Injury prevention/original researchDoes Screening in the Emergency Department Hurt or Help Victims of Intimate Partner Violence?
Introduction
Although victims of intimate partner violence frequently use emergency department (ED) services, most present for non-injury-related complaints and are not screened for intimate partner violence despite recommendations for routine intimate partner violence screening by the American Medical Association and The Joint Commission.1 However, neither the United States Preventive Services Task Force nor the Canadian Task Force on Preventive Health Care found sufficient evidence to recommend for or against intimate partner violence screening.2, 3
One piece of information needed and not available for the United States Preventive Services review was an assessment of the safety of intimate partner violence screening itself. In fact, there are limited data available on the potential for harm or retaliation that might result from routine screening and intimate partner violence identification in a health care setting with either women or men.
In addition, very few studies have examined the effectiveness of intimate partner violence screening related to seeking out resources or patient outcomes. One study found that almost half of women who disclosed intimate partner violence during screening accepted case management follow-up.4 Many of these women believed that they were no longer at risk for intimate partner violence after participating in the screening. However, another study revealed that most health care providers documented intimate partner violence status after patients participated in a mandatory waiting room screen, but only 10% of these medical records included any mention of a safety plan or referral.5 These results suggest that even if screening is implemented in health care settings, it may not objectively improve referrals or outcomes.
The goals of this study were (1) to determine whether patients (male or female) who disclosed intimate partner violence victimization on a computer screening assessment in the ED would have any safety issues (ie, disruption of the visit by a partner, security involvement) compared with ED patients who did not disclose intimate partner violence; (2) to ascertain whether intimate partner violence victims had any short-term safety issues at 1-week and 3-month follow-up related to screening, including increased number of violent acts, increased severity of intimate partner violence, and other self-reported safety issues after participation or any increases in 911 calls 6 months after the ED visit from the addresses of all patients who screened positive for victimization within 1 call district; and (3) to investigate whether screening linked with automatic (computer-generated) resource information would result in intimate partner violence victims contacting referrals or taking any measures to improve their safety.
Section snippets
Study Design
We conducted an intervention study with a prospective cohort of intimate partner violence victims from February 2004 to April 2006. We identified male and female intimate partner violence victims at an index ED visit by using a touch-screen computer kiosk. The intervention consisted of computer-generated targeted referrals tailored to the health risk behaviors, specifically intimate partner violence in this study that the patient disclosed on the kiosk. We then conducted follow-up interviews
Results
Approximately 6,328 patients were triaged to the waiting room during our study hours, and 5,473 were approached to participate in the study. Four thousand four hundred twenty-five patients were eligible for survey participation and 3,083 (69.6%) consented to participate. No differences existed for race or chief complaint between participants and nonparticipants, although participants tended to be younger and women. Overall, of the initial 3,083 consenting participants: 47% were women, 88% were
Limitations
Before one generalizes our findings, there are certain factors to consider. The study recruited a convenience sample of patients who were not acutely ill or severely injured. The limited sample size at the 3-month follow-up assessment limits analysis. Many intimate partner violence victims were lost to follow-up, and these victims may have had safety issues after screening positive for intimate partner violence or these victims may not have found the resource information helpful and decided not
Discussion
We found no evidence that computer-based screening for intimate partner violence in the ED setting resulted in harm or significant adverse events for intimate partner violence victims. However, ED follow-up is notoriously poor for all manner of acute medical and surgical complaints, so adverse events may well have occurred in the group without follow-up. Nonetheless, 65% of screened intimate partner violence victim participants who agreed to participate either returned to the ED for follow-up
References (22)
- et al.
Domestic violence screening and referral can be effective
Ann Emerg Med
(2002) - et al.
Women’s experiences with battering: a conceptualization from qualitative research
(1995) - et al.
Do responses to an intimate partner violence screen predict scores on a comprehensive measure of intimate partner violence in low-income black women?
Ann Emerg Med
(2003) - et al.
Screening for intimate partner violence by health care providers
Am J Prev Medicine
(2000) - et al.
Intimate partner violence screening and intervention: data from eleven Pennsylvania and California community hospital emergency departments
J Emerg Nurs
(2001) - et al.
“Between me and the computer.”Increased detection of intimate partner violence using a computer questionnaire
Ann Emerg Med
(2002) - et al.
One year follow-up of an emergency department protocol for abused women
Aust N Z J Public Health
(1999) - et al.
Effects of an emergency department-based advocacy program for battered women on community resource utilization
Ann Emerg Med
(1999) - et al.
Domestic violence against women: incidence and prevalence in an emergency department population
JAMA
(1995) Screening for family and intimate partner violence: recommendation statement
Ann Intern Med
(2004)
Interventions for violence against women: scientific review
JAMA
Cited by (102)
Screening for Intimate Partner Violence in Trauma: Results of a Quality Improvement Project
2024, Journal of Surgical ResearchSelf-Check-In Kiosks Utilization and Their Association With Wait Times in Emergency Departments in the United States
2020, Journal of Emergency MedicineTeen Dating Violence: Old Disease in a New World
2019, Clinical Pediatric Emergency MedicineCitation Excerpt :In general, whether in-person face-to-face questioning, or use of a computer-interface for screening, no harm to patients has been reported. However, none of these studies were specific to adolescents.84,85 Example screening questions are listed in Table 4 and a summary of best practices for screening adolescents for TDV are available in Table 5.
Clinical Practice Guideline: Intimate Partner Violence
2019, Journal of Emergency NursingThe use of a self-check-in kiosk for early patient identification and queuing in the emergency department
2019, Canadian Journal of Emergency Medicine
Supervising editors: Rita K. Cydulka, MD, MS; Michael L. Callaham, MD
Author contributions: DH, NJK, LAM, CC, HS, and KVR developed the study design and obtained funding. DH, NJK, and RSK oversaw the study protocol and enrollment of participants. ER and CL performed statistical analyses. All authors participated in drafting and revising the article and all approved the final version. DH takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Supported by CDC R-49 grant 4230113 (Houry), NIMH K-23 grant 069375 (Houry), and NIMH K23 64574 (Rhodes).
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