Domestic Violence Screening Research Articles

Randomized Comparison of 3 Methods to Screen for Domestic Violence in Family Practice

We undertook a study to compare 3 ways of administering brief domestic violence screening questionnaires: self-administered questionnaire, medical staff interview, and physician interview. We conducted a randomized trial of 3 screening protocols for domestic violence in 4 urban family medicine practices with mostly minority patients. We randomly assigned 523 female patients, aged 18 years or older and currently involved with a partner, to 1 of 3 screening protocols. Each included 2 brief screening tools: HITS and WAST-Short. Outcome measures were domestic violence disclosure, patient and clinician comfort with the screening, and time spent screening. Overall prevalence of domestic violence was 14%. Most patients (93.4%) and clinicians (84.5%) were comfortable with the screening questions and method of administering them. Average time spent screening was 4.4 minutes. Disclosure rates, patient and clinician comfort with screening, and time spent screening were similar among the 3 protocols. In addition, WAST-Short was validated in this sample of minority women by comparison with HITS and with the 8-item WAST. Domestic violence is common, and we found that most patients and clinicians are comfortable with domestic violence screening in urban family medicine settings. Patient self-administered domestic violence screening is as effective as clinician interview in terms of disclosure, comfort, and time spent screening.

Domestic Violence and Abuse, Health Status, and Social Functioning

ABSTRACT Background: Current and past history of domestic violence (DV), including physical, sexual, and emotional abuse is common among women patients seen in health care settings and is associated with a higher frequency of many health problems. However, the association of DV with self-assessed social functioning is less well known. Methods: We administered a telephone survey to a random sample of 391 women HMO members seen for a routine annual check-up. The survey included questions about current and past physical, sexual, and emotional violence and self-assessed social functioning and health status from the SF-36. We included questions about attitudes toward routine DV screening, likelihood of disclosure, and the health care setting as a resource. Results: Seven percent of the women reported recent DV and 34% reported lifetime abuse. Abuse was related to limitations in social functioning (adjusted OR = 2.26). Among women with no recent history of abuse, those with a history of past physical (adjusted OR = 1.90), sexual (adjusted OR = 2.04), or emotional (adjusted OR = 2.20) abuse reported significantly poorer social functioning. Emotional abuse, even in the absence of a history of physical or sexual abuse, was strongly associated with limitations in social functioning (adjusted OR = 4.95). Most women believed it appropriate for clinicians to inquire routinely about DV (87%) and 83% believed that the health care setting was a source of help. Conclusions: Current and past DV, including emotional abuse, adversely affect social functioning. Therefore, clinicians in the health care setting have a unique and important opportunity to assist women victims of DV and abuse.

“Why aren't we screening?” A survey examining domestic violence screening procedures and training protocol in community mediation centers

AbstractThis article analyzes survey data from ninety‐four North American community mediation centers regarding their policies and practices for identifying and managing cases that include a history of domestic violence. We report the rate at which community mediation centers formally screen for cases with a history of domestic violence and the extent to which they mandate domestic violence training for their staff and mediators. We also examine the differences in screening and training related to the differences among the centers' policies for accepting cases with a history of domestic violence.

Screening for domestic violence during pregnancy in an antenatal clinic in Lebanon

The purpose of this brief article is to examine the prevalence of domestic violence during pregnancy using data from 349 women attending an antenatal clinic serving refugees in Saidon, Lebanon. The Abuse Assessment Screen was used to identify cases of abuse among the women attending the clinic during the months of June and July, 2005. A total of 240 (68.8%) women experienced one form of physical, emotional, and sexual abuse in their marital life, and 40 (11.4%) women experienced physical violence during their current pregnancy. Violence during pregnancy was strongly associated with previous experiences of physical, emotional and sexual violence.

Use Guidelines to Screen for Domestic Violence

Use Guidelines to Screen for Domestic Violence

Accuracy of Five Domestic Violence Screening Questions With Nongraphic Language

To assess the accuracy of 5 domestic violence screening questions designed with less graphic language that they may be appropriate when children are present, mothers (n = 400) were recruited from primary care waiting rooms. Sensitivities, specificities, and predictive values were calculated using the revised Conflict Tactic Scale. "How do you and your partner work out arguments?" was the best individual question (area under the receiver operating characteristics curve 0.82, sensitivity 25%, specificity 97.7%). The 3-question combination with the domains of argument, safety, and manner of treating you and the children had the best results (area under the receiver operating characteristics curve 0.86, sensitivity 45.5%, and specificity 94.6%). The high specificity suggests a less graphic and potentially more acceptable group of questions for introductory discussions about domestic violence.

