Individualized performance feedback to increase prenatal domestic violence screening

Screening and receiving information for intimate partner violence in healthcare settings: a cross-sectional study of Arab and Jewish women of childbearing age in Israel

OBJECTIVES

We studied the proportion of women who have ever been screened (ES) for intimate partner violence (IPV) in a healthcare setting, received information (RI) about relevant services, or both, and explored disparities in screening and information provision by ethnicity and other characteristics.

DESIGN

In 2014-2015, we undertook a cross-sectional study, conducting interviews using a structured questionnaire among a stratified sample of 1401 Arab and Jewish women in Israel.

SETTING

A sample of 63 maternal and child health clinics (MCH) clinics in four geographical districts.

PARTICIPANTS

Women aged 16-48 years, pregnant or up to 6 months after childbirth.

PRIMARY AND SECONDARY OUTCOME MEASURES

We used multivariable generalised estimating equation analysis to determine characteristics of women who were ES (Has anyone at the healthcare services (HCS) ever asked you whether you have experienced IPV?); RI (Have you ever received information about what to do if you experience IPV?); and both (ES&RI).

RESULTS

Less than half of participants (48.8%) reported ES; 50.5% RI; and 30% were both ES&RI. Having experienced any IPV was not associated with ES or ES&RI, but was associated with RI in an unexpected direction. Women at higher risk for IPV (Arab minority women, lower education, unmarried) were less likely to report being ES, RI or both. The OR and 95% CI for not ER&RI were: 1.58 (1.00 to 2.49) among Arab compared with Jewish women; 1.95 (1.42 to 2.66) among low education versus academic education women; 1.34 (1.03 to 1.73) among not working versus working. ES, RI and both differ across districts.

CONCLUSIONS

While Israel mandates screening and providing information regarding IPV for women visiting the HCS, we found inequalities, suggesting inconsistencies in policy implementation and missed opportunities to detect IPV. To increase IPV screening and information provision, the ministry of health should circulate clarification and provide support to healthcare providers to conduct these activities.

A Scoping Review of Intimate Partner Violence Screening Programs for Health Care Professionals

INTRODUCTION

Between 38 and 59 percent of women presenting to health care professionals have experienced intimate partner violence. Consequently, multiple intimate partner violence identification or screening programs within health care settings have been developed; however, substantial variations in program content and interpretation of program effectiveness has resulted in conflicting practice guidelines. The purpose of our scoping review is to broadly identify and synthesize the available literature evaluating intimate partner violence identification programs within health care settings to identify key areas for potential evidence-based recommendations and to focus research priorities in the field.

MATERIALS AND METHODS

We conducted a search of MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and psycINFO. We used broad eligibility criteria to identify studies that evaluated intimate partner violence identification programs in health care settings. We completed all screening and data extraction independently and in duplicate. We used descriptive statistics to summarize all data.

RESULTS

We identified 59 eligible studies evaluating intimate partner violence identification programs within health care settings. The most commonly reported outcome themes were IPV disclosure (69%, n = 35), number of patients screened (39%, n = 20), HCP opinions towards screening (37%, n = 19), and patient opinions towards screening (29%, n = 15). The majority of studies (36 studies (70.6%)) reported positive program evaluation results.

DISCUSSION

The majority of studies reported positive program evaluation results. This may suggest that many different intimate partner violence identification programs are beneficial for identifying victims of abuse, however, it remains unknown as to whether identification programs prevent future episodes of abuse. Additionally, the substantial heterogeneity of the intervention characteristics, study methodology, and outcome measures assessed limits the ability to make clear recommendations as to the optimal method(s) of screening.

Universal screening for intimate partner violence: a systematic review

Intimate partner violence (IPV) is known to be prevalent among therapy-seeking populations. Yet, despite a growing understanding of the dynamics of IPV and of the acceptability of screening, universal screening practices have not been systematically adopted in family therapy settings. A rapidly growing body of research data-almost entirely conducted in medical settings-has investigated attitudes and practices regarding universal screening for IPV. This article is a systematic review of the IPV universal screening research literature. The review summarizes literature related to IPV screening rates and practices, factors associated with provider screening practice, the role of training and institutional support on screening practice, impact of screening on disclosure rates, client beliefs and preferences for screening, and key safety considerations and screening competencies. Implications for family therapy and recommendations for further inquiry and screening model development are provided.

Feeling shame: Insights on intimate partner violence

Intimate partner violence (IPV) is a serious health issue; however, many healthcare providers do not routinely ask about IPV or administer screening. Due to the high incidence of this problem, providers must be aware of risk factors, screening methods, and appropriate interventions, and screen all female patients for abuse.

Results of a multifaceted Intimate Partner Violence training program for pediatric residents

OBJECTIVE

To evaluate the efficacy of a multifaceted Intimate Partner Violence (IPV) intervention on knowledge, attitudes, and screening practices of pediatric residents.

METHODS

The intervention included: an on-site IPV counselor, IPV training for attending physicians, residents and social workers, and screening prompts. Evaluation included baseline and post-training surveys of residents, assessing their knowledge, attitudes, and comfort with IPV screening, patient chart reviews at baseline, 3 months, and 8 months for documentation of IPV screening, and review of the IPV counselor's client charts.

RESULTS

Baseline chart review showed screening rates of less than 1%. Screening rates were 36.2% at 3 months and 33.1% at 8 months. After training, residents were more likely to know: IPV screening questions (47.1% vs. 100%); referral sources (34.3% vs. 82.9%); and the relationship between child abuse and IPV (52.9% vs. 97.1%). At baseline, barriers to IPV screening included time (50%), lack of knowledge of how to screen (26.5%) and where to refer (23.5%). Post-training, barriers were time (44%), presence of children (25.9%) or other adults (18.5%) in the room, and inappropriate location (18.5%). Post-training, none of the residents listed "lack of knowledge" or "lack of referral sources" as barriers to IPV screening. After 12 months, 107 victims of IPV were identified; most referred from inpatient units and subspecialty clinics.

CONCLUSION

A multifaceted IPV intervention increased identification of IPV victims and markedly improved attitudes, comfort, and IPV screening practices of pediatric residents. IPV screening rates were sustainable with minimal ongoing training.

PRACTICE IMPLICATIONS

Consideration should be given to the training and practice supports necessary to encourage IPV screening in the pediatric setting. Educational efforts that familiarize pediatricians with the content surrounding the risk and potential impact of IPV to children and families along with practice supports that make incorporating screening for IPV as easy as possible have the potential to increase the identification of this problem and promote referrals to IPV agencies for follow-up and intervention where needed.