By BETSY TAYLOR
KentuckyOne Health is testing a new approach to better identify emergency room patients who are victims of domestic violence — including those most at risk of serious harm or death at the hands of their intimate partner — and to immediately connect them to an advocate and support services, including transportation and emergency shelter.
The effort includes a different set of screening questions than those asked in the past related to domestic violence and it includes a commitment to screen all emergency department patients. KentuckyOne Health's University of Louisville Hospital started using the new protocol in April.
Nurses Vicki Yazel, left, and Amanda Corzine review documentation for a forensic exam at KentuckyOne Health's University of Louisville Hospital. The women are, respectively, assistant coordinator and coordinator of KentuckyOne Health's sexual assault forensic examiners program.
If a patient tells a clinician that he or she is being harmed or is at risk of being harmed by an intimate partner or a past partner, the clinician reassures the patient and calls in a patient advocate to identify immediate needs and offer information about community resources and advice about staying safe, especially while escaping the abuser. (Hospital security and law enforcement are notified immediately if the abuser is present in the hospital.)
Advocates also are trained to assess the likelihood that a patient faces serious immediate harm or even the possibility of a lethal confrontation.
Planting seeds
If an abuse victim is admitted to the emergency room late at night or early in the morning before a scheduled advocate is on-site, an on-call advocate comes to the hospital to meet with the patient.
If the patient is ready to act, the advocate can secure a spot at a shelter. If the patient is not ready to leave the partner, the advocate will offer guidance, including help developing an escape plan for later use.
Reif
A staff member of the Center for Women and Families, a private nonprofit based in Louisville that provides services to survivors of intimate partner abuse or sexual violence, and Amanda Corzine, a KentuckyOne Health employee who oversees hospital support services related to domestic violence, trained the advocates and emergency room clinicians in the protocols. The advocates are employed by, or volunteer for, the Center for Women and Families.
Tamara Reif, vice president of programs for the Center for Women and Families, said sometimes advocates are "planting seeds" — letting patients who aren't ready to leave their current situation know about resources, including the center's 79-bed shelter that houses woman and men separately and accepts their dependent children up to age 24. Patients are told about the center's 24-hour crisis line.
A team from the University of Louisville's Commonwealth Institute of Kentucky, part of the university's School of Public Health and Information Sciences, will evaluate the program over two years to gauge its effectiveness in assisting patients. This assessment includes interviews with emergency room nurses and patients, who have taken part in the abuse prevention program.
Bridges
The effort to better identify and assist domestic violence victims is slated to expand to KentuckyOne Health's Jewish Hospital of Louisville later this year, and it likely would expand to the system's other hospitals, if the evaluation of the program shows its effectiveness, according to Alice Bridges, KentuckyOne Health's vice president of healthy communities. KentuckyOne is part of Catholic Health Initiatives of Englewood, Colo.
Four questions
Corzine said under the protocol used in the past at KentuckyOne hospitals and which will likely be phased out if the new protocol proves effective, when patients came into one of the system's emergency rooms with visible physical injuries, clinicians were accustomed to asking if they were safe at home and if anyone was hurting them. "The research showed we were missing a lot of other patients, ones who weren't willing to share how the injuries occurred and patients checking in for noninjury reasons, maybe with chronic migraines or gastrointestinal issues, or other chronic health issues due to stress and trauma."
Since the spring, University of Louisville Hospital emergency room clinicians have asked four direct questions of all emergency room patients, making sure the patient didn't have a spouse, partner or other family member in the room at the time. They ask: Have you been injured, hit, kicked, punched in the past year, and, if so, by whom? Do you feel unsafe in your current relationship? Is there a partner from a previous relationship who is making you feel unsafe now? Are you here today for injuries related to intimate partner violence?
When assessing patients and reviewing their medical records, clinicians now see prompts on their hospital computer screen, which include a few lines of dialogue to introduce the questions and to inform patients that all patients are asked questions related to intimate partner violence. Staff also are given a few lines to help them know how to respond if a patient makes known they are a victim of domestic abuse.
Out of the shadows
In April, patient advocates made visits to 21 patients identified as victims of intimate partner abuse through the new screening process; in May, they met with 30 patients, and 31 in June. Corzine said especially notable is that during those three months, the hospital identified 17 patients who did not come in for physical injuries related to domestic partner violence, but who did disclose intimate partner violence as part of the screening process. Those patients were all linked to advocates.
Bridges added, "The program could literally be saving people from being killed by catching them before the situation becomes lethal and connecting them immediately with needed services."
One advocate visited with a woman who came into the emergency room with depression and chest pains, and disclosed she'd had been abused by her partner, including during a pregnancy. The woman wasn't ready yet to leave that partner, but Reif said, "She now knows we have options for her."
A window of opportunity
To develop the approach, KentuckyOne and the Center for Women and Families teamed up with the Mary Byron Project. The organizations said the effort is "grounded in the philosophy that violence is preventable and a medical visit offers a brief moment to engage with and connect victims to needed services — and to end the cycle of violence."
The Mary Byron Project is a Louisville-based organization established in 2000 in memory of a woman who was murdered by her intimate partner. It supports efforts to attack the root causes of domestic violence. It highlights innovations and approaches that demonstrate promise in breaking the cycle of domestic violence.
For example, the KentuckyOne project is modeled after the Rose Brooks' Bridge Program, which is in use in some Kansas City-area emergency rooms, Bridges said.
A $150,000 grant from the Jewish Heritage Fund for Excellence is funding the Louisville effort. That fund is a nonprofit that awards grants to invest in the area's health care, to foster innovative research and to support the Louisville Jewish community. The fund was created when Jewish Hospital HealthCare Services hospital operations merged with Saint Joseph Health System in Lexington, Ky., to form KentuckyOne.
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