Gaps in telehealth: Ensuring victims of domestic violence are not left behind in the COVID-19 pandemic

By Renée Reimer


The immediate impacts of the COVID-19 pandemic have been felt worldwide. From travel bans to social distancing mandates to business and school closures, no one is immune to the consequences of this novel virus. As we move from the initial acute phase to adjusting to this (hopefully) transient new normal, additional ripple effects of the pandemic are being elucidated. Intimate partner violence (IPV) is among those concerns. A recent CMAJ article by Bradley and colleagues addressed this issue and discussed how to avoid letting victims of IPV slip through the cracks within the telehealth system [1].

The article highlights an increase in reported IPV across multiple countries, including China, Italy, Spain, the United Kingdom, France, and here in Canada [2-4]. A combination of psychosocial stress, uncertainty about the future, financial hardship, and inequitable attitudes towards gender roles is believed to be catalyzing this disturbing trend. Reports of domestic abuse killings have also increased [5], provoking a worldwide call to action. The problem? Domestic abuse frequently goes unreported in healthcare settings, even at the best of times [6-8]. In a population facing stigma, fear, and barriers to getting help, a healthcare system already struggling to serve them is further hindered by the current COVID-19 pandemic.

I spoke with Dr. Colleen Varcoe, a UBC-based researcher who studies violence and inequity particularly in the context of women’s and Indigenous people’s health. She emphasized that women can present with trauma and abuse in a multitude of ways, and that most do not exhibit physical injuries during examination. Based on her research, she recommends that healthcare professionals adopt a trauma and violence informed approach (such as described in the EQUIP Health Care resources) to recognize and support individuals facing IPV [9,10]. She expressed that all healthcare providers should “practice in a trauma and violence informed way with everyone, regardless of presentation”. The alarming increase in IPV rates calls for even greater vigilance in identifying this problem amidst the backdrop of the current COVID-19 pandemic.

Even in face-to-face settings, IPV often goes undetected by healthcare practitioners due to barriers such as time constraints, lack of training, inadequate follow-up protocols and lack of resources to support victims [11]. These barriers are further compounded in the current pandemic by a reduction in access to health care services and the use of telehealth as a primary means of communication. Although telehealth serves as an excellent resource for those seeking medical care, the lack of face-to-face contact, and potentially even privacy, adds another layer of difficulty in screening for IPV. To provide avenues through which women can communicate a need for help, some European countries have created a “safe word” for women to use in healthcare settings – such as pharmacies – in order to signal for help [12]. Employing this strategy in the context of telehealth, the Canadian Women’s Foundation has created the Signal for Help campaign, whereby patients can signal to their healthcare provider during a telehealth conversation while remaining discreet [13].

Fortunately, the Canadian government is also taking steps to address increasing rates of IPV in Canada, announcing $40 million for women’s shelters and sexual assault centers and $10 million for Indigenous women and children [14]. With this influx in funding, shelters will remain open and healthcare facilities will need to adapt to the changing circumstances and needs of these populations.

Finally, it is important to acknowledge that, with the eventual transition back to normalcy, vigilance surrounding IPV must be sustained. Bradley discussed how the inevitable economic downturn will perpetuate domestic abuse, and victims will feel the effects of COVID-19 long after our intensive care units have settled. As patients return to in-person visits, healthcare practitioners are encouraged to screen everyone for IPV, regardless of their presentation or social circumstances.

While some are enjoying the comforts of home, many women in our communities and around the world are suffering domestic abuse in complete isolation. Actions taken to stop the spread of the virus are paradoxically putting vulnerable women at increased risk of violence. Although telehealth remains an optimal solution given the current pandemic, measures must be taken to ensure that women are able to signal for help when needed, and that practitioners are prepared to identify and act on these signals.

Resources for healthcare practitioners:

Violence, Gender & Health (https://violencegenderandhealth.ca/)

EQUIP Health Care (https://equiphealthcare.ca/)

McMaster’s VEGA (Violence, Evidence, Guidance, and Action) Project – Family Violence Education Resources (https://vegaproject.mcmaster.ca/)

EDUCATE Program (http://www.ipveducate.com/the-educate-training-program)

References

1. Bradley NL, DiPasquale AM, Dillabough K, Schneider PS. Health care practitioners’ responsibility to address intimate partner violence related to the COVID-19 pandemic. Can Med Assoc J. May 2020:cmaj.200634. doi:10.1503/cmaj.200634

2. How Domestic Abuse Has Risen Worldwide Since Coronavirus – The New York Times. https://www.nytimes.com/2020/04/06/world/coronavirus-domestic-violence.html. Accessed May 4, 2020.

3. Calls to Vancouver domestic-violence crisis line spike 300% amid COVID-19 pandemic | Globalnews.ca. https://globalnews.ca/news/6789403/domestic-violence-coronavirus/. Accessed May 4, 2020.

4. Domestic violence calls surge during coronavirus pandemic – CityNews Toronto. https://toronto.citynews.ca/2020/04/08/domestic-violence-calls-surge-during-coronavirus-pandemic/. Accessed May 4, 2020.

5. Domestic abuse killings “more than double” amid Covid-19 lockdown | Society | The Guardian. https://www.theguardian.com/society/2020/apr/15/domestic-abuse-killings-more-than-double-amid-covid-19-lockdown. Accessed May 4, 2020.

6. D’Avolio DA. System issues: challenges to intimate partner violence screening and intervention. Clin Nurs Res. 2011;20(1):64-80. doi:10.1177/1054773810387923

7. Waalen J, Goodwin MM, Spitz AM, Petersen R, Saltzman LE. Screening for intimate partner violence by health care providers: Barriers and interventions. Am J Prev Med. 2000;19(4):230-237. doi:10.1016/S0749-3797(00)00229-4

8. Davis JW. Domestic violence: The “rule of thumb”: 2008 western trauma association presidential address. In: Journal of Trauma – Injury, Infection and Critical Care. Vol 65. ; 2008:969-974. doi:10.1097/TA.0b013e31817f9e6f

9. Ponic P, Varcoe C, Smutylo T. Trauma- (and Violence-) Informed Approaches to Supporting Victims of Violence: Policy and Practice Considerations.; 2016. https://www.justice.gc.ca/eng/rp-pr/cj-jp/victim/rd9-rr9/p2.html. Accessed May 6, 2020.

10. Varcoe C, Wathen N. Top Things Any Provider Can Do To Support People Experiencing Violence. https://equiphealthcare.ca/equip/wp-content/uploads/2018/01/Top-things-support-people-Jan-15-2018.pdf. Published 2017. Accessed May 4, 2020.

11. Sprague S, Madden K, Simunovic N, et al. Barriers to Screening for Intimate Partner Violence. 2012. doi:10.1080/03630242.2012.690840

12. Coronavirus: When home gets violent under lockdown in Europe – BBC News. https://www.bbc.com/news/world-europe-52216966. Accessed May 4, 2020.

13. Signal For Help | Use Sign to Ask for Help | Canadian Women’s Foundation. https://canadianwomen.org/signal-for-help/. Accessed May 4, 2020.

14. Canada announces support to those experiencing homelessness and women fleeing gender-based violence during the coronavirus disease (COVID-19) pandemic – Canada.ca. https://www.canada.ca/en/employment-social-development/news/2020/04/canada-announces-support-to-those-experiencing-homelessness-and-women-fleeing-gender-based-violence-during-the-coronavirus-disease-covid-19-pandemic.html. Accessed May 6, 2020.

Leave a Reply