| Description |
This project has an overall goal of improving screening and referral for violence against women, and specifically targets intimate partner violence (IPV) and adverse childhood experiences (ACE). In 1995, the CDC and Kaiser Permanente discovered an exposure that dramatically increased the risk for seven out of ten of the leading causes of death in the United States. That exposure is toxic stress caused by various ACEs. Those who are exposed have triple the lifetime risk of heart disease and lung cancer, increased rates of obesity, diabetes, preterm labor, low birth weight, unplanned pregnancy, chronic pelvic pain, vaginismus, vaginitis, depression, PTSD, impaired sexual function, and increased perception of pain in labor. However, many Utah midwives and nurse practitioners are not trained in appropriate assessment or management of ACE survivors. This is problematic, as over half of Utahans have experienced at least one ACE. In addition to ACEs affecting the health of women, IPV leads to worsened health outcomes and increased healthcare costs. Furthermore, one in three women in Utah will be victims of rape, physical violence, or stalking by an intimate partner at least once in their lifetime. Despite the prevalence of IPV and ACEs, midwives at a national and local level are not following ACOG guidelines for IPV screening, which state to screen at the new obstetrical visit, every trimester, and postpartum, nor are they assessing ACE scores or resiliency. Helping an individual develop resiliency traits is the hallmark of ACE intervention, and local mental health providers in Utah are trained to do so. However, healthcare providers are mostly unaware of such interventions. Therefore, the objectives of this project include obtaining knowledge of IPV, ACEs, screening tools, questionnaires, and recommendations for positive screens; implementing an IPV screening tool into new obstetrical and postpartum visits within a large midwifery practice in Utah; implementing an ACE assessment in this same practice; and providing midwives and nurse practitioners with resources for responding to a positive or negative screen. The HARK screening tool was used to screen for IPV. To assess ACEs and resiliency, the Health-Resiliency-Stress-Questionnaire (HRSQ) was built into and distributed via mEVAL, a patient-reported outcome email system for all seven clinics within this practice. Over 30 trauma-informed counselors were identified, and healthcare providers were given this information in addition to other resources for referral and follow-up for positive screens. Overall, the goal for IPV screening was to implement a validated IPV screening tool to allow prevention strategies to take place and to provide the woman with resources to improve her health and safety. For ACE assessment, the goal was to increase provider awareness of patients' ACE score as it relates to their medical history and resiliency traits, provide appropriate referral resources to promote treatment for positive scores, and identify local resources that can help with toxic stress. |
