Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Lutheran Settlement House

Name of Innovative Program: 
Intimate Partner Violence Medical Advocacy Project
Sponsoring Organization
Lutheran Settlement House
Name of Innovative Program Lead: 
Lutheran Settlement House- Kelly Davis
E-mail Address of Innovative Program Lead:
Project Description: 
 LSH’s innovative medical advocacy program successfully cracks the cycle of intimate partner violence (IPV).  We know that many IPV victims are scared and  hesitant to call a hotline or seek other sources of help. So how do you reach these women? LSH’s pioneering Medical Advocacy Program (MAP) is making this happen by situating a DV Medical Advocate (MA) onsite in pediatric hospitals.  MAs provide training to hospital staff and, crucially, provide immediate interventions with IPV victims in the woman’s hospital room.   The long-term sustainability of MAP is ensured by identifying and developing hospital staff  “champions” that work hand in hand with the MA.   Recently published studies of  MAP have shown that IPV screening rates at hospitals have dramatically  increased and more women are connecting with  DV services as a result. MAP has already been replicated in four pediatric settings with 496 victims of IPV identified through the project, and 2402 medical and non-medical professionals trained in the last year.
Creativity and Innovation: 
MAP is the nation’s first on-site domestic violence program reaching pediatric settings. MAP is an effective, cost-efficient way to promote DV awareness and intervention.  By placing a medical advocate on-site at the hospital, we have learned that that goal of universal screening for IPV can be achieved.  Without an MA onsite, data shows that hospital staff will not consistently screen for DV for many reasons including, lack of specialized training and a fear of not knowing how to help a woman after she admits to being a victim of violence.   MAP also involves the hospital in being aware of IPV issues by recruiting staff “Champions” at each hospital and by creating DV task forces comprised of every level of hospital staff from top administrators to janitors.  LSH has been identified as the premier MAP by the Institute for Safe Families and presents on MAP at conferences throughout the country.  
MAP works to change the organizational culture of pediatric units using Medical Advocates assisted by engaged staff “champions” to reach all levels of staff with compelling data about IPV, its impact on children and adults, and the unique opportunity medical settings provide, to bring help to victims and stop the cycle of violence.  The key to sustaining MAP within hospitals is its use of MAP Champions. Where the DV Medical Advocate brings specialized expertise to victims and colleagues, Champions spread the word among broader networks of staff, new employees, students, residents and others.  They can promote IPV screening and support coworkers that have questions when the Medical Advocate is unavailable. The IPV counselor provides Champions with current research information and tools.   Medical Advocates also lead policy change to ensure, each setting develops its own IPV policies, appointing a DV Task Force with representation from each department to institutionalize the program.
MAP is funded through a variety of sources- the Pennsylvania Coalition Against Domestic Violence, the Curaterra Foundation, the First Hospital Foundation and varying amounts from the hospitals themselves. Over the last 2-years, LSH has moved to a model requiring hospitals to contribute to MAP in order to receive an advocate.  This strategy is intended to create a sustainable funding model and has been successful in receiving funding from the = hospitals.  It has also created a clear structure for replication in additional hospitals.  LSH believes that building a diversified funding model will be the best way to ensure the future of MAP. This insistence has already acted as a catalyst to CHOP, which has committed to funding the cost of two separate MAs after seeing the effectiveness of its first.  Einstein has committed to funding for a 3-year cycle and is interested in finding funding for an additional advocate.
Making IPV-screening a universal standard of care is the broad goal of MAP, and it can be replicated in every pediatric hospital in the country. MAP has already been implemented at St. Christopher's Hospital for Children, Einstein Medical Center, and  two units of CHOP.. Training medical staff in how to screen for intimate partner violence is one of the chief activities of DV Medical Advocate on-site at these hospitals. These trainings have been done with groups small and large. LSH has received commitments from two managed care medical providers to help fund another MA position in an as yet to be determined hospital.  These managed care providers are confident that MAP will lower hospital readmission rates and are interested in piloting and evaluating this model which will lead to more replication.
Interest in MAP has resulted in the publication of several articles sharing program accomplishments.  In 2010, Dr. Mario Cruz, LSH’s collaborator at St. Christopher’s Hospital, published “Results of a multifaceted Intimate Partner Violence training program for pediatric residents,” in Child Abuse and Neglect; this study established that the MAP program improved resident knowledge in: IPV screening questions, referral sources, and the relationship between child abuse and IPV. Screening for IPV went from less than 1% to 33.1% in the first 8-months.  Other published results include a study of referral patterns and service utilization for MAP in Aug2013 Child Abuse and Neglect and a chapter in Social Work in Health Settings.  This year, the program has expanded beyond pediatric settings with the Medical Advocate at Einstein hospital available to patients hospital-wide.  In the past year 496victims of IPV were reached, 124trainings were held reaching more than 2402medical and non-medical professionals.