1. Prevention Against Violent Experiences (PAVE)
Successes and Barriers in the Implementation of Computerized Screening

2. AUTHORS Lise E. Fried, DSc, MS,1 Megan Gerber, MD, MPH,2 Elizabeth Claggett-Borne, LMFT, MEd,3 Emily Chiasson, MSW, MPH,1,3 Yadira Ramos,3 Omonyele Adjognon, MPH,1 Alice Verhoeven, MS,3 and Kathleen Harney, MD3
1Institute for Community Health 2Veteran’s Administration 3Cambridge Health Alliance

3. Outline Background on screening and intervention PAVE: primary goals
Computerized screening tool
Implementation
Screening results
Challenges and successes

4. Background Screening for DV is controversial
Up to 50% of primary care patients have a lifetime prevalence of DV
Boston OB/GYN patients have a 12.7% annual prevalence and 35% lifetime prevalence of DV
Screening rates for DV remain low in health care settings
Research into screening strategies for vulnerable/underserved populations lacking
Alternative screening methods effective

5. PAVE Primary Goals Increase DV screening and detection rates by:
Improving standardization of screening
Developing and piloting a computerized DV tool
Provide follow-up intervention for DV victims
Focus on under-served victims
Provide DV response training for health care providers and clinic personnel
Funding:
3 Yr VAWA STOP Grant ( ) through the Massachusetts Executive Office of Public Safety and Security (EOPSS)
Private donors
Cambridge Health Alliance

6. PAVE Activities Train clinic staff about DV
Develop computerized screening tool
Do baseline medical record review on screening
Hire part time DV advocate

7. Computerized Screening
Allows patients to self-disclose DV confidentially
Can be used for health education
Well-suited for low-literacy populations
Can be translated into multiple languages to serve diverse populations
Generates reports that can guide providers - focus on assessment, counselling, and referrals

8. The Computerized DV Screening Tool
Created using Authorware software
Touch screen computers
Takes 5-10 minutes to complete
Implemented in 4 languages: English, Haitian Creole, Spanish, and Portuguese
Audio-recorded feature
All responses collected in database
Automatic printout generated at end of screening for provider review

9. Implementation Started in September 2007 in 1 clinic
Second clinic added in May 2008
Chief of OBGYN piloted
Rolled out to all providers in both clinics

11. Results

12. Results of Baseline Medical Record Review
Clinic 1: Sept – Dec 2005, Clinic 2: March to December 2006
873 valid records – 505 people
15.5% screened
9.0% current DV
20.5% lifetime DV

13. Medical Record Review: Screened vs. Not Screened
One clinic more likely to screen (19% vs. 11%)GYN
More likely to get screened prenatally than at a GYN visit (24% vs. 13%)
Nurses more likely to screen than MDs (24% vs. 11%)

14. Screening Data Roll-out: Clinic 1 - Sept 2007, Clinic 2 - May 2008
Data through April 7, 2009
300 screens in Clinic 1 (90%, n=271, completed)
57 screens in Clinic 2 (91%, n=52 , completed)
9.5% of women refused to continue with screening

15. Screening Trends at Clinic 1
After peaking in May 2008, there has been a significant decrease in the number of women screened.
Screening rates in January through March of 2009 are similar to those in 2008

16. Screening Trends at Clinic 2
Screenings in clinic 2 peaked at start up in May 2008 but experienced a significant decline in the number of women screened by December 2008.
In January 2009, screening prevalence was at almost half of what it was at start up in May 2008, and further declined in March.

17. Screenings: Patient Demographics
Site
Clinic 1
Clinic 2
Number
Percent
Type of Visit
GYN
257
85% 44
77%
Post Partum 7 2% 2 3%
Pre Natal 36
12% 11
19%
Language
English
220
73% 20
35%
Spanish 30
10% 6
Portuguese 47
15%
52%
Haitian Creole 3 1% 1

18. Domestic Violence Positive Patients by Type of Visit
Clinic 1: 65 women screened positive (24% )
Clinic 2: 8 women screened positive (15% )

19. Domestic Violence Positive Patients by Language

20. Domestic Violence Positive Patients
15-24% of the women report DV
Approximately 1/2 DV+ women report current experience of DV ( in the past year)
About 12% of DV+ women request to speak to advocate at clinic 1
About 37% of DV+ women request to speak to advocate at clinic 2

21. Satisfaction with Screening Tool
Positive Screen No
Yes
Percent
How comfortable did you feel answering questions on this computer?
Not comfortable 1%
Somewhat comfortable 8%
30%
Very comfortable
90%
69%
How comfortable did you feel answering to these questions here in the exam room? 4% 5%
24%
94%
71%
How easy was it to understand the information given to you today?
Somewhat easy
Very easy
98%
95%

22. PAVE: FAST TRACK Report Clinics 1 & 2

23. Challenges & Successes
DV screening one more task for MAs and providers
Introducing screening tool to patients difficult
Availability of DV advocate
Sustainability
Success:
Patients like and trust computerized screening
Standardized screening
More patients being educated about DV
DV patients seen by advocate

24. Next Analyses Are more women being screened?
Is more DV being detected?
Is advocacy/intervention making a difference?

25. Acknowledgements Cambridge Health Alliance
WHC provider teams at the clinics
Patients at the clinics
ICH Data and Evaluation Team
Victims of Violence Program
Yadira Ramos, screening tool developer, Community Affairs Department
Megan Gerber, MD, MPH
EOPSS and private donors

26. Any questions or comments?