Determinants of domestic violence among women attending an Human Immunodeficiency Virus voluntary counseling and testing center in Bangalore, India

Violence against women is a global phenomenon that cuts across all social and economic classes. This study was designed to measure the prevalence and correlates of domestic violence (DV) among women seeking services at a voluntary counseling and testing (VCT) center in Bangalore, India. A cross-sectional survey was conducted among women visiting an human immunodeficiency virus (HIV) VCT center in Bangalore, between September and November 2005. An interviewer-administered questionnaire was used to collect information about violence and other variables. Univariable associations with DV were made using Pearson Chi-squared test for categorical variables and Student t-test or the Mann-Whitney test for continuous variables. Forty-two percent of respondents reported DV, including physical abuse (29%), psychological abuse (69%) and sexual abuse (1%). Among the women who reported violence of any kind, 67% also reported that they were HIV seropositive. The most common reasons reported for DV included financial problems (38%), husband's alcohol use (29%) and woman's HIV status (18%). Older women (P < 0.001) and those with low income levels were the most likely to have experienced DV (P = 0.02). Other factors included husband's education, HIV seropositivity and alcohol or tobacco use (P < 0.001). This study found DV levels comparable to other studies from around the world. The findings highlight the need for additional training among health care providers in VCT centers in screening for DV, detection of signs of physical abuse and provisions and referrals for women suffering from domestic partner violence.

Barriers to Screening for Domestic Violence in the Emergency Department

The identification of victims of domestic violence is important to prevent further abuse and injury. The purposes of this pilot project were to identify potential barriers emergency department registered nurses encounter in screening patients for domestic violence and to assess nurses' educational backgrounds for continuing education and training needs. The most significant potential barriers to screening identified were a lack of education and instruction on how to ask questions about abuse, language barriers between nurses and patients, a personal or family history of abuse, and time issues. These findings may benefit other researchers who are trying to determine the continuing education needs of emergency department staffs.

Mothers' Comfort with Screening Questions

To the Editor: The recent article by Zink et al, “Mothers’ Comfort with Screening Questions about Sensitive Issues, Including Domestic Violence,”[1][1] provides valuable clinical information regarding the difficulty of screening for domestic violence (DV) in mothers who present to the health

Domestic Violence Screening in Medical and Mental Health Care Settings

ABSTRACT Health care providers and patients agree that domestic violence presents a serious health issue that falls within the purview of medical care. The patient-physician encounter has the potential to assist domestic violence victims in considering their options of living without violence and playing a critical role in preventing future violence. Despite this possibility, many persons evaluated in the health care system do not experience the benefits of such interactions. This article reviews current research that evaluates physician, patient, and systems barriers to providing care to patients experiencing domestic violence as well as gaps in the current research and suggestions for how these barriers might be overcome. Educational initiatives, implementation of protocols, and increasing environmental cues that prompt patients and physicians to discuss domestic violence may all increase the likelihood of screening and the success of interventions.

Pediatrician Characteristics Associated With Child Abuse Identification and Reporting: Results From a National Survey of Pediatricians

Pediatrician experience with child protective services (CPS) and factors associated with identifying and reporting suspected child physical abuse were examined by a survey of members of the American Academy of Pediatrics (AAP). Respondents provided information about their demographics and experience, attitudes and practices with child abuse. They indicated their diagnosis and management of a child in a purposely ambiguous clinical vignette. Pediatricians who had received recent child abuse education were more confident in their ability to identify and manage child abuse. High confidence in ability to manage child abuse and positive attitude about domestic violence screening and value of anticipatory guidance predicted that pediatricians would have high suspicion that the child in the vignette was abused and that they would report the child to CPS. Future efforts to improve medical intervention in child abuse should focus on physician attitudes and experience, as well as cognitive factors.

