ESTABLISHING AN ONSITE HEALTH CLINIC IN A DOMESTIC VIOLENCE SHELTER

Purpose: Screening for Domestic/Intimate Partner Violence (D/IPV) is a protocol in most health care organizations. However health care providers remain uncomfortable with addressing D/IPV with clients. Also provider-patient trust relationship remains poor and D/IPV victims continue to experience poorer health outcomes than non-victims. Clients in a domestic violence shelter already acknowledge their condition as survivors. Shelter staff and partners are trained to be trauma informed and to meet clients where they are. The purpose of this study was to identify from clients and staff members, the barriers that keep survivors from accessing health care services, and determine priority services for an onsite health clinic. Methods: A review of the literature was used to establish the health consequences for survivors of D/IPV. An IRB approved needs assessment was conducted with clients and direct service staff at a domestic violence agency. The clients were surveyed with a questionnaire and self-reported on barriers to accessing health care, health needs forgone and top three desired services for an onsite health clinic. Staff members were interviewed on health needs observed with clients and barriers preventing clients from accessing health care services. Results: Clients identified insurance, transportation and waiting time as the three top barriers preventing accessing health care services. Staff identified additional barriers as client's state of mind and awareness of healthcare need. Clients reported dental care as the need most ignored, followed by primary care and vision. The top three services reported by clients as the most desired were primary care, women's health and dental care. The most observed health care needs as observed by staff were primary care, medication needs, mental health and women's health. Conclusions: An onsite health clinic can eliminate barriers identified by clients and staff as preventing survivors from accessing health care services. While clients and staff both agree that primary care services is the most needed service in an onsite health clinic, they differ on the next two most pressing services needed. The medication needs identified by staff is however crucial - whatever care a client gets can be negated by their inability to get the needed medication. Mental health services can also influence how best a client responds to other health care services. These can be considered the top three priorities for an onsite health clinic.