Journal of Family Violence

, Volume 28, Issue 8, pp 823–831 | Cite as

VHA Primary Care Providers’ Perspectives on Screening Female Veterans for Intimate Partner Violence: A Preliminary Assessment

  • Katherine M. IversonEmail author
  • Stephanie Y. Wells
  • Shannon Wiltsey-Stirman
  • Rachel Vaughn
  • Megan R. Gerber


Female Veterans experience intimate partner violence (IPV) at alarming rates. The Veterans Health Administration (VHA) requires foundational research to guide the development of policy and programs to detect IPV among women Veterans and provide interventions. This pilot study reports findings from in-depth qualitative interviews conducted with 12 VHA primary care providers treating female Veterans in the New England region. Although most providers indicated that they were not currently routinely screening for IPV, they expressed positive attitudes and beliefs about screening in VHA primary care settings. Themes also included the importance of a comprehensive health care response to IPV, such as interdisciplinary coordination of care and team-based approaches to detection and intervention. Barriers to routine screening were identified, as well as recommendations for training programs and clinical tools to inform the successful implementation of a standardized IPV screening and response program in VHA. Although preliminary, these findings represent an initial step in an essential line of research.


Women Veterans Domestic violence Screening Qualitative research Implementation Veterans Health Administration 



This work was supported by the Lynne Stevens Research Award from the Department of Family Medicine at Boston University School of Medicine awarded to Dr. Katherine Iverson. This work was also supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service as part of Dr. Iverson’s Career Development Award (CDA 10–029) at the VA Boston Healthcare System. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The authors are grateful to Dr. April Gerlock for her consultation on the interview guide, as well as the dedicated providers who participated in this study and all those who care for women Veterans.


