursing JACQUELYN CAMPBELL, Professor, Johns Hopkins University School of Nursing REGARDT “REGGIE” FERREIRA, Director of the Tulane University’s Disaster Resilience Leadership Academy and Associate Professor at the Tulane School of Social Work FRANCISCO GARCIA, Deputy County Administrator for Health and Community Services and Chief Medical Officer for Pima County ROSA M. GONZALEZ-GUARDA, Associate Professor at Duke University School of Nursing and Assistant Dean of the Ph.D. Program ELIZABETH MILLER, Distinguished Professor of Pediatrics, Public Health, and Clinical and Translational Science, University of Pittsburgh MONA MITTAL, Associate Professor in the Department of Family Science, School of Public Health, at the University of Maryland, College Park HEIDI D. NELSON, Professor of Health Systems Science at the Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, California USHA RANJI, Associate Director for Women’s Health Policy at KFF MERRITT SCHREIBER, Professor of Clinical Pediatrics in the Department of Pediatrics at Harbor–UCLA Medical Center Lundquist Institute. JAMILA K. STOCKMAN, Professor and Vice Chief of Global Public Health in the Division of Infectious Diseases and Global Public Health at the University of California, San Diego School of Medicine MITCHELL STRIPLING, Director of the New York City Pandemic Response Institute LINDSAY F. WILEY, Professor of Law and Founding Faculty Director of the Health Law and Policy Program at University of California, Los Angeles School of Law v PREPUBLICATION COPY—Uncorrected Proofs 

Study Staff CRYSTAL J. BELL, Study Director/Responsible Staff Officer KAREN L. HELSING, Senior Program Officer TAYLOR KING, Associate Program Officer LYLE CARRERA, Research Associate MARJANI CEPHUS, Research Associate (through June 2023) ANESIA WILKS, Senior Program Assistant SCOTT WOLLEK, Senior Program Officer SHARYL NASS, Senior Director, Board on Health Care Services ROSE MARIE MARTINEZ, Senior Director, Board on Population Health and Public Health Practice vi PREPUBLICATION COPY—Uncorrected Proofs 

Reviewers This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manu- script remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: DAVID M. ABRAMSON, New York University ANDREIA ALEXANDER, Indiana University School of Medicine KAMILA A. ALEXANDER, Johns Hopkins University School of Nursing CATHERINE CERULLI, University of Rochester MELISSA L. GILLIAM, Ohio State University TONDA L. HUGHES, Columbia University School of Nursing KATHERINE M. IVERSON, Boston University DEAN G. KILPARTRICK, Medical University of South Carolina ALEXANDER KRIST, Virginia Commonwealth University ANNIE LEWIS-O’CONNOR, Brigham and Women’s Hospital CLINT OSBORN, DC Homeland Security and Emergency ­Management Agency SARAH M. PEITZMEIER, University of Michigan School of Nursing vii PREPUBLICATION COPY—Uncorrected Proofs 

viii REVIEWERS JENNIFER L. PIATT, Arizona State University JESSICA R. WILLIAMS, University of North Carolina at Chapel Hill Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by BETTY R. FERRELL, City of Hope National Medical Center, and MARSHALL H. CHIN, Uni- versity of Chicago. They were responsible for making certain that an inde- pendent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. PREPUBLICATION COPY—Uncorrected Proofs 

Acknowledgments The committee extends its sincere thanks to the many individuals who shared their time and expertise to support its work and inform its deliberations. The study was sponsored by the Health Resources and ­Services Administration’s (HRSA’s) Office of Women’s Health. The com- mittee extends its thanks to HRSA for initiating this effort to identify the essential health care services related to intimate partner violence and hopes that the report will positively affect HRSA’s programming in this field. In particular, the committee thanks Stephen Hayes, Ellen Hendrix, Helen Wesley, and Timothy Corrigan for their guidance and support. The commit- tee benefited greatly from discussions with the individuals who presented at the committee’s open sessions: Nancy Mautone-Smith, Melissa Simon, Athena Sherman, Rob Stephenson, Sarah Peitzmeier, Maria Balata, Ivon Mesa, Marianne Gausche-Hill, Lisa D. Martin, Lorena Halwood, Gregory J. Della Roca, Hirsch Handmaker, and Anita Ravi. Agendas for the public meetings are located in Appendix C. Our appreciation goes to the reviewers for their invaluable feedback on an earlier draft of the report and to the monitor and coordinator who oversaw the report review. The committee acknowledges the many staff within the Health and Medicine Division who provided support in various ways to this project, including Crystal J. Bell (study director), Taylor King (associate program officer), Lyle Carrera (research associate), ­Marjani Cephus (research associate), Anesia Wilks (senior program assis- tant), Karen Helsing (senior program officer), Scott Wollek (senior program officer), Rose Marie Martinez (senior director, Board on Population Health and Public Health Practice), Arzoo Tayyeb (finance business partner), and ix PREPUBLICATION COPY—Uncorrected Proofs 

