Integrating intimate partner violence assessment and intervention into healthcare in the United States: a systems approach

"And then the person sort of just drops off the radar…": barriers in the transition from hospital to community-based care among survivors of intimate partner violence in Metropolitan Atlanta

Introduction

Hospitals and community-based organizations (CBOs) provide the service-base for survivors of intimate partner violence (IPV), particularly those in acute crisis. Both settings face discrete challenges in meeting survivors' needs. In hospitals these challenges include the pressures of a fast-paced work setting, and a lack of trauma-informed and survivor-centered care. Connections to community care are often unmeasured, with relatively little known about best practices. Often IPV survivors who receive hospital care fail to connect with community-based services after discharge. Despite the critical role of CBOs in supporting IPV survivors, there is limited research examining the perspectives and insights of CBO staff on the challenges and opportunities for improving care coordination with hospitals. The purpose of this study was to address this knowledge gap by characterizing CBO staff perceptions of IPV care coordination between hospital and community-based organizations in Metropolitan Atlanta.

Methods

We used a qualitative study design to conduct a cross-sectional examination of the perceptions and experiences of staff working at CBOs serving IPV survivors in Metropolitan Atlanta, Georgia. The adapted in-depth interview (IDI) guide was used to explore: (1) IPV survivor experiences; (2) Survivors' needs when transitioning from hospital to community-based care; (3) Barriers and facilitators to IPV care coordination; and (4) Ideas on how to improve care coordination. Data analysis consisted of a thematic analysis using MAXQDA Analytics Pro 2022.

Results

Participants (N = 14) included 13 women and one man who were staff of CBOs serving IPV survivors in Metropolitan Atlanta. CBO staff perceived that: (1) IPV survivors face individual-, organizational-, and systems-level barriers during help seeking and service provision; (2) Care coordination between hospitals and CBOs is limited due to siloed care provision; and (3) Care coordination can be improved through increased bidirectional efforts.

Conclusion

Our findings highlight the multi-level barriers IPV survivors face in accessing community-based care following medical care, the limitations of existing hospital-CBO coordination, and opportunities for improvement from the perspectives of CBO staff. Participants identified silos and inconsistent communication/relationships between hospital and CBOs as major barriers to care connections. They also suggested warm handoffs and a Family Justice Center to support care connection.

Patient Abuse, Neglect, and Exploitation: Why Physicians Need to Be Trauma-Informed

Introduction

Many people experience trauma, and its cumulative effects throughout the life span can alter health, development, and well-being. Despite this, few publications focusing on interpersonal trauma include a holistic understanding of the nature and widespread exposure of trauma experiences for patients. We developed an educational resource to teach residents about identifying and intervening with patients who experience trauma across the life span using a trauma-informed care (TIC) perspective.

Methods

We created a 4-hour educational session for residents that included didactics, a virtual visit with a domestic violence shelter, a discussion with a person who had experienced trauma, and role-playing. A pretest/posttest retrospective survey assessed resident confidence level in identifying and intervening with patients who may have experienced trauma. We used the Wilcoxon signed rank test to compare pretest and posttest scores and the Kruskal-Wallis test to compare responses by residency type and year. Free-text questions were analyzed for thematic content.

Results

During the 2021-2022 academic year, 72 of 90 residents (80%) from four residency programs attended and evaluated the session. More than 90% of respondents reported the session met their educational needs and provided them with new ideas, information, and practical suggestions to use in their clinical endeavors. The results demonstrated significantly increased confidence on most of the metrics measured.

Discussion

This session significantly improved residents' confidence in identifying and intervening with patients who have had trauma experiences using a TIC perspective, which may lead them to provide improved patient care to those who have experienced trauma.

Centring the health of women across the HIV research continuum

Despite tremendous advances in HIV research, women and gender diverse people-particularly women from racial and ethnic groups under-represented in research, transgender women, and young women-remain disproportionately affected by HIV. Women and gender diverse people face unique challenges and have been under-represented in HIV research. The National Institutes of Health (NIH) is tasked to apply fundamental knowledge about the nature and behaviour of living systems to enhance health, lengthen life, and reduce disability. Rigorous exploration of-and interventions for-the individual, social, biological, structural, and environmental factors that influence HIV prevention, transmission, treatment, and cure is crucial to advance research for women, girls, and gender diverse people across the lifespan. In this Position Paper, we introduce a framework for an intersectional, equity-informed, data-driven approach to research on HIV and women and highlight selected issues for women and gender diverse people, including HIV prevention, HIV cure, ageing with HIV, substance use and misuse, violence, pregnancy, and breastfeeding or chestfeeding. This framework underlines a new HIV and Women Signature Programme from the NIH Office of AIDS Research and Office of Research on Women's Health that advances the NIH vision for women's health, in which all women receive evidence-based HIV prevention, treatment, and care across their lifespan tailored to their unique needs, circumstances, and goals. The time is now to centre the health of women, girls, and gender diverse people across the HIV research continuum.

Screening for Intimate Partner Violence

More than a decade has passed since the Affordable Care Act (ACA) required screening for intimate partner violence (IPV) and related counseling with no co-payment and eliminated insurers' ability to deny coverage based on preexisting conditions, including IPV. While screening for IPV and coverage of services became more feasible after implementation of the ACA, in theory, gaps remain. Nearly half of women in the United States report that they have experienced IPV in their lifetime, but the true number is likely even higher. In this column, I review screening recommendations for IPV and related policies, gaps in research on groups at higher risk, systems-level approaches to increase screening, and recommendations from professional organizations on screening and supporting IPV survivors.

The Measurement of Intimate Partner Violence Using International Classification of Diseases Diagnostic Codes: A Systematic Review

Intimate partner violence (IPV) is challenging to measure yet systematic surveillance of IPV is critical to informing public health prevention and response efforts. Administrative medical data provide opportunities for such surveillance, and often use the International Classification of Diseases (ICD). The primary purpose of this systematic review was to document which ICD codes have been used in empirical literature to identify IPV, understand the justification used to select specific codes to develop IPV case definitions, and identify the data sources and types of research questions addressed by the existing literature. We searched 11 databases and of the initial 2182 results, 21 empirical studies from 2000 to 2020 met the study inclusion criteria including using ICD codes to measure IPV. The majority of these studies (90.5%) used either national samples of data or population-based administrative data from emergency departments (52.4%) or inpatient hospitalizations (38.1%). We found wide variation of ICD diagnostic codes to measure IPV and categorized the sets of codes used based on the number of codes. The most commonly used ICD-9 codes were E967.3, 995.81, 995.80, 995.85 and the most common ICD-10 codes were T74.1 and Z63.0. Few studies validated the ICD codes used to measure IPV. Most included studies (81.0%) answered epidemiological research questions. The current study provides suggestions for future research, including justifying the selection of ICD codes and providing a range of estimates based on narrow and broad sets of codes. Implications for policy and practice, including enhanced training for healthcare professionals in documenting IPV, are discussed.

A case series measuring campus and clinic level factors during implementation of a sexual violence prevention intervention in campus health and counseling centers: does environment matter?

OBJECTIVE

This study examined campus and clinic factors that may influence likelihood of implementing sexual violence (SV) prevention for college students seeking care in campus health and counseling centers.