Impact of Domestic Violence Posters on Female Caregivers' Opinions About Domestic Violence Screening and Disclosure in a Pediatric Emergency Department

The objectives of this study were to examine female caregivers' attitudes about the display of domestic violence (DV) resources in a pediatric emergency department (ED) and to explore whether these resources engendered positive feelings about DV screening and encouraged disclosure. We conducted a cross-sectional survey in a pediatric ED during 2 distinct periods, comparing responses of female caregivers before (pre) and after (post) displaying DV posters and cards. Women were surveyed about (1) personal experience with DV, (2) the appropriateness of DV posters and screening in a pediatric ED, and (3) willingness to divulge DV, if abused. The 2 groups (pre, n = 133; post, n = 136) did not significantly differ with respect to age, race, education, or personal DV history. The majority endorsed that "it is appropriate to have DV posters," with the post group responding in this manner more often than the pre group (pre, 85%; post, 95%; odds ratio [OR], 3.3; 95% confidence interval [CI], 1.3-8.5). The post group was less likely to prefer pediatric ED DV screening (pre, 76%; post, 63%; OR, 0.5; 95% CI, 0.3-0.9) and tended to be less likely to say that they would divulge (pre, 85%; post, 75%; OR, 0.6; 95% CI, 0.3-1.1). In both groups, women with a DV history were less likely than women without this history to say that they would disclose DV to their pediatric ED provider (P < 0.001). These results suggest the need for further exploration of how to most effectively help and provide resources for abused women in this setting.

A practice-centered intervention to increase screening for domestic violence in primary care practices.

BackgroundInterventions to change practice patterns among health care professionals have had mixed success. We tested the effectiveness of a practice centered intervention to increase screening for domestic violence in primary care practices.MethodsA multifaceted intervention was conducted among primary care practice in North Carolina. All practices designated two individuals to serve as domestic violence resources persons, underwent initial training on screening for domestic violence, and participated in 3 lunch and learn sessions. Within this framework, practices selected the screening instrument, patient educational material, and content best suited for their environment. Effectiveness was evaluated using a pre/post cross-sectional telephone survey of a random selection of female patients from each practice.ResultsSeventeen practices were recruited and fifteen completed the study. Baseline screening for domestic violence was 16% with a range of 2% to 49%. An absolute increase in screening of 10% was achieved (range of increase 0 to 22%). After controlling for clustering by practice and other patient characteristics, female patients were 79% more likely to have been screened after the intervention (OR 1.79, 95% CI 1.43–2.23).ConclusionAn intervention that allowed practices to tailor certain aspects to fit their needs increased screening for domestic violence. Further studies testing this technique using other outcomes are needed.

Child Abuse and Domestic Violence

1. Linda Cahill, MD* 2. Peter Sherman, MD† 1. *Medical Director, Children’s Protection Center, Children’s Hospital at Montefiore, Bronx, NY 2. †Director, Division of Adolescent Medicine, Department of Pediatrics, St. Barnabas Hospital, Bronx, NY After completing this article, readers should be able to: 1. Understand the strong association between child abuse and domestic violence. 2. Screen for domestic violence in cases where child abuse has occurred. 3. Discuss how exposure to violence affects the health of children. 4. Refer children who have been exposed to domestic violence for treatment. MR, a bright, chatty 6-year-old boy, disclosed physical and sexual abuse by his father. There is a history of domestic violence in the home, which he shares with his 7-year-old sister and his mother. The children witnessed their father hitting their mother, choking her, pushing her against the wall, and kicking her in the stomach on several occasions while she was pregnant with her third child. MR heard his father say that he wished his mother would die. Once during a physical assault when MR tried to pull his father off his mother, his father slapped him. His mother delivered a stillborn baby, after which MR’s behavior declined. He threatened to kill himself by cutting his wrists to be in heaven with the deceased baby. He attempted to choke his sister and to hurt the family dog and described hearing voices telling him to do bad things . MR reported that his father got into the bathtub with him every day and “washed” MR’s private area with soap and water. At times, his father grabbed MR’s penis forcefully enough to cause pain. He said that his father asked him to touch and kiss his (father’s) penis. His father pulled his ear, slapped him on his buttocks and face, and hit him with a belt. MR said that his father did a lot of things and that he didn’t remember them all . MR’s mother said that she told the father to leave the apartment. According to her, when he …

Practical approaches to screening for domestic violence

Practical approaches to screening for domestic violence

Hidden from plain sight: Residents’ domestic violence screening attitudes and reported practices

Hidden from plain sight: Residents’ domestic violence screening attitudes and reported practices

