Intimate Partner Violence Screening Programs in the Veterans Health Administration: Informing Scale-up of Successful Practices

Abstract

Screening women for intimate partner violence (IPV) is increasingly expected in primary care, consistent with clinical prevention guidelines (e.g., United States Preventive Services Task Force). Yet, little is known about real-world implementation of clinical practices or contextual factors impacting IPV screening program success. This study identified successful clinical practices, and barriers to and facilitators of IPV screening program implementation in the Veterans Health Administration (VHA). DESIGN: Descriptive, qualitative study of a purposeful sample of 11 Veterans Affairs Medical Centers (VAMCs) categorized as early and late adopters of IPV screening programs within women's health primary care clinics. VAMCs were categorized based on performance measures collected by VHA operations partners. PARTICIPANTS: Thirty-two administrators and clinician key informants (e.g., Women's Health Medical Directors, IPV Coordinators, and physicians) involved in IPV screening program implementation decisions from six early-and five late-adopting sites nationwide. MAIN MEASURES: Participants reported on IPV screening and response practices, and contextual factors impacting implementation, in individual 1-h semi-structured phone interviews. Transcripts were analyzed using rapid content analysis with key practices and issues synthesized in profile summaries. Themes were identified and iteratively revised, utilizing matrices to compare content across early-and late-adopting sites. KEY RESULTS: Five successful clinical practices were identified (use of two specific screening tools for primary IPV screening and secondary risk assessment, multilevel resource provision and community partnerships, colocation of mental health/social work, and patient-c e nt er e d d o c u m en t a t i o n). M u l t i l ev e l b a r r i e r s (time/resource constraints, competing priorities and mounting responsibilities in primary care, lack of policy, inadequate training, and discomfort addressing IPV) and facilitators (engaged IPV champions, internal and external supports, positive feedback regarding IPV screening practices, and current, national attention to violence against women) were identified. CONCLUSIONS: Findings advance national efforts by highlighting successful clinical practices for IPV screening programs and informing strategies useful for enhancing their implementation within and beyond the VHA, ultimately improving services and women's health.

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

“…Although improvement in screening practices is a pivotal step toward broader uptake of IPV screening, continued barriers to screening exist at many VHA sites. Survey respondents in our study reported IPV screening barriers similar to barriers identified in previous VHA research 17,23 and in non-VHA health care settings. 15,[24][25][26] Our findings extend this literature by illustrating challenges identified by health care providers at CWHCs, clinics uniquely positioned to address women veterans' health needs.…”

The experience of health and welfare workers in identifying and responding to domestic abuse among military personnel in the UK

“…A recent study highlighted the appropriateness of considering routine screening for DVA in military settings (military personnel and veterans) as it led to a better response (i.e., triage, signposting and appropriate intervention [39]. Nevertheless, some challenges were noted, such as time and resource constraints, competing responsibilities of professionals, lack of formal policies and guidelines on DVA screening and response procedures, as well as lack of appropriate training and discomfort inquiring.…”

Patient and provider barriers, facilitators, and implementation preferences of intimate partner violence perpetration screening

“…Certainly, a primary care setting sees more patients and thus would be able to screen a larger number of people. However, primary care providers also often report being overburdened by screening, having a large volume of patients, being under-staffed, and not have enough time with each patient to conduct the many screenings that are already currently required [44][45][46][47][48]. Future research should formally evaluate the feasibility and effectiveness of screening for IPV use in these settings.…”