System Issues: Challenges to Intimate Partner Violence Screening and Intervention

Abstract

This ethnographic study examines the experiences of health care providers (HCPs) and advocates implementing intimate partner violence (IPV) screening and interventions in their health care organizations. Numerous policies and protocols have been developed to improve the response of HCPs to survivors of IPV. Typically studies have focused on HCPs with little attention to the role of organizations in providing care. The findings from this study highlight that even with IPV programs in place the organizational environment can contribute to suboptimal outcomes. Identified challenges included time constraints, organizational expectations for increased productivity, and dwindling organizational support and services for IPV. With the continuing debate regarding universal screening, this study illuminates the need for clinicians to have a supportive clinical environment and resources for IPV screening and intervention.

Mapping and exploring health systems’ response to intimate partner violence in Spain

“…Individual willingness and voluntarism remains a strong driver for actions, and it should be acknowledged that this motivation has generated changes all over the country. However, sustaining programs that rely on individual motivation becomes difficult if organizational structures do not change [13,27,46]. In terms of institutionalization of policies and programs, budget assignment is key.…”

“…It is important to fill this gap, since successful and sustained policy integration in the health sector cannot be achieved through isolated strategies directed towards individuals and/or health facilities alone, rather they should target larger health system functions, including: i) governance, ii) financing, iii) planning, iv) service delivery, and v) monitoring and evaluation [24,25]. Research shows that in order to sustain long-term improvements in the health sector response to IPV, changes should be made not only at the individual provider/facility level through training, but should also involve changes in health policies, protocols, managerial structures and practices [13,26,27]. …”

Possibilities for Intervention in Domestic Violence: Frame Analysis of Health Care Professionals’ Attitudes

“…To improve identification, routine screening for domestic violence-defined as asking all adult clients standardized questions about domestic violence when they present themselves to receive designated services-has been introduced in many social and health care settings (Laing, Humphreys, & Cavanagh, 2013;Spangaro, Zwi, Poulos, & Man, 2010). It is widely recommended that screening for domestic violence should be included in routine interviews, yet professionals often do not ask clients and patients about domestic violence and they do not recognize violence even in cases where the signs of physical violence are clearly evident (Bacchus, Mezey, & Bewley, 2003;D'Avolio, 2011;Lepp€ akoski, 2007; L. Robinson & Spilsbury, 2008;Piispa, Heiskanen, K€ a€ ari€ ainen, & Siren, 2006).…”

“…It has been shown that most victims presenting for social and health care are not screened and do not receive intervention (Furniss, McCaffrey, Parnell, & Rovi, 2007;Owen-Smith et al, 2008). Several studies have sought explanations for the low screening rates (D'Avolio, 2011;Thurston et al, 2009;Todahl & Walters, 2011). It has been suggested that social and health care providers fail to ask about domestic violence because of infrastructure barriers: time limitations, insufficient resources, and inadequate institutional support for screening.…”

Improving Injury Prevention Through Health Information Technology

“…Rates of screening for intimate partner violence are low, 37 although numerous organizations recommend routine screening or assessment. 10,38-41 To address identified barriers, 42,43 save healthcare provider time, and reduce patient reluctance to disclose, 44,45 CASIs have been developed.…”