Sociotechnical Challenges in Implementing Domestic Violence Screening via Telehealth and In-Person Care: Qualitative Study on Clinicians' Perspectives.

backgroundNew York State Public Health Law Section 2805-z (NYSPHL§2805-z) mandates that hospitals implement certain protocols for the identification of domestic violence (DV) to strengthen support for DV survivors. However, there are challenges within our current health care delivery settings that raise critical questions about the effectiveness and adaptability of mandated policies for DV screening. The COVID-19 pandemic significantly accelerated the adoption of telehealth services, leading to the widespread use of combined telehealth and in-person clinical care. This shift has brought challenges associated with implementing the mandated DV screening protocols.

objectiveThis study aimed to explore the challenges health care providers face in implementing DV screening that complies with NYSPHL§2805-z to support effective screening practices. Considering both the telehealth and in-person environment, we aimed to identify the challenges that health care providers face in meeting policy requirements, with a focus on the technical, environmental, and social factors impeding effective DV screening. We also explored potential sources of support to address these challenges. This study sought to provide actionable insights for enhancing policy implementation and improving care for DV survivors.

methodsWe conducted interviews with health care professionals-nurses, social workers, and physicians-across New York City involved in DV screening. These interviews were analyzed using an adapted version of the Centers for Disease Control and Prevention sociotechnical model to understand how policy, organizational structures, and individual practices intersect and impact the effectiveness of DV screening, especially in telehealth settings.

resultsOur findings revealed gaps in awareness of the policy and inconsistent DV screening processes. Through our interviews, we identified challenges in effective DV screening and strategies to improve the screening process. We found that the shift to telehealth introduced additional layers of complexity, with challenges in ensuring patient privacy and safety. Our findings revealed a lack of clear guidelines tailored to remote DV screenings and a need for training programs to prepare health care providers for the nuances of telehealth-based DV screening, both of which are crucial for complying with policy mandates. On the basis of this analysis, we developed a list of recommendations to support health care providers in effective screening for DV. Through user feedback, we confirmed that this list is consistent with the application of NYSPHL§2805-z among health care providers.

conclusionsAs telehealth care is increasingly becoming an integral component of health care, there is an urgent need to refine and reinforce DV screening policies and procedures designed to comply with NYSPHL§2805-z. This study highlights the importance of developing practical and consistent telehealth protocols, enhancing provider training, creating supportive workflows, allotting adequate resources, and fostering collaboration among stakeholders to ensure that DV survivors receive the care they need in both remote and in-person clinical settings.