A Multisite Quality Improvement Initiative to Enhance the Adoption of Screening Practices for Intimate Partner Violence Into Routine Primary Care for Women Veterans

Abstract

Objective The Veterans Health Administration established comprehensive women’s health clinics (CWHCs) to provide coordinated, high-quality primary care to women veterans. Intimate partner violence (IPV) is prevalent among women using these clinics. The Veterans Health Administration recommends screening women for IPV, yet screening uptake is low in CWHCs nationwide. We describe a multisite quality improvement initiative to enhance the adoption of IPV screening practices in the Veterans Health Administration’s CWHCs. Methods This quality improvement initiative, implemented in 2017-2018, included 4 steps in which we (1) conducted a baseline survey of screening practices at CWHCs throughout the United States; (2) selected and tailored evidence-based implementation strategies based on identified barriers and facilitators; (3) deployed multicomponent implementation support, targeting low-adopting facilities; and (4) conducted a follow-up survey to evaluate changes in IPV screening practices from baseline (winter 2017) to 1-year follow-up (winter 2018) using quantitative and qualitative analyses. Results Responders from 62 CWHC sites provided information on IPV screening practices and barriers; 42 low-adopting sites were targeted for implementation support. At follow-up, responders provided information on IPV screening practices, perceived usefulness of implementation support strategies, and continued barriers. Among sites that responded to both surveys (n = 47), the number of sites that implemented recommended screening practices increased by 66.7%, from 15 at baseline to 25 at follow-up ( P = .02). Emergent themes reflected barriers and facilitators for IPV screening implementation. Conclusions Improvement in IPV screening practices in CWHCs is a pivotal step toward enhancing care for women. Yet, even with numerous implementation supports, barriers to adoption persist at many sites. Findings on modifiable barriers and unique facilitators can inform next steps for increasing screening uptake.

Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women.

“…Accordingly, there is increased attention to implementing IPV screening and counseling practices within health care settings (Dichter et al, 2021; Hamberger et al, 2015; Portnoy et al, 2021). A broad evidence base informs specific screening practices in these settings (Dichter et al, 2015; Feder et al, 2006; Sprague et al, 2012), but there is less evidence supporting effective brief counseling interventions following disclosure (O’Doherty, Taft, et al, 2014).…”

“…There is a need for more comprehensive and individualized healthcare-based IPV interventions. Given increased IPV screening efforts in the public service sector, including the Veterans Health Administration (VHA; Portnoy et al, 2021), it is important to develop interventions for these specific contexts.…”

Screening for Intimate Partner Violence Experience and Use in the Veterans Health Administration

“…Historically, efforts to implement screening for IPV experiences have targeted women in primary care settings. Although screening implementation has improved steadily, logistical, educational, and structural barriers to screening adoption remain . These primary care barriers, coupled with interdisciplinary clinician beliefs that mental health clinicians may be more effective at assessing IPV use and responding to positive disclosures, suggest mental health may be a more appropriate setting for initial IPV use screening implementation.…”

Intimate Partner Violence (IPV) in Military and Veteran Populations: A Systematic Review of Population-Based Surveys and Population Screening Studies

“…Methodological approaches that can generate representative figures may also include studies that involve systematic screening of a population, such as veterans seeking services in specific health settings. In the U.S., for example, population screening for IPV among women has been widely implemented in Veteran’s Health Administration (VHA) services [ 15 ], and the resulting data provides evidence regarding IPV disclosures among services users. The latter comprise an important sub-population of AD personnel or veterans (i.e., that attend health services and are willing to disclose IPV), with resulting findings that have implications for interventions in health service contexts [ 16 ].…”