On Your Mark, Get Set, Go: A Descriptive Study of Initial Implementation of Universal Intimate Partner Violence Screening at a Veterans Health Administration Facility

Abstract

Intimate partner violence (IPV) negatively impacts mental, physical, and social health, and veterans are at a greater risk for experiencing lifetime IPV than civilians. Prior research has identified facilitators and barriers to sustained implementation of IPV screening but has often focused solely on screening reproductive-aged women or screening within a single clinical setting. In contrast, the Veterans Health Administration (VHA) IPV Assistance Program has recently developed a comprehensive plan for universal training and education of all staff and universal screening and intervention for all veterans, which, to our knowledge, is the first such large-scale IPV program. This program evaluation project examines the plan’s initial implementation across multiple clinical settings at one VHA site following a concerted training effort of 422 interdisciplinary staff. Over 17 months, clinicians completed 2,596 screenings out of 4,128 screening opportunities utilizing the Hurt, Insult, Threaten, and Scream tool. Eighteen percent of veterans screened positive for past-year IPV experience; of those, 29% screened positive on a secondary screen for acute safety needs and risk for lethality. Female veterans were screened more frequently than male veterans (χ2= 119,p< .001) and younger veterans more frequently than older veterans (effect of age strata ≤47, 48–64, or ≥65: χ2= 107,p< .001), but all age strata and genders had clinically important rates of positive screens. In addition to establishing local baseline prevalence, data on screening outcomes by sex, age, deferred screening opportunities, clinics where screening occurred, and interventions utilized offer insights on the impact of training, specific barriers, and future directions for enhancing and expanding training and screening efforts.