Impact of emergency department–Based intimate partner violence intervention

Abstract

Study objectives: Thirty percent of women and 5% of men treated in the emergency department (ED) have been victims of intimate partner violence (IPV); therefore, it is essential that EDs screen and offer intervention for IPV victims. Several studies investigated the performance of ED-based IPV intervention in decreasing medical recidivism and increasing community resource use. At the outset of this study, the investigators were unaware of any published studies assessing the impact of an ED-based IPV program on patient safety. This investigation sought to verify the benefit of ED-based IPV counseling and resource referral on patient safety. Methods: The study hospital was an urban Level I trauma center with an annual census of 110,000 patients. Female patients 12 years and older and male patients presenting with risk factors for IPV were screened using the Partner Violence Scale. Critically ill and non–English speaking, non–Spanish speaking patients were not screened. Consenting patients screening positively who accepted consultation with an IPV counselor made up the study population. Inclusion of a control population, to which intervention was not offered, was considered unethical. IPV counselors completed a safety assessment, developed an individualized safety plan, and provided resource referrals. Patients were contacted at 48-hour and 2-, 6-, and 12-week intervals after ED intervention to reassess safety. The intervention's effect on patient safety was assessed by patient-perceived change in safety and fraction of safety plan completed. Simple percentages were calculated to convey the amount of the safety plan completed and the number of patients with a patient-perceived increase in safety. Student's t test and Spearman coefficients were used for grouped and linear variables, respectively, to examine the relationship between recorded demographic and action variables and change in patient safety. Results: Two hundred seventy-eight patients with a mean age of 32 years and a mean annual income of $6,700 underwent initial IPV intervention during the first 16 months of the program. The group described themselves as predominantly black (64%) and white (26%). The mean length of victim-perpetrator relationship was 4 years, with the predominance (65%) described as heterosexual, unmarried partnerships. Seventy-four (27%) patients have been contacted in follow-up. The majority of failed follow-ups (65%) were due to inability to contact the victim after 3 attempts using the provided information; 22 had disconnected telephone numbers, whereas 4 refused to participate in follow-up after consenting initially. Sixty-eight (92%) of the 74 victims contacted after ED-based IPV intervention stated they felt safer. These 74 victims had implemented a mean of 68% of their safety plan tenets. Law enforcement and legal referrals were reported to be the most helpful in improving safety. Correlation between patient-perceived safety and demographic variables was unable to be examined because only 6 victims did not believe their safety improved after IPV intervention. No statistically significant correlation existed between the victim's age, race, income, or length of relationship with the perpetrator and safety plan implementation. In addition, no relationship could be demonstrated between previous attempts at safety (such as leaving the relationship and filing of a police report) and successful implementation of safety plan. Conclusion: This study was limited by insufficient follow-up, although the rate was consistent with that of previous studies involving similar populations. Such a limitation likely stems from the known difficulty of telephone follow-up in an urban ED patient population and is amplified by the focus of this study on a subsegment of that population with inherently unstable living environments. Assuming previously established recidivism of IPV is present in the study population, the data confirm that ED-based IPV intervention improves patient-perceived safety. In addition, ED-based intervention led to implementation of 68% of safety plans. Success of IPV intervention was equitable between victims of varied ages, races, and incomes. Previous attempts to increase safety did not indicate successful implementation of safety plan.