Executive Summary: Suburban Cook County Hospital Survey Analysis of Intimate Partner Violence Policies and Protocols Prepared by Amy Cornell, LCSW Cornell Consulting For the Cook County Department of Public Health Office of Violence Prevention Coordination June 1, 2011
Executive Summary The Cook County Department of Public Health s (CCDPH) Office of Violence Prevention Coordination received an Illinois Health Cares grant to increase the capacity of 26 suburban Cook County (SCC) hospitals to identify patients impacted by domestic violence/intimate partner violence (DV/IPV) and respond with appropriate resources and services. CCDPH s Intimate Partner Violence Prevention Network project goals are to work collaboratively with SCC hospitals to promote routine IPV assessments with patients, improve IPV policies and protocols for patients, create a culture where IPV victims are encouraged to seek assistance from hospital providers, and increase formal partnerships between SCC hospitals and local IPV and law enforcement agencies. A literature review of IPV policies and practices for the health care setting was completed in January 2011 to inform CCDPH s recommendations for system-wide improvements at SCC hospitals related to IPV training for staff and assessments, responses and services for patients. To assess the current IPV policies and protocols at SCC hospitals, CCDPH developed a survey titled the Suburban Cook County Domestic Violence Health Care Response Inventory Tool. CCDPH conducted the surveys in-person with key hospital personnel from 13 of the targeted 26 SCC hospitals in December, 2010. Survey respondents roles included: three Trauma Coordinators; two Emergency Medical Service (EMS) Coordinators; three Trauma and/or EMS Nurse Coordinators/Directors; two EMS/Trauma Services Managers; and two Social Services Directors/Supervisors. One survey respondent completed the survey for two different hospitals. CCDPH plans to conduct the survey with the remaining 13 SCC hospitals to take a baseline measurement of IPV policies and protocols and then re-implement the survey with all SCC hospitals within two years to measure changes over time. The survey assessed: 1. SCC Hospitals Response to IPV with Patients: Current IPV Policies and Protocols Use of Standardized Instruments for IPV Assessment 2. Efforts to Promote IPV Awareness with Patients Using Educational Materials 3. IPV Service Coordination and Collaborations 4. IPV Training for Hospital Staff 5. Workplace Policies and Employee Assistance Programs Addressing IPV for Staff 6. Hospital s Self-Assessment of IPV Efforts The surveys were conducted confidentially with the hospitals; therefore identifiable information is not included in this report. What follows are key findings from the survey analysis and recommended next steps. 1. IPV Policies and Practices 92% of SCC hospitals surveyed had written policies regarding patient assessment and treatment for IPV 61% appear to be routinely assessing for IPV within their Emergency, Trauma or multiple departments, but not all departments 92% use standardized instruments to assess for IPV with patients (e.g. written forms, computer prompts) 46% reported that the instruments were being used across all hospital departments 2
Table 1 85% of the SCC hospitals reported having written action steps for responding to IPV (e.g. safety planning, safe transportation, safe shelter, mandatory reporting of suspected cases to local law enforcement, safe discharge planning and referral services) SCC Hospital Departments Currently Using Standardized DV Assessment Instruments 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 69% 54% 54% 1 15% 92% 61% Emergency Departments Pediatrics Behavioral/Mental Health Security Staff Triage Staff Social Services Table 2 Hospital Personnel Responsible for DV Assessments 100% 100% 95% 90% 85% 80% 85% 85% 85% 92% Physicians Nurse Practitioners Nurses Triage Nurses Trauma Nurses 75% Other staff responsible for patient screening and assessments included: Physician Assistants Social Workers Spiritual Care Personnel Floor Nurses CCDPH recommends that hospital IPV policies and protocols should at minimum address the following: IPV Definitions Guiding Principles Identification and Assessment Procedures Intervention Procedures State Reporting Requirements Confidentiality Rules Collection of Evidence and Photographs Medical Record Documentation Referral and Follow-up Plan for Staff Education 3
CCDPH is encouraged that 92% of the hospitals surveyed have a standardized instrument to assess IPV with patients and written IPV policies and protocols, a requirement for accreditation by The Joint Commission. CCDPH recommends that IPV assessments occur routinely across all departments with all adolescent and adult females and with boys and men presenting signs of abuse. 2. IPV Documentation in Medical Records 54% had digital or film cameras to document patient injuries due to IPV 23% reported that no documentation regarding IPV is recorded in patients medical records 61% reported that local prosecutors received IPV information about their patients under certain circumstances (e.g. records were subpoenaed; patient signed a release of information form) CCDPH recommends that all SCC hospitals have easily accessible digital cameras in Emergency, Trauma and OB/GYN departments at minimum to document injuries due to IPV when patients sign a written consent form. Every patient who discloses IPV and has visible injuries should be given the option of having photos taken of their injuries for future prosecution, if pursued. Additionally, all departments should have access to Body Maps, a form for documenting IPV and injuries, securely retained in patients medical records when IPV has been disclosed. The IPV Toolkit provides information about Illinois statutes that apply to documenting and reporting IPV in patient records and with law enforcement authorities. 