Domestic Violence Screening in the PPACA

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Screening for Domestic Violence is a provision in the PPACA

A doctor’s examination room is often perceived as simply a sterile and routine place to most of us.  However, to a woman who is a victim of domestic abuse, it can be a sanctuary, a refuge and escape from the confining trap of shame that she has often endured for decades.  Emotional and physical trauma eats away at the soul of its victims and they often do not know where to turn.

Since the early 1990’s the Pennsylvania Coalition Against Domestic Violence (PCADV) has been a trailblazer in the field of screening for domestic violence in the health care setting through its Medical Advocacy Project.  The basic components of this project include training medical staff on how to accurately and effectively screen, counsel and refer victims to domestic violence programs.  This project has found that when a woman is routinely screened by a trained professional within the confidential doctor/patient privilege, she is more likely to disclose and therefore receive help.  

This is a vital service for an often overlooked public health issue.  Traumatic Brain Injury (TBI) from physical abuse is a common injury among domestic abuse victims leaving them with lifelong physical, cognitive and emotional challenges.  Research has shown that 90% of all injuries related to domestic abuse involve the head, neck and face (Monohan and O'Leary 1999). 

As of August 1, 2012, the Patient Protection and Affordable Care Act will require that all insurance plans cover screening and counseling for domestic abuse, a provision found under preventive services for women’s health.  According to Nicole Lindemyer, Policy and Special Project Manager at PCADV, when a victim who is at a high risk of being killed receives intervention services, she has a 60-70% reduction in risk of being re-assaulted and killed.  Therefore, this early intervention is critical to curtailing the incidence of TBI and often preventing homicide.

In 2014, more people will have access to healthcare because of the PPACA, and hence more victims will be screened for domestic violence and connected to these life-saving services.  Ms. Lindemyer is expecting a greater request for trainings for practitioners because they will now be reimbursed for this service.  She finds the provision in the PPACA as a validation of what they have known for decades: that in order to curtail domestic violence, you need to meet women “where they are at”.  Ms. Lindemyer proclaims that this provision in the PPACA is a “victory for women” in that “It’s a paradigm shift from seeing domestic violence a simply a criminal justice issue and now recognizing it for what it is: a public health issue.” 

Nicole Lindemyer is the Public Policy and Special Projects Manager for the Pennsylvania Coalition Against Domestic Violence, Pennsylvania’s statewide network of domestic violence programs.  In this role, she leads the development and implementation of the Coalition’s legislative and public policy agenda—analyzing and drafting legislation, lobbying and testifying before the legislature, and encouraging civic engagement in the political process.

Prior to her current role, Nicole was a civil rights litigator in Minneapolis and Chicago in the areas of housing and employment discrimination and in poverty law, specializing in violence against women issues within these contexts.  She was an Equal Justice Fellow from 2001 to 2003, and has written and lectured extensively on violence against women in housing.  A survivor herself, Nicole is a zealous advocate for women’s rights, particularly the right to be free of physical and sexual violence.