HEALTHY START LOCAL EVALUATION REPORT 1 PROJECT NAME : Kalamazoo County MI Healthy Babies-Healthy Start TITLE OF REPORT : Patient & Provider Factors that Increase Disclosure of Psychosocial Problems

Many psychosocial factors impact overall health. Domestic violence, mental illness, and substance abuse are leading risks that present substantial health burden, especially during pregnancy. Medical providers are perfectly positioned to identify, refer and administer treatment. As a result, medical guidelines recommend screening, referral and treatment for these psychosocial issues. Unfortunately, there are many barriers that exist and hinder disclosure of important risk factors. Both patients and providers face multiple barriers to disclosure. For patients, these can include mistrust with the provider,1 lack of access to health care,2 a fear for their own safety and concerns about child protective services involvement. For providers, these may include discomfort asking appropriate questions, concern about responding in the event of a disclosure and fear that they may be unequipped with the resources to address the unique needs of each patient3.