3. IPV Awareness Efforts with Patients 77% have IPV posters and/or brochures on display within the hospital 61% have IPV materials for patients in restrooms 31% have IPV materials for patients in waiting rooms 8% have IPV materials for patients in exam rooms CCDPH highly recommends that all SCC hospitals have IPV safety cards (business card sized brochures about IPV for patients) and/or informational brochures displayed in all women s restrooms, exam rooms and waiting rooms; particularly private areas where information can be taken discreetly. CCDPH also recommends displaying educational IPV posters in hallways, waiting areas and exam rooms to create a climate where patients are encouraged to discuss IPV with health care providers. 4. Information and Services for Patients When IPV is Identified 77% provide educational materials or printed referral information on IPV for patients 92% have translators on-site when English is the patient s second language 31% let family members translate for patients who don t speak English 77% have on-site IPV services 69% provide transportation assistance for off-site IPV services (e.g. shelter) CCDPH recommends that every patient assessed to be in an abusive relationship should at minimum be given a hotline number to a local IPV agency. Ideally, SCC hospitals distribute IPV safety cards and other informational materials every time IPV has been disclosed by a patient. CCDPH s IPV Toolkit provides tools for health care providers to help victims of abuse develop strategies for their own safety in the case of current or future violence from their abusers. The tool is a fill-in-the-blank form that lists important documents and resources to keep on-hand and can be printed and handed out to patients. As reported by SCC hospitals, 92% have translators on-site when a patient s first language is not English; however 31% of surveyed hospitals let family members translate for patients. If a patient is assessed for IPV in front of her or his abuser, family or friends, the patient is not likely to feel safe enough to disclose abuse and may be put in physical danger by discussing the abuse openly. CCDPH recommends that all IPV assessments occur in a private, safe setting apart from family and friends. If a patient is accompanied by others, they should be asked to leave the area/room during the IPV assessment. 4
5. Partnerships with Local IPV Agencies and Law Enforcement 54% reported having an IPV Task Force or Work Group to address IPV issues 23% had a local IPV agency representative on the hospital s IPV Task Force 61% reported collaborating with a local IPV agency to provide IPV training for hospital staff 46% have formal partnerships with local IPV agencies where services are provided on-site at the hospital 85% reported a collaborative relationship with law enforcement (e.g. reporting IPV to police when requested by the victim, evidence collection) CCDPH recommends that all SCC hospitals create an IPV Task Force to review IPV policies and protocols, tour patient settings to ensure IPV materials are displayed, annually assess IPV training needs of both clinical and non-clinical employees, coordinate trainings with local IPV agencies based on needs, and build formal partnerships with community IPV agencies. The IPV Task Force should have the authority to make decisions regarding IPV issues for the hospital and have adequate staffing and resources to accomplish its tasks. The IPV Task Force should be comprised of at least one representative from a local IPV agency to assist in developing annual trainings and coordinating on-site services or formal partnerships to ensure patients receive IPV services seamlessly, when requested. 6. IPV Training for Hospital Personnel 77% have a formal IPV training plan in place for employees 61% have an IPV training plan that includes regular, ongoing training for clinical employees 54% of the IPV training plans include regular, ongoing training for non-clinical employees 85% have conducted IPV training for employees on IPV issues at some point in the past CCDPH recommends that all SCC hospitals have a formal IPV training plan in place; another requirement for hospital accreditation by The Joint Commission. The training plan should call for annual needs assessments, annual IPV trainings for both clinical and non-clinical employees based on identified needs, and IPV trainings that are coordinated with experts in the field; trainers from local IPV agencies. 7. What SCC Hospitals Report Doing Well and Areas for Improvement Regarding IPV Survey respondents were asked open-ended questions about what they believed their hospitals were doing well regarding domestic violence issues and areas for improvement. Answers were grouped by topic. In Tables 3 and 4 below, hospitals were assigned random numbers to ensure responses remain anonymous. 5
Table 3: What SCC Hospitals Report Doing Well Regarding IPV SCC Hospital IPV Assessments Collaborations with Local Agencies Cross-Department Collaborations On-Site IPV Services IPV Policies Patient Education and Awareness #1 X X X X X #2 X X X X #3 X X X X X #4 #5 X X #6 X X X X #7 X X #8 X X X X X #9 X X #10 X #11 X X X X X #12 X X X X #13 X X X X TOTAL PERCENTAGES 61% 54% 46% 46% 31% 31% 31% 15% 8% 8% It is encouraging that eight of the 13 respondents could identify four or more things they thought their hospitals were doing well regarding IPV issues for patients. Table 4: Areas for Improvement Regarding IPV Issues SCC Hospital #1 X Ongoing Training Referral/ Resource Lists for Patients Documenting IPV in Patient Records Cross- Departmental Collaboration and On-Site Services Staff Knowledge Assessments Patient Education and Awareness Off-Site Referrals Staff Training Community Outreach and Awareness #2 X X #3 X X X #4 X X X X X #5 X X #6 X X #7 X X #8 X X #9 X IPV Sensitivity Community Collaborations #10 X X X #11 X X #12 X X X #13 X X TOTAL PERCENTAGES 69% 38% 23% 23% 15% 15% 15% 8% 8% 8% 8% The most common area for improvement reported by nine of the 13 SCC hospitals was ongoing IPV training for staff. Internal IPV Task Force Patient Follow-Up Private Setting for Patients All Areas Need Improvements 6