Moving beyond assessment: Examining providers' responses to patient disclosures of violence

Purpose: Despite gains in screening for interpersonal violence (IPV), little is known about how health care providers respond to disclosures of violence. The purpose of this analysis was to examine providers' documented response to women's disclosure of IPV or sexual assault. Design: This qualitative analysis of response to the disclosure of violence was part of a larger retrospective review of medical records that examined the relationship between violence and reproductive health of women. Sample: 2,000 medical records of reproductive-aged women from four family planning clinics in the northeastern United States. Methods: After Institutional Review Board (IRB) approval, the medical records were reviewed for a positive response to standard violence screening questions. Trained research assistants transcribed the health care providers' written response to the patient's disclosure of violence documented in the medical record. Conventional content analysis with an inductive approach was used to analyze the data. Results: A positive response to violence screening questions was noted in 570 (28.5%) medical records. Three main response categories were: 1) No documentation, 2) Descriptive response of violence, and 3) Action oriented response to violence. Findings revealed that although screening for IPV is consistent, provider responses are often inconsistent, ranging from a few words to longer narratives. Conclusion: As universal violence assessment has increased, providers must move beyond descriptions of violence toward a response that is action-oriented and includes safety planning and referrals. Increased use of electronic documentation with prompts in the medical record may help guide busy practitioners toward more comprehensive documentation.