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.

Development and implementation of tablet-based screening for interpersonal violence in primary care settings.

Technology Enhanced Screening and Supportive Assistance (TESSA) is program that includes a patient-facing mobile web app designed to identify primary care patients with a history of interpersonal violence (IPV). The implementation study included 1495 participants screened. Approximately one in four reported experiences with intimate partner violence (29%) or sexual assault (24%). Among those offered health advocacy services based on their victimization experiences, 31% indicated they wished to accept the assistance. We conclude that a tablet-based self-screening tool in primary care clinics is a viable way to identify and offer services to people who have experienced interpersonal violence.

The Body in Crisis: A Health Needs Assessment among Female Survivors of Interpersonal Violence.

BACKGROUND: When women who experience violence seek social services, they are looking to meet immediate needs: shelter, safety, and support. Seeking assistance as part of a crisis may inadvertently detract attention away from other critical needs. Literature illustrates the emotional and physical effects of violence on women's bodies, as well as their long-term health. While health may present as an urgent need in cases of serious injury, it is often overlooked in crisis-oriented service delivery systems. This study explored the experience with violence, health status, and holistic healthcare needs among women accessing interpersonal violence services in Texas. METHODS: A tablet-based survey was conducted at a family justice center, rape crisis center, and emergency shelter among women (N = 99) in Fort Worth, Texas. Survey questions assessed the participants' demographic information, health status, health needs, healthcare utilization, barriers to accessing healthcare, and experience with interpersonal violence among participating women. RESULTS: Two-thirds of the sample reported suffering injuries from victimization experiences. More than half of the sample (62%) reported they went to the emergency room at least one time in the last 6 months, with 11 women reported staying five or more nights in the hospital in the last 6 months. Participants described urgent (e.g., advised by healthcare provider, too serious for a clinic) and non-urgent (e.g., not having another source of care, closest provider) reasons for using the emergency room. Roughly, half of the sample (50%) reported having at least three chronic conditions. DISCUSSION: This study illustrated that women seeking interpersonal violence related (IPV) services have multiple unmet needs and lack adequate access to physical and mental health care. Since the majority of the sample was living in poverty, there are multiple costs and investments in the participants' health that were forgone for their survival. This study provides data in support of the development of health-related services for IPV survivors.

Bystander Intervention Programming with Faculty: Recommendations for Institutions of Higher Education.

While bystander intervention programs have been implemented to help prevent sexual violence on campus, little is known about the impact of these programs on faculty members. We examined faculty perspectives and motivations regarding participation in a faculty-focused bystander intervention program. We facilitated three faculty focus groups (N = 10) in 2017 at a southwestern university in the U.S. Faculty were recruited through their voluntary participation in a faculty bystander intervention program. We found that faculty gained a variety of new skills from their participation in this program including new vocabulary to facilitate sensitive conversations, increased awareness regarding best practices for intervention, and practical tools to apply when intervening. Study results also revealed strategies for implementing faculty-focused bystander intervention programs that will increase the likelihood that they will affect changes in bystander behavior at all levels of the university and promote cultures of non-violence at institutions of higher education.

Use of a Health Advocacy Model for Survivors of Interpersonal Violence.

This article examines the implementation of a health advocacy model designed for survivors of interpersonal violence (IPV) in a metropolitan area of North Texas. Using a framework influenced by motivational interviewing, solution-focused therapy, and trauma-informed care, this program engaged IPV survivors in creating health and safety goals. Goal attainment scaling was used to track progress after each health advocacy encounter. Clients could set their own goals for healthcare, self-care, and safety. The program served 419 clients and 648 goals were set by clients at the first visit. Among all goals, 89% selected goals focused on healthcare, with 47% of those selecting obtaining health insurance or coverage as a need. These results demonstrate the need for an enhanced healthcare response for this population. The remaining goals selected were self-care (7%) and safety (3%). The design of the health advocacy intervention shows promise towards filling the gaps between IPV and healthcare service delivery systems.