Linking Healthcare and Violence Prevention Efforts

Intimate partner violence (IPV) continues to be a serious public health concern. In efforts to reduce subsequent health care risks and prevent further escalations of violence, healthcare providers can play a crucial role in identifying and helping at-risk patients by offering appropriate support via screening and assessment services. Dr. David Levine, Medical Director of Adult Emergency Services at Cook County (Stroger) Hospital, attests to an increase in referrals and client satisfaction feedback since his staff began incorporating domestic violence prompts throughout their electronic screening and assessment systems. According to a recent report in the New York City Department of Health and Mental Hygiene journal, screening has also been shown to increase disclosure and facilitate referral. Surveys indicate that most patients want their providers to inquire about IPV. Both sources agree that routine inquiry, on-going dialogue, and establishing patient trust are vital to patient disclosure.

In a workshop at the ICVP 13th annual Vision.Action.Change conference entitled, Practicing the Tools: Specific Screening Instruments, Dr. Levine and co-facilitator Sue Avila, RN, MPH referenced an initiative which encouraged hospitals to not just screen all patients for DV issues, but to also partner with external community organizations that would lend support to clients entering the emergency department with domestic violence related issues. Prior to the initiative, assessments found DV screenings to be sporadic, provider dependant, having poor buy-in from the system, and reported by staff throughout the emergency department to be too time consuming .

After receiving trainings on appropriate screening and assessment systems, changes included mandatory screening of all patients in triage, chart flagging for DV screenings, and screenings were completed by both the physicians and nurses in treatment area. Results from research conducted also showed that trainings regarding screening and assessment practices related to handling domestic violence cases are best done in partnerships with those in like professions (i.e. doctor to doctor) and should be brief and to the point. Other training recommendations were: use case scenarios, host repeat trainings, and share information with providers regarding success of training efforts.

Dr. Levine reports that hospitals that have participated in the initiatives have achieved sustained results with: screening processes serving a basic function rather than a mandate, an increase in posted materials, and handouts for all patients to view with additional resource information for support.

Implementation Needs:
• Should have a “champion” physician and/or nurse who is willing to advocate for domestic violence support in healthcare setting
• Have system in place for clients to give feedback on their feelings about screening experience
• Coordinate short trainings for impacted service professionals (i.e. nursing staff, triage staff, physicians, etc.)
• Relationships with service organizations throughout the community

Screenings should not occur if:
• There is no way to conduct the assessments in private
• There are concerns that assessing the patient would place the patient or provider at risk
• There is a language barrier and the provider is unable to secure an appropriate interpreter

If screening and assessment do not occur and you suspect that the patient is experiencing IPV, note in the patient’s chart that inquiry was not completed and schedule follow-up appointment or referral to another provider.