In the exam room, Kira’s doctor goes through a list of questions about her health and homelife. When she gets to the ones about whether Kira fears her partner, if he hurts her, coerces her to participate in sex, or controls who she sees outside the home, she quickly says, “No.” Kira stiffens with anxiety over these questions and what might happen if she says yes. She feels shame and fear that speaking up might set in motion actions that would make her situation worse. She could find herself alone with young children and no support, or her partner could be jailed briefly and return home determined to exert more control over her.
Kira’s experience isn’t isolated.
One in 4 women and 1 in 9 men are survivors of intimate partner violence, and only 21 percent of women and 5.6 percent of men who are known survivors report that they ever disclosed this information to a health care professional. Like Kira, many feel shame and fear the consequences of reporting a partner. Other reasons for not disclosing are related to immigration status, fear of having children taken away, or even cultural norms that prevent them from seeing a partner’s behavior as abusive.
As Medi-Cal moves to improve outcomes for vulnerable populations, it is uniquely positioned to support survivors.
Domestic violence is everywhere, and it involves a range of controlling and abusive behaviors, including physical and psychological abuse.
Universal education can make a difference. Universal education calls for training health-care providers to talk about intimate partner violence with all patients, whether they suspect abuse or not, and to provide access to support without pressing for disclosure. Providers taught to use universal education report increased confidence in discussing the issue with their patients, and patients report increased awareness of resources and increased confidence in their ability to take steps to protect themselves.
Universal education is one approach out of many trauma-informed strategies for domestic violence prevention that Medi-Cal could adopt as it prepares to launch its Population Health Management Program next year.
Medi-Cal provides health insurance for more than 14.5 million California residents with low incomes. As Medi-Cal moves to improve outcomes for vulnerable populations, it is uniquely positioned to support survivors and to foster the prevention of intimate partner violence.
Ending the cycle of intimate partner violence, which has touched the lives of 58% of California adults, has broad implications for society.
An evidence-based model for implementing universal education is a program by Futures Without Violence called CUES — Confidentiality, Universal Education and Empowerment, Support. The CUES program provides information cards that can help guide a discussion between provider and patient. The patient receives two sets of cards, including a set to share with friends and family. The cards include resources like hotlines for additional help and information about safety planning, strategies for staying healthy, and counseling.
These resources help ensure survivors and those at risk can receive support even if they do not disclose violence.
Ending the cycle of intimate partner violence, which has touched the lives of 58% of California adults, has broad implications for society. Prevention reduces costs to the health-care system and improves health outcomes across the board.
Since domestic violence almost always includes financial control, it can trigger financial instability that persists for generations, leading to housing and financial instability, food insecurity, social isolation, lack of transportation, and even other forms of violence. People who witness violence as children are more likely to experience it as adults, making intimate partner violence part of a multigenerational cycle that must be broken to allow people to heal and prevent long-lasting harm to individuals, families, and society.
The chain can be broken with better engagement of multiple sectors, including the health care system.
Intimate partner violence has the greatest impact on people with low incomes and people of color, who also make up a high proportion of the Medi-Cal eligible population.
As Medi-Cal re-envisions its approach to population health, state leaders have a unique opportunity to play a role in ending domestic violence by exploring universal education and other tested trauma-informed and community-based approaches to this deep-rooted problem.
Editor’s Note: Debbie I. Chang is president and CEO of the Blue Shield of California Foundation, which supports work to end domestic violence. Esta Soler is president of Futures Without Violence.