204188 A look at barriers, problems and why providers can't screen: The critical role of coordinated institutional systems in the development of interpersonal violence screening and referral programs in health care

Wednesday, November 11, 2009: 12:30 PM

Jane Maffie-Lee, MSN, APRN-BC , Chief Operations Officer, Manet Community Health Center, Quincy, MA
Interpersonal violence (IPV) is the leading cause of injures for women in the U.S. Reluctance by health care providers to screen has been part of why IPV screening, treatment and referral programs are often not successful. But there are other inhibiting factors, such as institutional system barriers that can negatively affect both provider screening and patient disclosure of IPV. These institutional systems, which include record-keeping, staffing, policies and protocols and oversight, have often not been tailored to work with the other parts of the IPV program design.

Our research has looked at these institutional and service delivery systems from both the provider and patient perspectives, through the examination of screening programs at three different sites. In the course of this research we uncovered systemic problems effecting the quality of care in IPV screening, disclosure, treatment and referral. The use of multi-year baseline screening and disclosure data, provider and patient focus groups, anonymous provider surveys and individual interviews with providers is guiding the development of interventions at these sites that include both personnel training and changes in delivery and institutional systems.

We will discuss the problems we found in the health care delivery systems and on the systemic levels and address the changes needed in order for screening for IPV to be successfully integrated into health care

The focus of most program development in this area has been on educating providers on the importance of screening, and training them on how to screen women patients for IPV. Yet training alone does not work. If screening women for IPV is to become integrated into health care, developing models that are holistic, coordinated and have buy-in from administrators, providers and patients is critical.. It's critical that we develop and implement program models that focus on changing institutional systemic and service delivery systems. What we have found in our study points to problems that are crucial for program success but as of yet may not be addressed as part of building IPV screening programs. The complexity of IPV speaks to the need to look at all of the components necessary to implement successful programmatic interventions.

Learning Objectives:
Discuss the importance of assessing and coordinating institutional systems as part of the development of domestic violence screening programs. Explain how systemic problems can discourage both screening by providers and disclosure by patients. Name the potential systemic barriers and identify the tools and activities that can be used to identify the barriers

Keywords: Quality Improvement, Violence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I work at the health center and agreed to the study that was done concerning assessment of domestic violence in our patient's lives. I am a family practice NP.
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.