METHODS

Campus-, clinic-, and student-level data were collected from both intervention and control campuses as part of a 28-campus cluster randomized controlled trial. A case series exploratory data analysis assessed differences in the implementation of an SV prevention intervention by campus characteristics.

RESULTS

All large schools were in the top quartile for reporting positive prevention policies regarding SV. At the clinic level, the presence of SV protocols and procedures varied widely with no clear correlation with school size. Students at intervention schools where providers received instruction and tools to facilitate these discussions reported more discussions with providers about SV. Only school size appeared to be associated with positive SV policies on campus and student-reported receipt of SV prevention intervention. Large schools performed well on campus-level policies, yet students reported some of the lowest levels of intervention receipt in the clinics at these larger schools.

IMPLICATIONS

Consistency between campus and clinic environments and implementation of the intervention was not observed. Our findings suggest that high performance regarding SV policy and prevention on a campus do not necessarily translate to implementation of appropriate SV prevention and care for students seeking care on campus, including assessments, resources, referrals, and services.

TRIAL REGISTRATION

NCT registration: NCT02355470.

Policy and Systems Change in Intimate Partner Violence and Human Trafficking: Evaluation of a Federal Cross-Sector Initiative

Objectives: This study evaluates Project Catalyst's impact on policies related to Intimate Partner Violence (IV) and Human Trafficking (HT), which contribute to negative health outcomes for survivors. Methods: We utilized continuous evaluation using data from policy assessment tools and interviews with participating state leadership team (SLT) members. Results: Five SLTs reported integration of IPV into state-level initiatives. All implemented clinical practice and organizational policy recommendations. SLTs reported that Project Catalyst increased awareness of IPV/HT and health impacts and established ongoing partnerships between the three organizations. Conclusions: Funding, training, and technical assistance to encourage cross-sector collaboration at the state level can promote policy changes that support comprehensive health center responses to IPV/HT.

Domestic violence assault during the first year of the COVID-19 pandemic: a longitudinal community study

BACKGROUND

The consequences of the COVID-19 pandemic have been far-reaching, disproportionately impacting vulnerable populations. Of particular concern is the impact on individuals experiencing domestic violence (DV), an urgent public health issue. There have been numerous reports of pandemic-related surges in DV, and it has been speculated that prolonged periods of state-mandated isolation may be the source of these surges. The current study utilized publicly available records to examine fluctuations in DV coinciding with COVID-19 lockdown restrictions in a diverse metropolitan county.

METHODS

Data were extracted from local police blotters and mapping engines in Orange County, California (United States), documenting police-reported DV assault. All incidents were coded for time to examine the time course of DV among other types of assault, allowing for a longitudinal view of incidents over a 66-week window. Changepoint analyses were used to determine whether and when DV assaults changed when mapped with coinciding tightening or loosening of restrictions county-wide. Piecewise regression analyses evaluated whether any detected fluctuations were statistically meaningful.

RESULTS

In Santa Ana, rates saw a small but significant spike in the week following the first major lockdown in March 2020 (b = .04, SE = .02, t = 2.37, p = .01), remaining stable at this higher level thereafter (b = -.003, SE = .003, t = -1.29, p = .20). In Anaheim, no meaningful change in DV assault rates was observed at any time interval.

CONCLUSION

Results suggest that surges in DV vary between communities and that systemic issues may set the stage for the surge of an already endemic problem.

Disparities in Resource Availability, Psychological Intimate Partner Violence, and Depression Among Hispanic Women

This study aims to analyze the relationship between the availability of resources, exposure to psychological intimate partner violence (P-IPV), and depression in Hispanic women in South Florida. This secondary data analysis used cross-sectional baseline data from SEPA (Salud, Educación, Prevención y Autocuidado) III. SEPA III was a randomized controlled trial that tested the SEPA intervention with 320 cisgender, sexually active Hispanic women. Descriptive analysis, logistic, and multiple regressions were conducted. Lower sexual relationship power and attending religious services were associated with higher odds of P-IPV. Reporting a history of P-IPV in the last 3 months predicted depression scores and higher depression scores were associated with higher odds of experiencing P-IPV. Participants with higher depressive scores reported less education, increased emergency room utilization, and less sexual relationship power. P-IPV is highly prevalent among Hispanic women living in South Florida. The availability of personal and community resources can buffer the risk of P-IPV and its mental health consequences. Nurses can strengthen women's resources to prevent Hispanic women from exposure to P-IPV.

The Role of Minority Stressors in Digital Dating Abuse Victimization and Perpetration among Sexual Minority Men

Digital dating abuse (DDA), a manifestation of intimate partner violence (IPV), is becoming more relevant. Despite elevated rates of IPV among sexual minority individuals and increased experiences of DDA, research has focused largely on face-to-face forms of IPV (e.g., physical assault) among presumed heterosexual couples. The minority stress theory offers a lens through which we can understand the elevated rates of IPV, including DDA, among sexual minority individuals. The purpose of this study was to explore the role of minority stressors in DDA victimization and perpetration among sexual minority men. A sample of 491 cisgender gay and bisexual men (M_age = 31.35, SD_age = 11.60) was recruited online. Consistent with prior research, discrimination was associated positively with internalized homophobia (IHP). Discrimination and IHP were directly linked to DDA victimization and perpetration. Indirect effect from discrimination to DDA victimization and perpetration, mediated by IHP, were significant. This study highlights the relationship between minority stressors and DDA among sexual minority men and indicates the need for more work on DDA among marginalized groups including sexual and gender minorities.

Exploration of barriers to screening for domestic violence in the perinatal period using an ecological framework

AIMS

To explore Australian healthcare providers' perspectives on factors that influence disclosure and domestic violence screening through the lens of Heise's (1998) integrated ecological framework.

DESIGN

This paper reports the findings that were part of a sequential mixed methods study with survey data informing interview questions. Participants for interviews were recruited after expressing an interest after completing surveys, as well as via snowball sampling.

METHODS

Semi-structured interviews were undertaken in 2017 with 12 practicing healthcare providers delivering care to women in the perinatal period in Greater Western Sydney, NSW, Australia. Data were analysed using Braun and Clarke's (2006) six-step thematic approach.

FINDINGS

The findings were framed within Heise's integrated ecological framework under four main themes. The main themes were 'Ontogenic: Factors preventing women from disclosing'; 'Microsystem: Factors preventing healthcare providers from asking'; 'Exosystem: Organizational structures not conducive to screening'; and 'Macrosystem: Cultural attitudes and socioeconomic influences affecting screening'.

CONCLUSION

Organizational policies are needed for better systems of reminding healthcare providers to enquire for domestic and family violence and mandating this within their practices. Mandatory domestic and family violence education and training that is suitable for the time constraints and learning needs of the healthcare provider is recommended for all healthcare providers caring for perinatal women. Further research is needed in addressing culturally specific barriers for healthcare providers to enquire about domestic and family violence in a culturally appropriate way.

PUBLIC AND PATIENT ENGAGEMENT AND INVOLVEMENT IN RESEARCH (PPEI)

No Patient or Public Contribution was embedded into the research reported in this paper as this research was specifically exploring healthcare providers' perspectives on domestic violence screening within their own practice experience.

Intimate Partner Violence; Are Saudi Physicians in Primary Health Care Setting Ready to Identify, Screening, and Respond?

