Abstract
BackgroundDomestic violence and abuse (DVA) damages the health of survivors and increases use of healthcare services. We report findings from a multi-site evaluation of hospital-based advocacy services, designed to support survivors attending emergency departments and maternity services.MethodsIndependent Domestic Violence Advisors (IDVA) were co-located in five UK hospitals. Case-level data were collected at T1 (initial referral) and T2 (case closure) from survivors accessing hospital (T1 N = 692; T2 N = 476) and community IDVA services (T1 N = 3544; T2 N = 2780), used as a comparator. Measures included indicators of sociodemographic characteristics, experience of abuse, health service use, health and safety outcomes. Multivariate analyses tested for differences in changes in abuse, health and factors influencing safety outcomes. Health service use data in the 6 months pre-and post- intervention were compared to generate potential cost savings by hospital IDVA services.ResultsHospital IDVAs worked with survivors less visible to community IDVA services and facilitated intervention at an earlier point. Hospital IDVAs received higher referrals from health services and enabled access to a greater number of health resources. Hospital survivors were more likely to report greater reductions in and cessation of abuse. No differences were observed in health outcomes for hospital survivors. The odds of safety increased two-fold if hospital survivors received over five contacts with an IDVA or accessed six or more resources / programmes over a longer period of time. Six months preceding IDVA intervention, hospital survivors cost on average £2463 each in use of health services; community survivors cost £533 each. The cost savings observed among hospital survivors amounted to a total of £2050 per patient per year. This offset the average cost of providing hospital IDVA services.ConclusionsHospital IDVAs can identify survivors not visible to other services and promote safety through intensive support and access to resources. The co-location of IDVAs within the hospital encouraged referrals to other health services and wider community agencies. Further research is required to establish the cost-effectiveness of hospital IDVA services, however our findings suggest these services could be an efficient use of health service resources.
Highlights
Domestic violence and abuse (DVA) damages the health of survivors and increases use of healthcare services
Most survivors supported by both services were white British or Irish (84.2% hospital; 77.5% community), heterosexual (98.0% hospital; 90.2% community) women (93.6% hospital; 96.2% community) who were, on average, in their mid-thirties (M = 35.6, 95% CI 34.6 to 35.4; hospital; M = 34.9, 95% CI 34.5 to 35.3 community)
Survivors working with hospital Independent Domestic Violence Advisors (IDVA) were more likely to be pregnant (17.1% hospital; 6.3% community) or not have children at home (67.2% community; 51.1% hospital)
Summary
Domestic violence and abuse (DVA) damages the health of survivors and increases use of healthcare services. Domestic violence and abuse (DVA) is a public health problem and challenge to clinical services. DVA can include physical and sexual violence, coercive, controlling and emotionally abusive behaviours, economic restrictions, as well as harassment and stalking. Intimate partner violence (IPV) can have life-long physical and mental health consequences [4]. The severe health outcomes of IPV leads to increased use of healthcare services (e.g., primary care, emergency departments (ED), mental health) [7, 8]. Evidence shows that while 54% of all women presenting at ED are likely to have lifetime experience of IPV, only 5% are identified by healthcare professionals [10]
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