2023 HSR&D/QUERI National Conference

1075 — Piloting the implementation of bidirectional intimate partner violence screening in routine mental health care: A mixed methods evaluation

Lead/Presenter: Galina Portnoy,  COIN - West Haven
All Authors: Portnoy GA (VA Connecticut Healthcare System; HSR&D PRIME Center; Yale School of Medicine), Presseau C (VA Connecticut Healthcare System; HSR&D PRIME Center; Yale School of Medicine) Orazietti S (VA Connecticut Healthcare System; HSR&D PRIME Center) Runels TN (VA Connecticut Healthcare System; HSR&D PRIME Center) Relyea MR (VA Connecticut Healthcare System; HSR&D PRIME Center; Yale School of Medicine) Walls S (San Diego VAMC) Parkes DJ (San Diego VAMC) Parmenter M (VA Connecticut Healthcare System) Bruce LE (National Intimate Partner Violence Assistance Program, Care Management & Social Work) Brandt CA (VA Connecticut Healthcare System; HSR&D PRIME Center; Yale School of Medicine) Martino S (VA Connecticut Healthcare System; HSR&D PRIME Center; Yale School of Medicine)

In 2014, Veterans Health Administration (VHA) began implementing recommendations for screening women Veterans for IPV experiences (i.e., victimization) and “at risk” Veterans for IPV use (i.e., perpetration), formalized by VA Directive 1198 in 2019. These efforts significantly enhanced screening for IPV experiences, yet screening for IPV use or bidirectional IPV (i.e., both partners engaging in relationship violence) remains limited due to minimal tools and protocols for screening. In partnership with the VA Office of Care Management and Social Work’s National IPV Assistance Program (IPVAP), we conducted a multi-site bidirectional IPV screening implementation pilot in six VA medical centers to assess reach, effectiveness, adoption, acceptability, and feasibility of implementation.

We developed and disseminated a screening and implementation package, including a validated bidirectional IPV screening tool, clinician training and toolkit, CPRS templates, and implementation materials. We used implementation facilitation, with our team serving as external facilitators and imbedded IPVAP Coordinators as internal facilitators who provided training, consultation, and support to participating mental health clinicians (N = 26). The Theoretical Domains Framework guided semi-structured qualitative interviews to assess capacity and motivation to screen and acceptability and feasibility of screening. The RE-AIM framework was used to evaluate reach, effectiveness, and adoption of screening implementation.

To assess reach of screening implementation, we examined electronic health record data from 1,707 Veterans eligible for screening during the 90-day pilot period revealing that 194 (11.4%) Veterans were offered screening and 154 (9.0%) completed screening. Among those screened, 82 (53.2%) denied IPV experience and use, 52 (33.8%) endorsed bidirectional IPV, 12 (7.8%) reported IPV experiences only, and 8 (5.2%) reported IPV use only. Qualitative analysis of post-pilot clinician interview data revealed themes demonstrating acceptability of bidirectional IPV screening. Clinicians stated that screening was important, reduced stigma, created new opportunities to discuss relationship health (particularly with male Veterans who have historically not been a focus of IPV screening within VA), and improved care through increased referrals to appropriate follow up services. Other emergent themes included Veterans’ openness and receptiveness to bidirectional IPV screening and benefits of the implementation facilitation support provided by embedded IPVAP Coordinators. However, critical feasibility barriers to screening implementation emerged, including the length of time to complete screening and follow up procedures, competing priorities, and high burden/low user-friendliness of the CPRS template.

Results from this highly partnered, multi-site screening implementation indicate that bidirectional IPV among Veterans is common, and screening for it appears effective, acceptable, and well-suited for an implementation facilitation model. However, improving feasibility of the instrument and procedures to ensure fit in busy healthcare settings is needed to enhance reach and adoption.

VHA has demonstrated a strong commitment to relationship health and safety and remains invested in developing and evaluating strategies for detecting and treating IPV. Implementation of bidirectional IPV screening in routine mental healthcare can effectively detect positive cases of IPV use and experience and connect Veterans to care. Continued operational partnerships and implementation research is needed to address feasibility barriers related to screening adoption.