Introduction

Intimate partner violence (IPV) is a growing hot topic in Saudi Arabia and primary health care (PHC) physicians play a significant role in preventing it. Our objective was to assess the PHC Physicians' readiness and barriers to identify, screen, and respond to IPV in Saudi Arabia.

Methods

A cross-sectional study recruited physicians working in PHC centers in Saudi Arabia. Data was collected using a modified online self-administered questionnaire based on the PREMIS "The Physician Readiness to Identify and Manage IPV." The questionnaire consisted of respondent profile, perceived preparedness and knowledge, actual knowledge, practice issues, and opinion regarding barriers.

Results

Among 169 PHC physicians, 60.9% had never experienced any formal IPV training. Around one-fifth of participants have a good perceived and actual knowledge, whereas one-third have a good perceived preparedness. Nearly half of the participants (46.7%) do not screen for IPV and two-thirds of them (66.3%) have never identified an IPV case during the previous 6 months. The logistic regression model showed that family physicians were 2.27 times more likely to have a good knowledge than a general practitioner, and participants with IPV training were more likely to have a good level of perceived preparedness, perceived knowledge, and more likely to perform screening of IPV.

Conclusion

The low level of PHC physicians' readiness to identify and respond to IPV is worrisome. Findings emphasize the urgent need for an IPV training program, a supportive work environment, and a clear referral system in order to help the practitioner to provide comprehensive services and ensure safety plans for abused women.

The Gendered Pathways Through Which Intimate Partner Violence Affects Health: Exploring the Role of Unmet Healthcare Needs

The aim of this study was to examine the relationships between intimate partner violence (IPV), gender, unmet healthcare needs, and health. Specifically, this study identified how unmet healthcare needs mediate the relationship between IPV and health, and how this mediation is moderated by gender. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) (N = 15,425), we first estimated ordinary least squares regression models to investigate the association between IPV and self-rated health. Then, we used structural equation models to examine how unmet healthcare needs mediate this relationship. Lastly, we conducted a moderated mediation model to investigate whether gender moderates these mediation patterns. The results of this study showed that experiencing IPV was associated with a decrease in self-rated health and an increase in the unmet need for medical care (but not in unmet need for routine health check-ups). Unmet need for medical care explained about one-quarter of the negative association between IPV and self-rated health. A moderated mediation model revealed that indirect effects of IPV on health via unmet medical care needs were more pronounced among victimized women than victimized men. This study filled knowledge gaps about the mechanisms underlying the association between IPV and poor health status. Unmet healthcare needs partially mediated the relationship between IPV victimization and health. This mechanism was more salient for the health of victimized women than victimized men. Interventions designed to improve the health of IPV victims may focus on addressing unmet healthcare needs and could be tailored according to the gender of patients.

Perspectives of service providers on aftercare service provision for persons with substance use disorders at a Rural District in South Africa

Background

Provision of aftercare services for persons with substance use disorders (PWSUD) within a rural context is typically met with various intersecting challenges, including unclear policy implications and lack of resources. In the South African context, service providers are expected to provide aftercare services that should successfully reintegrate persons with PWSUD into society, the workforce, family and community life as mandated by Act No. 70 of 2008, despite population diversity. Little has been established on the provision of aftercare services in South Africa and specifically within a rural context. This article explores service providers’ perspectives in aftercare service provision for PWSUD in a rural district.

Methods

A qualitative exploratory study design was conducted in a rural district in South Africa using semi-structured interviews and focus group discussions with forty-six service providers from governmental and non-governmental institutions, ranging from implementation to policy level of service provision. Data were analyzed thematically using a deductive approach. Codes were predetermined from the questions and the aims and objectives of the study used Beer’s Viable Systems Model as a theoretical framework. NVivo Pro 12 qualitative data analysis software guided the organization and further analysis of the data.

Results

Four themes emanated from the data sets. Theme 1 on reflections of the interactional state of aftercare services and program content identified the successes and inadequacies of aftercare interventions including relevant recommendations for aftercare services. Themes 2, 3, and 4 demonstrate reflections of service provision from implementation to policy level, namely, identifying existing barriers to aftercare service provision, situating systemic enablers to aftercare service provision, and associated aftercare system recommendations.

Conclusions

The intersecting systemic complexities of providing aftercare services in a rural context in South Africa was evident. There existed minimal enablers for service provision in this rural district. Service providers are confronted with numerous systemic barriers at all levels of service provision. To strengthen the aftercare system, policies with enforcement of aftercare services are required. Moreover, a model of aftercare that is integrated into the existing services, family centered, sensitive to the rural context and one that encourages the collaboration of stakeholders could also strengthen and sustain the aftercare system and service provision.

IPV nurse education: Scoping things out to see who's doing what?

Introducing best practice approaches to help nursing students identify and respond to patients who are/have been exposed to intimate partner violence (IPV) is instrumental to their professional development. The objectives of this study are to gather preliminary data from the American Association for the Colleges of Nursing (AACN) affiliated schools of nursing to determine 1) if they offer any training of students at the undergraduate or graduate level in identifying and responding to IPV; 2) if so, what are the components of that training, outcomes, and satisfaction with the existing approach; 3) if not, what are the individual and institutional level barriers to offering this training; and 4) if schools are interested in incorporating best practice, IPV training content into their curriculum.

DESIGN AND METHODS

A total of 836 AACN affiliated nursing schools across the US were surveyed using a 64-item electronic survey.

RESULTS

Of the 95 (11%) schools that completed at least 40% of the survey, approximately 60% offer IPV training once at the undergraduate level and only 30% offered such preparation at the graduate level. We found that most IPV education took place as embedded material within an existing course. Those nursing schools not providing any IPV education identified that they would like to at both levels and the 50% of nursing schools already providing this education said they wanted to provide more. The greatest barriers to offering IPV education were lack of faculty expertise and time constraints, yet about 70% of the participants stated that IPV education should be an essential part of undergraduate and graduate nursing school.

CONCLUSION

This study provides useful insights to inform IPV curriculum development by identifying common gaps in IPV education experienced by participating schools and strategies for addressing them.

Asking the Right Questions: Screening Men for Partner Violence

With lifetime intimate partner violence (IPV) victimization rates for self-identified men between 14% and 20%, and an expanding understanding of gender as a nonbinary construct, practitioners in some clinical environments have expressed interest in screening all patients for IPV. Yet, few IPV screening instruments have been validated for use in nonfemale populations. This research tests the appropriateness and acceptability of a screening instrument developed for use with women.A literature review was completed to determine the current state of research into IPV screening practices tailored to men. Next, cognitive interviews were conducted to test a 9-question IPV screening instrument with men considered at average and elevated risk for experiencing partner violence. Participants were read the questions aloud and asked about item comprehension and question appropriateness and acceptability.The literature review uncovered no published reports describing routine clinic based IPV screening of men, and only two screening instruments had been validated with men. Twenty men participated in cognitive interviews from a variety of settings in a large urban center. All participants accurately described the intended meaning of each question and verified the appropriateness of asking the questions.This work addresses the gap in research on routine IPV screening with men, building on efforts to screen individuals and support improved health and response to violence to those across the gender spectrum.

