Using Tablet-Based Screening for Interpersonal Violence in Primary Care Settings: An Exploration of Screening Results and Help Seeking Behaviors

Background and Purpose: Approximately one in three women and one in four men experience lifetime interpersonal violence (IPV) and one in five women are currently in intimate partner relationships that include emotional or physical abuse. Experiencing IPV increases the likelihood that women will be diagnosed with a range of chronic conditions that are commonly treated in primary care settings. Screening rates for IPV in primary care clinics remain low and numerous barriers prevent successful screening. Screening for victimization in primary care settings can be a means to link to services that may help promote well-being, self-management, and safety planning. The objective of this study is to describe the results of an intervention that introduced tablet-based screening in 9 primary care clinics. Research questions include: What are the reported rates of current and lifetime IPV, as well as high risk indicators, among primary care clinic patients? How do these rates vary by clinic populations? Among those screened, how many responded positively to an offer of assistance? What behavioral health characteristics are associated with help seekers?

Methods

The setting includes primary care clinics across three health systems in an urban area. Some clinics are located in settings that are intended to reach specific populations, such as people who are homeless, residents of high-poverty communities, undocumented immigrants, and general residents. Measures: Measurements include rates of positive responses to current and past victimization assessments, high risk/lethality indicators, sexual assault and child abuse history, and responses to offers of assistance. Secondary measures include associations with behavioral health indicators including depression, quality of life, and substance abuse.

Results: Early pilot results (n=252) demonstrated the majority showed some lifetime experiences with trauma including child abuse, sexual assault and intimate partner violence. 22% reported being choked by an intimate partner and 15% currently feared for their safety. Clinics serving populations experiencing homelessness or poverty showed the highest rates of victimization. 42% of respondents were offered specialized services for victims of interpersonal violence. One in seven patients screened requested services, and help-seeking was associated with having a past abusive partner, high risk intimate partner violence indicators, sexual assault history, frequent pain, depression and feeling unsafe.

Implications: Even after an abusive relationship has ended, chronic problems can persist. Using a tablet-based screening can effectively identify people who have experienced victimization and trauma and can offer primary care providers a mechanism to facilitate integrated care with community service systems. The majority of who experience interpersonal violence do not seek assistance from social work organizations specializing in trauma and victimization, yet a large proportion obtain primary medical care. Partnering with health care providers to screen and offer intervention is a feasible way to identify and assist victims of violence.