As part of the college's coverage of the ongoing outbreak of coronavirus disease (COVID-19), we're reprinting a recent article by Melissa Dichter, associate professor in the School of Social Work and associate director of the VA Center for Health Equity Research and Promotion; Ashlee Murray, an emergency medicine physician at CHOP and a fellow with CHOP’s Violence Prevention Initiative; and Jessica Palardy, STOP IPV supervisor at Lutheran Settlement House in Philadelphia. The three authors are part of an Interdisciplinary Research Leader team at the Robert Wood Johnson Foundation, "Centering Survivor Voices to Improve Medical-Community Partnerships Addressing Intimate Partner Violence." This article has been reprinted, with permission, from KevinMD.
As the coronavirus pandemic spreads across the country, states are mandating “stay at home” orders; and with these orders comes further social isolation for domestic violence (DV) survivors and their families. Many recent articles highlight the potential risks for DV victims “stuck at home” with their abusers as their opportunities to seek help and support are dwindling. With only ‘essential’ businesses, such as grocery stores, gas stations, and hospitals, still open, survivors have fewer places to go and fewer chances to interact with others and receive services, creating even further social isolation. In addition, as nonessential businesses begin to close, unemployment rates continue to climb, potentially increasing stress in relationships and survivors become more financially dependent upon their abusers.
Surprising to many, however, domestic violence survivors have been experiencing #socialdistancing long before the hashtag was trending. As a matter of fact, perpetrators of domestic violence more often than not utilize social isolation as part of their power and control cycle. Isolation can start subtly and quickly escalate until a survivor’s only interactions are with their abuser. Survivors can find themselves feeling alone and detached from people in their lives, feeling anxious and uncertain about their future, having difficulty concentrating, making simple decisions, and even developing depression and/or depressive symptoms.
So, what can we do?
Health care providers and others on the front lines in health care are critical – both for managing the virus spread and symptoms but also for helping those experiencing domestic violence. The health care setting may be the first place that a DV survivor encounters information about services and can receive help – this factor is heightened in a time when all other public services and programs and places are closed. It is even more critical than ever that as a health care community, we do not forget about the social needs of our community. It is critical that we continue to screen for and address domestic violence in all health care settings. Survivors who have learned about DV services through health care settings tell us that they hadn’t previously known that such services existed, that they benefitted from receiving support and navigation through the health care system.
Seeking medical care right now may be the only opportunity for victims to leave their homes, and now is an important time for us to help. Most hospitals are restricting visitors, so most survivors are alone and can be safely screened. It is critical that we provide a safe space to talk to our patients about domestic violence and offer support. When possible, we need to sit down and actively create safety plans with our patients; safety plans that consider an individual’s current living situation, their children and pets, their reproductive health as well as the current coronavirus pandemic. Additionally, this is a time to consider telemedicine screening amid the COVID-19 outbreak as telehealth services surge and payment rules have shifted.
Many in health care settings now are overwhelmed with care directly related to the novel coronavirus and related concerns. But providers do not have to manage this alone. Every community has a local domestic violence program that may be able to provide services remotely. The National Domestic Violence Hotline offers free and confidential support 24/7 via telephone or text and can help survivors’ safety plan and connect to local services. Services for DV survivors extend beyond shelter and police and protection-from-abuse orders. The majority of clients of DV services receive empowerment counseling, advocacy, and system navigation support – during this time of physical distancing, many organizations are still offering these services via Zoom, Skype, FaceTime, phone, or text. Counseling is a crucial service at this time to help those experiencing abuse to continue to feel supported. Advocacy must continue so that housing applications do not fall by the wayside, landlords do not take advantage of vulnerable folks out of work, and legal systems continue to uphold the rights of survivors to stay safe.
For more information on how you and your health care system can integrate screening and safety planning into your practice visit Futures Without Violence.