Intimate partner violence integration strategy supports women who 'suffer in silence'

Key takeaways:

• An implementation facilitation method improved uptake for intimate partner violence screening in primary care clinics.
• A researcher told Healio that screening “in a trauma-informed way” better supports victims.

An implementation facilitation strategy improved intimate partner violence screening rates in primary care clinics and increased the use of post-screening psychosocial services, providing critical support to vulnerable patients, data show.

At least one in three women in the United States face intimate partner violence (IPV) — which can include stalking, psychological aggression and physical or sexual violence — in their lifetime, Katherine M. Iverson, PhD, a clinical research psychologist in the National Center for PTSD’s women’s health sciences division at the VA Boston Health Care System and an associate professor of psychiatry at the Boston University School of Medicine, and colleagues wrote.

IPV has been significantly connected to worse social, psychological and physical health, and medical organizations in the United States, like the American College of Preventive Medicine, support screening women of childbearing age for IPV.

“Primary care appointments can provide an ideal time to safely and sensitively ask women about their experiences with IPV and provide information and support that can help,” Iverson told Healio. “Although screening and brief counseling for IPV has been recommended in U.S. primary care settings for over a decade, many clinics have struggled to put these practices into place in a meaningful way — ie, such that they are screening all of their women patients at least annually and taking the time to be empathetic and provide supportive education and referral options.”

Iverson said that she knows “many primary care providers want to help in this way,” but that they face barriers like not feeling comfortable discussing IPV, worrying about “opening Pandora’s box” and being unsure about when and where to refer.

So, the researchers conducted a randomized program evaluation trial to assess the impact that implementation facilitation might have on IPV screening in nine mixed-gender and shared space primary care clinics.

Iverson said that implementation strategies are methods used to improve the uptake of clinical innovations into routine practice. The clinical innovation in this study was IPV screening and response practices, which are referred to as IPV screening programs.

The strategy to promote uptake, she said, was implementation facilitation: “a dynamic process of interactive problem-solving and support from an ‘external facilitator’ working with an identified ‘internal facilitator’ to help clinical personnel to put IPV screening programs into place.”

“External facilitators are located outside of the medical center and provide high-level implementation expertise and support. Internal facilitators are located within the medical center and provide boots-on-the-ground knowledge to assist with implementation within primary care,” Iverson said. “The external facilitators were in regular contact with the internal facilitators for about 6 months, which included regular one-on-one meetings and emails, and at times, group meetings with other members of the primary care team.”

Iverson and colleagues found that implementation facilitation could be a “promising strategy” for improving the scope of IPV screening programs in primary care, subsequently increasing IPV detection and support for those in need.

Women who were seen during the implementation period, they wrote, were almost three times more likely to be screened for IPV than those who were seen during the pre-implementation facilitation period (OR = 2.7; 95% CI, 2.46-2.97). Additionally, those who were screened during the implementation facilitation period were more likely to use post-screening psychosocial services than women who were screened during pre-implementation facilitation (OR = 1.29; 95% CI, 1.06-1.57)

Iverson said the findings are important because “they point to a well-developed strategy, implementation facilitation, that can be applied to break down these barriers to IPV screening implementation and ensure women receive the care that is recommended by the U.S. Preventive Services Task Force and many other medical agencies.”

“The more women we screen and respond well for IPV — by this I mean doing it in a trauma-informed way (ie, make good eye contact, do not rush, ask follow-up questions, provide validating comments and information about IPV, do not push women to disclose, inquire about privacy and safety concerns, offer options in terms of resources and referrals) — the more we are able to provide much-needed support to women experiencing IPV, who often suffer in silence,” she said.

For health care workers wanting to learn more about implementation facilitation, Iverson said there is a publicly available training manual developed by the Veterans Health Administration Behavioral Health Quality Enhancement Research Initiative that “applies to implementation of any evidence-based practice or clinical innovation.”