Identification Of Domestic Violence Research Articles

Medical student identification of domestic violence as measured on an objective, standardized clinical examination

This study examined the incidence and predictors of domestic violence screening by third-year medical students at an end of clerkship Objective Standardized Clinical Examination. Two hundred and seventy-five third-year medical students completed an 8-station end of clerkship Objective Standardized Clinical Examination as part of this retrospective observational study, one with nonspecific abdominal pain and possible domestic violence. Checklists on history, physical, communication, and interpersonal skills were collected. Domestic violence screening was analyzed by logistic regression and analysis of variance. The incidence of domestic violence screening by history alone was 34% before the physical. Interpersonal scores on the overall exam and domestic violence station, but not gender or rotation sequence, predicted domestic violence questioning. In this standardized patient study there was a low rate of domestic violence screening by history.

Child welfare as a gateway to domestic violence services

This paper uses data from the National Survey of Child and Adolescent Well Being to examine the identification of domestic violence (DV) by child welfare workers during investigations of maltreatment and determine how this contributes to the receipt of DV services. The study focuses on female caregivers of children remaining in the home following the investigation ( n = 3165). While child welfare workers indicate that active DV is present in only 12% of families investigated for maltreatment, 31% of caregivers reported DV victimization in the past year. The sensitivity of reports of DV is low between caregivers and workers, with both reporting active or recent DV in only 8% of families. Substance abuse by the primary caregiver is a strong predictor of under identification of DV by the child welfare worker (OR = 7.6). Overall, about half of the caregivers with active DV identified by the worker received DV services over the 18 months following the investigation. Logistic regression analyses examined whether receipt of child welfare services (CWS) increases the likelihood that a referral will be made to DV services and whether caregivers will then obtain these services. Both the identification of DV by the worker and having an open CWS case are significant contributors to receipt of DV services.

How nurses’ experiences of domestic violence influence service provision: Study conducted in North‐west province, South Africa

This study was undertaken to determine whether nurses' experiences of domestic violence (DV) influence their management of DV and rape cases. In total, 212 nurses were interviewed in two South African health districts using a standardized questionnaire. We measured sociodemographic characteristics, quality of care in the areas of rape and DV management, and experiences of DV in their own lives and amongst family and friends. A total of 39% nurses reported having experienced either physical or emotional abuse themselves and 40.6% amongst family and friends. Having personally experienced DV had no influence on DV identification and management. Those with experience from friends and family were more likely to have provided better care for patients who presented after DV (mean quality of care score = 23.1), while nurses who reported no personal experience of DV, either in their own lives or among family and friends, had a lower quality of care score of 19.8 (P = 0.02). Having ever intervened in a domestic dispute was associated with higher quality of care (P < 0.001). This suggests that the greater degree to which nurses identify with DV and intervene, the more likely they are to provide higher quality of care. Training of nurses in DV must try to build such empathy.

Screening for Domestic Violence in a General Pediatric Clinic: Be Prepared!

Exposure to violence, particularly domestic violence (DV), negatively affects children's physical, emotional, and cognitive well-being. The American Academy of Pediatrics recommends routine DV screening of female caretakers of pediatric patients. Few reports of screening in pediatric practices exist, and none have reported outcomes from a resident-run urban academic center. We set out to determine whether the use of the Partner Violence Screen (PVS) increases detection of DV and to test the mechanics of implementing large-scale DV screening in a busy, pediatric residency training clinic. Using the PVS, we screened a sample of consecutive female caretakers/guardians of children seen for pediatric care in the general pediatric clinic of Children's Hospital of Michigan from March 1, 2002, through February 28, 2003. Positive screens obtained during the study period were compared with the number of DV referrals received by the clinic social workers from January 1, 2001, through December 31, 2001, before PVS screening began. To test the mechanics of screening, we also analyzed the number of forms returned blank or marked "no opportunity to screen" in the last 8 months of the study period. In the 12 months before use of the PVS, our social work department received 9 referrals because of DV from the general pediatric clinic, among a total of 5446 caretakers/guardians bringing 6380 children for a total of 13,576 patient care visits. In contrast, the social work department received 164 referrals because of positive screening results among 5445 caretakers/guardians bringing 7429 children for 17,346 patient care visits in the 12-month study period after introduction of the PVS. Fourteen of 164 positive PVSs were found to involve nondomestic violence perpetrated by nonpartners or violence with the patient as the victim, not the mother or female caretaker. A total of 150 PVSs involved true DV. The difference in identification of DV with the PVS, compared with the rate before its introduction, was highly significant. The positive predictive value for the PVS was 91.5%, and the identified prevalence rate was 3.7%. In the last 8 months of the study period, 6301 of 8055 PVS forms (78%) were completed; 1754 of 8055 PVS forms (22%) were left blank, but it was not possible to determine whether these represented duplicate screening forms for instances in which the mother or female caretaker had brought >1 child for care. Formal screening for DV with the PVS in this study setting of a busy, urban, academic, general pediatric clinic appeared to be very successful, in terms of increasing referrals and documentation of previously unrecognized DV situations. This increase signals the need for resources (time and/or social work services) to provide appropriate referral services. The PVS identifies nonpartner violence occasionally.

