Transforming the Health Care Response to Intimate Partner Violence

Young-Wolff, Kelly C.; Kotz, Krista; McCaw, Brigid

doi:10.1001/jama.2016.4837

Cited by 36 publications

(32 citation statements)

References 9 publications

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“…Additional research should further examine the role and mechanisms of childhood stress and trauma exposures as independent predictors of healthcare utilization, potentially identifying factors suitable for intervention. Even in the absence of a full understanding of the underlying mechanisms driving the association of ACEs with healthcare costs, our finding of this independent relationship between ACEs and high costs suggest the potential value of better and earlier ACEs screening, prevention, assessment and trauma-informed treatment in healthcare settings ( Young-Wolff et al, 2016 ). Experiences of IPV as an adult, while not an independent predictor, was associated with high cost status at the bivariate level, underscoring the relationships we found between trauma exposure and healthcare costs.…”

Section: Discussionmentioning

confidence: 94%

Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs

Sterling

Chi

Weisner

et al. 2018

Preventive Medicine Reports

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A high proportion of U.S. health care costs are attributable to a relatively small proportion of patients. Understanding behavioral and social factors that predict initial and persistent high costs for these “high utilizers” is critical for health policy-makers. This prospective observational study was conducted at Kaiser Permanente Northern California (KPNC), an integrated healthcare delivery system with 4.1 million members. A stratified random sample of high-cost vs. non-high-cost adult KPNC members matched by age, gender, race/ethnicity, type of health insurance, and medical severity (N = 378) was interviewed between 3/14/2013 and 3/20/2014. Data on health care costs and clinical diagnoses between 1/1/2008 and 12/31/2012 were derived from the electronic health record (EHR). Social-economic status, depression symptoms, adverse childhood experiences (ACEs), interpersonal violence, financial stressors, neighborhood environment, transportation access, and patient activation and engagement were obtained through telephone interviews. Initial and subsequent high-cost status were defined as being classified in top 20% cost levels over 1/1/2009–12/31/2011 and 1/1/2012–12/31/2012, respectively. Psychiatric diagnosis (OR 2.55, 95% CI 1.52–4.29, p < 0.001), financial stressors (OR 1.97, 95% CI 1.19–3.26, p = 0.009), and ACEs (OR 1.10, 95% CI 1.00–1.20, p = 0.051) predicted initial high-cost status. ACEs alone predicted persistent high-cost status in the subsequent year (OR 1.12, 95% CI 1.00–1.25, p = 0.050). Non-medical factors such as psychiatric problems, financial stressors and adverse childhood experiences contribute significantly to the likelihood of high medical utilization and cost. Efforts to predict and reduce high utilization must include measuring and potentially addressing these factors.

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Section: Discussionmentioning

confidence: 94%

Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs

Sterling

Chi

Weisner

et al. 2018

Preventive Medicine Reports

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“…Model guidelines and resources for a health system response to violence against women have been developed by the World Health Organization 33,34 . The US HMO Kaiser Permanente have described policies and processes for responses to violence among their client populations 35 . Clinicians in all health care services should have a high index of clinical suspicion especially among young women with unwanted pregnancies, partner violence or illicit drug use and provide non‐judgmental responses, safety planning, information and referrals to supportive services in order to reduce the number of abortions in Australia.…”

Section: Resultsmentioning

confidence: 99%

Factors associated with induced abortion over time: secondary data analysis of five waves of the Australian Longitudinal Study on Women’s Health

Taft

Powell

Watson

et al. 2019

Australian and New Zealand Journal of Public Health

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Objective: A trend analysis of associations with induced abortion. Methods: Secondary analysis of the 1973/78 cohort of the Australian Longitudinal Study of Women’s Health of women responding to two or more consecutive surveys out of five (N=9,042), using generalised estimating equations. Results: New abortions dropped from 7% to 2% at surveys 4 and 5. By survey 5, 16% of respondents reported abortions, only 2% of them new. Women aged in their twenties were more likely to terminate a pregnancy if they reported less‐effective contraceptives (aOR2.18 CI 1.65–2.89); increased risky drinking (aOR1.65 CI 1.14–2.38); illicit drugs ≤12 months (aOR3.09 CI 2.28–4.19); or recent partner violence (aOR2.42 CI 1.61–3.64). By their thirties, women were more likely to terminate if they reported violence (aOR2.16 CI 1.31–3.56) or illicit drugs <12 months (aOR2.69 CI 1.77–4.09). Women aspiring to be fully‐ (OR1.58 CI 1.37–1.83) or self‐employed (OR1.28 CI 1.04–1.57), with no children (OR1.41 CI 1.14–1.75) or further educated (OR 2.08 CI 1.68–2.57) were more likely to terminate than other women. Conclusions: Abortion remains strongly associated with factors affecting women’s control over reproductive health such as partner violence and illicit drug use. Implications for public health: Healthcare providers should inquire about partner violence and illicit drug use among women seeking abortion, support women experiencing harm and promote effective contraception.

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“…Initiating universal, evidence‐informed IPV screening practices in a busy clinical setting is challenging under the best of circumstances. Wolff and colleagues describe a large health care system that has integrated domestic violence identification and response, but for many, addressing “wicked problems” continues to be a challenge . Here, we have described our adaptation of the Active Implementation Framework to facilitate the early stages of such a programme in a busy, urban fracture clinic.…”

Section: Discussionmentioning

confidence: 99%

Using implementation science to build intimate partner violence screening and referral capacity in a fracture clinic

Velonis

O’Campo

Rodrigues

et al. 2019

Evaluation Clinical Practice

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Rationale, aims, and objectives: Over the past two decades, research informing good clinical practices related to intimate partner violence (IPV) has been plentiful, yet partner violence screening remains challenging to translate into action. In spite of the documented efficacy of routine screening for women of reproductive age and the availability of validated screening instruments, many IPV screening programmes lack the components necessary for success. In Toronto, a multidisciplinary team of researchers and clinicians is using the tools of implementation science to scale up an evidence-based IPV screening and response programme in an urban orthopaedic clinic where prior screening attempts have been ineffective.Methods: Using the Active Implementation Framework as a guide, researchers collected data across multiple sources to inform the first stage of implementation. Analysis focused on identifying the characteristics of the clinic that support or hinder implementation of new processes, evidence-based screening practices that fit with the clinic, and characteristics of a strong implementation team.Results: Through this process, researchers and clinicians uncovered organizational strengths and weaknesses related to IPV screening that may not have been identified previously. The need to incorporate technology into our screening processes became apparent, as did the importance of shared communication and colearning between clinicians and researchers. Conclusions:The benefits of investing in the preparatory phases of implementation are discussed. Without undertaking the process of gathering and analysing data, examining the factors that support effective and sustainable implementation, and investing in the creation of a strong implementation team, it is likely that decisions about our screening approaches would have resulted in a less-effective and sustainable process.

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Transforming the Health Care Response to Intimate Partner Violence

Cited by 36 publications

References 9 publications

Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs

Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs

Factors associated with induced abortion over time: secondary data analysis of five waves of the Australian Longitudinal Study on Women’s Health

Using implementation science to build intimate partner violence screening and referral capacity in a fracture clinic

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