Initial organizational practices and contextual factors related to brain injury screening and referral in intimate...

Early detection of brain injury (BI) among survivors of intimate partner violence (IPV) through screening and referral to follow-up care can help mitigate the impact of IPV-related BI. Despite the high risk for BI among IPV-survivors, BI screening is not standard practice in IPV-serving community-based organizations (CBOs). This project evaluates implementation strategies co-developed with CBOs to embed BI screening and referral processes into their workflows. This paper presents baseline findings from an ongoing stepped-wedge, mixed methods study designed to improve the integration of BI screening and referral practices into IPV-serving CBO.

Guided by the Practical Robust Implementation and Sustainability Model (PRISM) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, baseline data were collected from 12 IPV-serving CBOs in rural and urban areas of a Midwestern state prior to the start of an action learning collaborative (ALC) implementation strategy. CBOs were randomly assigned to three virtual ALC groups of four CBOs each, phased in at four-month intervals. ALCs worked collaboratively, to identify, adapt, and implement strategies to support BI screening and referral. Data sources included organizational records on screening and referral practices, and staff surveys that assessed perceptions of implementation readiness, barriers, and facilitators. The broader parent study uses a participatory, community-engaged, dissemination and implementation research (CEDI) approach across project activities.

Twelve participating CBOs served average monthly from 6 to 340 clients and represented diverse IPV service settings including shelter and walk-in services. At baseline, 7 of the 12 CBOs had conducted at least one BI screening, while only one had completed referrals. Staff survey data highlighted several contextual barriers to implementation, including competing client demands, limited staff readiness to conduct screening and referral, complexity in the BI screening tool, and communication of results to clients. Staff reported strengths including awareness of BI, perceived importance of screening and referral, and management support.

Findings suggest that IPV-serving CBOs are promising but inconsistently prepared for BI screening and referral. The identified practice gaps and contextual factors can guide site-tailored strategies for future efforts to adapt and integrate BI screening and referral into IPV service settings.