197317 Increasing detection of intimate partner violence in the health care setting using the adult social health survey

Sunday, November 8, 2009

Mira Gohel, MD , Philadelphia Department of Public Health, Health Care Center #3, Philadelphia, RI
Karin Rhodes , Department of Emergency Medicine School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
Background: Intimate Partner Violence (IPV) is a major public health problem affecting approximately 15-25% of women who access healthcare services. Despite strong patient support for routine screening, rates of provider detection and documentation are still low (0-4%). Our prior work and that of others suggests that allowing patients an opportunity for self-disclosure is effective in increasing rates of IPV detection and intervention.

Objective: To identify if a low-tech, minimally invasive system intervention- the Adult Social Health Survey (ASHS)-that allows for patient self-disclosure will result in an increase in IPV detection over the current method of provider screening in a busy, outpatient setting.

Setting: Philadelphia Department of Public Health-operated FQHC look-alikes

Methods: The ASHS- an optional, self-administered survey, screened for IPV within the context of other social and behavioral health issues. It was implemented for 4-week periods during routine care at 4 ambulatory health centers. Intervention effectiveness was determined by review of stratified, random sampling of patient charts during the intervention period compared to chart review for the control condition (no intervention tool) at the same centers.

Results: Review of 486 intervention charts found 62 ASHS surveys returned to providers. Of the surveys returned, 15 (24%) identified a new diagnosis of IPV exposure. There were no cases of newly diagnosed IPV in the 447 control charts.

Conclusion: The ASHS confirmed that patients are willing to self-disclose psychosocial health risks to their healthcare providers at high rates and that their doing so via the ASHS increases detection and documentation of IPV.

Learning Objectives:
1. Describe the the Adult Social Health Survey, a tool to screen for IPV in the context of psychsocial health issues. 2. Learn how self-disclosure of IPV can be effectively incorporated into a busy practice setting. 3. Discuss data that demonstrate the superiority of self-disclosure over provider screening for IPV in the health care setting.

Keywords: Violence Prevention, Community Health Centers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the co-investigator on this study. Additional biographical info: I am an academically trained family physician. I am currently the clinical Director of Health Care Center #3, one of 8 ambulatory health centers run by the Philadelphia Department of Public Health. I care for numerous families living with intimate partner violence (IPV). I am a consultant for the Institute for Safe Families (ISF), a non-profit organization whose goal is to end family violence. ISF developed the initial RADAR protocol to identify IPV in the health care setting. I was instrumental in developing and implementing department-wide policy and procedure for screening and intervention for IPV in the Health Care Centers of the PDPH. I have taught and presented extensively on the topic of IPV in the healthcare setting.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.