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2023 HSR&D/QUERI National Conference Abstract

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4063 — Veteran, provider, and setting characteristics related to bidirectional intimate partner violence screening implementation

Lead/Presenter: Candice Presseau ,  PRIME Center, Yale School of Medicine
All Authors: Relyea MR (PRIME Center, Yale School of Medicine), Runels, T (PRIME Center) Presseau, C (PRIME Center, Yale School of Medicine) Stover, C (PRIME Center, Yale School of Medicine) Brandt, C, A (PRIME Center, Yale School of Medicine) Martino, S (PRIME Center, Yale School of Medicine) Portnoy, G, A (PRIME Center, Yale School of Medicine)

The VHA Intimate Partner Violence (IPV)/Domestic Violence Plan for Implementation in 2013 recommended pilot screening for IPV use (i.e., perpetration) with the goal of reducing IPV through enhanced detection. Toward this aim, the IPV Center for Innovation and Research conducted a bidirectional IPV implementation pilot at six VHA facilities. The pilot included training VHA mental health providers to screen for bidirectional IPV (i.e., both IPV use and experiences) and implementation facilitation during a three-month pilot period wherein providers were encouraged to use a new bidirectional IPV screening instrument in their routine practice. The objective of the current study was to identify Veteran, provider, and setting factors associated with screening.

We examined electronic health records for 1707 eligible Veterans seen by the 25 participating providers during the pilot period and post-test surveys administered following the provider training, prior to implementing screening. We conducted chi square analyses to identify Veteran and encounter characteristics associated with screening. We also examined correlations between provider post-test scores (e.g., motivation) and provider screening rates.

Rates of screening out of eligible Veterans varied across pilot facilities (5.4-17.8%) and providers (0-45.5%). Providers were more likely to conduct screening with Veterans who were White (12.5%) compared to Black (6.3%, p < .01), Hispanic (16.2%) compared to non-Hispanic (10.5%, p < .01), and who had prior screening for IPV experiences (14.1%) compared to those who had not (10.1%, p < .05). Other Veteran demographic characteristics (e.g., gender, age) and psychosocial difficulties (e.g., alcohol use, PTSD) were not associated with screening. Providers also screened more Veterans when working in primary care (21.1%) or substance use disorder clinics (27.5%) rather than a mental health (7.2%), PTSD (4.8%), or PCMHI (4.3%) clinics (all p < .001). Screening rates of providers were not associated with any provider post-training attitudinal scores, including self-reported individual or organizational readiness to screen, preparedness, perceived or actual IPV knowledge, or perceived barriers to screening.

Results indicate that Veteran characteristics and clinic settings were associated with screening for bidirectional IPV whereas provider attitudes were not. Provider motivation alone may be insufficient to encourage implementation of bidirectional IPV screening into routine clinical care. Results suggest that providers may prioritize screening certain Veterans (e.g., those with prior IPV experience screening), possibly due to the infeasibility of screening all patients given time limitations. Yet, findings indicate screening may be more feasible in particular clinics. Future research should determine whether provider judgements concerning whom to screen are identifying Veterans at highest risk for IPV. It is unclear why providers were more likely to screen White and Hispanic Veterans. Research is necessary to understand these disparities and the impact differential screening could have on referrals and outcomes for Veterans of other races or ethnicities.

Effective provider training, facilitation, and validated screening tools may be necessary yet not sufficient to encourage successful implementation of bidirectional IPV screening. Identifying contextual and organizational factors that can help enhance implementation may be critical to increase screening and referrals for treatment to reduce IPV among Veterans.