Intimate partner violence is a complex public health issue that requires comprehensive service responses involving multiple stakeholders. Hillsborough County, Florida was awarded a 3-year grant by the Office on Violence Against Women to establish a Coordinated Community Response (CCR) to better respond to domestic violence (DV) and increase positive outcomes for DV survivors in a county with one of the highest DV fatality rates.

A multi-agency participatory assessment was conducted using a series of nominal group interviews with professionals from law enforcement, the criminal and civil justice systems, child welfare, victim service providers, and academia. The sessions included clarification of responses and discussions on barriers and ways to increase systems-level alignment and improvements in policy and practice. Responses were captured in flipcharts and thematically analyzed.

The outcomes of the first two years include policy improvements to streamline protective measures for survivors including remote notarizations of injunctions for protection petitions, increasing law enforcement access to details of no contact orders, and victim-survivor centered changes to intake processes by our State Attorney’s Office. Also, there is an increased uptake of DV trainings across sectors (law enforcement, Guardians Ad Litem, and others).

Our CCR was effective in creating multi-sectoral community collaborations that centered on a common goal. The structure and process for engaging CCRs is unique to each community based on the make-up and needs of that specific locale. This project serves as a model of how to tailor the CCR model to achieve collective impact for addressing domestic violence in the community.

About half of all people living with intimate partner violence (IPV) experience non-fatal strangulation. Victims of strangulation are at an increased risk of IPV-related lethality. Repeated non-fatal strangulation can lead to stroke, traumatic brain injury, and post-traumatic stress disorder. Strangulation screening in patients with documented IPV is often absent.

Increasing healthcare provider awareness creates an opportunity to expand best-practice treatment decision-making. Identifying patients who have experienced strangulation allows for timely and appropriate treatment for related injuries. Screening for strangulation in patients positive for IPV is meant to reduce IPV-related homicides and increase patient knowledge of the associated lethality risk.

Nursing staff were educated regarding the relationship between non-fatal strangulation, IPV and the increase risk of homicide. A positive score utilizing a universal IPV screen within the electronic health record (EHR) triggers the nurse to ask the patient about a history of strangulation. Scripted responses built into the workflow provide consistency for interventions.

Over twelve months, 42.95% of patients positive for IPV experienced strangulation. Roughly seven percent of all positive strangulations were male. Thirty-six percent of patients’ cases reviewed by physicians received further medical evaluation, including specific radiological studies to determine further medical treatment. Of those evaluated, 78% received a CTA of the neck.

Nursing staff education and prompts within the EHR increase compliance for screening and physician notification. Including a non-fatal strangulation question increases the patient’s knowledge of potential lethality, which impacts the decision to accept referrals and resources. These changes are aimed to save lives and improve patient outcomes.

Intimate partner violence (IPV) is a serious, preventable public health problem and affects millions in the U.S. each year. 21.4% of women and 14.9% of men in the U.S. report having experienced severe physical violence from an intimate partner in their lifetime (Smith et al., 2018). IPV is the primary cause of traumatic injury to women with 50% of violent events resulting in injury (Johnston, 2006; Tribal Forensic Healthcare, 2017). Additionally, victims of IPV experience increased chronic health problems such as pain, memory loss, headaches, irritable bowel syndrome, gynecological problems, gastrointestinal disorders, depression, anxiety, and PTSD (World Health Organization, 2012). After an IPV event, 49% of victims desire healthcare assistance to address injuries, pregnancy, sexually transmitted diseases, safety, or PTSD symptoms (Tribal Forensic Healthcare, 2017). Forensic nurses (FNs) play a central role in caring for victims of IPV, including assessment, injury documentation, treatment intervention, safety planning, violence prevention education, and health promotion strategies. The purpose of the presentation is to discuss 1) the purpose of an IPV examiner program and 2) steps in developing and implementing a successful and effective IPV examiner program. The recent introduction of an IPV examiner program in a mid-sized U.S. city will be discussed and descriptive statistics will be available. It is vital for community health professionals to understand the nature and impact of IPV on health. The use of trauma-informed and patient-centered principles and practices that promote recovery and healing after an IPV event impact short and long-term health outcomes for victims.

Historically, domestic violence (DV) has been addressed through a criminal justice lens; siloed, individual and intervention focused. In 2018, the Los Angeles County (LAC), Office of Women’s Health (OWH), began administration of DV shelter and support service contracts with the goal of comprehensively addressing DV as a public health (PH) issue. This requires a systemic shift in perspectives, practices, and prioritization of prevention, root causes, and trauma informed practices. While also, addressing intersecting issues that survivors face, like substance use and mental health.

OWH conducted the following: (1) online surveys and focus groups to assess strengths, challenges and programmatic needs of providers; (2) trainings aimed at enhancing providers’ capacities; and (3) integration of substance use disorder (SUD) prevention into DV services through screening and psychoeducation.

Fifty surveys were completed, 100 participated in focus groups and 186 attended two trainings. Themes around insufficient funding and secondary trauma rose to the top of provider concerns. The ability to serve special populations and clients that speak various languages was an asset of LAC DV providers. Additionally, 29 providers participated in SUD strategies including completion of 1,194 client SUD screenings.

Adequately meeting the needs of DV survivors with a holistic approach is essential. Engaging DV service providers through education, capacity building, resources, and addressing infrastructure and programmatic needs is critical in achieving this goal. Enhanced management of intersecting issues, multi-sector partner collaboration, incorporation of emerging issues to meet the needs of survivors requires systems level strategies, leadership and utilizing a public health approach.