Medical provider versus social worker screening to detect interpersonal violence

Abstract

Study objectives: We compare 2 methods of screening emergency department (ED) patients for concordance in detection of intimate partner violence (IPV). Methods: This is an ongoing study occurring in an urban academic ED. In this facility, nurses and physicians, mandated by the Jointre Organizations, screen female patients older than 12 years for IPV. An additional convenience sample was screened by Social Services personnel for IPV. Social worker indications for screening included patients presenting with mood disorder, self-destructive behavior, chest pain, headache, dyspnea not related to asthma, nonmotor vehicular trauma, or chronic pain. These social service personnel were blinded to the result of IPV screening carried out by the nurse or physician. Social Services personnel were asked to record the presenc Commission on Accreditation of Healthcae or absence of IPV on a data collection instrument. Other demographic information is being collected about age and race of patients, providers, and social workers. Concordance and discordance between the social workers and providers was then assessed. If IPV was detected by any method, the presence of IPV was determined to be positive. Results: One hundred seventeen women were screened by social workers. Thirty-four (29%) answered yes to screening by either the social worker or medical provider. Five of these 34 patients responded yes to nurse/physician screening but no to social worker screening. Additionally, 13 patients (38% of those with IPV) denied IPV by nurse/physician screening but responded yes to social worker screening. The sensitivity of nurse/physician screening was 62%. Social worker screening sensitivity was 83%. Conclusion: Standard screening by health care providers seems to be insensitive in identifying IPV victims in the ED. Additionally, screening by Social Services personnel was not perfectly sensitive. The focus of continuing work in this project is to determine whether demographic factors of the patients or questioners play a role in sensitivity of IPV screening.