MayView approved the protocols in October 2015 and launched the official screening tool in November. As a result of the trainings and extensive promotion of the the tool, the initial implementation went smoothly.
Domestic violence screening was conducted before all primary care visits, family planing visits, pediatric and prenatal visits. All women and adolescent girls (18+) were screened, as were men or boys who presented with signs of abuse. The screening took place when the patient was in the exam room, just after the Medical Assistant took their vitals and before the physician came in for the exam. If the patient screened positive for possibly experiencing domestic violence, the physician was notified. The patient would be asked questions to determine the history of abuse and the physician would look for signs of injury or scars. The patient was then referred to the onsite advocate who would assess the immediate risk for the patient (where they safe to go home?), the risk for children in the home (was the perpetrator or patient harming them?), what resources or assistance was the patient interested in and whether the patient was at risk of suicide. The advocate could then conduct further assessment in conjunction with a local domestic violence service provider if the patient wished. Advocates would emphasize that patients were not at fault for being abused, that there was no excuse for violence, they were not alone and that there were several avenues available to them for help.
- Screen for domestic violence in a safe environment. -Use your own words and speak in a non-threatening, nonjudgmental manner. Ensure you have privacy before asking about domestic violence. When screening for domestic violence, have friends, family or significant others wait in another room. If it is not possible to screen for domestic violence privately or safely, do not screen the patient and arrange for return visit.
- Ask questions that are direct, specific and easy to understand. For example: "Are you in a relationship with a person who threatens or physically hurts you?". If the patient has a physical injury: "Many people come in with injuries like yours and often they are from someone hurting them. Is this what happened to you?"
- When unable to converse fluently in the patient's primary language use a professional interpreter or another healthcare provider fluent in the patient's language. The patient's family, friends or children should not be used as interpreters when asking about domestic violence.
- Screen verbally in addition to any written questionnaire form.
- Document that domestic violence screening was complete.