Someone You Know: Empowering Interpersonal Violence Survivors through Trauma and Violence Informed Care in Health Behavior Research and Practice

Chuka Emezue, PhD, MPH, MPA¹; Bushra Sabri, PhD, MPH²; & the Violence and Trauma SIG

With the ubiquity of interpersonal violence, whether it is sexual assault, physical, sexual, or psychological violence (also called emotional violence), stalking, domestic violence, or any other form of abuse, it has become critical to revisit evidence-based resources and support for survivors (primarily women) in research and practice settings.

Interpersonal violence involves the purposeful use of physical force or power against another person by an individual or small group.¹ Globally, 1 in 3 women and girls report experiences of physical and sexual violence by an intimate partner (intimate partner violence (IPV) at some point during their life.² In the United States, this number comes to one in four women and one in 10 men.³ Despite breakthroughs in understanding and treating violence-related trauma, survivors of violence frequently face challenges in accessing trauma and violence-informed care in research and therapeutic settings, including a lack of awareness of red flags of abuse and a lack of knowledge as behavioral medicine interventionists on how to identify and support survivors.

Interpersonal violence intersects with behavioral medicine through its impact on psychological well-being, maladaptive coping behaviors, health-related behaviors, physiological responses, healthcare utilization, prevention efforts, and trauma-informed care. Research shows survivors of violence often report a range of modifiable health factors in response to the forms of violence encountered. For instance, IPV survivors may be at a higher risk for unhealthy behaviors (excessive substance use, decreased physical activity), and adverse health outcomes affecting the heart, muscles, and bones, neurobiological, digestive, reproductive, and mental and psychological co-morbidities (such as anxieties, depression, and PTSD⁴). Ultimately about 1 in 5 homicide victims are killed by an intimate partner.⁵

Behavioral medicine emphasizes trauma-informed care, recognizing the impact of trauma on individuals’ physical and psychological health and well-being. The power of trauma-informed screening and support in empowering survivors of traumatic experiences is a topic that deserves the attention and commitment from the SBM scientific community — which is uniquely poised to understand the effects of trauma and its close links to health and behavior and play a role in identifying and screening for the signs of violence and abuse co-occurring with health and behavioral issues.

Trauma- and violence-informed care (TVIC) represents a first step and a beacon of hope that considers the intersecting impacts of systemic and interpersonal violence and structural inequities on the people we routinely serve. Proactively integrating trauma and violence screening into routine behavioral health care and health behavior research can lead to more comprehensive care for violence and trauma survivors. Some actionable TVIC techniques to effectively enhance screening and early detection of violence and abuse are listed below:

1. Trauma-Informed Training and Awareness: Informed screening and trauma awareness comprise training healthcare providers to recognize signs of trauma and mental distress, allowing them to respond to patients, clients, and research participants in a timely and appropriate manner.
2. Awareness of Universal Screening Protocols and Instruments: The following tools are effective at detecting violence and can be discreetly applied in research, community, and clinical settings: WHO’s LIVES (Listen, Inquire, Validate, Ensure Safety, Support) Protocol; Humiliation, Afraid, Rape, Kick (HARK); Hurt, Insult, Threaten, Scream (HITS); Extended–Hurt, Insult, Threaten, Scream (E-HITS); Partner Violence Screen (PVS); and Woman Abuse Screening Tool (WAST). However, depending on the demographic treated, various screening tools are available.
3. Culturally Competent Approaches: Healthcare professionals should be trained in equity-promoting approaches and culturally competent care to ensure that survivors from diverse backgrounds, often with the highest violence burden (i.e., rural, immigrant, racial, and ethnic minorities, SGM) receive appropriate and sensitive support, even as we come to grasp with how violence is rooted in sociocultural systems.
4. Digital Health Solutions: Studies show evidence that technology-based intervention can enhance screening and support and provide survivors convenient access to information, resources, and virtual support.⁴ The National Hotline on Domestic Violence hotline - 800.799.SAFE (7233) remains a reliable, round-the-clock, and confidential digital resource that can be included in program guides, one-pagers, study brochures, and human subjects protection protocols.
5. Institutional Support: TVIC also addresses systemic and institutional policies and practices that perpetuate harm to meet the requirements of the system rather than the needs of the individual (for example, asking participants to carry out behavioral health protocol in situations that may be actively violent).⁶ Medical professionals’ capacity to recognize trauma symptoms and respond directly depends on the resources dedicated to their education and training.

TVIC has enormous potential benefits, but it also faces significant obstacles. Access to adequate care can be hampered for survivors and interventionists by a lack of mental health resources, insurance restrictions, and institutional biases. It will need efforts from healthcare practitioners, lawmakers, advocacy groups, and survivors themselves to find solutions to these problems. It will be crucial for the SBM scientific community to acknowledge the significance of TVIC-based screening and support in behavioral medicine. We can pave the road for a more compassionate and resilient society by recognizing the patients, participants, and clients hidden behind the statistics and providing them with complete, integrated care.

Affiliations

1. Assistant Professor, Rush University College of Nursing
2. Assistant Professor, Johns Hopkins University

References

1. Mercy, J. A. et al. Interpersonal Violence: Global Impact and Paths to Prevention. in Injury Prevention and Environmental Health (eds. Mock, C. N., Nugent, R., Kobusingye, O. & Smith, K. R.) (The International Bank for Reconstruction and Development / The World Bank, 2017).
2. Scoglio, A. A. J. et al. Intimate Partner Violence, Mental Health Symptoms, and Modifiable Health Factors in Women During the COVID-19 Pandemic in the US. JAMA Netw. Open 6, e232977 (2023).
3. Hardesty, J. L. & Ogolsky, B. G. A Socioecological Perspective on Intimate Partner Violence Research: A Decade in Review. J. Marriage Fam. 82, 454–477 (2020).
4. Emezue, C., Chase, J.-A. D., Udmuangpia, T. & Bloom, T. L. Technology-based and digital interventions for intimate partner violence: A systematic review and meta-analysis. Campbell Syst. Rev. 18, e1271 (2022).
5. Fast Facts: Preventing Intimate Partner Violence |Violence Prevention|Injury Center|CDC. https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html (2022).
6. Wathen, C. N. & Mantler, T. Trauma- and Violence-Informed Care: Orienting Intimate Partner Violence Interventions to Equity. Curr. Epidemiol. Rep. 9, 233–244 (2022).