Women's experiences and expectations of intimate partner abuse identification in healthcare settings: a qualitative evidence synthesis

OBJECTIVES

To explore women's experiences and expectations of intimate partner abuse (IPA) disclosure and identification in healthcare settings, focusing on the process of disclosure/identification rather than the healthcare responses that come afterwards.

DESIGN

Systematic review and meta-synthesis of qualitative studies DATA SOURCES: Relevant studies were sourced by using keywords to search the databases MEDLINE, EMBASE, CINAHL, PsychINFO, SocINDEX and ASSIA in September 2021.

ELIGIBILITY CRITERIA

Studies needed to focus on women's views about IPA disclosure and identification in healthcare settings, use qualitative methods and have been published in the last 5 years.

DATA EXTRACTION AND SYNTHESIS

Relevant data were extracted into a customised template. The Critical Appraisal Skills Programme checklist for qualitative research was used to assess the methodological quality of included studies. A thematic synthesis approach was applied to the data, and confidence in the findings was appraised using The Confidence in the Evidence from Reviews of Qualitative research methods.

RESULTS

Thirty-four studies were included from a range of healthcare settings and countries. Three key themes were generated through analysing their data: (1) Provide universal education, (2) Create a safe and supportive environment for disclosure and (3) It is about how you ask. Included papers were rated overall as being of moderate quality, and moderate-high confidence was placed in the review findings.

CONCLUSIONS

Women in the included studies articulated a desire to routinely receive information about IPA, lending support to a universal education approach that equips all women with an understanding of IPA and options for assistance, regardless of disclosure. Women's suggestions for how to promote an environment conducive to disclosure and how to enquire about IPA have clear implications for clinical practice.PROSPERO registration numberCRD42018091523.

Provider perspectives on implementing a student health and counseling center intervention for sexual violence

Objective: To describe provider experiences with implementation of the GIFTSS (Giving Information for Trauma Support and Safety) intervention. Participants: Health and counseling center staff from participating campuses attended trainings between August 2015 and August 2016. Interviews were conducted between May and August 2017. Methods: Providers (n = 230) completed surveys prior to and six months following a 3-hour training on the intervention. Structured phone interviews were conducted with a purposively selected subset of 14 providers. Results: Overall, staff found the intervention acceptable. Implementation barriers noted were time and competing patient priorities. Providers noted variation based on patient and visit characteristics. Clinic commitment, particularly in adopting strategies for universal dissemination of the GIFTSS card, was seen as helpful. Conclusion: Implementation of a brief trauma-informed intervention in campus health and counseling centers was feasible and acceptable to most providers. Opportunities to change organizational culture regarding ensuring adequate time and safety for patients are discussed.

Lessons Learned: A Case of Intimate Partner Violence During the COVID-19 Pandemic

Intimate partner violence (IPV) has been a major public health threat long before COVID-19. However, the pandemic has removed protective measures from victims, while heightening risk factors associated with IPV. Emergency department providers are often the initial point of contact in the health care system for IPV victims; therefore, knowledge of current screening guidelines and best practices in assessment and management of IPV is essential. The purpose of this case report is to present a missed opportunity involving IPV in an emergency department during the COVID-19 pandemic and to discuss the lessons learned with the aim of educating health care providers on the subtle signs of IPV and current screening guidelines.

Intimate Partner Violence and the COVID-19 Pandemic

OBJECTIVES

To describe the effects of the coronavirus disease 2019 (COVID-19) pandemic and associated practice shifts on consultation and referral patterns of an intimate partner violence program at a large, urban children's hospital.

METHODS

Secondary data analyses examined COVID-19-related variations in patterns of consultations and referrals in the 11 months before the COVID-19 pandemic (April 1, 2019-February 29, 2020) and those after its emergence (April 1, 2020-February 28, 2021). χ2 analyses were used to examine differences in categorical outcomes of interest by time and practice setting, as well as differences within practice settings. Poisson regressions were used to compare the number of reasons for consultation and the number of referrals during the 2 periods.

RESULTS

Analyses revealed significant decreases in face-to-face consults (28% to 2%; P < .001) during the period after COVID-19 emergence alongside significant increases in the total number of consults (240 to 295; P < .001), primarily for emotional abuse (195 to 264; P = .007). Psychoeducation referrals also increased significantly (199 to 273; P < .001), whereas referrals to community resources decreased significantly (111 to 95; P < .001). Setting-specific analyses revealed that primary care settings were the only practice settings to demonstrate significant differences in overall number of and specific reasons for consultation and associated referral types before and after COVID-19 emergence.

CONCLUSIONS

Even during a shift away from face-to-face care, there was an increase in intimate partner violence referrals after the start of the COVID-19 pandemic. These findings suggest the importance of pediatric primary care as a location for survivors to access support.

Obstetric gaslighting and the denial of mothers' realities

Gaslighting is a type of abuse aimed at making victims question their sanity as well as the veracity and legitimacy of their own perspectives and feelings. In this article, we show how gaslighting can operate as a key, yet underexamined strategy of obstetric violence, or the institutional and interpersonal violation of women's rights during pregnancy, childbirth, and postpartum. We draw on forty-six in-depth, semi-structured interviews with mothers who experienced a traumatic childbirth to examine how obstetric providers gaslight mothers before, during and after childbirth when they deny - and thereby destabilize - mothers' realities. We identify and examine four core types of denials: denials of 1) mothers' humanity, 2) mothers' knowledge as valid, 3) mothers' judgements as rational and 4) mothers' feelings as legitimate. All four denials work to render mothers noncredible and their claims illegible within clinical encounters. In explicitly naming, theorizing, and examining obstetric gaslighting, our aims are threefold: 1) to uncover and theorize an underexamined mechanism of obstetric violence through a sociological lens, 2) to offer a typology of obstetric gaslighting's manifestations to aid scholars and practitioners in recognizing when obstetric gaslighting is occurring and 3) to advance a growing research program on gaslighting in medicine.

Correlates of reproductive coercion among college women in abusive relationships: baseline data from the college safety study

ObjectiveThe purpose of this study was to examine correlates of reproductive coercion (RC) among a sample of college women in abusive relationships. Participants: 354 college students reporting a recent history of intimate partner violence (IPV). Methods: This study examines baseline data from a randomized controlled trial testing effectiveness of an interactive safety decision aid (myPlan). Results: Almost a quarter (24.3%) of the sample reported RC. Associated factors included races other than White (p = 0.019), relationship instability (p = 0.022), missing class due to relationship problems (p = 0.001), IPV severity (p < 0.001), technology abuse (p < 0.001), traumatic brain injury-associated events (p < 0.001), and depression (p = 0.024). Conclusions: RC was a significant predictor of depression, with implications for providers working with abused college women regarding the need for mental health services concurrent with IPV/RC services. A larger proportion of women who experienced RC sought help from a healthcare provider for contraception, which suggests intervention opportunities for college health providers.

