Transforming philadelphia's response to intimate partner and sexual violence in obstetric settings - the city of philadelphia created the nation's first county-level maternal mortality review…

Transforming philadelphia's response to intimate partner and sexual violence in obstetric settings - the city of philadelphia created the nation's first county-level maternal mortality review committee (MMRC) in 2010. Among the various risk factors collected in the maternal mortality database, the risk factor with the highest prevalence was history of behavioral health issues at 73.9% including substance use (56% of cases) and mental illness (65% of cases). Given these findings, there has been considerable attention and resources dedicated to tackling these issues in the city. However, the third leading risk factor-a history of intimate partner violence (IPV)-has not garnered the same attention. Thirty-five percent of maternal deaths due to violence had a reported history of intimate partner violence, this number is likely an underestimation due to the limitations that MMRC currently has to identify IPV in case abstraction. Notably, significant racial disparities exist in maternal mortality due to violence. Black, non-hispanic women made up about 78% of homicide/suicide deaths but they account for only 43% of total births in philadelphia. Eighty-seven percent of the homicide/suicide maternal deaths were insured by medicaid and 26% of homicide/suicide maternal deaths reported not engaging in prenatal care under the leadership of the philadelphia department of public health's division of maternal, child, and family health (MCFH) and the office of domestic violence strategies (ODVS), this five-year project aims to: (1) enhance current maternal mortality surveillance system in philadelphia, and (2) increasing delivery hospitals' and emergency departments' capacity to identify and respond to patient's experiences of intimate partner (IPV) and sexual violence. All activities related to both goals will be informed and monitored by a cross-section collaboration ("the IPV implementation team") that will include delivery hospitals, IPV organizations, people with lived experience, and other stakeholders identified by initial landscape analysis. People with lived experience and community-based organizations will be remunerated for their participation in the collaboration; a scaled reimbursement system will be used to ensure that small organizations -usually with fewer staff- could participate next to larger organizations that have more resources. IPV implementation team will be trained in racial and gender bias, trauma-informed care, IPV dynamics, and other topics identified by team's members. The project will develop and implement three main interventions: (1) incorporate IPV-specific data tracking into maternal mortality surveillance system, (2) increase capacity of obstetric settings and emergency departments to assess for intimate partner and sexual violence, and (3) create a new model of care that will connect patients with IPV services and other support. Activities creating training modules for obstetric and emergency department staff, establishing a warm hand off referral system, developing a sustainability plan, changing hospitals' protocols and policies to incorporate training plan and new model of care, and ongoing monitoring and evaluation of interventions. The outcomes of the project are: increase in obstetric and emergency department (ED) staff's knowledge about IPV dynamics and best practices for screening, increase in IPV screening rate in obstetric and ED settings, an improved model of care to connect patients to IPV and support, and increase in referrals from delivery hospitals to IPV services.