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Medical-Community Partners Enable Stronger Support for Domestic Violence Survivors
By limjr [at] email.chop.edu (Jillian Rose Lim)
Editor’s note: Now in its 10th year, Community-Driven Research Day (CDRD) is a unique program that supports collaboration between academic researchers and community-based organizations. Following an annual event that features a line-up of speakers, poster sessions, and networking, CDRD awards pilot grants to encourage these collaborations with the basic tenet that both community and research partners are involved in all phases of research. This year, Community-Driven Research Day will be held Dec. 9, with registration open until Dec. 6.
Ashlee Murray, MD, MPH, has attended almost every Community-Driven Research Day since 2016, the year she joined a panel with the Lutheran Settlement House (LSH), a nonprofit organization, to speak about their medical-community partnership. Like many of CDRD’s participants, Dr. Murray, who is a pediatric Emergency Department (ED) physician at Children’s Hospital of Philadelphia, attends the annual event to learn what’s happening at the juncture of research and the community. At CDRD, she joins a unique forum where researchers can address the questions of community-based organizations like LSH and vice versa.
But alongside being a regular calendar event, CDRD has played another key role in Dr. Murray’s research into intimate partner violence (IPV): In 2018, she secured a pilot grant from CDRD to lead a project that, as of October 2019, formally evaluated and improved the STOP IPV program at Karabots Pediatric Care Center. Dr. Murray and her team are also developing partnerships with other sites across the community to implement similar programs there.
Developed by Joel Fein, MD, MPH, Dr. Murray, and colleagues in 2014, STOP IPV enables providers to screen patients and their caregivers for IPV in the ED. The program also provides access to an on-site IPV specialist. Though CHOP initially implemented STOP IPV at its University City ED alone, Dr. Murray wondered how the program would fare at outpatient community sites where more families might be reached, like Karabots in West Philadelphia.
Fast-forward one year, and that project has proven to be a collaborative success.
“We decided that if we want [STOP IPV] to be successful in a new community, we have to think about taking a different approach,” Dr. Murray said. “We couldn’t just go in and say, ‘This is what has worked at the main hospital.’ We had to take a really big, aerial view of true community-based participatory research.”
To develop a sustainable STOP IPV program for primary care clinics, Dr. Murray enlisted the help of Caitlin Axtmayer, MSW, MPH, a research assistant at the Center for Injury Research and Prevention, and worked side-by-side with the Karabots community as well as LSH. Taking into account the different goals and expertise that each community group had to offer, the result reflects a truly dynamic community-based participatory research approach.
Evolving Roles: Turning Advocates Into Active Participants
The STOP IPV team at CHOP has partnered with LSH for many years. Since 2007, CHOP has employed an “IPV specialist” or medical advocate to support any patients or caregivers who might require their support. With the new grant, however, that specialist’s role significantly evolved. Dr. Murray and her team wanted LSH to play an even more dynamic and deep-rooted part. LSH advocates, after all, had unique expertise in how to deliver domestic violence support to healthcare settings.
Rather than joining the project at its implementation stage, LSH – as well as the team from Karabots – would participate in research and development of the program from the start.
“What’s unique about the CDRD grant is that we ask, ‘How can we streamline and make this process better by having our community partners be engaged in the process?’” Dr. Murray said. “We will involve our LSH advocate at Karabots, [Teresa Salinas], in this robust research process. Her skills now go beyond what a normal advocate would do.”
With Salinas’ input as well as that of the Karabots team, STOP IPV for primary care clinics became a dynamic research process – one that will have a strong framework that can be sustained long after the CDRD grant itself ends. Like any community-based participatory research, Dr. Murray explains that is the definitive end game: “The ultimate goal is to turn the clinical and community work we do into publishable research that policymakers and advocates and clinical staff can spread even further.”
One Year of Progress and Counting
The past year has been marked by milestones and memories for Dr. Murray’s team and their community partners.
In the summer of 2018, they kicked off the project by engaging key Karabots and LSH stakeholders, brainstorming ideas with discussion and presentations. Alongside involving LSH advocates, the research team also spoke with IPV survivors from LSH to incorporate their input in the process as well.
Into the fall, they began to gather what Dr. Murray calls their “champion team” – the program’s early adopters and the individuals who would essentially be “on the ground.”
“These are the [individuals] who are going to be doing the screening, interacting with our patients, and giving us real-time feedback,” Dr. Murray said. The “champion” team included nursing leadership, physician leadership, a social worker, a medical assistant, an information technology specialist, and advanced practice providers and practitioners.
Over a period of several months, Dr. Murray and her team then held regular meetings and information sessions with their champions to review STOP IPV practices at the main hospital, gather opinions on what champions’ believed the workflow at primary care clinics should look like, and map out a workflow process.
Next, the team rolled out a pre-implementation survey to providers at Karabots. Everyone from nurses to doctors to security personnel could offer a baseline assessment of where Karabots stood in their competency of identifying and addressing IPV. On top of the champions’ opinions, Dr. Murray now had the input of almost 200 people about what the most effective screening process might look like.
“What’s wonderful about this, is that this is rich data you can now use to leverage leadership and stakeholders,” Dr. Murray said.
Finally, in the spring of 2019, the team put it all together, developing documentation of the workflow with the guidance of their information technology champions. They needed to ensure that the documentation was appropriate and acceptable at Karabots as well as safe as recommended by LSH. “That’s where everybody’s opinion is important,” Dr. Murray said.
In October, STOP IPV routine screening program at Karabots “went live.”
Looking to the Future
Over the next nine months, Dr. Murray’s team will conduct analyses of their reach at Karabots, maintain follow-ups with their champions, and focus on quality improvement.
“Ultimately, the goal is to basically implement screening that is fully integrated into the culture and workflow at Karabots,” Dr. Murray said, “something that is sustainable, easy, and safe.”
Long-term, however, Dr. Murray’s vision goes even further.
“We want to learn from what we did with Karabots and spread it to all of the CHOP outpatient clinics,” Dr. Murray said. “That’s our ultimate goal – that we can go to Cobb’s Creek and say, we’ve learned this at Karabots, and we’d love to help you integrate this model and this is the support that we can provide.”
A true effort by the community, for the community.
Learn more about the goals of Community-Driven Research Day in this Cornerstone guest blog by Ayana Bradshaw, MPH.