A Systematic Review of Intimate Partner Violence Interventions Impacting South Asian Women in the United States

This systematic review is the first published attempt to synthesize literature pertaining to intimate partner violence (IPV) interventions impacting South Asian women in the United States. Applying the conceptual framework of intersectionality, the goals of this review are to (1) understand current trends, intervention modalities, and areas of focus within IPV interventions targeting South Asian communities in the United States and (2) to identify gaps in the address of IPV among these communities. Using the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched 35 databases and identified 12 research studies. Our study included a collective sample of 318 South Asian IPV survivors and 25 organizations. Findings underscore that there are minimal IPV interventions available to South Asian women living in the United States. Most interventions have not been systematically evaluated, making their efficacy questionable. Those that reported outcome evaluation, namely recurrence of IPV, demonstrated limited efficacy. IPV research on South Asian women often dismisses financial concerns in light of cultural dimensions impacting IPV. Given that financial dependence is a major driver of violence against South Asian women, scholars must question the efficacy of available interventions that cannot foster the social and economic security of IPV survivors. Without sufficient attention to the intersecting social, cultural, and economic challenges that South Asian women face in abusive relationships, the efficacy of IPV interventions will remain limited.

Help seeking behavior by women experiencing intimate partner violence in india: A machine learning approach to identifying risk factors

BACKGROUND

Despite the low prevalence of help-seeking behavior among victims of intimate partner violence (IPV) in India, quantitative evidence on risk factors, is limited. We use a previously validated exploratory approach, to examine correlates of help-seeking from anyone (e.g. family, friends, police, doctor etc.), as well as help-seeking from any formal sources.

METHODS

We used data from a nationally-representative health survey conducted in 2015-16 in India, and included all variables in the dataset (~6000 variables) as independent variables. Two machine learning (ML) models were used- L-1, and L-2 regularized logistic regression models. The results from these models were qualitatively coded by researchers to identify broad themes associated with help-seeking behavior. This process of implementing ML models followed by qualitative coding was repeated until pre-specified criteria were met.

RESULTS

Identified themes associated with help-seeking behavior included experience of injury from violence, husband's controlling behavior, husband's consumption of alcohol, and being currently separated from husband. Themes related to women's access to social and economic resources, such as women's employment, and receipt of maternal and reproductive health services were also noted to be related factors. We observed similarity in correlates for seeking help from anyone, vs from formal sources, with a greater focus on women being separated for help-seeking from formal sources.

CONCLUSION

Findings highlight the need for community programs to reach out to women trapped in abusive relationships, as well as the importance of women's social and economic connectedness; future work should consider holistic interventions that integrate IPV screening and support services with women's health related services.

Community Health Worker Knowledge, Attitudes, Practices and Readiness to Manage Intimate Partner Violence

Intimate partner violence (IPV) is an important public health concern with higher prevalence among women. Community health workers (CHWs) are trusted frontline public health workers that bridge gaps between communities and healthcare services. Despite their effectiveness in delivering services and improving outcomes for different chronic conditions, there is a dearth of understanding regarding CHW management of IPV. The purpose of this study is to examine knowledge, attitudes, practices, and readiness to manage IPV among a sample of CHWs (n = 152). Participants completed an online version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), which was modified for CHW practice. Psychometrics of the newly adapted tool, along with empirical relationships between knowledge, attitudes, and readiness to manage IPV were examined. Most sub-scales yielded moderate to high reliability (0.70 < α's < 0.97), some sub-scales had low reliability (0.57 < α's < 0.64), and construct validity was established for several of the subscales. On average, many CHWs had low scores on objective knowledge of IPV (mean = 15.4 out of 26), perceived preparation to manage IPV (mean = 3.8 out of 7), and perceived knowledge of IPV (mean = 3.7 out of 7). About 56% of CHWs indicated having no previous IPV training, 34% did not screen for IPV, and 65% were in the contemplation stage of behavior change. Multiple regression models indicated that knowledge, staff capabilities and staff preparation were significant predictors of perceived preparedness to manage IPV (all p's < 0.05). Results can inform future credentialing requirements and training programs for CHWs to better assist their clients who are victims of IPV.

Describing the Health Status of Women Experiencing Violence or Abuse: An Observational Study Using Claims Data

Introduction:

Violence against women (VAW) can result in long-term and varied sequela for survivors, making it difficult to evaluate healthcare intervention. This study seeks to improve understanding of the healthcare experiences of women survivors prior to a violence-related diagnosis, allowing healthcare systems to better design strategies to meet the needs of this population.

Methods:

Using population-based data from 2016 to 2019, this cross-sectional observational study presents healthcare spending, utilization, and diagnostic patterns of privately insured women, age 18 or older, in the 10-months prior to an episode of care for a documented experience of violence (DEV).

Results:

Of 12 624 764 women meeting enrollment criteria, 10 980 women had DEV. This group had higher general medical complexity, despite being 10 years younger than the comparison group (mean age 32.7 vs 43.5). These relationships held up when comparing participants in each cohort by age. Additional key findings including higher numbers of medical visits across clinical settings and higher total cost ($10 138-$4585).

Conclusions:

The study utilized population-based data, to describe specific areas of health and medical cost for women with DEV. Increased medical complexity and utilization patterns among survivors broaden the understanding of the health profiles and healthcare touchpoints of survivors to inform and optimize strategies for medical system engagement and resource allocation for this public health crisis.

Fears of disclosure and misconceptions regarding domestic violence reporting amongst patients in two US emergency departments

Patients often do not disclose domestic violence (DV) to healthcare providers in emergency departments and other healthcare settings. Barriers to disclosure may include fears and misconceptions about whether, and under what circumstances, healthcare providers report DV to law enforcement and immigration authorities. We sought to assess undocumented Latino immigrants (UDLI), Latino legal residents/citizens (LLRC) and non-Latino legal residents/citizens (NLRC) beliefs about disclosure of DV victimization to healthcare providers and healthcare provider reporting of DV to law enforcement and immigration authorities. From 10/2018-2/2020, we conducted this survey study at two urban emergency departments (EDs) in California. Participants, enrolled by convenience sampling, responded to survey questions adapted from a previously published survey instrument that was developed to assess undocumented immigrant fears of accessing ED care. Our primary outcomes were the proportions of UDLI, LLRC and NLRC who knew of someone who had experienced DV in the past year, whether these DV victims were afraid to access ED care, reasons DV victims were afraid to access ED care, and rates of misconceptions (defined according to current California law) about the consequences of disclosing DV to healthcare providers. Of 667 patients approached, 531 (80%) agreed to participate: 32% UDLI, 33% LLRC, and 35% NLRC. Of the 27.5% of respondents who knew someone who experienced DV in the past year, 46% stated that the DV victim was afraid to seek ED care; there was no significant difference in this rate between groups. The most common fears reported as barriers to disclosure were fear the doctor would report DV to police (31%) and fear that the person perpetrating DV would find out about the disclosure (30.3%). Contrary to our hypothesis, UDLI had lower rates of misconceptions about healthcare provider and law enforcement responses to DV disclosure than LLRC and NLRC. Fear of disclosing DV and misconceptions about the consequences of disclosure of DV to healthcare providers were common, indicating a need for provider, patient, and community education and changes that lower barriers to help-seeking.

Symptom Trajectory among Formerly Abused Women: An Exploratory Study

Women who have experienced intimate partner violence suffer from symptoms that persist long after the abuse has ended. However, the patterns and trajectory of these symptoms are poorly understood. The objective of this longitudinal research was to explore symptom trajectory typologies. A latent class growth analysis with multi-outcomes modeling was used to explore typologies based on women's (N = 30) trajectories over 4 months. Two distinct symptom typologies were identified: (1) consistently lessening symptom group (n = 16); (2) moderately worsening symptom group (n = 14). Women who experienced severe psychological vulnerability exhibited better symptom trajectories; a potential reflection of resilience in this population.

