Screening to Identify the Unrecognized Victims in Practice: Implementing an EBP HITS Domestic Violence Tool in Neurology

Domestic violence (DV) or intimate partner violence (IPV) is the cause of major physical and emotional health consequences in neurological patients; yet many are not screened or referred for DV services. A need for the DV screening was identified for this project since the neurology practice did not have a DV screening policy and limited research for screening in neurology practices is in the literature. This pilot quality improvement (QI) study occurred in a 3-office private neurological practice in South Florida that treated 300 to 400 patients per month. The problems associated with the complications of DV among neurological patients can create increased psychological and chronic pain conditions while also leading to reduced quality of life from the sequalae related to the DV trauma. This QI quasi-experimental study aimed to evaluate the Nurse Practitioner (NP) provider screening and referral rates pre and post educational intervention using the evidence-based practice (EBP) HITS DV screening tool (Hurts, Insults, Threatens, Screams). The secondary objectives of the project were to translate this to screening practice by educating the staff on the evidenced based DV training and implementing an organizational policy for universal domestic violence screening. The Ace Star model of evidence-based practice was utilized as the conceptual framework (Permission for use was obtained via email from the author Dr. Kathleen Stevens). The ACE framework offered the 5 steps to evaluate and implement effective practice and organizational policy change. Final results of the study indicated an increase in provider compliance post educational intervention with DV screening and referral rates. The research questions were answered with further data analysis demonstrating an increase in provider DV screening and referrals with pre and post percentage scores. Scores ranged from 0.3% pre intervention screened and 87 % patients screened post intervention. DV referrals pre intervention were 0.6% and post referral were 100 % with the 10 patients that screened positive in the one-month time period. Results were consistent with other literature indicating provider screening barriers and more women screened positive on the HITS tool with 8 women and 2 men out of 10 positive screens in the one-month time period.

Keywords: Domestic Violence; Intimate Partner Violence; HITS DV screening tool; neurological complications; ACE Star model.