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#2 Prepare Your Practice

Six steps to prepare your practice

There are six steps to prepare your practice:

  • Build buy-in for your DV/SA program
  • Support staff in addressing their own experiences of violence
  • Create or update policies or protocols on IPV/HT
  • Measure quality improvement
  • Enhance the clinic environment by displaying patient and provider tools
  • Document and code

At the beginning of our IPV work we first offered information and resources for employees on vicarious trauma, including developing a support group just for staff, and because of that we were able to build staff resiliency before addressing IPV with patients.

— Sara Gavin, LMFT, LPCC, Director of Behavioral Health, CommuniCare Health Centers (Woodland, CA)

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PowerPoint for CEOs and board members to build buy-in for why health centers should create a response to DV/SA.

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Sample workflow that outlines each staff member’s role—from the front office to the exam room—in responding to DV/SA.

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Sample blog posts for October Domestic Violence Awareness Month and April Sexual Assault Awareness Month.

Build buy-in for your DV/SA program

You will need support from all staff levels of your health center to create a sustainable and effective response to IPV and HT. This includes CEOs, Board Members, clinicians, peer educators, and billing and front desk staff. Identify one or more champions for your program to build and maintain buy in. Consider engaging a leader from the staff level and one from the provider level to lead and manage changes. This toolkit provides the designated champions all of the necessary tools to support their engagement.

  • Sample Slide Presentation for CEOs and board members to build buy-in for why health centers should create a response to DV/SA
    Click to download
  • Sample workflow that outlines each staff person's role- from the front office to the exam room- in responding to DV/SA
    Click to download
  • Sample blogpost for October Domestic Violence Awareness Month and April Sexual Assault Awareness Month 
    Click to download

Support staff in addressing their own experiences of violence

Creating a trauma informed health setting is a critical first step in building a response to IPV. Trauma informed workplaces recognize the needs of both clients and employees. Considering the high prevalence rates of IPV, it is likely that some health center employees are also personally, affected by IPV and others will experience vicarious trauma. Develop policies and implement training specific to health center employees:

Adapt or update policies and protocols on IPV and HT

It is critical to establish or update your protocol on IPV/SA and HT by identifying roles and responsibilities for staff, establishing a policy to see patients alone, and implementing uniform standards for documentation and reporting. Examples of adaptable protocols from health centers from across the U.S. are featured below.

  • Sample health center protocol on IPV/HT/exploitation
    Click to download
  • Toolkit for developing a clinical protocol for human trafficking
    Click to order
  • Video vignette on the importance of seeing patients alone
    Click to play

Measure Quality Improvement

Work with your quality improvement staff or committee to establish a baseline assessment of the quality of care currently provided to survivors of IPV and HT. Identify appropriate tools to measure progress such as the following Quality Assessment/Quality Intervention (QA/QI) tool. Complete the tool at initial IPV and HT program implementation, at the 6-month mark, and again as needed to measure change, address barriers, and evaluate sustainability.

Enhance the clinic environment by displaying patient and provider tools

Research shows that creating a supportive environment helps survivors feel more comfortable talking about violence.14 Hang posters in lobbies and exam rooms with IPV/HT prevention and health messages; stock safety cards in exam rooms and bathrooms; and consider other culturally appropriate patient and provider tools.

Documentation and Coding

Be sure to train staff and the billing team on how to document and code for IPV/HT as well as how to implement important privacy protections for what information gets shared about IPV. Current Procedural Technology (CPT) and International Classification of Diseases (ICD) codes are available for age appropriate counseling and risk factor reduction interventions as well as codes to record assessment and counseling for IPV. Starting in 2020 HRSA BPHC’s added new Uniform Data System (UDS) measures on IPV and HT and outlined the associated codes.

Footnotes

14. Chang JC, Decker MR, Moracco KE, Martin SL, Peterson R, Frasier PY. (2005). Asking about intimate partner violence: advice from female survivors to health care providers. Patient Education and Counseling, 59:141-147

Next Step

Adopt the evidence-based intervention to educate all patients about the connection between IPV and their health and engage them in strategies to promote wellness and safety.

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