Marisa Bartley, DO

Title: Implementing Screening for Intimate Partner Violence in Pregnancy

Authors: Marisa Bartley, DO; Gretchen Crum, LCSW; Alissa Cohen, DO; Stephanie Richards, MD; Lindsay Nakaishi, MD MPH; Phil Phelps LCSW BCD

Introduction:

Pregnant women are high risk for intimate partner violence (IPV) and the American College of Obstetricians and Gynecologists recommends IPV screening during pregnancy. A chart review of obstetrics patients at the Shadyside Family Health Center (SFHC) in 2020 revealed patients with a history of IPV at or above national expected rates (19%, 4/21), but none were identified during pregnancy. The goal is to identify and offer resources to pregnant patients experiencing IPV.

Methods:

SFHC implemented IPV screening for pregnant patients during the initial prenatal visit with the standardized IPV screen “Hurt, Insulted, Threatened with Harm and Screamed” (HITS). HITS is administered on paper, then providers enter a positive or negative result using a HITS smartphrase template for chart documentation. Project implementation included enhanced privacy at patient rooming, distribution of IPV resources, and didactic training for physicians. Charts were reviewed for all obstetric patients with initial prenatal visits between December 2021 through March 2022. The primary outcomes were IPV screening and positive screens. Process measures included IPV screening documentation, HITS smartphrase use, and HITS forms. Secondary measures included social work referrals and documented distribution of resources.

Results:

Thirty patients had an initial prenatal visit; half were screened for IPV (15/30) and 1 screened positive for IPV (1/15) with documented safety plan. Chart documentation with the IPV smartphrase was completed for 60% (9/15). IPV resources were provided to 2 patients, and none were referred to social work.

Conclusion:

The intervention implemented IPV screening and introduced patients to resources but did not identify IPV at expected rates. Further steps are needed to address barriers to IPV screening and documentation.