Summer Miller-Wallfish

Background: As part of a Domestic Violence and Health care Partnership (DVHCP) project in California, 19 leadership teams consisting of representatives from domestic violence agencies and health care delivery systems in California came together to improve care related to intimate partner violence (IPV). We evaluated the impact of a Quality Assessment/Quality Improvement (QA/QI) tool on health care delivery systems' ability to collaborate with victim service agencies to address IPV. Methods: Each leadership team completed the QA/QI tool every 6 months between 2014 and 2017. Fifteen clinics that completed the tool at least twice are included in this analysis. Results: The largest changes noted in the QA/QI tool were having written protocols for assessing for IPV, providers distributing educational safety cards about IPV to patients, scripts for providers on how to assess and support survivors of IPV, trainings led by IPV agency advocates, and support for staff to discuss difficult cases. Conclusions: Implementation of a QA/QI tool can guide health care delivery systems to make changes in provider practices and clinic protocols to improve care and support for survivors of IPV. Such clinic-level changes may support providers to more readily or consistently integrate addressing IPV in clinical encounters while facilitating and promoting cross-sector collaborations with victim service advocacy and related social service agencies.

Relatively few studies have considered the impact of the COVID-19 pandemic on intimate partner violence (IPV) advocates or the agencies where they work. In this study, based on United States IPV advocates’ experiences working with survivors during the COVID-19 pandemic, we conducted interviews to explore: 1) personal challenges and resilience working as IPV advocates during the COVID-19 pandemic; 2) how agencies adapted to the pandemic to support IPV survivors and advocates; and 3) specific needs and challenges of culturally-specific agencies. We conducted semi-structured interviews with 53 IPV advocates from June to November 2020. Participants were included if they worked directly with survivors, identified as an IPV advocate, worked at a US-based agency, and spoke and understood English. We created a sampling matrix to ensure adequate representation from IPV advocates serving survivors from communities which have been marginalized. Interviews were conducted through a virtual platform by a trained member of the research team. We used an inductive thematic analysis approach, with weekly coding meetings to resolve discrepancies in coding. Five themes emerged from the data: 1) IPV advocates described how working as an IPV advocate during the COVID-19 pandemic impacted them personally; 2) agencies developed new methods of addressing IPV advocates’ needs; 3) agencies developed new solutions to address pandemic-related client needs; 4) transitioning advocacy work to virtual formats created challenges but also opportunities and; 5) pandemic limitations and impacts compounded pre-pandemic challenges for culturally specific agencies. IPV advocates are frontline workers who have played essential roles in adjusting services to meet survivor needs during the COVID-19 pandemic while simultaneously coping with pandemic impacts on themselves and their agencies. Developing inter-agency collaborations and promoting advocates’ safety and wellbeing during future public health crises will help support IPV survivors.