Symptom Sequelae Following Violence Against Youth With Disabilities

The objective of this study was to examine the physical and mental health impact of violence against youth with and without disabilities. We analyzed data from the National Crime Victimization Survey (2008-2016), a nationally representative survey on crime in the United States. Respondents included 729 adolescents (12-17 years) and 953 young adults (18-24 years) who experienced violence in the previous 6 months. Disability status was determined using a six-item screener. Outcome measures included several physical and mental health symptoms experienced for at least one month following violence. Data were analyzed using multivariable logistic, Poisson, and negative binomial regression models. The results indicated that, for at least one month following a violent incident, adolescents and young adults with disabilities were more likely to experience headaches, sleep difficulty, changes in eating or drinking habits, fatigue, muscle pain, and severe distress compared to peers without disabilities. Young adults with disabilities were also more likely to experience stomach problems, depression, and anxiety. Adolescents and young adults with disabilities experienced a greater number of concurrent physical and mental health symptoms compared to peers without disabilities. The results suggest that the health effects of violence are worse for youth with disabilities compared to their nondisabled peers. These findings emphasize the importance of screening young people with disabilities for violence exposure and ensuring that trauma and health services are universally accessible.

Exploring Adolescent Experiences with Disclosing Self-Injurious Thoughts and Behaviors Across Settings

Disclosure of self-injurious thoughts and behaviors (SITBs) is critical to current treatment and prevention programs. Limited research has examined patterns of and barriers to SITB disclosure in adolescents. This work is critical given the limits of confidentiality in this population. Over 1,000 adolescents aged 13-17 with a history of mental health treatment and SITBs were recruited online. Participants reported their history with disclosing SITBs across a range of relationships, honesty in and barriers to disclosure to health care providers, and their experiences with breaches of confidentiality to parents/guardians. We examined relationships among these experiences and a range of outcomes, including perceived likelihood of future disclosure. Participants reported most frequent disclosure of all SITBs to friends, and more frequent disclosure of nonsuicidal self-injury compared to suicide ideation or attempts. Adolescents were most likely to disclose SITBs when directly asked by health care providers, though many participants reported continued SITB concealment. The most commonly endorsed barrier to disclosure was fear that the provider would tell a parent/guardian. Experiences with confidentiality breaches involving a non-collaborative breach were negatively associated with future disclosure, mental health symptoms, and adolescent-parent relationships. SITB disclosure is a cornerstone to their treatment and prevention. Better understanding of to whom and when, barriers, and the impact of disclosure experiences is critical. Our research suggests that most adolescents do not want their parents to know about their SITBs, and that fear of parent involvement prevents disclosure. Results have several implications for SITB assessment across physical and mental healthcare settings.

Health Care Providers' Readiness to Identify and Respond to Intimate Partner Violence

Screening rates for intimate partner violence (IPV) among most health care providers are low; yet, positive interactions with providers can benefit people who experience IPV, with respect to increased safety, support, and self-efficacy. Missing is a broad assessment and comparison of knowledge, attitudes, and behavior across the range of providers who are likely to be involved in a response to IPV disclosure. The purpose of our study was to assess health care providers' IPV preparation, knowledge, opinions, and practices and examine differences across three types of health care providers (medical providers, nursing staff, and social/behavioral health providers). We used an anonymous online survey to gather self-reported information on preparation, knowledge, opinions, and practices around IPV. A random sample of 402 providers was drawn from 13 clinics in a large multispecialty outpatient practice setting. The respondents (N = 204) consisted of medical providers (n = 70), nursing staff (n = 107), and social/behavioral health providers (n = 27). Data analyses consisted of univariate, bivariate, and multivariate analyses. Social/behavioral health providers reported more preparation, knowledge, victim understanding, and less job-related constraints, yet they reported lower screening rates than medical providers and nursing staff. Overall, no provider group seemed well-equipped to work with patients who disclose IPV. Our findings identify unmet needs within our health system to better train health care providers and restructure care models to support IPV identification and response. A focus on interprofessional training and care collaboration would bolster competency and reduce constraints felt by the health care workforce.

Psychological Effects of Abuse, Partner Pressure, and Alcohol: The Roles of in-the-Moment Condom Negotiation Efficacy and Condom-Decision Abdication on Women's Intentions to Engage in Condomless Sex

Women's experiences of intimate partner violence (IPV) from their male partners can include psychological, physical, and sexual control and abuse. The psychological effects of abuse (PEA) include terror, shame, and loss of power and control in relationships. While women's experiences of IPV are associated with decreased condom use, limited research has examined the impact of PEA on women's condom use. Intoxicated (breath alcohol content [BrAC] = .10%) versus sober women were evaluated to test the hypothesis that PEA would interact with intoxication and scenario-context partner pressure to forgo condom use and be associated with intentions to engage in condomless sex. After beverage administration, community women (N = 405) projected themselves into a computerized scenario depicting a male partner exerting high or low pressure for condomless sex. In-the-moment condom negotiation self-efficacy and condom-decision abdication-letting the man decide on condom use-were assessed. Path analysis examined the direct and indirect effects of PEA, alcohol, and partner pressure conditions on condomless sex intentions. PEA increased condomless sex intentions indirectly through decreased condom negotiation self-efficacy. Intoxication increased condomless sex intentions indirectly through decreased condom negotiation self-efficacy and increased condom-decision abdication. Intoxicated women in the low pressure condition were more likely to abdicate the condom decision than women in the high pressure condition. Women who have experienced greater PEA may benefit from interventions focusing on how condom negotiation self-efficacy, condom-decision abdication, and intoxication influence sexual decision-making.

Intimate partner violence (IPV) in male and female orthopaedic trauma patients: a multicentre, cross-sectional prevalence study

OBJECTIVES

Identify the proportion of patients attending fracture clinics who had suffered intimate partner violence (IPV) within the past year.

DESIGN

Powered cross-sectional study using validated participant self-reported questionnaires.

SETTING AND PARTICIPANTS

Adult trauma patients (no gender/age exclusions) attending one of three Scottish adult fracture clinics over 16-month period (from October 2016 to January 2018).

PRIMARY OUTCOME MEASURE

Number of participants answering 'yes' to the Woman Abuse Screening Tool question: 'In your current relationship over the past twelve months, has your partner ever abused you physically/emotionally/sexually?'

RESULTS

Of 336 respondents, 46% (156/336 known) were women with 65% aged over 40 (212/328 known). The overall prevalence of IPV within the preceding 12 months was 12% 39/336) for both male and female patients. The lifetime prevalence of IPV among respondents was 20% (68/336). 38% of patients who had experienced IPV within the past 12 months had been physically abused (11/29). None of the patients were being seen for an injury caused by abuse. Two-thirds of respondents thought that staff should ask routinely about IPV (55%, 217/336), but only 5% had previously been asked about abuse (18/336).

CONCLUSIONS

This is the first study worldwide investigating the prevalence of IPV in fracture clinics for both male and female patients. 12-month prevalence of IPV in fracture clinic patients is significant and not affected by gender in this study. Patients appear willing to disclose abuse within this setting and are supportive of staff asking about abuse. This presents an opportunity to identify those at risk within this vulnerable population.