Should health professionals screen women for domestic violence? Systematic review

abstractObjective: To assess the evidence for the acceptability and effectiveness of screening women for domestic violence in healthcare settings.Design: Systematic review of published quantitative studies.Search strategy: Three electronic databases (Medline,...

Domestic violence in child welfare preventative services: Results from an intake screening questionnaire

This paper describes the results from a domestic violence screening questionnaire implemented in neighborhood-based child welfare preventive service agencies. The goal of these preventive service agencies is to avert the unnecessary placement of children into foster care as well as preventing child maltreatment. The purpose of the project described in this paper was to systematically change the manner in which child welfare preventive service agencies identified and worked with battered women. Components of the project included recruitment of participant agencies; training of the workers in domestic violence identification; and the use of a new screening questionnaire during intake interviews with women clients. Findings indicated that training enhanced identification; women appreciated being asked about current and historical abuse; and that women felt better able to protect themselves and their children after disclosure of domestic violence to the worker. A secondary effect of the project was that child welfare agencies developed specific services for batterers, battered women and their children.

Health Care System Responses to Children Exposed to Domestic Violence

The health care system has only recently adopted protocols and training to enable practitioners to identify and respond to victims of domestic violence. Currently, most hospitals have domestic violence protocols in place, although training in the use of protocols is less routine. However, because the provision of health care focuses on the treatment of the individual, the well-being of the children of adult domestic violence victims has received little attention in adult health care settings. Pediatricians do not routinely receive training in domestic violence identification and do not see responding to battered mothers as within the purview of their practice. Innovative programs in children's hospitals in Boston, Massachusetts, and San Diego, California, recognize that the safety of children is integrally tied to the safety of their mothers. These programs identify abused children whose mothers are the victims of domestic violence and provide advocacy and support that allow mothers and children to remain together in most instances. Little is known about the health impacts of teen dating violence, and opportunities for screening exist in the settings where teens receive health care. Likewise, prenatal visits provide regularized opportunities for domestic violence screening. Integrating the health care needs of mothers and children from violent households will require continued and expanded training, collaboration with community institutions, and improvements in insurance reimbursements to cover the costs of needed services.

A Training Program to Improve Domestic Violence Identification and Management in Primary Care: Preliminary Results

Domestic violence as encountered in day-to-day practice is greatly underidentified. It is estimated that only 3% of cases are presently being identified, and practitioners are uncertain of what to do if a case is discovered. In this paper, a training program to improve identification and management of domestic violence (DV) in primary care and the providers' responses to the program are described. A multimodal training program was undertaken to demonstrate and practice the incorporation of didactic content into practice for the health care teams. Two medical centers from a large staff-model HMO were chosen at random from five volunteering for training. The entire adult health care medical center teams, including physicians, physician assistants, RNs, LPNs, medical assistants, and receptionists, were the recipients of the training. Assessment of provider valuation of the components of the training program was performed by administering a standardized 5-point Likert-scaled questionnaire 9 months after the training. This time interval was chosen because we were interested in lasting program effects. Core didactic content, such as the epidemiology of DV, identification and management of victims and batterers, and legal issues, was highly rated. Delivery of the content through role-playing, start-stop videos and presentations by former victims received lesser but solid support. Follow-up assessment 9 months post training demonstrates solid support for many components of the program: highest for specific information content areas, but strong for techniques and processes. The training program appears to be a promising method to improve provider skills in DV management.

