Consensus Study Report
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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: 978-0-309-71389-4
International Standard Book Number-10: 0-309-71389-7
Digital Object Identifier: https://doi.org/10.17226/27425
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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.
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COMMITTEE ON SUSTAINING ESSENTIAL HEALTH CARE SERVICES RELATED TO INTIMATE PARTNER VIOLENCE DURING PUBLIC HEALTH EMERGENCIES
SUSAN J. CURRY (Chair), Dean and Distinguished Professor, Department of Health Management and Policy, University of Iowa College of Public Health
SUE ANNE BELL, Assistant Professor, University of Michigan School of Nursing
JACQUELYN CAMPBELL, Professor, Johns Hopkins University School of Nursing
REGARDT “REGGIE” FERREIRA, Director, Tulane University Disaster Resilience Leadership Academy, and Associate Professor, Tulane School of Social Work
FRANCISCO GARCIA, Deputy County Administrator, Health and Community Services and Chief Medical Officer, Pima County, Arizona
ROSA M. GONZALEZ-GUARDA, Associate Professor, 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, Department of Family Science, School of Public Health, University of Maryland, College Park
HEIDI D. NELSON, Professor of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
USHA RANJI, Associate Director for Women’s Health Policy, KFF
MERRITT SCHREIBER, Professor of Clinical Pediatrics, Department of Pediatrics, Harbor–University of California, Los Angeles Medical Center Lundquist Institute
JAMILA K. STOCKMAN, Professor and Vice Chief of Global Public Health, Division of Infectious Diseases and Global Public Health, University of California, San Diego, School of Medicine
MITCHELL STRIPLING, Director, New York City Pandemic Response Institute
LINDSAY F. WILEY, Professor of Law and Founding Faculty Director of the Health Law and Policy Program, University of California, Los Angeles, School of Law
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 (through March 2024)
SHARYL NASS, Senior Director, Board on Health Care Services
ROSE MARIE MARTINEZ, Senior Director, Board on Population Health and Public Health Practice
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 manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
Although the reviewers listed above provided many constructive comments 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, University of Chicago. They were responsible for making certain that an independent 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.
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 committee 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 Timothy Corrigan, Stephen Hayes, Ellen Hendrix, and Helen Wesley for their guidance and support. The committee benefited greatly from discussions with the individuals who presented at the committee’s open sessions: Maria Balata, Gregory J. Della Roca, Marianne Gausche-Hill, Lorena Halwood, Hirsch Handmaker, Lisa D. Martin, Nancy Mautone-Smith, Ivon Mesa, Sarah Peitzmeier, Anita Ravi, Athena Sherman, Melissa Simon, and Rob Stephenson. 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 assistant), 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
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 appreciates 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.
3 INTIMATE PARTNER VIOLENCE AND PUBLIC HEALTH EMERGENCIES
Intersection of Public Health Emergencies and Intimate Partner Violence
Existing Guidance for Intimate Partner Violence Health Care During Public Health Emergencies
4 HEALTH CONDITIONS RELATED TO INTIMATE PARTNER VIOLENCE
Most Common Health Conditions Related to Intimate Partner Violence
Gynecologic, Reproductive Health, Perinatal, and Obstetric Conditions
5 ESSENTIAL HEALTH CARE SERVICES FOR INTIMATE PARTNER VIOLENCE
Essential Health Care Services Related to Intimate Partner Violence
Treatment of Conditions Related to Acute Intimate Partner Violence
Intimate Partner Violence Health Care Access and Delivery
Existing and Promising Models for Intimate Partner Violence Care
Addressing Health Disparities and Barriers Specific to People Experiencing Intimate Partner Violence
Policy and Regulatory Considerations
6 SUSTAINING INTIMATE PARTNER VIOLENCE SERVICES DURING PUBLIC HEALTH EMERGENCIES
Essential Health Care Services During Public Health Emergencies
Restoring Essential Intimate Partner Violence Care in Phases
Intimate Partner Violence Care During Public Health Emergencies in Global Crisis Settings
Addressing Challenges in Sustaining Health Care Services
Systems for Intimate Partner Violence Care During Public Health Emergencies
Promising Models for Intimate Partner Violence Care in Public Health Emergencies
Supplies for Intimate Partner Violence Care in Emergencies
Training Staff for Intimate Partner Violence Care in Emergencies
Space and Sheltering in Public Health Emergencies
Challenges Associated with Sheltering
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Boxes, Figures, and Tables
BOXES
S-1 Statement of Task and Charge to the Committee
1-1 Statement of Task and Charge to the Committee
3-1 Effect of the COVID-19 Pandemic on Health Services Delivery
3-2 Effect of Distancing Orders on IPV Shelters
3-3 IPV Service Providers’ Adaptations During the COVID-19 Pandemic
6-1 Essential Actions to Support IPV Survivors During PHEs
7-1 Swedish Hospital Pathways Program
7-3 Family Spirit Home Visiting Program
7-4 Amá Dóó Álchíní Bíghan (ADABI) Healing Shelter
7-5 Indigenous Communities and the Digital Divide
7-6 Miami Dade County Violence Prevention and Intervention Division
FIGURES
2-1 Risk and protective factors contributing to people engaging in IPV
3-1 Federal Emergency Management Agency (FEMA) Community Lifelines
3-2 Natural Hazards Index (NHI) Map v2.0
3-3 Social Vulnerability Index (SVI) Map
5-1 Access to essential health care services for those experiencing IPV
5-4 March of Dimes Maternity Care Deserts by county in the United States Map
5-5 Health Resources and Services Administration (HRSA) Mental Health Professional Shortage Map
6-1 Five phases of emergency planning, with three phases of disaster response
TABLES
2-3 Individual- and Relationship-Level Risk Factors for Engaging in IPV
2-4 Community- and Society-Level Risk Factors and Protective Factors for Engaging in IPV
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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 standards 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 |
| 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 |
| PTSD | post-traumatic stress disorder |
| PurpLE | Purpose, Listen and Engage (health foundation) |
| RISE | Recovering from Intimate Partner Violence 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 |
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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 health care 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 focus 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 providers 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 PHEs that were identified over the course of this study.
Given the complexities of both IPV and PHEs, 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 that 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 health care services to those experiencing IPV in steady state and PHE conditions.
Susan J. Curry, Ph.D.
Committee Chair
