Step 5: Develop Protocols
The initial protocol was drafted by the Project Coordinator after reviewing existing Intimate Partner Violence protocols available from leaders throughout the field, such as Futures Without Violence.
The Project Coordinator already had a rough idea of what the process might look like and MayView staff had previously identified how staff clinic staff might have a hand in the process. The draft was presented to MayView for review and staff made revisions based on their knowledge of what was needed during collaborative meetings. The back and forth was substantial and as the discussions progressed, several issues bubbled to the surface.
First, there was the question of exactly who needed to be screened. The Affordable Care Act mandates that all adolescent and adult women be screened for intimate partner violence. However, MayView’s Director of Clinic Operations, Harsha Mehta,strongly advocated that all patients be screened.
“Based on our earlier meetings, I already had an idea of what was needed to suit MayView’s workflow. I wanted to devise a method that was both easy to implement and would not be time consuming for the clinic staff” – Erica Villa, Project Coordinator, Next Door Solutions
Second, was the issue of staff reluctance to ask the screening questions, largely because they were unsure how to ask them or they were afraid they would inadvertently say the wrong thing . Domestic violence and suicidality are at the top of the list of things that are difficult for staff. MayView wanted to be sensitive to this and NDS developed trainings for MayView to empower staff to feel confident in asking the screening questions.
The third issue to be addressed was how to integrate domestic violence education into all visits, so that there was a preventive component to the screenings as well. The collaborative agreed that regardless of whether a patient screened positive, all patients would receive basic domestic violence education including a small wallet-sized card outlining characteristics of a healthy relationship as well as indicators of potential abuse. Because studies have shown that screening in and of itself is always effective, this prevention strategy serves as solution to reaching patients who do not disclose.
Maintaining compliance with mandated reporting regulations and how providers could balance the need to establish rapport and trust with patients was a prominent and ongoing discussion.
Sample Screening Tool
- Within the past year or since you became pregnant, have you been hit, slapped, kicked or otherwise physically hurt by someone?
- Are you in a relationship with a person who threatens to or physically hurts you?
- Has anyone forced you to engage in sexual activities that made you feel uncomfortable?