Responses to Patients' Positive Screen for Past-Year Intimate Partner Violence: What Happens in the Health Care Setting?

Background and Purpose:

Experience of intimate partner violence (IPV) is associated with a variety of adverse health and social outcomes, including chronic medical conditions, mental health symptoms, unhealthy substance use, unintended pregnancies, sexually-transmitted infections, suicide and self-harm, housing instability, and poverty. Healthcare providers are well-positioned to identify patients’ experiences of IPV and provide resources or referrals to appropriate services. The U.S. Preventive Services Task Force and other organizations recommend that healthcare providers screen all women of childbearing age for experience of IPV and provide or refer to follow-up services as needed. The Veterans Health Administration (VHA), the nation’s largest integrated healthcare system, has established screening and response protocols, including on-site IPV specialists for follow-up assessment and support. We have little information, however, about how such screening and response protocols actually function. The purpose of this study was to examine what happens following a positive screen for IPV in the healthcare setting. We examined the documented healthcare response (or lack thereof) to a positive screen for past-year IPV experience in a large, integrated healthcare system through an in-depth analysis of patient medical records.

Methods:

We conducted an in-depth review of electronic medical records of all patients at a single VHA medical center identified as female who screened positive for past-year IPV exposure over a nine-month period (n = 159) for the time from index screen date to six months following a positive screen. Abstracted data included patient demographics, context of IPV screening, screening responses and score, clinical response to positive screen, and any other follow-up care. Data were analyzed to assess frequency and patterns of responses to positive IPV screens within the observation period.

Results:

Within six months of IPV disclosure in response to routine screening, 27% of the patients received services from the on-site IPV specialist. Categories of follow-up response to positive IPV screens included: patient decline follow-up intervention, IPV specialist assessment and consultation, referral to outside resources (e.g., hotline numbers), mental health counseling, ongoing monitoring in primary care, and/or no documented follow-up assessment or intervention. We will present patient characteristics associated with each type of follow-up, as well as case examples.

Conclusions and Implications:

Despite the limitation of study data to information documented in a patient’s medical record, findings reveal diverse trajectories following IPV disclosure, including multiple pathways to service receipt as well as instances in which no further assessment and intervention was documented. Findings demonstrate the opportunities and complexity of IPV screening response within a large integrated healthcare system and suggest ways to improve systemic responsiveness to IPV, including the need for ongoing clinical staff training on screening, response, and coordination of care.