How You Screen is as Important as Whether You Screen: A Qualitative Analysis of Violence Screening Practices in Reproductive Health Clinics

Abstract

Adolescent and young adult women are disproportionately burdened by violence at the hands of dating and intimate partners. Evidence supports routine screening in clinical settings for detection and intervention. Although screening for intimate partner violence in reproductive health care settings is widely endorsed, little is known about screening practices. We conducted qualitative in-depth interviews with healthcare providers (n = 14) in several urban reproductive health clinics in Baltimore City, Maryland to understand screening practices, including related barriers and motivations. Interviews were transcribed verbatim and analyzed using inductive content analysis. Findings demonstrated substantial variation in screening practices as well as related referral and follow-up, despite the existence of a screening tool. Factors that appeared to undermine consistent and successful screening implementation included lack of a common goal for screening, lack of clarity in staff roles, a gap in on-site support services, as well as lack of time and confidence. Findings affirm the value of applying a systems model to intimate partner violence (IPV) screening programs. This research advances the understanding of the implementation challenges for violence-related screening for high-risk populations such as adolescents and young adults in reproductive health care settings and is particularly relevant given the recent endorsement by the DHHS to cover IPV screening under the Affordable Care Act.

High Prevalence and Partner Correlates of Physical and Sexual Violence by Intimate Partners among Street and Off-Street Sex Workers

“…New WHO practice and policy guidelines now discourage universal screening in the general population, based on a lack of evidence demonstrating that screening for IPV produces better outcomes for women [60], [61]. Among marginalized populations, the challenges with effective IPV screening remain related to implementation, follow-up and support, with new research suggesting value in a systems approach to IPV screening among key populations [62]. Stigma remains a primary barrier to accessing violence prevention and health care services for SWs.…”

Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada

“…These findings support existing literature documenting the normalization of violence and victimization among criminalized, isolated and street-involved environments (Bourgois, Prince, & Moss, 2004; Decker, Pearson, Illangasekare, Clark, & Sherman, 2013; Rhodes, Simic, Baros, Platt, & Zikic, 2008; Shannon et al, 2008), and the role of physical and sexual violence from intimate partners in elevating HIV risk for sex workers (Argento et al, in press). Integrated violence and HIV prevention/intervention strategies tailored to this key population are needed, yet the extent to which screening for intimate partner violence improves health outcomes for women remains unclear (Hegarty et al, 2013; Macmillan et al, 2009) and implementation of effective screening for violence is a key challenge in high-risk populations (Ramachandran, Covarrubias, Watson, & Decker, 2013). Stigma remains as a primary barrier to accessing violence prevention and health care services for sex workers; therefore, health care facilities and programs need to work in partnership with sex workers to reduce stigma and discrimination and improve access to health (Lazarus et al, 2012).…”

Implementing an Intimate Partner Violence (IPV) Screening Protocol in HIV Care

“…Routine screening for IPV has been introduced in family medicine, 45,46 emergency department, 47,48 prenatal care environments, [49][50][51] and HIV care centers 26,52 with mixed results. Reported barriers to disclosure of IPV voiced by patients have included the fear of increasing violence from partners and a lack of sensitivity of the health care workers to deal adequately with IPV issues in a clinical setting when IPV issues are presented.…”