Assessment for Lifetime Exposure to Violence as a Pathway to Prevention

Exposure to violence over the lifespan is very common and is associated with long-term health problems, increased risk of revictimization, and intergenerational violence. Assessment for lifetime exposure to violence can identify unknown, unresolved histories of victimization and lead to detection, early intervention, and prevention of predictable health consequences and future violence. This paper examines how assessment for lifetime exposure to violence can create a pathway to prevention and address the long-term consequences of exposure to violence over the lifespan.

For the purpose of this discussion, lifetime exposure is limited to childhood abuse, childhood exposure to domestic violence, domestic violence, and lifetime physical and sexual abuse. Retrospective studies that ask adults to recall past traumatic events have revealed that these forms of victimization are extremely prevalent. A growing body of research has documented similar patterns of chronic diseases, risk behaviors, and other health problems that are highly correlated with these different forms of victimization (Felitti et al, 1998; Goodman et al, 1993; Springer et al, 2003). An often ignored outcome of lifetime exposure to violence is the elevated risk of revictimization, perpetrating violence, and transmitting violence to the next generation (Arias, 2004; Avery et al, 2002; Noll, 2005; Whitefield et al, 2003).

The long-term adverse adult outcomes associated with past victimization make a strong case for addressing lifetime exposure to violence in a wide range of service settings. Assessment for lifetime exposure to violence in the health care setting can be a starting point to develop a community-wide response. Questions for lifetime exposure to violence can be integrated into routine health histories and self-administered patient assessment forms. Research suggests that survivors want to talk about their past experiences in a supportive, safe environment (Rhodes, 2005; Whiteman, Chamberlain & Greenwood, 2004).

Making the connection between past victimization and chronic diseases provides a unique opportunity to identify hidden risk factors and provide more effective case management for patients' physical and psychosocial needs. Identifying past victimization also creates opportunities for early intervention and prevention of long-term adverse outcomes. This paper introduces a conceptual model called the prevention continuum that builds upon traditional prevention theory to identify ongoing opportunities for multi-level prevention strategies to address the effects of violence over the lifespan and prevent future violence. This approach creates the opportunity to build 'prevention-readiness' into prevention activities by addressing how past victimization can impact the effectiveness of prevention strategies. The prevention continuum is survivor-inclusive, meaning that survivors are included in all levels of prevention (primary, secondary and tertiary). Examples are provided to demonstrate how providers who assess for lifetime exposure to violence have an important role in primary prevention.