UNIVERSAL IPV SCREENING AT PLANNED PARENTHOOD, NYC Leslie Rottenberg, LCSW Center Director, Margaret Sanger Center

UNIVERSAL SCREENING: POLICY AND PROCEDURE PPNYC has had an existing policy regarding IPV screening in its Health Centers since – “every woman, every visit” – Two questions on medical history – Staff verbally asked client if “yes” on medical history, or if there was ‘clinical indication’ – Training for staff once a year

POLICY AND PROCEDURE cont. On-site Health Center Social Workers available for crisis intervention, limited counseling and referrals to other agencies. Policy on referrals to Center Social Worker (Minors vs. Adults) Referral manual for other agencies and services

Two phases of research used to Develop a Screening Tool for IPV in Young Women Leslie Davidson +, Niki Palmetto +, Kathleen Jones+, Vaughn Rickert+, Vicki Breitbart #, Jini Tanenhaus #, Leslie Rottenberg #, Tamu Aljuwani #, Melissa Forbes #, Michelle Zeitler +, Cari Olsen +, Lynne Stevens^ (+Mailman School of Public Health, Columbia University, #Planned Parenthood of NYC, ^Boston University)

FUNDING Research Funded by the CDC. Planned Parenthood partnered with the Columbia University Center for the Prevention of Youth Violence.

SURVEY: Phase 1 of Research Anonymous A-CASI survey of 645 ethnically diverse women (15-23yr) found 46% of young women reported physical or sexual violence in current relationship Women’s views of screening were also evaluated to develop the tool.

Focus Group Results 1 Women do not want to be talked down to by a provider. Providers should ask about the relationship before launching into questions about violence (i.e., “How is your relationship going?”). Providers should not use terms “violence” or “abuse,” but descriptions of behaviors. Providers should normalize screening questions. Providers must be clear about limits of confidentiality and of intervention young women

Recommendations from women who had disclosed abuse What would make women more likely to disclose in the future? – Confidentiality assured – Clinic environment is friendly and understanding – Comfort with provider, harder if it is a man 1 – Provider wouldn’t take any action without patient’s permission 1 64% 15-19, 26% – p<07

Screening: Recommendations 1 from the women surveyed – 87% would not mind being asked2 2,3 – 73% felt they could be honest – 90% of women feel screening all women is a good or a very good idea 2 – 74% of women would find it easier if the provider were a woman 3 1 Whole sample of 645 women 2 Varies by violence experience 3 Varies by age or ethnicity

Participants’ views: Who Should Be Asking them? Parents – 90% mom – 73% dad – 65% stepmom – 57% stepdad Professionals – 95% health care professional – 89% counselor or social worker – 58% coach

Survey Conclusions High prevalence rates in young women Many young women are exposed to several types of violence in their relationships, and rarely are they exposed to ONLY one. Violence affects women’s contraceptive use Young women support being asked about IPV, particularly by their health care provider Many women who consider themselves abused are not disclosing IPV to their providers.

PHASE 2 OF RESEARCH: Randomized Trial of Three IPV Screens 3 Screen Types:  “Basic”  “Healthy Relationship”  “Mutual”

The “Basic” Screen (5 questions) In the Past Year: (Never, Seldom, Sometimes, Often, Always) My partner is suspicious that I am unfaithful My partner forced me to have sex when I didn’t want to. My partner hit, slapped, or physically hurt me on purpose Ever in your lifetime: (Yes / No) Have you ever been slapped, hit, or otherwise physically hurt by any partner? Has anyone ever raped you or forced you into a sexual act?

The “Healthy Relationship” Screen (7 Questions) “Basic” Screen PLUS: My partner respects me My partner treats me well Responses: Never, Seldom, Sometimes, Often, Always

The “Mutual” Screen (8 questions) “Basic” Screen PLUS: in the past year I am suspicious that my partner is unfaithful I forced my partner to have sex when s/he didn’t want to I hit, slapped, or physically hurt my partner on purpose Responses: Never, Seldom, Sometimes, Often, Always

Implementing Screening was integrated into existing reproductive health care services Medical providers were given a series of extensive training sessions Follow-up with medical providers was done to gather feedback of provider experience.

TRAINING CONTENT Definition of Intimate Partner Violence. Views and values around IPV and screening. Why Screen in a health care facility? Trial of three screens and procedures. Feedback of results at end of trial.

RESEARCH TRIAL CONCLUSIONS RESEARCH TRIAL CONCLUSIONS All three screens performed well, and were significantly improved over previous practices. No screening approach performed better than the others.

WHERE ARE WE NOW? Revision to medical history using data from trial of 3 screens Additional training for providers given research feedback Monitoring the process – Yearly chart audit – Feedback from providers and social workers