Intimate Partner Violence Identification and Response: Time for a Change in Strategy
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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.
Examine emergency department (ED) case finding and response within a known population of abused women.
Retrospective longitudinal cohort study.
Police-involved female victims of IPV in a semi-rural Midwestern county.
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.
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.
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.
KEY WORDSintimate partner violence police incidents health care screening risk identification interventions emergency departments
The authors wish to thank Patricia Smith, Director, Violence Against Women Prevention Program, Michigan Department of Community Health; the Kalamazoo County Prosecutor’s Office, all members of the Community Advisory Board, the YWCA Domestic Violence Program, and the many research assistants who worked on this project. This project builds on data collected for the MEDCIIN Projects under the CDC cooperative agreement U17/CCU551067.
Conflict of Interest
Research support was primarily provided by a grant from the National Institute of Justice: NIJ 2006-WG-BX-0007; additional support for investigator time was provided by NIMH K23 MH64572 (Rhodes) and K01MH75965-01 (Cerulli) and the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center (Dichter). Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice the Department of Veterans Affairs or the United States Government.
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