|ERs Fail to Identify Three of Four Domestic Violence Victims|
|Living - Society|
|TS-Si News Service|
|Friday, 18 March 2011 08:00|
Philadelphia, PA, USA. Although nearly 80 percent of domestic violence victims who report the incidents to police seek health care in emergency rooms, as many as 72 percent are not identified as victims of abuse. Of those who are, very few are offered adequate support.
These findings from a new study point to a missed opportunity to intervene and offer help to women who suffer violence at the hands of an intimate partner.
Karin V. Rhodes, MD, MS, directs the Division of Emergency Care Policy Research in the department of Emergency Medicine at the University of Pennsylvania School of Medicine (Penn Medicine). She says “Emergency departments are a safety net for women with health issues of all kinds, but our study shows we’re not doing a good enough job of assessing our patients’ entire situation.”
Previous studies have shown that as many as 20 percent of women have been victims of domestic violence in the past year, but moves toward universal screening in emergency departments have yet to be shown to be effective.
This happens despite the existence of mandated protocols for intimate partner violence screening and intervention.
“There is no reason in the age of information technology that we should not provide routine screening and referrals to the social services patients can use to protect themselves from future violence,” says Rhodes.
— Karin V. RhodesTo better focus on how often — and how — victims are identified when they come to the emergency room, the study authors conducted a longitudinal cohort study that cross-checked court, police and emergency department records in a semi-rural county in Michigan over a four-year period (1999-2002).
The researchers examined all emergency department visits and intimate partner violence-related police events. The study took place within eight emergency departments, twelve police jurisdictions, and the prosecuting attorney's office. A total of 993 female victims of domestic violence generated 3,246 related police incidents.
The findings, published in the Journal of General Internal Medicine (JIGM), revealed that women who reported domestic assaults to the police relied heavily on emergency rooms for medical care:
The authors found that intimate partner violence was more likely to be identified when the ED visit occurred on the day of the police incident — assaults were four times more likely to be revealed at this point — and when patients were transported to the hospital by police. Providers were also more likely to identify abuse among patients whose chief complaints involved mental health or substance abuse issues such as suicidal behavior or overdoses.
The data showed that when abuse was identified, ED staff provided legally useful notes in the patient’s chart 86 percent of the time and communicated with police about half the time.
However, those steps didn’t always lead to interventions to actually protect the women — fewer than 35 percent of cases where abuse victims were identified, contained any documented assessment of whether the patient has a safe place to go after discharge from the hospital. Nor were they consistent in referring victims to community-based domestic violence resources — that occurred only 25 percent of the time.
Since health care workers have limited resources to devote to interventions for domestic violence, the authors point out the need to take a cross-systems approach to make it easier for providers to do the right thing.
“Most hospitals have a social work infrastructure to counsel patients with social risks and assist them in linking to needed services, but our study shows that these resources are infrequently utilized. This may be due to the fact that social workers are not always readily available in the ED,” Rhodes said. “As providers, we should strive to set up our health care system to present every patient with an opportunity to feel safe and supported in disclosing instances of abuse and give them information and resources that can help.”
Among strategies Rhodes and her coauthors suggest to boost the identification of women who’ve been abused: Use of confidential patient portals in which patients could use the Internet to link to their medical record and communicate with their providers, and development of easy-to-access interventions for victims, such as the on-site programs used to help patients with substance abuse and mental health problems. Integrated databases linking hospitals, criminal justice and social service agencies could also increase identification and tracking of abuse and use of support services.
The authors conclude: "Our work shows that the majority of police-identified intimate partner violence victims frequently use the emergency department for health care, but they are unlikely to be identified or receive any intervention in that setting. Current screening practices for intimate partner violence victims are ineffective and policy-driven interventions for identified victims are, at best, erratically implemented."
CitationIntimate Partner Violence Identification and Response: Time for a Change in Strategy. Karin V. Rhodes, Catherine L. Kothari, Melissa Dichter, Catherine Cerulli, James Wiley, and Steve Marcus. Journal of General Internal Medicine (JIGM) 2011; ePub ahead of print. doi:10.1007/s11606-011-1662-4
Background.While victims of intimate partner violence (IPV) present to health care settings for a variety of complaints; rates and predictors of case identification and intervention are unknown.
Objective. Examine emergency department (ED) case finding and response within a known population of abused women.
Design. Retrospective longitudinal cohort study.
Subjects. Police-involved female victims of IPV in a semi-rural Midwestern county.
Main Measures. We linked police, prosecutor, and medical record data to examine characteristics of ED identification and response from 1999–2002; bivariate analyses and logistic regression analyses accounted for the nesting of subjects’ with multiple visits.
Results. IPV victims (N?=?993) generated 3,426 IPV-related police incidents (mean 3.61, median 3, range 1–17) over the 4-year study period; 785 (79%) generated 4,306 ED visits (mean 7.17, median 5, range 1–87), which occurred after the date of a documented IPV assault. Only 384 (9%) ED visits occurred within a week of a police-reported IPV incident. IPV identification in the ED was associated with higher violence severity, being childless and underinsured, more police incidents (mean: 4.2 vs 3.3), and more ED visits (mean: 10.6 vs 5.5) over the 4 years. The majority of ED visits occurring after a documented IPV incident were for medical complaints (3,378, 78.4%), and 72% of this cohort were never identified as victims of abuse. IPV identification was associated with the day of a police incident, transportation by police, self-disclosure of “domestic assault,” and chart documentation of mental health and substance abuse issues. When IPV was identified, ED staff provided legally useful documentation (86%), police contact (50%), and social worker involvement (45%), but only assessed safety in 33% of the women and referred them to victim services 25% of the time.
Conclusion. The majority of police-identified IPV victims frequently use the ED for health care, but are unlikely to be identified or receive any intervention in that setting.
Keywords: intimate partner violence, police incidents, health care screening, risk identification, interventions, emergency departments.
|Last Updated on Thursday, 17 March 2011 20:55|