  1. Batuman, F., Bean-Mayberry, B., Goldzweig, C., Huang, C., Miake-Lye, I. M., Washington, D. L., et al. (2011). Health effects of military service on women Veterans. Washington DC: Department of Veteran Affairs.Google Scholar
  2. Benda, B. B. (2005). Gender differences in predictors of suicidal thoughts and attempts among homeless veterans that abuse substances. Suicide and Life-Threatening Behavior, 35, 106–116.PubMedCrossRefGoogle Scholar
  3. Campbell, J. C. (2002). Health consequences of intimate partner violence. The Lancet, 359, 1331–1336. doi: 10.1016/S0140-6736(02)08336-8.CrossRefGoogle Scholar
  4. Campbell, J. C., Coben, J. H., McLoughlin, E., Dearwater, S., Nah, G., Glass, N., et al. (2001). An evaluation of a system-change training model to improve emergency department response to battered women. Academic Emergency Medicine, 8, 131–138. doi: 10.1111/j.1553-2712.2001.tb01277.x.PubMedCrossRefGoogle Scholar
  5. Campbell, J. C., Garza, M. A., Gielen, A. C., O’Campo, P., Kub, J., Dienemann, J., et al. (2003). Intimate partner violence and abuse among active duty military women. Violence Against Women, 9, 1072–1092. doi: 10.1111/j.1552-2712.2001.tb01277.CrossRefGoogle Scholar
  6. Campbell, R., Greeson, M. R., Bybee, D., & Raja, S. (2008). The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: a mediational model of posttraumatic stress disorder and physical health outcomes. Journal of Consulting and Clinical Psychology, 76, 194–207. doi: 10.1037/0022-006X.76.2.194.PubMedCrossRefGoogle Scholar
  7. Centers for Disease Control and Prevention. (2012). Understanding intimate partner violence: Fact sheet. Retrieved on March 21, 2013, from
  8. Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks: Sage Publications.Google Scholar
  9. Coker, A. L., Smith, P. H., McKeown, R. E., & King, M. J. (2000). Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering. American Journal of Public Health, 90, 553–559. doi: 10.2105/AJPH.90.4.553.PubMedCrossRefGoogle Scholar
  10. Coker, A. L., Davis, K. E., Arias, I., Desai, S., Sanderson, M., Brandt, H. M., et al. (2002). Physical and mental health effects of intimate partner violence for men and women. American Journal of Preventive Medicine, 23, 260–268. doi: 10.1016/S0749-3797(02)00514-7.PubMedCrossRefGoogle Scholar
  11. Davis, R. E., & Harsh, K. E. (2001). Confronting barriers to universal screening for domestic violence. Journal of Professional Nursing, 17, 313–320. doi: 10.1053/jpnu.2001.28181.PubMedCrossRefGoogle Scholar
  12. Department of Veterans Affairs. (2010a). Patient aligned care team: Overview. Retrieved August 29, 2012, from
  13. Department of Veterans Affairs (2010b). VHA Handbook 1330.01, Health care services for women Veterans. Washington, DC: Author. Retrieved on March 1, 2013, from
  14. Dichter, M. E., Cerulli, C., & Bossarte, R. M. (2011). Intimate partner violence victimization among women veterans and associated heart health risks. Womens Health Issues, 21, S190–S194. doi: 10.1016/j.whi.2011.04.008.PubMedCrossRefGoogle Scholar
  15. Ehrensaft, M. K., Cohen, P., Brown, J., Smailes, E., Chen, H., & Johnson, J. G. (2003). Intergenerational transmission of partner violence: a 20-year prospective study. Journal of Consulting and Clinical Psychology, 71, 741–753. doi: 10.1037/0022-006X.71.4.741.PubMedCrossRefGoogle Scholar
  16. Elliott, L., Nerney, M., Jones, T., & Friedmann, P. D. (2002). Barriers to screening for domestic violence. Journal of General Internal Medidicne, 17, 112–116.CrossRefGoogle Scholar
  17. Family Violence Prevention Fund. (2004). National consensus guidelines on identifying and responding to domestic violence victimization in healthcare settings. San Francisco: Author.Google Scholar
  18. Ferris, L. E. (1994). Canadian family physicians’ and general practioners’ perceptions of their effectiveness in identifying and treating wife abuse. Medical Care, 32, 1163–1172.PubMedCrossRefGoogle Scholar
  19. Frayne, S. M., Phibbs, C. S., Friedman, S. A., Berg, E., Ananth, L., Iqbal, S., et al. (2010). Sourcebook: Women Veterans in the Veterans Health Administration. Volume 1. Sociodemographic characteristics and use of VHA care. Washington, DC: Women's Health Evaluation Initiative, Women Veterans Health Strategic Health Care Group, Veterans Health Administration, Department of Veteran Affairs.Google Scholar
  20. Friedman, L. S., Samet, J. H., Roberts, M. S., Hudlin, M., & Hans, P. (1992). Inquiry about victimization experiences: a survey of patient preferences and physician practices. Archives of Internal Medicine, 152, 1186–1190. doi: 10.1001/archinte.1992.00400180056008.PubMedCrossRefGoogle Scholar
  21. Gerber, M. R., Leiter, K. S., Hermann, R. C., & Bor, D. H. (2005). How and why community hospital clinicians document a positive screen for intimate partner violence: a cross-sectional study. BMC Family Practice, 6, 48–56.PubMedCrossRefGoogle Scholar
