The Case for Mandatory Training on Screening for Domestic Violence in the Wake of the Affordable Care Act

Abstract

The legal and political controversy over the Patient Protection and Affordable Care Act (ACA) has obscured the opportunity for the federal government and states to act collaboratively to address public health problems. In particular, state policymakers have new opportunities to combat a leading social affliction by increasing protections for the victims of domestic violence. The pervasive and devastating effects on individuals, families, and communities from domestic violence have been recognized as a public health crisis. As implementation of the ACA changes the healthcare landscape, a provision of the Act offers powerful impetus for states to dramatically improve their ability to reduce the incidence of domestic violence and mitigate its impact. The Health Resources and Services Administration (HRSA) guidelines incorporated into the ACA now require insurance coverage to include routine medical domestic violence screening and counseling as a preventive service for women and adolescent girls at no additional cost. This comprehensive change was buttressed by recommendations for medical screening for domestic violence made by the United States Preventive Services Task Force. These sweeping transformations -- along with new funding under the reauthorization of the Violence against Women Act to improve the medical community’s response to victims -- should spur states to fill a serious gap in services by mandating that physicians have training in the complex dynamics of domestic violence. In this way, screening and referrals to community services can become widespread and effective. Without such mandated training, the promise of this potentially potent tool in the effort to reduce this crime will not be fulfilled.