Identifying red flags early and providing resources

By Ana Gajic

One in six women in fracture clinics around the world has experienced intimate partner violence, but screening for such abuse remains scarce.

The MAP Centre for Urban Health Solutions has partnered with the Fracture Clinic at St. Michael’s Hospital to design and implement an electronic screening application for intimate partner violence that can be used within and beyond the hospital.

“We talked to women who had either lived with or were living with partner violence and we kept hearing them say that they realized too late in their relationship that they were living with unsafe behaviours,” said Dr. Patricia O’Campo, scientist at MAP, and co-lead on the development of the app.

“They wished they had known earlier that there were red flags. That’s where the initial idea to put screening into women’s hands came from.”

The WITHWomen app will be available to all female patients in the St. Michael’s Fracture Clinic this summer, and was trialed earlier this month. A generic version of the app is also available outside of the hospital, free to use by other institutions for intimate partner violence screening.

The Fracture Clinic currently uses a paper screening form with three questions and a few resources listed on the sheet.

“With the paper process, you still have to pick up a piece of paper, report violence, hand the paper to someone and then be spoken to – it’s not always a very private process,” said Dr. Jeremy Hall, a staff physician in the Fracture Clinic.

The app will make the questionnaire and its results more confidential. Patients will be asked to fill it out individually close to the clinic’s registration desk, and an ‘escape’ function that transforms the violence questionnaire into one about bone health will keep the questions discreet.

Instead of three questions, the app contains nine questions that were developed in partnership with people with lived experience of intimate partner violence. Based on how patients respond, the app will also provide an indication of the level of safety concern associated with their relationship.

“Many screening questions just focus on physical violence, but our research has shown that emotional violence and controlling behaviours are far more common,” Dr. O’Campo said. “We wanted to focus on that and capture more nuanced behaviours.”

WITHWomen was developed in partnership with the frontline staff who see patients who experience violence. From concept, to implementation, to results, the clinic’s staff and the research team have been working side by side.

Esther, a registered nurse in the Fracture Clinic at St. Michael’s, anticipates the app will encourage more women to report abuse. Right now, the clinic sees more than 400 patients every week, and Esther estimates one or two of those indicate they may be in a dangerous relationship on the paper screening.

“I think people will be more honest with the app – it’s more private,” she said.

For Dr. Hall, in addition to more honest reporting in the clinic, he hopes the WITHWomen app will make those experiencing violence feel heard.

“The ideal is to create a process where people can see that even in a busy clinic setting, there’s still an opportunity to privately flag concerns about intimate partner violence, report their concerns and access resources about these issues,” he said.

Because the app is available to anyone in the GTA and Hamilton area, he hopes that it will be a useful resource to those who need it.

The next steps for this application are to make it accessible to diverse populations, including men and patients who identify as LGBTQ+, and translate it to other languages. The team also hopes to expand the app’s reach by making it more applicable to areas outside the GTA and Hamilton. They’re in the process of developing a complementary app that will create personalized safety plans for those who need them.

“Ultimately, we want people to be aware they’re not alone,” said Dr. Hall. “There are resources they can access within our hospital and beyond it.”

Dr. Patricia O’Campo (third from right) with the WITHWomen Research team.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.