x ACKNOWLEDGMENTS Julie Wiltshire (senior finance business partner). The committee extends great thanks and appreciation to Sharyl Nass, senior director, Board on Health Care Services, who oversaw the project. The committee also appre- ciates Anne Marie Houppert’s (senior librarian) research assistance. The report review, production, and communications staff all provided valuable ­guidance to ensure the success of the final product. Catherine McKinley and Lisa Fedina drafted papers for the committee, which were valuable contributions to the narrative. Finally, the committee thanks Allie Boman of Briere Associates for drafting technical writing and editorial assistance in preparing the report and Robert Pool, copyeditor for the final report. PREPUBLICATION COPY—Uncorrected Proofs 

Contents Acronyms and Abbreviations xvii Preface xxi Summary 1 1 Introduction 19 BACKGROUND, 19 STUDY APPROACH AND SCOPE, 20 ORGANIZATION OF THE REPORT, 32 REFERENCES, 33 2 Intimate Partner Violence in Steady State Conditions 37 PREVALENCE OF IPV, 37 POPULATION-SPECIFIC CONSIDERATIONS, 40 ADDITIONAL CONSIDERATIONS, 47 RISK FACTORS FOR PEOPLE ENGAGING IN IPV, 50 FACTORS INFLUENCING DISCLOSURE, 53 CHAPTER SUMMARY, 55 REFERENCES, 55 3 Intimate Partner Violence and Public Health Emergencies 63 PUBLIC HEALTH EMERGENCIES, 63 INTERSECTION OF PHES AND IPV, 77 xi PREPUBLICATION COPY—Uncorrected Proofs 

xii CONTENTS EXISTING GUIDANCE FOR IPV HEALTH CARE DURING PHES, 88 CHAPTER SUMMARY, 90 REFERENCES, 91 4 Health Conditions Related to IPV 99 MOST COMMON HEALTH CONDITIONS RELATED TO IPV, 99 CHAPTER SUMMARY, 113 REFERENCES, 113 5 Essential Health Care Services for IPV 123 ESSENTIAL HEALTH CARE SERVICES RELATED TO IPV, 123 TREATMENT OF CONDITIONS RELATED TO ACUTE IPV, 129 IPV HEALTH CARE ACCESS AND DELIVERY, 133 EXISTING AND PROMISING MODELS FOR IPV CARE, 143 ADDRESSING HEALTH DISPARITIES AND BARRIERS SPECIFIC TO PEOPLE EXPERIENCING IPV, 155 POLICY AND REGULATORY CONSIDERATIONS, 164 CONCLUSION, 170 REFERENCES, 170 6 Sustaining Intimate Partner Violence Services During Public Health Emergencies 187 ESSENTIAL HEALTH CARE SERVICES DURING PUBLIC HEALTH EMERGENCIES, 187 RESTORING ESSENTIAL IPV CARE IN PHASES, 189 IPV CARE DURING PHEs IN GLOBAL CRISIS SETTINGS, 194 ADDRESSING CHALLENGES IN SUSTAINING HEALTH CARE SERVICES, 199 CHAPTER SUMMARY, 202 REFERENCES, 202 7 Planning and Operationalization of IPV Essential Health Care Services During PHEs 205 SYSTEMS FOR IPV CARE DURING PUBLIC HEALTH EMERGENCIES, 206 PROMISING MODELS FOR IPV CARE IN PUBLIC HEALTH EMERGENCIES, 208 SUPPLIES FOR IPV CARE IN EMERGENCIES, 224 TRAINING STAFF FOR IPV CARE IN EMERGENCIES, 225 PREPUBLICATION COPY—Uncorrected Proofs 

CONTENTS xiii SPACE AND SHELTERING IN PUBLIC HEALTH EMERGENCIES, 232 CHALLENGES ASSOCIATED WITH SHELTERING, 234 CHAPTER SUMMARY, 234 REFERENCES, 235 8 Recommendations 241 Appendixes A Emergency Declarations and Federal Frameworks 255 FEDERAL AND STATE EMERGENCY DECLARATIONS, 255 FEDERAL FRAMEWORKS OVERVIEW, 259 REFERENCES, 261 B Health Effects of IPV on Individuals Experiencing IPV Across the ­Lifespan 263 C Public Session Agendas 283 D Biographical Sketches of Committee Members 287 PREPUBLICATION COPY—Uncorrected Proofs 

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Boxes, Figures, and Tables BOXES 1-1 Statement of Task, 20 3-1 Effect of the COVID-19 Pandemic on Health Services Delivery, 83 3-2 Effect of Distancing Orders on IPV Shelters, 84 3-3 IPV Service Providers’ Adaptations During the COVID-19 Pandemic, 87 6-1 Essential Actions to Support IPV Survivors During PHEs, 196 7-1 Swedish Hospital Pathways Program, 210 7-2 PurpLE Health Foundation, 212 7-3 Family Spirit Home Visiting Program, 213 7-4 Amá Dóó Álchíní Bíghan (ADABI) Healing Shelter, 215 7-5 Indigenous Communities and the Digital Divide, 218 7-6 Miami Dade County Violence Prevention and Intervention D ­ ivision, 221 7-7 The CACTIS Foundation, 223 FIGURES 1-1 Social ecological model, 24 2-1 Risk and protective factors contributing to people engaging in IPV, 51 xv PREPUBLICATION COPY—Uncorrected Proofs 

xvi BOXES, FIGURES, AND TABLES 3-1 FEMA Community Lifelines, 72 3-2 Natural Hazards Index (NHI) Map v2.0, 76 3-3 Social Vulnerability Index (SVI) Map, 77 5-1 Access to essential health care services for those experiencing IPV, 135 5-2 Health care cycle leading to avoidance and distrust by patients s­ eeking care for intimate partner violence, 137 5-3 HRSA Primary Care Health Professional Shortage Map, 158 5-4 March of Dimes Maternity Care Deserts by county in the United States Map, 159 5-5 HRSA Mental Health Professional Shortage Map, 163 6-1 Five phases of emergency planning, with three phases of disaster response, 189 TABLES 2-1 Lifetime Prevalence by Victimization Type for U.S. Women from the National Intimate Partner and Sexual Violence Survey: 2016–2017 Report, 38 2-2 Lifetime Prevalence by Race and Ethnicity for U.S. Women from the National Intimate Partner and Sexual Violence Survey: 2016–2017 Report, 39 2-3 Individual- and Relationship-Level Risk Factors for Engaging in IPV, 52 2-4 Community- and Society-Level Risk Factors and Protective Factors for Engaging in IPV, 53 5-1 Validated Tools for Screening for IPV, 126 5-2 CDC IPV Prevention Strategies, 150 6-1 Restoring Essential Health Care Services for Intimate Partner ­Violence (IPV) During Public Health Emergencies—A Phased Return to Steady-State, 191 8-1 Essential Health Care Services for IPV During Public Health ­Emergencies—A Phased Return to Steady State, 247 PREPUBLICATION COPY—Uncorrected Proofs 

Acronyms and Abbreviations ACA Patient Protection and Affordable Care Act ACS alternate care site AI/AN American Indian and Alaska Native ART antiretroviral therapy ASPR Administration for Strategic Preparedness and Response CCR Coordinated Community Response CDC U.S. Centers for Disease Control and Prevention CFPI Colorado Family Planning Initiative CMS Centers for Medicare & Medicaid Services CSC crisis standard of care DCM disaster case management or manager DHS U.S. Department of Homeland Security DMAT Disaster Medical Assistance Team DOVE Domestic Violence Enhanced Home Visitation Program DV domestic violence ED emergency department EMAC Emergency Management Assistance Compact EMTALA Emergency Medicine Treatment and Active Labor Act ESF Emergency Support Function ESP Essential Services Package EUA Emergency Use Authorization xvii PREPUBLICATION COPY—Uncorrected Proofs 

