Improving Response to Partner Violence
Julie Goodrich, Violence Prevention Program Supervisor
Chris Sorvari, Senior Research Analyst, Multnormah County Health Department
As part of the demonstration project, a violence screening tool, The Home Violence Screening Questionnaire, was designed to identify the behaviors associated with IPV and the physical consequences. This innovative questionnaire asked about violent situations from both the victim's and perpetrator's perspectives. In addition to the tool development, the project included training providers on how and when to use the screening tool, and how to offer culturally-relevant services to women who disclosed abuse.
Screening rates for IPV did increase the first year in both home visiting and clinical settings following implementation of the project. However, higher rates of screening were more likely to be sustained at the home-visiting sites compared to the clinical sites in subsequent years. The success of the home visiting programs can be attributed to several factors: 1) home-visiting staff spent more time with their clients establishing trusting relationships that were conducive to discussing violence compared to the typical clinical provider-patient relationship; 2) home-visiting programs had more on-going contact with clients, and 3) home-visiting staff had more knowledge and experience connecting clients with outside services and resources.
Feedback from home-visiting staff and clinical providers was consistent in that they thought The Home Violence Screening Questionnaire was too long, too intense, and therefore uncomfortable to use. Additionally, home-visiting staff expressed concern that the intensity of the questionnaire made clients uncomfortable and resulted in superficial responses versus more spontaneous responses if clients were asked one or two direct questions. As a result of the feedback and the poor adoption of the tool, a new mechanism for violence screening for all of the home-visiting teams was developed by an internal work group. It is now the expectation that each client will be screened for violence at least once during their prenatal period, at least once during the postpartum period, and at any point during which the client experiences a significant change in her life. Providers are instructed to ask whether there is a history of violence, current physical or emotional violence, and whether the client needs or has a safety plan.
In addition to the shorter and more frequent screening protocol, screening rates have been incorporated into the annual performance measures that affect funding levels of the programs. Additionally, a client education packet was developed that covered IPV as part of a larger safety message—including emergency preparedness. This packet was developed as a way to diffuse the information enough to make it safe to bring home, comfortable to read, and not stigmatizing. Recognizing that all families need to prepare for emergencies, family violence can be discussed as a safety concern for families.
We learned that internal buy-in from the providers we are asking to conduct the screening and interventions with clients experiencing family violence was crucial to increasing and sustaining IPV screening rates. Building an experienced staff included ensuring that providers conducting the interventions were knowledgeable about any local laws and organizational guidelines that are relevant to reporting abuse, especially child abuse.
Time and time again, feedback from providers emphasized their discomfort in having a woman disclose violence and then not having any way to help her. Although resources were available to help, providers' perceptions of their availability was what mattered. As a result of this feedback, group trainings and individual case conferences were held with staff to ensure that they were knowledgeable and comfortable in screening for family violence.
How a program screens for violence is important, but not as important as deciding in the first place that screening for IPV needs to be done. Providers need to understand that asking a woman if she is being hurt is an intervention. This type of questioning from someone who is in authority and responsible for helping the individual stay healthy begins to let the woman know that violence isn't "normal," or something she has to put up with. After several times being asked, she may disclose or she might make decisions in her relationships that result in the violence ending. Screening for violence, even when disclosure of violence isn't forthcoming or services aren't readily available, can help a client make some decisions about her self worth and life that will ultimately keep herself and her family safer.
An additional consideration to support providers who are screening and intervening for IPV is that staff supervisors need to provide a mechanism for debriefing in order to reduce vicarious trauma. Staff voiced the need to "vent" after working with clients living with high levels of violence and stress. Having the opportunity to case conference helped staff feel that they were working appropriately with their clients.
The Reducing Family Violence Grant ended in 2005 and screening for violence has been sustained as part of daily practice within the Early Childhood Services of Multnomah County Health Department. A resource guide with information/protocols for providers was developed and disseminated. This guide entitled "Improving Response to Partner Violence" can be downloaded at www.mchealth.org/violprev.