Increasing Emergency Physician Recognition of Domestic Violence

Study objective: To determine whether recognition of domestic violence in the emergency department is affected by restructuring of the ED chart to include a specific question about domestic violence, to evaluate whether training concerning domestic violence further increases its recognition, and to develop a profile of women who present to the ED as a result of domestic violence. Methods: We collected prospective data on all females aged 15 to 70 years who presented to an urban Level I trauma center during a 3-month period. Two keywords were used to define domestic violence: (1) mechanism (eg, kicked, hit, pushed) and (2) perpetrator (eg, current/former boyfriend, spouse). We used the first month to define the baseline number of domestic violence cases. We modified charts in the second and third months (intervention months) to include, "Is the patient a victim of domestic violence?" In addition, the third month included a 1-hour educational lecture on the identification of domestic violence in the ED. Results: We identified 123 cases of domestic violence from a survey population of 4,073: 25 (2.0%) in the baseline month, 49 (3.4%) in the chart-modification month, and 49 (3.6%) in the education month. The proportion of cases identified during the intervention months was 1.8 times higher than during the control month (relative risk [RR], 1.78; 95% confidence interval [CI], 1.15 to 2.75), but did not differ between each other (RR, 1.06; 95% CI, .72 to 1.57). Women identified as domestic violence cases ranged in age from 15 to 61 years (median, 28.5 years). Most of the identified domestic violence patients presented with a triage classification of assault (54.5%), trauma (8.1%), or abdominal complaints (7.3 %). Triage complaint differed for domestic violence and non–domestic violence cases (χ 2=830; P<.0001). Nearly one third of domestic violence patients (31.7%) presented between 11 PM and 6:59 AM, compared with 19.0% of non–domestic violence patients (χ 2=12.4; P=.005). Conclusion: Modification of the chart significantly increased the recognition rate of domestic violence. An educational intervention did not significantly improve this rate. The profile of a woman presenting to the ED differs from those of other women with respect to chief complaint and time of presentation. [Olson L, Anctil C, Fullerton L, Brillman J, Arbuckle J, Sklar D: Increasing emergency physician recognition of domestic violence. Ann Emerg Med June 1996;27:741-746.]

Physical therapists' recognition of battered women in clinical settings.

The purposes of this study were to describe physical therapists' knowledge regarding battered women and to determine whether physical therapists recognize these patients in clinical settings. Two hundred questionnaires were distributed to outpatient physical therapists in northern California. One hundred fifty-one usable questionnaires (76%) were returned. Although 43% of the respondents reported treating a patient they identified or strongly suspected as having been battered, only two respondents (1%) reported they routinely asked patients about physical abuse. Less than 50% of the respondents correctly identified that battering injuries are more likely to occur in a central pattern (ie, head, neck, chest, abdomen). The results of this survey suggest that physical therapists have treated patients who are battered. Many physical therapists, however, may not be fully educated to detect the signs of abuse. This study is the first step in initiating physical therapy research in domestic violence identification and education.

Identifying domestic violence in primary care practice.

To improve detection of domestic violence as a problem for women seeking primary care, we compared the addition of a single question about domestic violence on an existing self-administered health history form, to discretionary inquiry alone. We studied 689 consecutive new women patients in an internal medicine practice. Domestic violence identification rose from 0% in the control group with discretionary inquiry alone to 11.6% (95% confidence interval 8.8-14.4%) when the health history form included the following question: "At any time has a partner ever hit you, kicked you, or otherwise physically hurt you?" The addition of a single question can increase identification of domestic violence as a problem in patients' lives.

Domestic Violence: Domestic Violence Identification, Assessment, Intervention

Domestic Violence: Domestic Violence Identification, Assessment, Intervention