| Barriers | Solutions |
| Rooming the Patient Alone | Implementing policy across the board that all patients will be seen alone for a portion of their visit Putting up signs in waiting areas to tell patients about the policy |
| EHR Documentation (Documenting positive screens or disclosures of IPV accurately and confidentially) | Creating a confidential notes section of EHR to note a patient’s experience of IPV (one that can’t be seen by an abuser through any online patient portal) Whoever screens verbally telling provider/behavioral health about a positive screen/disclosure of IPV Using coded language within clinic to indicate a positive screen/ disclosure of IPV |
| Time/Clinic Flow | Letting clinic create and adapt a screening and response protocol that fits their own clinic flow For instance using a screening tool at intake may work at some clinics while having an MA ask patient screening questions may work at another site Using behavioral health or social workers on-staff to respond to a positive screen may work in some clinics while others may choose to have providers respond because they are already meeting with the patient (see the Site Profiles page for more about examples of how different clinics set up their protocol) *See example below of MAHEC’s piloting and QI process |
| Clinic and DV Agency Relationship | Involve each other in trainings: local DV agencies are experts in DV and clinics are experts in healthcare, each organization can learn a lot from the other Build the relationship: Meeting each other face-to-face allowed clinic staff to offer patients a referral to a person they know and can name instead of just an agency. One clinic and partner DV Agency set up a lunch and learn to find out more about each organization and who they serve. They also used this meeting to plan best communication methods. |
*MAHEC’s 10 month Piloting and QI Process:
- MAHEC began a human-centered design process of designing a new intake screening in March of 2017.
- First they created a pilot screening tool and implemented it in one of their smaller family health center sites.
- They decided on a staggered rollout of IPV education (staff trainings) for their staff/providers.
- They piloted the screening and response protocol for about two months in one small practice and , learned from it, and did an intense quality improvement on the protocol which led to designing the EHR templates and workflows.
- Then they began to expand the process to two other similarly sized satellite practices.
- The final step was expanding to the main campus with residents, in January of 2018.