UNIVERSAL IPV SCREENING AT PLANNED PARENTHOOD, NYC

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

2. UNIVERSAL SCREENING:POLICY AND PROCEDURE • PPNYC has had an existing policy regarding IPV screening in its Health Centers since 2003. • “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

3. 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

4. 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)

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

6. 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.

7. Focus Group Results1 • 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. 1 12 young women

8. 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 man1 • Provider wouldn’t take any action without patient’s permission 164% 15-19, 26% 20-24 – p<07

9. Screening: Recommendations1 from the women surveyed • 87% would not mind being asked22,3 • 73% felt they could be honest • 90% of women feel screening all women is a good or a very good idea2 • 74% of women would find it easier if the provider were a woman3 1 Whole sample of 645 women 2 Varies by violence experience 3 Varies by age or ethnicity

10. 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

11. 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.

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

13. 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?

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

15. 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

16. 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.

17. 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.

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

19. 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