Intimate Partner Violence and the Role of Breast Imaging Centers

Intimate partner violence (IPV) is defined as physical violence, sexual violence, stalking, or psychological harm by a current or former intimate partner. In the United States, one in three women will experience a form of IPV in their lifetime. Screening for IPV at breast imaging centers provides an important opportunity to identify and assist affected women. Breast imaging centers provide a private environment where passive and active IPV screening methods can be employed. In addition, when obtaining a mammogram or breast ultrasound, the patient's upper chest is exposed, which could demonstrate patterns of abuse. This article discusses the need for IPV screening, via both passive and active methods, and implementation steps for breast imaging centers.

The possible impact of increased physical intimate partner violence during the COVID-19 pandemic on ocular health

During the COVID-19 outbreak, sheltering at home has led to an increase in physical intimate partner violence cases. Intimate partner violence-sustained ocular injuries may be higher during the pandemic due to the increase in physical intimate partner violence. Left untreated, intimate partner violence-related ocular or orbital trauma can lead to permanent vision loss. Even with treatment, patients often lose vision from intimate partner violence-related traumatic ocular injuries. Eye care providers and eye care facilities should understand the community services available to intimate partner violence survivors to better care for these patients. Due to the potential lasting economic burden and social strain of this pandemic, eye care providers and facilities should stay vigilant as there may still be a sustained increase in intimate partner violence even after the global COVID-19 pandemic.

Women's Experiences of Sexual Violence in Intimate Relationships: Applying a New Taxonomy

How do women describe their experiences of sexual violence in their intimate relationships? In answering this question, the present article builds upon a newly developed taxonomy of intimate partner sexual violence (IPSV). Women with past or present intimate partner violence experience (N = 28) were recruited from a domestic violence program and the community at large. Data were collected with semistructured, in-person interviews, audio recorded, and transcribed. As defined by the taxonomy, 27 women (96%) experienced intimate partner sexual abuse; 19 (68%) experienced intimate partner sexual coercion; 14 (50%) experienced intimate partner sexual assault; and two (7%) experienced intimate partner-forced sexual activity. Intimate partner sexual abuse was central to women's experiences of IPSV. Common categories of sexual abuse were having sex outside of the relationship, controlling reproductive decisions, degrading with sexual criticism and insults, refusing communication, denying pleasure, and withholding sex. The types of IPSV did not typically occur in isolation; the taxonomy revealed a grouping pattern, with intimate partner sexual assault and intimate partner sexual coercion co-occurring with sexual abuse. Understanding the different types of IPSV as a comprehensive mechanism of sexual control is a meaningful way to conceptualize sexual violence in intimate relationships. The expanded taxonomy provides a useful therapeutic tool in helping women share and heal from these experiences.

Application of the Consolidated Framework for Implementation Research to Facilitate Violence Screening in HIV Care Settings: a Review of the Literature

PURPOSE OF REVIEW

This review summarizes the literature on violence screening practices within HIV care settings globally as well as identified salient multi-level barriers and facilitators for adopting and implementing violence screening within HIV care. We utilized the Consolidated Framework for Implementation Research (CFIR) to systematically identify multi-level factors related to violence screening within HIV services.

RECENT FINDINGS

Across the 15 articles included, several highly salient CFIR constructs emerged as particularly relevant for violence screening adoption and implementation within HIV including inner setting factors, outer setting factors, as well as select constructs specific to characteristics of the violence screening process, the individuals charged with screening, and violence screening execution. This review underscores the importance of considering CFIR constructs to bolster successful violence screening implementation in HIV care settings. We describe several potential implementation strategies to overcome the most salient barriers identified across this limited body of summarized research.

Challenges of Using Videos in Exam Rooms of Safety-Net Clinics to Encourage Patient Self-Disclosure of Intimate Partner Violence and to Increase Provider Screening

Identifying intimate partner violence (IPV) in clinics allows for early intervention. We tested a comprehensive approach in five safety-net clinics to encourage female victims to self-identify and providers to screen. The main components were (a) short, multilingual videos for female patients; (b) provider training; and (c) management tools. Although videos were viewed 2,150 times, only 9% of eligible patients watched them. IPV disclosure increased slightly (6%). Lack of internal champions, high turnover, increased patient load, and technological challenges hindered outcomes. Safety-net clinics need feasible methods to encourage IPV screening. Management champions and IT support are essential for video-based activities.

Promoting Cross-Sector Collaborations to Address Intimate Partner Violence in Health Care Delivery Systems Using a Quality Assessment Tool

Background: As part of a Domestic Violence and Health care Partnership (DVHCP) project in California, 19 leadership teams consisting of representatives from domestic violence agencies and health care delivery systems in California came together to improve care related to intimate partner violence (IPV). We evaluated the impact of a Quality Assessment/Quality Improvement (QA/QI) tool on health care delivery systems' ability to collaborate with victim service agencies to address IPV. Methods: Each leadership team completed the QA/QI tool every 6 months between 2014 and 2017. Fifteen clinics that completed the tool at least twice are included in this analysis. Results: The largest changes noted in the QA/QI tool were having written protocols for assessing for IPV, providers distributing educational safety cards about IPV to patients, scripts for providers on how to assess and support survivors of IPV, trainings led by IPV agency advocates, and support for staff to discuss difficult cases. Conclusions: Implementation of a QA/QI tool can guide health care delivery systems to make changes in provider practices and clinic protocols to improve care and support for survivors of IPV. Such clinic-level changes may support providers to more readily or consistently integrate addressing IPV in clinical encounters while facilitating and promoting cross-sector collaborations with victim service advocacy and related social service agencies.

Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study

BACKGROUND

Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services.

OBJECTIVE

We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates.

METHODS

The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order.

RESULTS

We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts.

CONCLUSIONS

App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider.

Human-Centered Design for a Women's Health Screening Tool: Participant Experiences

OBJECTIVES

Screening is a priority in primary care and women's health, and increasingly used for intimate partner violence. Integrating such routine screening into primary care screening may be challenging for clinicians. Human-centered design (HCD) is a participatory process emphasizing stakeholder input and is used increasingly in health care. A growing body of literature has examined the science of patient and community engagement in health research, yet few qualitative studies investigate how participants recruited to collaborate in designing screening tools perceive HCD processes. This study examined participants' perceptions of an HCD process used as an engagement tool to inform the development of a women's health screening tool.

METHODS

Qualitative study using data collected from community members and providers and staff recruited through a southern Appalachian medical education center and network of family medicine clinics and in the surrounding community. Using opportunistic and key informant sampling, study participants (some of whom were also intimate partner violence survivors) were part of an earlier HCD process undertaken to redesign a women's health/primary care screening tool and were invited to be interviewed about their perceptions of and experiences in the HCD process. Interviews were conducted using a semistructured guide. Interviews were audio-recorded, transcribed, hand-coded, and analyzed using modified grounded theory.

RESULTS

All of the participants reported that they valued the opportunity to be part of the HCD process; however, they reported divergent views of the process itself. Some found it easy to engage, whereas others found it confusing or embarrassing. All valued the opportunity to be part of determining the best process for screening, yet concerns were expressed about access to and full participation in the process. Community members reported more concerns; providers and staff reported fewer concerns about their own involvement and participation, although some expressed doubts about community members' full engagement.

