Step 9: Document, Assess, and Adjust
Harsha Mehta, Director of clinic operations voiced her commitment to screening succinctly: “we screen every patient, every time”.
The screening was launched in November 2015 and within the first six month a total of 2,676 patients were screened. These assessments are documented in electronic patient files. Of these, 98 screened positive for domestic violence and 35 of those patients received additional advocacy, intervention or referrals to domestic violence agencies. Local law enforcement was called four times to provide immediate assistance to victims. Additionally, every patient recieved basic domestic violence education and information cards.
Three months after the routine screening began, MayView was able to bring back their behavioral health program and along with it Behavioral Health Family Nurse Practitioner, Carolyn Purcell, who assumed a leadership role in the assessment process. With this personnel change came a change in approach. Rather than screening patients verbally, the clinic staff transitioned to providing patients with the questions printed on a half sheet of paper (in both English and Spanish). Driving the change was the belief that it would be better for the staff’s work flow and that allowing patients to respond in writing in a private room while waiting for their doctor would facilitate a more honest response.
Since the implementation of the screening, MayView has also expanded its program offerings to patients, in large part thanks to the needs assessment. They now offer a domestic violence support group in Spanish through a third party provider and are optimistc they will be able to offer an English language support group soon.
A Note About Best Practices
Futures Without Violence’s publication National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Healthcare Settings advocates asking screening questions directly. They recommend framing the questions using phrases that let patients know they are not being singled out and then moving into very simple, direct and nonjudgmental questions. This allows staff to ask follow up questions, builds trust and sets the stage for immediate interventions if needed or desired.
When MayView was considering changing their screening process they looked at best practices put in place by Kaiser and other large providers and saw they were successfully screening patients using written questions. Harsha Mehta stated “if a provider has their back turned to the patient because they are inputting the answers into the computer it is easy for a patient to just answer no to every question. Giving them the questions and letting them answer in private and handing the answers directly to their providers lets them feel like they can be truthful”. Mehta believes the changes have resulted in better results and better data.