title: Implementation of a Family Planning Clinic-Based Partner Violence and Reproductive Coercion Intervention: Provider and Patient Perspectives.
abstract: Despite multiple calls for clinic-based services to identify and support women victimized by partner violence, screening remains uncommon in family planning clinics. Furthermore, traditional screening, based on disclosure of violence, may miss women who fear reporting their experiences. Strategies that are sensitive to the signs, symptoms and impact of trauma require exploration.
  
  
  
  In 2011, as part of a cluster randomized controlled trial, staff at 11 Pennsylvania family planning clinics were trained to offer a trauma-informed intervention addressing intimate partner violence and reproductive coercion to all women seeking care, regardless of exposure to violence. The intervention sought to educate women about available resources and harm reduction strategies. In 2013, at the conclusion of the trial, 18 providers, five administrators and 49 patients completed semistructured interviews exploring acceptability of the intervention and barriers to implementation. Consensus and open coding strategies were used to analyze the data.
  
  
  
  Providers reported that the intervention increased their confidence in discussing intimate partner violence and reproductive coercion. They noted that asking patients to share the educational information with other women facilitated the conversation. Barriers to implementation included lack of time and not having routine reminders to offer the intervention. Patients described how receiving the intervention gave them important information, made them feel supported and less isolated, and empowered them to help others.
  
  
  
  A universal intervention may be acceptable to providers and patients. However, successful implementation in family planning settings may require attention to system-level factors that providers view as barriers.
authors.affiliation: director, Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh, and professor of pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miller
authors.affiliation: assistant professor, Human Development & Family Studies, Michigan State University, East Lansing, and assistant professor, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine.
authors.forename: Heather L
authors.initials: HL
authors.lastname: McCauley
authors.affiliation: associate professor, Department of Population, Family and Reproductive Health, and director, Women's Health & Rights Program, Center for Public Health & Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
authors.affiliation: senior policy analyst, Futures Without Violence, San Francisco.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Levenson
authors.affiliation: clinical research assistant, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine.
authors.forename: Sarah
authors.initials: S
authors.lastname: Zelazny
authors.affiliation: postdoctoral associate, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine.
authors.forename: Kelley A
authors.initials: KA
authors.lastname: Jones
authors.affiliation: clinical research coordinator, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine.
authors.forename: Heather
authors.initials: H
authors.lastname: Anderson
authors.affiliation: director of research, Center on Gender Equity and Health, and professor of medicine and global public health, University of California, San Diego, La Jolla.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D003068:Coercion; D005193:Family Planning Services / Q000193:education* / Q000379:methods; D005260:Female; D006282:Health Personnel / Q000193:education / Q000523:psychology; D006284:Health Plan Implementation; D006801:Humans; D000066511:Intimate Partner Violence / Q000517:prevention & control / Q000523:psychology*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010414:Pennsylvania; D015397:Program Evaluation; D012742:Sex Offenses / Q000517:prevention & control / Q000523:psychology*; D012747:Sexual Partners / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult