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PLANS to widely implement screening for domestic violence across hospitals and general practice must first ensure adequate systems are in place to support victims, according to experts.
Associate Professor Diana Egerton-Warburton, chair of the Australasian College for Emergency Medicine’s Public Health Committee, told MJA InSight that for emergency doctors, screening for domestic violence “can feel like opening a Pandora’s box”.
Professor Egerton-Warburton said screening could be as simple as asking “do you feel safe at home?”
However, it was the step that came next which was more complex. If a patient disclosed that they were experiencing domestic violence, it should trigger a system of processes to provide them with the support they needed.
Professor Egerton-Warburton was commenting on a study published in JAMA Surgery which found a high prevalence of domestic violence among trauma patients in the US. (1)
The retrospective analysis included 16 575 trauma patients and found the prevalence of domestic violence was 5.7 cases per 1000 discharges. This prevalence increased among children and adults over the 6-year study period, but remained unchanged for elderly patients.
The authors said their results indicated that there was a lack of proper screening and subsequent reporting of domestic violence in trauma centres, especially among adults and the elderly.
“Initiation of active screening and preventive measures, robust educational campaigns, and uniform screening strategies in trauma centres might help counter this silent epidemic”, they wrote.
Professor Angela Taft, director of the Judith Lumley Centre at La Trobe University’s School of Nursing and Midwifery, told MJA InSight that in Australia, routine screening for domestic violence in adults differed from state to state.
“NSW, for example, has been screening since 2003 in a range of health services, including antenatal, mental health, child and family health, and alcohol and other drugs services. As far as I know, the emergency department is not routinely included”, Professor Taft said.
Professor Egerton-Warburton confirmed that screening for domestic violence in emergency departments (EDs) was not routine, saying it was done on an ad hoc basis in some centres.
She recently conducted a survey of 800 ED clinicians, who were asked about the development of domestic violence screening tools. While these doctors were “keen” on the idea of screening, they did identify several concerns, Professor Egerton-Warburton said.
Some said they did not have enough time and resources to screen for domestic violence, some thought they did not have the specific training required, while others felt it was an issue they were not comfortable discussing with patients.
Professor Egerton-Warburton said it was particularly important to encourage the routine use of a simple, non-invasive screening question in women’s hospitals.
“The question should be asked three or four times during a patient’s stay in hospital, as they may not feel comfortable disclosing that information straight away”.
She said that domestic violence screening should not be restricted to emergency departments, with general practice important in the process “because GPs already have a relationship with the patient. It may not be the exact same question we ask in EDs, but a question should still be asked”.
However, Professor Taft said it was important not to presuppose that screening for domestic violence would translate into positive outcomes.
“There is no evidence, yet, that screening improves the lives of women in any respect, because the supporting systems are not in place.”
Professor Taft coauthored a 2013 Cochrane Review on the screening of women for intimate partner violence in health care settings. (2)
The review included 11 trials on 13 027 women, and found that while screening was likely to increase identification rates, the rates of referral to support agencies were low.
Nevertheless, Professor Egerton-Warburton said that the recent spike in media coverage and public discussion around family violence in Australia indicated that “it is increasingly becoming less of a taboo subject”.
“Now is the time to act on domestic violence because, on an international level, we’re very behind in developing screening methods”, she said.
(Photo: LoloStock / shutterstock)
MJA podcast with Australian of the Year Rosie Batty on the medical profession's crucial role in suporting victims. Click here
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First some links:
http://www.abc.net.au/news/2015-07-03/hegarty-forsdike-family-violence-f…
http://www.spiked-online.com/newsite/article/394#.Viq_IaLdsbE
Next, some thoughts:
Family violence is far greater in geographic areas with “bottle shops” & take away alcohol services, also in communities where amphetamines are abused. These must be stopped. one drink and one dose at a time, we can all do our bit. If no-one shopped at the bottle shop it would close down. If no-one took amphetamines and all dobbed in the dealers, same result.
Domestic violence perpetrators (mostly male, less female, some are minor children) have scant support services, and many existing social welfare service providers will not see perpetrators.
When a doctor obtains a history of domestic violence, makes a Mandatory Report (in some jurisdictions) & links the victim to the Domestic Violence Line, their job is done. This is a poor cousin to actually saving the domestic violence victim from the domestic violence, but doctors are not Social Workers. Doctors do not suddenly have the resources to wave a magic wand & personally protect individual victims of domestic violence, or to change the ways of the perpetrators.
The perpetrators are not sufficiently held responsible for their violence. By means of social change & enforcement of the law,they must realise they are responsible for their deeds and that they are held personally and legally accountable by their community and the wider society.
Finally a link below to ABC Late NIght Live, program which discusses aspects of domestic violence.
http://www.abc.net.au/radionational/programs/latenightlive/silence-on-in…
This is a sensitive situation and as a society we should look to capture these instances wherever we can to ensure the victims can get the help and support they need. It is also important to acknowledge that not all domestic violence victims are female. Any screening should be all encompasing so as not to marginalise a proportion of the victims and making them feel as if they don’t matter.
NSW has been one of the leaders in DV screening in the public health system.
One of the big and curious gaps has been in screening women who present with their child as the patient – in Emergency Departments and generalist and subspecialist paediatric clinics – especially those where the child is presenting with behaviour problems or more direct indicators or possible child maltreatment. It is a curious omission because of the awareness that DV warrants a Risk of Significant Harm report to the relevant statutory child protecttion agency. Many of the police Helpline reports in contrast relate to DV for which they have been called to the family home.
I suspect the reluctance is not so much against the value of screening, but uncertainty about what should happen next, and whether appropriately trained staff are available.
“social worker” – confirms that the recurring presentation with injuries is a legal problem – in fact it is a Police matter.- so medical personnel are required in some states to report this.
Please read the original comment.
Screening women for relationship violence is on par to having any sensitive conversation…consideration to the approach, how and when to introduce the questions, knowing how to respond when there is disclosure, having the appropriate and current local resources and contacts available…and making the choice to ask women about their and their children’s safety, including what she wants…we all play a part in violence prevention strategies!.
Sure the use of a screening tool to assist with these conversations is paramount and helpful in practice…as are skills and knowledge around using the tool. Confidence comes with practice.
Individuals make choices to be violent…there are no excuses…nothing ever!…and we as professionals and individual community members can make a difference by simply ‘asking’ women about relationship safety.
I believe “sociologist” missed the point, no-one is suggesting it is a purely a ‘medical’ problem , however I imagine if the same woman keeps showing up at your practice/ emergency dept. with injuries from an unexplained source to suggest that she has chosen “an inappropriate life partner” is not really going to be met with much interest. Medical personnel would also , presumably feel a sense of helplessness at treating someone, to then have them keep returning to the situation in which they incurred the injuries. Many other patients visiting an emergency dept may also be ‘suffering’ from poor life choices ( in sociologists opinion) , the emergency dept is still charged with managing the medical consequences of these choices and then if at all possible providing information and or referral to other agencies to mitigate the impact of those situations.
Not a medical problem !!!!
It is a social problem of society – Unless therei injury involved to one or both of the parties.
requiring medical treatment.
Both parties should shoulder portion of the blame
the main reasons for the problem are
1 Choice of partner inappropriate
2 Stressor in life [at work etc]
3 Economic strain
Etc
Medical diagnosis treatment is not applicable to the problem – social avenues – [law etc ] are the areas in which this problem belongs.
I agree that screening for violence is hard for a number of reasons.
What about reported and not acted upon violence to patients in hospitals?
Those interested should view: A current affair thursday 10th september
The topic of mixed gender wards has been mentioned in MJA insight previously and via a complex pathway resulted in the TV report
I strongly urge doctors’ organisations to devise screening tools to be applied nationally so that data are collected. These screening tools should be used in GP offices and community clinics which are generally considered to be places of safety and succour. Similar tools should be devised for the specialties, especially psychiatry, where the codes of ethics of colleges of practice may not be enough to impel doctors to act with care, concern and effectively on behalf of patients. It is not unknown for doctors to brush off or invalidate patients’ expressions of fear either through medicalisation (depression) or sexist labelling (histrionic). It is important to remember that domestic violence is a form of bullying with the objective of rendering victims extremely vulnerable. It is imperative that the aid mechanisms available do not re-victimise the victim. For change to happen, the healthcare system itself must not be another locus of perpetration but rather a haven of care.