A Resident Driven Initiative to Implement Intimate Partner Violence Screening in the Outpatient Pediatric Setting

Purpose/Objectives:

Background: Childhood exposure to Intimate Partner Violence (IPV) is considered one of the adverse childhood experiences (ACEs). Exposed children are at risk of psychological, emotional, and behavioral problems in addition to becoming victims of violence themselves. It is estimated that 1 in 15 children are exposed to IPV each year, with the highest rates in children 5 years or younger. Though abused parents are often reluctant to seek care for their own injuries, they will usually continue to ensure appropriate medical care for their children, therefore a pediatric office may be an ideal environment to screen for IPV. Most screening tools aim to identify social determinants of health, however in most questionnaires, IPV among the caretakers is not commonly asked about. Review of well-child (WC) visit records from the pediatric primary care clinic at New York Health and Hospitals/Jacobi, a municipal hospital in the Bronx, from December 2020 to Feb 2021 revealed a baseline of 0% having documented screening for IPV.

Objective: Our aim was to increase screening for IPV to 75% of families with children <6 years of age during WC visits. Data included is from the initial 6 week period after screening implementation.

Design/Methods: A resident-led QI project used the model for improvement with a multidisciplinary team of residents, pediatric physicians, social workers, nurses, administrative and information technology (IT) staff. A cause-effect diagram was developed by the team (Fig 1). Tests of change included development of a short screening tool, which was adapted from a longer validated questionnaire, in addition to staff education, interactive case-based workshops for providers, invited expert guest speaker, and embedding the tool with decision support directly into the WC visit template.

Results: In a 6 week period, a total of 1395 (WC) visits for children ages 0-5 years were conducted in the clinic. These visits were seen by residents, attendings, and mid-level providers. A median of 81.8% of WC visits of all patients <6 years old had the IPV tool administered (Fig 2). Of these families, 12 screened positive for IPV exposure and 1 for unsafe housing. They were referred to social work during that visit for further evaluation and assistance.

Conclusion/Discussion: As a result of directed education, training with case-based workshops, and embedding a screening tool into WC note templates, screening for IPV was significantly improved in the outpatient clinic setting. The tool helped identify at-risk children and provide resources to the families in need of support.