Promising - One study
Date: This profile was posted on June 14, 2011
An abuse assessment screening tool for medical staff to aid in the detection and referral of abuse in pregnant women. The program is rated Promising. After implementation, 88 percent of maternity medical records contained the assessment form. Once implemented, intervention clinics had a significantly higher rate of abuse reporting than the comparison. At 12 months, referrals were included in 53 percent of records compared to none prior to using the tool.
The Abuse Assessment (The Abuse Screen) protocol aims to detect abuse in pregnant women and refer them to a counselor, and also to increase documentation of abuse in medical records.
The Abuse Screen is a multiple-item questionnaire that asks about past and current emotional, sexual, and physical abuse, both prior to and during pregnancy. The questions assess the severity and frequency of injury and abuse. The form is included in all medical charts prepared for new prenatal care patients at their first visit to a clinic or emergency room.
The form is completed during the initial intake interview and usually is conducted by the clinic or a triage nurse. But it also could be conducted by other nurses, physicians, nutritionists, counselors, or clerical staff. Any referrals of abuse are given to an onsite counselor for further assessment and follow-up.
Wiist and McFarlane (1999) found that before implementation of The Abuse Assessment (The Abuse Screen) protocol no specific form to detect abuse was used in maternity medical records. After implementation, however, 88 percent of maternity medical records contained The Abuse Screen. After 12 months, the number of medical records that had the form decreased, nonsignificantly, to 85 percent. Of the forms included, 96 percent were completed and all were completed during the initial visit.
Abuse Detection and Reporting
Before the protocol was implemented, there were three instances of abuse reported in medical records at the intervention clinics and one in the control clinic. Once implemented, intervention clinics had a significantly higher rate of abuse reporting than the comparison (7 percent versus 0 percent). The number of women identified as abused at the intervention clinics was proportionately higher than that of the comparison location (7.22 percent versus 0.83 percent). According to an odds ratio, women were 6.78 times as likely to be identified as abused after implementing the protocol (confidence interval=2.34, 19.56).
Referrals for Abuse
Before implementation, there were no documented referrals in the medical records at any of the clinics for women identified as abused. At 3 months postimplementation, referrals were included in 67 percent of records. At 12 months, referrals were included in 53 percent of records.
Using a quasi-experimental design, Wiist and McFarlane (1999) evaluated an implementation of The Abuse Assessment (The Abuse Screen) protocol in two public health department clinics in a large southwestern U.S. city. A third clinic of the same health department that did not implement the Abuse Screen served as the comparison group. During their initial prenatal visit, women in the intervention clinics were given the form to complete in a private room without the male partner or other individuals present. The form was available in English and Spanish, and there was a bilingual counselor onsite in case of abuse referral.
The researchers conducted an audit of randomly selected first-visit maternity patient charts at each of the three clinics at two time periods: 15 months before implementation of The Abuse Screen (n=540) and 15 months afterward (n=540). To evaluate short- and long-term effects, the latter period was then divided into a 3-month period and a 12-month period. Researchers audited records of women who were past their due date, to include abuse screening at any prenatal visit.
Using a data collection form, researchers collected information on demographics, number of prenatal visit, whether The Abuse Screen form was included in the records, whether The Abuse Screen form was completed, whether the women had been abused, documentation of referrals for abuse, and who made the referral (a nurse, a physician, or a health care provider). Statistical significance between groups before and after protocol implementation was tested using a Fisher two-tailed exact test. The Bonferroni technique was used to control the overall error rate at 0.05 for each set of Fisher exact tests.
There is no cost information available for this program.
The Abuse Assessment Screen (The Abuse Screen) form is available in English and Spanish.
Evidence-Base (Studies Reviewed)
These sources were used in the development of the program profile:Study 1Wiist, William H., and Judith McFarlane. 1999. “The Effectiveness of an Abuse Assessment Protocol in Public Health Prenatal Clinics.” American Journal of Public Health 89(8):1217–21.http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.89.8.1217
These sources were used in the development of the program profile:McFarlane, Judith, Barbara Parker, Karen Soeken, and Linda Bullock. 1992. “Assessing for Abuse During Pregnancy: Severity and Frequency of Injuries and Associated Entry Into Prenatal Care.” Journal of the American Medical Association 267(23):3176–78.McFarlane, Judith and William H. Wiist. 1996. “Documentation of Abuse to Pregnant Women: A Medical Chart Audit in Public Health Clinics.” Journal of Women’s Health 5(2):137–142.Parker, Barbara, and Judith McFarlane. 1991. “Identifying and Helping Battered Pregnant Women.” American Journal of Maternal Child Nursing 16:161–64.