Case Studies

CHRISTUS St. Vincent Regional Medical Center - Bridge to Safety

Santa Fe, NM

Overview
The domestic violence program of CHRISTUS St. Vincent Medical Center (CSV) domestic violence program falls into the “Violence in the Home” super priority – one of the four super priorities that were adopted by the CSV Board following the 2016 Community Health Needs Assessment (the others were Adult Behavioral Health, Seniors and Equity of Care).

The domestic violence (DV) program – Bridge to Safety – began in 2010 with a pilot program, which trained 1,200 associates and distributed “badge buddies” that detailed the four questions to ask if DV is suspected, plus who to call and what to do if DV is confirmed. The CSV DV program coordinator also works closely with the local DV community collaborative group composed of law enforcement, the District Attorney’s office, the fire department, domestic violence shelter, counseling services, housing specialists and more. CSV hosts the group, providing a place to meet and lunch for their quarterly meetings.

The program consists of a dedicated coordinator who consults on any potential domestic violence issues that arise for patients or hospital staff. The coordinator also trains staff including all new hires on how to identify signs of DV in a patient and how to reach out to the patient and connect them to community resources. Bridge to Safety keeps patients safe as inpatients and follows them outside the hospital walls with phone check-ins and clinical case management to ensure that these patients know how to tap into available DV resources in the community.

Impact
In 2011, CSV started collecting data on emergency department patients who self-disclosed as being in a violent relationship or situation. Thirteen victims of violence identified through the data collection accounted for 59 hospitalizations in the previous year. The top three utilizers accounted for 30 new ED admissions per quarter (10 per patient or 40 per year) for all of the previous three years. Through Bridge to Safety, these individuals were connected with community resources and provided support services. Their ED admissions continued to reduce markedly, going from 50 percent to zero over the period of their involvement with the program. Since the program was launched, approximately 30 associates have gone through the DV training each month.

Lessons Learned
Collaboration with the community is key. One system alone cannot successfully address complex social issues. Protection from violence requires a web of service providers, all of whom communicate closely with each other. In addition, hospitals need to articulate domestic violence as a priority – and dedicate resources to it. A DV program needs a full-time coordinator whose sole focus is reducing domestic violence throughout the community. Further, hospitals need to use their own ED data because the ED is one of the first departments to see a client, and this data can be used to identify patterns or safety concerns.

Hospitals should expect to face some barriers. It isn’t easy to communicate to all hospital staff the many nuances in DV. For example, the violence may not be physical. It can be emotional or financial as well. And although DV survivors are 2½ times more likely to self-disclose in a health care setting, they still may not self-disclose to all providers – and many survivors get patched up in the hospital and then return again to their abusive situation. Another potential barrier is the electronic medical record, which may not be suitable for tracking a patient’s DV experiences and treatment. Updating the format for all EMRs is an expensive undertaking.

Future Goals

Program leaders plan to continue to create connections with the community, with some automatic linkages, e.g., police alerting the hospital if they’re bringing in a DV survivor, the hospital reaching out to shelters to find space for a patient, and continued connection to community. They also plan to train all associates in identifying and responding to DV, child abuse and sexual assault. If all staff have the information, it becomes much more likely that survivors will receive better and more thorough treatment. Finally, they will build awareness and skill across the medical community. The program has created a toolkit for providers, which is a great start, but continuing education focused on DV is needed.

Contact: Kathy Armijo-Etre
Vice President, Mission and Ministry
Telephone: 505-913-5701
Email: kathy.armijoetre@stvin.org


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