  22. Glaser, B. G., & Straus, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine Publishing Company.Google Scholar
  23. Guillery, M. E., Benzies, K. M., Mannion, C., & Evans, S. (2012). Postpartum nurses’ perceptions of barriers to screening for intimate partner violence: a cross-sectional survey. BMC Nursing, 11, 2–8. doi: 10.1186/1472-6955-11-2.PubMedCrossRefGoogle Scholar
  24. Hamberger, L. K., Ambuel, B., Marbella, A., & Donze, J. (1998). Physician interaction with battered women: the women’s perspective. Archives of Family Medicine, 7, 575–582.PubMedCrossRefGoogle Scholar
  25. Hamberger, L. K., Guse, C., Boerger, J., Minsky, D., Pape, D., & Folsom, C. (2004). Evaluation of a healthcare provider training program to identify and help partner violence victims. Journal of Family Violence, 19, 1–11.CrossRefGoogle Scholar
  26. Humphreys, J., Cooper, B. A., & Miaskowski, C. (2011). Occurrence, characteristics, and impact of chronic pain in formerly abused women. Violence Against Women, 17(10), 1327–1343. doi: 10.1177/1077801211425216.PubMedCrossRefGoogle Scholar
  27. Iverson, K. M., Gradus, J. L., Resick, P. A., Suvak, M. K., Smith, K. F., & Monson, C. M. (2011a). Cognitive-behavioral therapy for PTSD and depression symptoms reduces risk for future intimate partner violence among interpersonal trauma survivors. Journal of Consulting and Clinical Psychology, 79, 193–202. doi: 10.1037/a0022512.PubMedCrossRefGoogle Scholar
  28. Iverson, K. M., Jimenez, S., Harrington, K. M., & Resick, P. (2011b). The relative contribution of three forms of childhood maltreatment on intimate partner violence reported by female and male victims of rape and or robbery. Violence and Victims, 26, 73–87.PubMedCrossRefGoogle Scholar
  29. Iverson, K. M., King, M. W., Resick, P. A., Gerber, M. R., Kimerling, R., & Vogt, D. (2013a). Clinical utility of an intimate partner violence screening tool for female VHA patients. Advance online publication. Journal of General Internal Medicine. doi:. doi: 10.1007/s11606-013-2534-x.Google Scholar
  30. Iverson, K. M., Litwack, S. D., Pineles, S. L., Suvak, M. S., Vaughn, R., & Resick, P. A. (2013b). Predictors of intimate partner violence revictimization: the relative impact of distinct PTSD symptoms, dissociation and coping strategies. Journal of Traumatic Stress, 26, 102–110.PubMedCrossRefGoogle Scholar
  31. Kelly, U. A., Skelton, K., Patel, M., & Bradley, B. (2011). More than military sexual trauma: interpersonal violence, PTSD, and mental health in women veterans. Research in Nursing and Health, 34, 457–467. doi: 10.1002/nur.20453.PubMedCrossRefGoogle Scholar
  32. Kimerling, R., Street, A. E., Pavao, J., Smith, M. W., Cronkite, R. C., Holmes, T. H., et al. (2010). Military-related sexual trauma among Veterans health administration patients returning from Afghanistan and Iraq. American Journal of Public Health, 100, 1409–1412. doi: 10.2105/AJPH.2009.171793.PubMedCrossRefGoogle Scholar
  33. Maguen, S., Ren, L., Bosch, J. O., Marmar, C. R., & Seal, K. H. (2010). Gender differences in mental health diagnoses among Iraq and Afghanistan Veterans enrolled in Veterans affairs health care. American Journal of Public Health, 100, 2450–2456. doi: 10.2105/ajph.2009.166165.PubMedCrossRefGoogle Scholar
  34. McCauley, J., Kern, D. E., Kolodner, K., Derogatis, L. R., & Bass, E. B. (1998). Relation of low-severity violence to women’s health. Journal of General Internal Medicine, 13, 687–691. doi: 10.1046/j.1525-1497.1998.00205.x.PubMedCrossRefGoogle Scholar
  35. Merrill, L. L., Stander, V. A., Thomsen, C. J., Crouch, J. L., & Milner, J. S. (2006). Premilitary intimate partner violence and attrition from the U. S. Navy. Military Medicine, 171, 1206–1210.PubMedGoogle Scholar
  36. Minsky-Kelly, D., Hamberger, L. K., Pape, D. A., & Wolff, M. (2005). We’ve had training, now what? Qualitative analysis of barriers to domestic violence screening and referral in a health care setting. Journal of Interpersonal Violence, 20, 1288–1309. doi: 10.1177/0886260505278861.PubMedCrossRefGoogle Scholar
  37. Murdoch, M., & Nichol, K. L. (1995). Women veteran’s experiences with domestsic violence and with sexual harrassment while in the military. Archives of Family Medicine, 4, 411–418.PubMedCrossRefGoogle Scholar
  38. Nelson, H. D., Bougatsos, C., & Blazina, I. (2012). Screening women for intimate partner violence: a systematic review to update the U.S. Preventative Services Task Force recommendation. Annals of Internal Medicine, 156, 796–808.PubMedCrossRefGoogle Scholar
  39. O’Campo, P., Kirst, M., Tsamis, C., Chambers, C., & Ahmad, F. (2011). Implementing successful intimate partner violence screening programs in health care settings: evidence generated from a realist-informed systematic review. Social Science & Medicine, 72, 855–866. doi: 10.1016/j.socscimed.2010.12.019.CrossRefGoogle Scholar
