Domestic violence screening and referral can be effective

We provide a targeted intervention in the emergency department for intimate partner violence (IPV) victims and to facilitate follow-up care from a professional case manager.

This observational case study was conducted in an urban ED from July 1, 1997, through December 31, 1999. The targeted population consisted of all English-speaking women between the ages of 18 and 65 years presenting 24 hours a day, 7 days a week. There were 3 components to the study. The first consisted of an effort to improve the screening for IPV of female patients seen in the ED. The primary outcome for this component was the correlation of increased screening rates with increased violence detection. Universal screening of all women for IPV regardless of their chief complaint was encouraged through an IPV script and a new reporting area on the nursing note. The second component was an on-site IPV advocacy intervention. Once IPV was identified by means of screening or self-disclosure, the nurse notified a volunteer advocate from a local human service agency, who came to the ED within 30 minutes, conducted a crisis intervention, and encouraged the patient to follow-up with the case manager. The outcomes were patient cooperation with the ED intervention and subsequent follow-up with the community-based agency. The third phase was telephone-based counseling by an IPV case manager to help the client reduce her exposure to additional violence. The outcome was the client's self-report of a life free of violence.

Of the 528 women identified as IPV victims, 475 (84%) agreed to speak to the advocate, and 258 (54% of those seen by the advocate) accepted case management follow-up. After the case management process, lasting 3 to 6 weeks, 127 women reported that they no longer believed they were at risk for violence from their abuser.

Through a coordinated effort by the medical staff and the volunteer advocates, 258 of 528 IPV victims seen in the ED received ongoing community-based services to address their experience of IPV.