Date of Award

5-2017

Document Type

Thesis - Open Access

Degree Name

MS Human Genetics

Department

Human Genetics Graduate Program

Abstract

The Center for Disease Control (CDC) defines intimate partner violence (IPV) as physical, sexual, or psychological harm by a current or former partner or spouse (Breiding, Basile, Smith, Black, & Mahendra, 2015). Intimate Partner Violence (IPV) can occur among heterosexual or same-sex couples and does not require sexual intimacy. Studies conducted by the CDC in 2011 found that IPV affected approximately 29% of women and 10% of men in the U.S. When considering the relationship between IPV disclosure to healthcare providers and the receipt of intervention, McCloskey et al. found that patients who spoke with their healthcare providers about IPV were more likely to utilize interventions such as advocacy groups, shelters and restraining orders (2006). Additionally, the majority of victims who left abusive partners had interventions in place prior to leaving (2006). Despite the ability of healthcare providers to aid victims in leaving abusive relationships, barriers to aid remain. Some common barriers include financial dependency, lack of social or family support and desire to avoid separating children from an abusive parent (Gharaibeh & Oweis, 2009). Resta et al. define genetic counselling is a communicative process, which aims to help individuals, couples and families understand and adapt to the medical, psychological, familial and reproductive implications of the genetic contribution to specific health conditions (Resta et al., 2006) . However, that definition is not representative of the strong psychosocial component of genetic counseling sessions. Genetic counselors often discuss sensitive topics with patients such as family dynamics, personal and family diagnoses, and access to resources. Genetic counseling education also provides genetic counselors with psychosocial knowledge and skills. Domain two of the Accreditation Counsel for Genetic Counseling (ACGC) competencies stresses the importance for genetic counseling students to attain interpersonal, psychosocial and counseling skills within their genetic education program (2015). Some of the skills required by this domain include: employ active listening and interviewing skills to identify, assess, and empathically respond to stated and emerging concerns; promote client-centered, informed, non-coercive and value-based decision-making; and understand how to adapt genetic counseling skills for varied service delivery models. Another role of genetic counselors is to be an advocate for their patients and communities. All of these skills are useful in working with victims of IPV. By creating a safe place for patients, where they can feel heard, genetic counselors build rapport. Providers can dedicate anywhere from 30 minutes to one hour to a patient during a session. This may provide adequate time for patients to disclose IPV, and for genetic counselors to access hospital/department resources such as social workers and security. Furthermore, some patients may see the same genetic counselor, or the same genetic counseling department several times depending on the nature of their clinical situation. For example, a woman with an ultrasound anomaly may keep coming back for the same ultrasound. This may provide enough time and encounters between patient and counselor for the patient to gain enough trust in a counselor to disclose IPV. To determine if patients would feel comfortable to be asked about IPV by a genetic counselor, Chen et. al surveyed 50 patients about IPV disclosure Sixty-eight percent of patients felt comfortable having IPV asked about and 78% of patients felt comfortable having IPV addressed by a genetic counselor in a genetics session. In an unpublished follow up study, genetic counselors were asked about their feelings about IPV disclosure. With over 200 genetic counselors taking the survey, the majority of genetic counselors supported including IPV screening questions into their practice. In addition, over 1/3 of those genetic counselors who took the survey had experienced IPV disclosure during a session. Additionally, the majority of these individuals did not feel properly equipped to handle the disclosure. Systematic reviews of UK IPV screening tools found that several short screening tools were valid and reliable for use in healthcare settings (Feder et al., 2009). The HITS (Hurts, Insults, Threatens and Screams) scale had the best predictive power (sensitivity ranged from 86% to 100%, specificity ranged from 86% to 99%), concurrent and construct validity (r ranged from 0.75 to 0.85, p < 0.001) and reliability (Cronbach’s alpha ranged from 0.61 to 0.80), with a suitable cut-off score. Similarly, a systematic review identified 11 trials (including 13,027 participants in total) assessing the effect of universal, routine IPV screening of women in healthcare settings, without subsequent intervention beyond information giving, safety planning or referral that was offered to women immediately following suspicion (O’Doherty et al., 2014). The study found that screening increased the identification of women who had experienced IPV, but identification was still low compared with estimated prevalence rates. There is currently a debate about whether universal or targeted screening would be more effective at helping identify victims of IPV (Valpied & Hegarty, 2015). More targeted identification strategies involve asking victims about IPV if they present with psychosocial or physical symptoms that often occur as a result of IPV, or are in a high-risk category. Psychosocial “risk factors” for asking about IPV include anxiety, depression, eating, or panic disorders, alcohol abuse, suicide ideation or attempts and self-harm. There are various situational and physical signs of abuse as well. Based on observations and questions genetic counselors ask during genetic counseling sessions, it seems they are in an excellent position to recognize these signs in a patient.

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