October is Domestic Violence Awareness Month, yet despite increased education and awareness around the issue, domestic violence persists in our culture. Twenty-five percent of women and eight percent of men have experienced abuse from an intimate partner and a shocking three women a day are murdered by husbands or boyfriends in the United States.

People who are older or disabled are also at risk for abuse. Ten percent of elderly adults have suffered abuse or neglect and more than 90 percent of individuals with developmental disabilities will be physically or sexually abused during their lifetime.

The symptoms of domestic violence extend beyond visible, physical injuries. Victims suffer from psychological and emotional problems such as anxiety, depression and post-traumatic stress disorder and often display long-term health problems as a result of the violence, such as chronic pain, migraines, STDs and heart trouble.

These statistics and the troubling effects of domestic violence demonstrate that we have to do even more to improve our methods for inquiring about, documenting, and addressing domestic violence. As we see higher rates of abuse, the need for a more coordinated effort is clear. Increasingly, evidence points to the importance of addressing domestic violence in the healthcare setting. Doctors and nurses should be the first line of defense against domestic violence. Providers need to be aware of the signs of domestic abuse and have the proper training and resources to address and refer to appropriate services in-house or in the community.

In 2006, Neighborhood Health Plan founded the NHP Domestic Violence Initiative after observing a growing need for a healthcare-based, system-wide response to domestic violence. The multi-year, multi-level domestic violence program seeks to strengthen internal awareness and resources, create community collaborations, gather data on community needs, and implement best practices.

In collaboration with local community health centers (CHCs), NHP has been improving resources and practices across Massachusetts’ provider network. In 2010, NHP undertook a pilot program with three CHCs to improve domestic violence resources at these front-line care venues. The program provided training and resources to the CHCs to ensure their preparedness in identifying and addressing domestic violence. The program has been successful in implementing screening policies at the CHCs and providing multiple trainings to nurses and other staff. Those who received the trainings reported feeling more comfortable navigating domestic violence issues with patients and referring for services as needed.

Using these initial results from the pilot program, NHP will identify and share best practices and create standards for CHCs across the state, guaranteeing a higher level of care for victims of domestic violence.

CHCs provide an important safe haven for domestic violence victims because they go to be treated for another health issue. All too often, victims don’t feel safe reaching out to someone for help, or don’t even self-identify as victims, so it is critical that CHC staff are well-trained to identify domestic violence and respond appropriately when clients disclose or ask for help.

As we’ve seen in our pilot programs at CHCs around the state, integrating domestic violence screenings and prevention into the healthcare system has had a tremendous positive impact on the wellness of those affected. As we encourage other healthcare organizations to follow suit, we’ll be able to identify the abuse and work with more victims to work toward safety and interrupting the cycle of violence. We still have a long way to go, but we are making great strides across Massachusetts by recognizing the importance of addressing and preventing domestic violence in the healthcare setting.

Paul Mendis, MD is the Chief Medical Officer for Neighborhood Health Plan. A graduate of Princeton University and Harvard Medical School, Dr. Mendis is board-certified in internal medicine.