What is the appropriate care plan for a patient experiencing intimate partner violence (IPV) with potential underlying mental health concerns, such as depression, anxiety, or post-traumatic stress disorder (PTSD)?

Care Plan for Intimate Partner Violence

Implement a structured intervention protocol centered on safety planning, supportive counseling, and guided referrals to community resources, while simultaneously screening and treating co-occurring mental health conditions including depression, anxiety, and PTSD. 1, 2, 3

Immediate Safety Assessment and Planning

• Conduct immediate safety assessment to determine if the patient is in imminent danger, including evaluating current living situation, access to weapons by the perpetrator, escalation patterns, and presence of children in the home 3
• Develop a personalized safety plan that includes identification of safe places to go, emergency contacts, important documents to gather, financial resources, and strategies for leaving safely if needed 1, 4
• Provide safety planning interventions using a 20-minute nurse case management protocol that includes a brochure with a 15-item safety plan, supportive care, anticipatory guidance, and guided referrals 1

Mental Health Screening and Treatment

• Screen for depression, anxiety, and PTSD using validated instruments, as these conditions are highly prevalent with 73% experiencing depression, 77% trait anxiety, and 87% meeting criteria for PTSD among IPV survivors 3, 5
• Initiate trauma-focused cognitive behavioral therapy immediately without a stabilization phase, as current evidence demonstrates this approach is safe and effective with large effect size reductions in symptoms 3
• Offer psychological therapies which probably reduce depression (SMD -0.24,95% CI -0.47 to -0.01) and may reduce anxiety (SMD -0.96,95% CI -1.29 to -0.63) with no evidence of harm 2, 6
• Treat primary comorbid mental health disorders with standard psychological and pharmacologic therapies, distinguishing these from substance-induced symptoms 1

Behavioral Counseling Interventions

• Provide prenatal and postpartum behavioral counseling for pregnant patients, which significantly reduces IPV victimization with an adjusted odds ratio of 0.48 (95% CI 0.29-0.80) 2, 1
• Offer brief empowerment-based counseling focused on empathetic listening, discussion of the cycle of violence, validation of experiences, and support for self-determination 7, 8
• Address pregnancy coercion through counseling interventions that help women discontinue unsafe relationships and decrease reproductive control by partners 2, 1

Comprehensive Medical Care

• Screen for physical trauma including injuries at various stages of healing, chronic pain, neurologic disorders, gastrointestinal disorders, and migraine headaches 3
• Provide empirical treatment for sexually transmitted infections (Chlamydia, gonorrhea, trichomoniasis) when sexual assault is involved 3
• Offer emergency contraception within 120 hours of sexual assault 3
• Monitor pregnancy outcomes closely, as IPV is associated with preterm birth, low birthweight, and decreased gestational age 3

Referral and Resource Coordination

• Establish "warm hand-off" to social workers or domestic violence advocates when available, rather than simply providing written information 4
• Connect patients to community-based domestic violence programs for ongoing advocacy, shelter services, legal assistance, and support groups 1
• Coordinate between therapeutic and advocacy services to ensure comprehensive support addressing both mental health and practical safety needs 8, 7
• Utilize CDC resources available at www.cdc.gov/ViolencePrevention/intimatepartnerviolence/resources.html for additional guidance 1

Substance Use Screening and Treatment

• Screen all IPV patients for substance use disorders, as rates of IPV exceed 50% in patients with drug use disorders in some settings 1
• Treat co-occurring alcohol use disorders, as this intervention appears to decrease both perpetration and victimization of IPV 1

Legal and Reporting Considerations

• Know your state's mandatory reporting requirements, as laws vary significantly by jurisdiction regarding IPV reporting (unlike child and elder abuse which are mandated in all 50 states) 1
• Understand HIPAA privacy regulations and inform patients about health information use and disclosure practices 1
• Document injuries thoroughly with photographs when possible and detailed descriptions for potential legal proceedings 3

Special Populations

• Assess children who witness IPV for developmental delay, school failure, violent behavior, depression, and oppositional defiant disorder 3
• Provide culturally and linguistically appropriate interventions for underserved populations including Spanish-speaking and low-income women 4

Follow-Up and Ongoing Care

• Schedule regular follow-up visits to reassess safety, monitor mental health symptoms, evaluate intervention effectiveness, and adjust the care plan as needed 7
• Maintain flexibility in treatment approach, recognizing that survivors may need responsiveness around discussion of IPV, respect for life complexity, and support for their own decision-making timeline 8
• Avoid requiring disclosure or discussion of IPV as a prerequisite for mental health treatment, allowing patients to control when and how they address the violence 8

Common Pitfalls to Avoid

• Do not delay trauma-focused therapy waiting for "stabilization," as immediate initiation is both safe and more effective 3
• Do not assume screening causes harm, as evidence shows screening and interventions have harms no greater than small while providing moderate net benefit 2, 3
• Do not provide only written resources without personal connection to services, as warm hand-offs are more effective than passive referrals 4, 7
• Do not overlook emotional abuse victims, as they experience psychological symptoms and daily life interference of similar magnitude to those suffering physical violence 5