Referrals for intimate partner violence increased during pandemic, study finds

Referrals for intimate partner violence increased significantly during the COVID-19 pandemic at a program within Boston Children’s Hospital, according to a study published in Pediatrics.

As part of the study, researchers analyzed a pattern of consultation requests at the Advocacy for Women and Kids in Emergencies (AWAKE) program at the hospital and compared numbers from the 11 months leading up to the COVID-19 pandemic to the same period during the pandemic.

The AWAKE program, which is led by social workers, provides educational training and support to health care providers to screen for intimate partner violence (IPV) and offers direct, confidential support to survivors.

“A recent meta-analysis of studies examining rates of IPV before and after implementation of lockdown measures suggests an average increase of 8.9% of domestic violence postimplementation in the U.S., with some estimates as high as 38%,” they wrote. “While necessary to preserve the health of the public, these data suggest that COVID-19-related precautions presented an opportunity for IPV perpetrators to capitalize on social isolation, one of the most frequently employed tactics used to separate survivors from their support networks.”

In the 11 months leading up to the COVID-19 pandemic, categorized in the study as April 1, 2019, to Feb. 29, 2020, the AWAKE team reported receiving 240 consultation requests, 197 of which were new. During the pandemic period, from April 1, 2020, to Feb. 28, 2021, consultation volume increased to 295, during a time when providers shifted away from face-to-face care because of the pandemic.

The researchers suggested the importance of pediatric primary care as a location for survivors to access support, adding that consultations can be successfully provided when offered remotely, and noting that the AAP has identified IPV as a pediatrics issue, as identification may be one of the most effective ways to prevent child maltreatment.

“Our data suggest that the presence of a IPV program within the pediatric setting has the potential to identify numerous individuals in need of support and provide referrals to ongoing care,” they wrote. “The fact that providers were able to identify and connect these patients/families even in the setting of a move to remote care should encourage clinicians that it is possible to provide these services across a range of settings and with a variety of resources.”

The study was accompanied by an editorial co-authored by Elizabeth Miller, MD, PhD and Maya Ragavan, MD, MS, MPH, both of the department of pediatrics at the University of Pittsburgh School of Medicine.

“IPV should be considered another ‘social determinant of health,’ and safety for survivors include housing and economic stability,” they wrote. “As health care systems are increasingly addressing health-related social needs, there is an opportunity to promote cross-sector collaborations across various systems and services critical for supporting survivors.”

They said that as practices emerge from the pandemic and reorganize, leaders should consider how to partner with IPV-based agencies.

“As we begin to emerge from the COVID-19 pandemic, pediatric health care settings must consider ways to engage in sustained partnerships with clinic, hospital, and community-based IPV agencies,” they wrote. “Health care settings must recognize that IPV agencies are integral to the pediatric medical home and essential collaborators in the provision of healing-centered care for IPV survivors and their children.”

References:

Ragavan M, et al. Pediatrics. 2022;doi:10.1542/peds.2022-56980.