CONCLUSIONS

Although a promising option and valuable process, the HCD process was not equally comfortable for or accessible to all participants. Community engagement beyond the clinical team is important for improving practices in health screening and health care, but it must be undertaken thoughtfully.

High sensitivity and specificity screening for clinically significant intimate partner violence

The U.S. Preventive Services Task Force has recommended that clinicians screen patients for intimate partner violence (IPV). This article aims to develop and test the first screeners for clinically significant physical and psychological IPV (i.e., acts meeting criteria in the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2019) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). The goal was to derive screeners that (1) are maximally brief, while still achieving high sensitivity and specificity; (2) assess perpetration and victimization when either men or women are reporting; and (3) use ICD-11/DSM-5 criteria as the reference standard. Random samples of active duty service members at 82 installations worldwide were obtained via e-mail invitation (2006: N = 54,543; 2008: N = 48,909); their response rates were excellent for long general population surveys with no payment (2006: 44.7%, 2008: 49.0%). The population of spouses at the participating installation was invited by mailed postcard (2006: N = 19,722; 2008: N = 12,127; response rates-2006: 12.3%, 2008: 10.8%). Clinically significant physical intimate partner violence can be effectively screened with as few as four items, with sensitivities > 90% and specificities > 95%; clinically significant psychological intimate partner violence can be screened with two items. Men and women can be screened with equivalent accuracy, as can those committing the violence and those victimized by it. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence

The leading causes of pregnancy-associated deaths, as defined by the Centers for Disease Control and Prevention, are homicide, suicide, and drug overdose. Intimate partner violence during pregnancy has been shown to contribute to maternal mortality from pregnancy-associated deaths. In this article, we discuss these leading causes of pregnancy-associated deaths. We review the prevalence, demographic characteristics, and possible factors leading to each cause of death, as well as evidence-based methods of identification, prevention, and intervention. The review also will include data showing racial and ethnic inequities. In addition, we identify gaps and guiding questions for further research, as well as suggestions for immediate changes in practice and policy.

The Implementation of an Interpersonal Violence Screening Program in Primary Care Settings: Lessons Learned

BACKGROUND

Interpersonal violence (IPV) is a public health issue that disproportionately affects women. IPV screening improves likelihood of survivor disclosure and access to additional support. To enhance primary care IPV screening, Technology Enhanced Screening and Supportive Assistance (TESSA) uses integrated technological systems to deliver bidirectional, evidence-informed health navigation, health management, and safety interventions. This study evaluates TESSA implementation in primary care clinics using the Consolidated Framework for Implementation Research (CFIR).

METHOD

CFIR is a metatheoretical framework used for evaluating clinical intervention implementation. Salient constructs within CFIR's five domains (intervention characteristics, outer setting, inner setting, characteristics of individuals, and process) were identified (23 constructs), and pertinent implementation details were examined.

RESULTS

Key lessons learned included intervention characteristic constructs like intervention source (e.g., selecting tablets that can screen for items integral to the program's aims) and adaptability (e.g., ensuring tablets worked with electronic medical records for each clinic), process constructs like engaging champions (e.g., garnering buy-in from key clinic stakeholders and staff), outer setting constructs like patient needs and resources (e.g., addressing pertinent patient resource needs) and external policies and incentives (e.g., incentivizing clinics by addressing clinic needs), and inner setting constructs like leadership engagement (e.g., ensuring buy-in from organizational leaders as leadership changed frequently).

CONCLUSIONS

CFIR identifies important implementation factors for programs like TESSA that screen for high-risk populations and implement in primary care settings. The TESSA program implementation permits increased IPV screening among primary health care populations, thus promoting access to resources for otherwise hard-to-reach populations.

Exposure to Interpersonal Violence During Pregnancy and Its Association With Women's Prenatal Care Utilization: A Meta-Analytic Review

Inadequate prenatal care utilization has been proposed as a mechanism between exposure to violence during pregnancy and adverse maternal and fetal obstetric outcomes. Adequate prenatal care is important for identifying and treating obstetric complications as they arise and connecting pregnant women to supports and interventions as needed. There is some evidence that pregnant women experiencing relational violence may delay or never enter prenatal care, though this association has not been systematically or quantitatively synthesized. The present meta-analysis investigates the relationship between interpersonal violence during pregnancy and inadequate prenatal care utilization across two dimensions: (1) no prenatal care during gestation (k = 9) and (2) delayed entry into prenatal care (k = 25). Studies were identified via comprehensive search of 9 social science and health-related databases and relevant reference lists. Studies were included if (1) participants were human, (2) violence occurred in the context of an interpersonal relationship, (3) abuse occurred during pregnancy (including abuse within 12 months before the time of assessment during pregnancy), (4) the study was empirical, peer-reviewed, and included quantitative data, (5) prenatal care utilization data were available, (6) they were in English, and (7) they were not part of an intervention study. Results from random-effects models found that women abused during pregnancy were more likely to never enter care (odds ratio [OR] = 2.62, 95% confidence interval [CI] = [1.55, 4.42]) or to delay care (OR = 1.81, 95% CI [1.48, 2.23]). Sociodemographic, abuse-related, and methodological factors emerged as moderators. Practice, policy, and research implications are discussed.

Process evaluation of a systemic intervention to identify and support partner violence survivors in a multi-specialty health system

BACKGROUND

Intimate partner violence (IPV) is highly prevalent in the United States and impacts the physical and mental health and social well-being of those who experience it. Healthcare settings are important intervention points for IPV screening and referral, yet there is a wide range of implementation of IPV protocols in healthcare settings in the U.S., and the evidence of the usefulness of IPV screening is mixed. This process evaluation investigates the facilitators and barriers to implementing Coordinated Care for IPV Survivors through the M Health Community Network ("M Health Network"), an intervention that aimed to standardize IPV screening and referral in a multi-specialty clinic and surgery center (CSC). Two validated IPV screens were introduced and mandated to be done by rooming staff at least once every 3 months with all clinic patients regardless of gender; the Humiliation Afraid Rape Kick (HARK) for presence of IPV and the shortened Danger Assessment (DA-5) for lethality of IPV. Upon a positive screen, the patient was offered immediate informational resources and, if willing, was referred to a social worker for care coordination with a community organization.

METHODS

Semi-structured, individual and group process interviews with clinic managers and clinic staff at 8 CSC clinics (N = 24) were undertaken at 3,12, and 27 months after intervention start. Semi-structured interviews were undertaken with the research team (N = 3) post-implementation. A Consolidated Framework for Implementation Research (CFIR) codebook was used to code data in two rounds. After each round, thick description was used to write detailed and contextual descriptions of each code. Facilitators and barriers to implementation were identified during the second round of thick description.

RESULTS

Facilitators to implementation were clinic staff support, dedication, and flexibility and research team engagement. Barriers were lack of prioritization, loss of intervention champions, lack of knowledge about intervention protocol and resources, staff and patient discomfort discussing IPV, and operational issues with screen technology.

CONCLUSIONS

The IPV protocol was implemented, but faced common barriers. CFIR is a complex, but comprehensive, tool to guide process evaluation for IPV screening and referral interventions in health systems in the U.S.