Mothers' Comfort with Screening Questions about Sensitive Issues, Including Domestic Violence

To assess patient ratings of comfort alone and in front of children with 5 domestic violence (DV) screening questions designed with less graphic language compared with questions about other sensitive issues. A sample of mothers (n = 200), including a small sample of Spanish-speaking women, were recruited from community locations. Mothers rated their perceptions of comfort for answering 13 sensitive issue screening questions (including sexual risk, substance abuse, depression, and DV questions). Logistic regression was performed to analyze participants' characteristics with respect to summary comfort scores. In addition, 40 mothers were asked to talk about their comfort in answering the DV questions. These interviews were audiotaped and analyzed. Mothers preferred to answer all questions alone. Comfort with answering the DV screening questions in front of their children was higher than comfort with sexual risk or depression questions and was similar to comfort with substance abuse questions. Latina mothers had more discomfort with the DV questions than other ethnicities. Although mothers were more comfortable with answering sensitive questions alone than in the presence of children, this may not be feasible in busy offices. General DV questions may be appropriate to ask in front of children as an initial screen.

Empirically Examining the Risk of Intimate Partner Violence: The Revised Domestic Violence Screening Instrument (DVSI-R)

This study extends recent research on assessing the risk of intimate partner violence by determining the concurrent and predictive validity of a revised version of the Domestic Violence Screening Instrument (DVSI-R) and whether evidence of such validity is sustained independent of perpetrator demographic characteristics and forms of intimate violence. The analyses highlight violent incidents involving multiple victims as an indicator of "severe" violence. Previous research did not address these issues. Data were analyzed on 14,970 assessments conducted in the State of Connecticut from September 1, 2004 through May 2, 2005. Hierarchical regression and receiver operating characteristic analyses were used to address the objectives of this research. The empirical findings support the concurrent and predictive validity of the DVSI-R and show that it is robust in its applicability. The findings further show that incidents involving multiple victims are highly associated with DVSI-R risk scores and recidivistic violence. Validating and demonstrating the robustness of a risk assessment instrument is only a first step in preventing violence involving intimate partners or others in family or family-like relationships. The challenge is to train professionals responsible for addressing the problem of such violence to link valid risk assessments to well-crafted strategies of supervision and treatment so that the victimized or other potential victims are protected and perpetrators are held accountable for their actions.

Mothers and Primary Care Medicine

To the Editor. — Dr Elwy1 is correct that a pediatrician sees the parents of chronically ill children, and even well infants, with great frequency and is well positioned to identify maternal or parental health issues that are affecting his or her patients. This fact has prompted calls for a structural inclusion in the pediatric visit of screening for domestic violence, as well as broader issues that could affect the functioning of the …

Hidden from plain sight: residents' domestic violence screening attitudes and reported practices.

Domestic violence (DV) is prevalent across all racial and socioeconomic classes in the United States. Little is known about whether physicians differentially screen based on a patient's race or socioeconomic status (SES) or about resident physician screening attitudes and practices. To assess the importance of patient race and SES and resident and clinical characteristics in resident physician DV screening practices. One-hundred and sixty-seven of 309 (response rate: 54%) residents from 6 specialties at a large academic medical center responded to a randomly assigned online survey that included 1 of 4 clinical vignettes and questions on attitudes and practices regarding DV screening. We measured patient, resident, and clinical practice characteristics and used bivariate and multivariate methods to assess their association with the importance residents place on DV screening and if they would definitely screen for DV in the clinical vignette. Residents screened the African-American and the Caucasian woman (51% vs 57%, P = .40) and the woman of low SES and high SES (49% vs 58%, P = .26) at similar rates. Thirty-seven percent of residents incorrectly reported rates of DV are higher among African Americans than Caucasians, and 66% incorrectly reported rates are higher among women of lower than of higher SES. In multivariate analyses, residents who knew where to refer DV victims (adjusted odds ratio [AOR] = 3.54, 95% confidence interval [CI]: 1.43 to 8.73) and whose mentors advised them to screen (AOR = 3.46, 95% CI: 1.42 to 8.42) were more likely to screen for DV. Although residents have incorrect knowledge about the epidemiology of DV, they showed no racial or SES preferences in screening for DV. Improvement of mentoring and educating residents about referral resources may be promising strategies to increase resident DV screening.