  40. Petersen, R., Moracco, K. E., Goldstein, K. M., & Clark, K. A. (2004). Moving beyond discolsure: women’s perspective on barriers and motivators to seeking assistance for intimate partner violence. Women & Health, 40, 63–76.CrossRefGoogle Scholar
  41. Rabin, R. F., Jennings, J. M., Campbell, J. C., & Bair-Merritt, M. H. (2009). Intimate partner violence screening tools: a systematic review. American Journal of Preventive Medicine, 36, 439–445. doi: 10.1016/j.amepre.2009.01.024.PubMedCrossRefGoogle Scholar
  42. Sadler, A. G., Booth, B. M., Mengeling, M. A., & Doebbeling, B. N. (2004). Life span and repeated violence against women during military service: effects on health status and outpatient utilization. Journal of Womens Health, 137, 799–811. doi: 10.1089/jwh.2004.13.799.CrossRefGoogle Scholar
  43. Salber, P. R., & Taliaferro, E. (2006). The physician’s guide to intimate partner violence and abuse: A reference for all health care professionals (2nd ed.). Volcano: Volcano Press.Google Scholar
  44. Sprague, S., Madden, K., Simunovic, N., Godin, K., Pham, N. K., Bhandari, M., et al. (2012). Barriers to screening for intimate partner violence. Women’s Health, 52, 587–605. doi: 10.1080/03630242.2012.690840.CrossRefGoogle Scholar
  45. Street, A. E., Stafford, J., Mahan, C. M., & Hendricks, A. (2008). Sexual harassment and assault experienced by reservists during military service: prevalence and health correlates. Journal of Rehabilitation Research and Development, 45(3), 409–419. doi: 10.1682/JRRD.2007.06.0088.PubMedCrossRefGoogle Scholar
  46. Street, A. E., Vogt, D., & Dutra, L. (2009). A new generation of women veterans: stressors faced by women deployed to Iraq and Afghanistan. Clinical Psychology Review, 29, 685–694. doi: 10.1016/j.cpr.2009.08.007.PubMedCrossRefGoogle Scholar
  47. Sweeney, A. C., Weitlauf, J. C., Manning, E. A., Sze, J. A., Waldrop, A. E., & Hasser, C. (2013). Intimate partner violence: perspectives on universal screening for women in VHA care. Women’s Health Issues, 23, 73–76.CrossRefGoogle Scholar
  48. Thompson, R. S., Rivara, F. P., Thompson, D. C., Barlow, W. E., Sugg, N. K., Maiuro, R. D., et al. (2000). Identification and management of domestic violence: a randomized trial. American Journal of Preventive Medicine, 19, 253–263.PubMedCrossRefGoogle Scholar
  49. U.S. Preventive Services Task Force. (2013). Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. Preventive Services Task Force recommendation statement. AHRQ Publication No. 12-05167-EF-2. Retrieved August 28, 2013, from
  50. Waalen, J., Goodwin, M. M., Spitz, A. M., Petersen, R., & Saltzman, L. E. (2000). Screening for intimate partner violence by health care providers: barriers and interventions. American Journal of Preventative Medicine, 19, 230–237.CrossRefGoogle Scholar
  51. Weitlauf, J. C., Frayne, S. M., Finney, J. W., Moos, R. H., Jones, S., Hu, K., et al. (2010). Sexual violence, posttraumatic stress disorder, and the pelvic examination: how do beliefs about the safety, necessity, and utility of the examination influence patient experiences? Journal of Women’s Health, 19(7), 1271–1280. doi: 10.1089/jwh.2009.1673.PubMedCrossRefGoogle Scholar
  52. Yano, E. M., Bastian, L. A., Frayne, S. M., Howell, A. L., Lipson, L. R., McGlynn, G., et al. (2006). Toward a VA women’s health research agenda: Setting evidence-based priorities to improve the health and health care of women Veterans. Journal of General Internal Medicine, 21, 93–101.CrossRefGoogle Scholar
  53. Yano, E. M., Hayes, P., Wright, S., Schnurr, P. P., Lipson, L., Bean-Mayberry, B., et al. (2010). Integration of women veterans into VA quality improvement research efforts: what researchers need to know. Journal of General Internal Medicine, 25(Suppl 1), S56–S61. doi: 10.1007/s11606-009-1116-4.CrossRefGoogle Scholar
  54. Zink, T., Lloyd, K., Isham, G., Mathews, D. J., & Crowson, T. (2007). Applying the planned care model to intimate partner violence. Managed Care, 16, 54–61.PubMedGoogle Scholar
  55. Zinzow, H. M., Grubaugh, A. L., Monnier, J., Suffoletta-Maierle, S., & Frueh, B. C. (2007). Trauma among female Veterans: a critical review. Trauma Violence & Abuse, 8, 384–400. doi: 10.1177/1524838007307295.CrossRefGoogle Scholar

Copyright information

© © Springer Science+Business Media New York (outside the USA)  2013

Authors and Affiliations

  • Katherine M. Iverson
    • 1
    • 2
    Email author
  • Stephanie Y. Wells
    • 2
  • Shannon Wiltsey-Stirman
    • 1
  • Rachel Vaughn
    • 2
  • Megan R. Gerber
    • 3
  1. 1.Women’s Health Sciences Division of the National Center for PTSDVA Boston Healthcare System and Boston University School of MedicineBostonUSA
  2. 2.Women’s Health Sciences Division of the National Center for PTSD, VA Boston Healthcare SystemBostonUSA
  3. 3.VA Boston Healthcare System and Boston University School of MedicineBostonUSA

Personalised recommendations