xviii ACRONYMS AND ABBREVIATIONS FDA U.S. Food and Drug Administration FEMA Federal Emergency Management Agency FMS federal medical station FQHC Federally Qualified Health Center HCC Health Care Coalition HHS U. S. Department of Health and Human Services HIPAA Health Insurance Portability and Accountability Act HIV Human Immunodeficiency Virus HRSA Health Resources and Services Administration IFRC International Federation of the Red Cross and Red Crescent IHS Indian Health Service IPV intimate partner violence IPVAP Intimate Partner Violence Assistance Program LARC long-acting reversible contraceptive LBTQ lesbian, bisexual, transgender, and queer LGBTQ lesbian, gay, bisexual, transgender, and queer LEP limited English proficiency MISP Minimum Initial Services Package NDMS National Disaster Medical System NDRF National Disaster Recovery Framework NEA National Emergencies Act NEISS-AIP National Electronic Injury Surveillance System–All Injury Program NISVS National Intimate Partner and Sexual Violence Survey NRF National Response Framework NVDRS National Violent Death Reporting System OB-GYN obstetrician/gynecologist OPA Office of Population Affairs OWH Office of Women’s Health (at HRSA) PHE public health emergency PHS Public Health Service PHSA Public Health Service Act PPE Personal Protective Equipment PREP Pandemic Readiness and Emergency Preparedness Act PRAMS Pregnancy Risk Assessment Monitoring System PROMiSE Promoting Safety in Emergencies PREPUBLICATION COPY—Uncorrected Proofs 

ACRONYMS AND ABBREVIATIONS xix PTSD post-traumatic stress disorder PurpLE Purpose, Listen and Engage (health foundation) RISE Recovering from IPV through Strengths and Empowerment RSF Recovery Support Functions SANE sexual assault nurse examiner SCBHC school- and college-based health center SLTT state, local, tribal, and territorial STI sexually transmitted infection SUD substance use disorder TBI traumatic brain injury UNFPA United Nations Population Fund USPHS U.S. Public Health Service USPSTF U.S Preventive Services Task Force VAWA Violence Against Women Act VHA Veterans Health Administration VOAD volunteer organization active in disasters WHO World Health Organization WPSI Women’s Preventive Services Initiative PREPUBLICATION COPY—Uncorrected Proofs 

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Preface Intimate partner violence (IPV) is deeply troubling and complex. A comprehensive approach that focuses both on providing a broad range of services and on ultimately eliminating IPV would extend far beyond the health care delivery system. Moreover, the committee recognized that even in steady state conditions our current health care system does not equitably deliver essential healthcare services. While the committee desired to address a broader scope of how to eliminate IPV and improve our overall health care system, the committee operated within the scope of our statement of task and with the body of research available. This committee’s task and this consensus report focuses specifically on the essential health care services for IPV, first during steady state conditions, then in the context of public health emergencies (PHEs). The committee members brought diverse thought and multidisciplinary expertise to the statement of work put forth by HRSA. It became apparent early in our committee discussions and public sessions that IPV care pro- viders and those responsible for planning and carrying out PHE response can benefit from learning more about each other’s respective fields. Thus, our report includes both basic information about IPV and PHE response to facilitate future cooperation in PHE preparation, planning, and response. Through hard work, deliberation, and careful review of the evidence, the committee achieved consensus on the 11 recommendations highlighted in this report. The recommendations are pragmatic, actionable, and address key gaps in responding to IPV during public health emergencies that were identified over the course of this study. xxi PREPUBLICATION COPY—Uncorrected Proofs 

xxii PREFACE Given the complexities of both IPV and public health emergencies, there are multiple sectors involved in the response (clinicians, disaster responders, emergency planners, etc.). Due to the various ways these response systems are structured across municipalities, the committee did not name specific local and state organizations who might lead the efforts in standing up the essential services during PHEs. The committee dedicated time and deep consideration to recommendations that call out specific national entities, ensuring that those entities were the most appropriate to take charge in those specific recommendations. I am convinced that implementation of these recommendations will be transformative for providing healthcare services to those experiencing IPV in steady-state and public health emer- gency conditions. Susan J. Curry, Ph.D. Committee Chair PREPUBLICATION COPY—Uncorrected Proofs