Does Stage of Change Predict Improved Intimate Partner Violence Outcomes Following an Emergency Department Intervention?

Abstract

Objectives: The objective was to assess the effect of an emergency department (ED)-based computer screening and referral intervention on the safety-seeking behaviors of female intimate partner violence (IPV) victims at differing stages of change. The study also aimed to determine which personal and behavioral characteristics were associated with a positive change in safety-seeking behavior. The hypothesis was that women who were in contemplation or action stages of change would be more likely to endorse safety behaviors during follow-up.Methods: This was a prospective cohort study of female IPV victims at three urban EDs, using a computer kiosk to deliver targeted education about IPV to provide referrals to local resources. All noncritically ill adult English-speaking women triaged to the ED waiting room during study hours were eligible to participate. Women were screened for IPV using the validated Universal Violence Prevention Screening Protocol (UVPSP), and all IPV-positive women further responded to validated questionnaires for alcohol and drug abuse, depression, and IPV severity. The women were assigned a baseline stage of change using the University of Rhode Island Change Assessment (URICA) scale for readiness to change their IPV behaviors. Study participants were contacted at 1 week and 3 months to assess a variety of predetermined safety behaviors to prevent further IPV during that period. Descriptive analyses were performed to determine if stage of change at enrollment and a variety of specific sociodemographic characteristics were associated with taking protective action during follow-up.Results: A total of 1,474 women were screened for IPV; 154 (10.4%) disclosed IPV and completed the full survey. Approximately half (47.4%) of the IPV victims were in the precontemplation stage of change, and 50.0% were in the contemplation stage. A total of 110 women returned at 1 week of follow-up (71.4%), and 63 (40.9%) women returned for the 3-month follow-up. Fifty-five percent of those who returned at 1 week and 73% of those who returned at 3 months took protective action against further IPV. Stage of change at enrollment was not significantly associated with taking protective action during follow-up. There was no association between demographic characteristics and taking protective action at 1 week or 3 months.Conclusions: Emergency department-based kiosk screening and health information delivery is a feasible method of health information dissemination for women experiencing IPV and was associated with a high proportion of study participants taking protective action. Stage of change was not associated with actual IPV protective measures.ACADEMIC EMERGENCY MEDICINE 2013; 20:169-177 © 2013 by the Society for Academic Emergency Medicine W ith an estimated 28.9% of women experiencing intimate partner violence (IPV) during their lifetime, 1 at an annual medical and mental health care cost of $4.1 billion, 2 IPV represents a significant problem with personal and societal consequences. The hospital emergency de...

Understanding management and support for domestic violence and abuse within emergency departments: A systematic literature review from 2000–2015

“…Under this theme, 5 of the 10 empirical studies (Basu & Ratcliffe, ; Boursell & Prosser, ; Choo et al., ; Kendall et al., ; Schrager et al., ) were investigating the use of different approaches for managing and referring DVA survivors. For example, two studies Basu and Ratcliffe () and Boursell and Prosser () tested an intervention that encompassed ED staff training, DVA resources and identified referral pathways.…”

“…Two studies (Kendall et al., ; Schrager et al., ) report use of a referral and counselling service for screened IPV survivors. They report positive benefits for survivors including preparation of future safety planning (Kendall et al., ) and proactive action (Schrager et al., ).…”

“…The review identified 10 empirical studies and one literature review (Anglin & Sachs, 2003) either describing methods of screening potential DVA survivors or the approaches for managing and supporting survivors of DVA that present at ED. Of the 10 empirical studies, there was a prominence of studies from the USA with seven studies (Choo et al, 2012;Houry et al, 2007;Kendall et al, 2009;Mills et al, 2006;Rhodes et al, 2006;Schrager, Smith, Herson, & Houry, 2013;Trautman, McCarthy, Miller, Campbell, & Kelen, 2007), two Australian studies (Boursell & Prosser, 2010;Ramsden & Bonner, 2002) and one conducted in the UK (Basu & Ratcliffe, 2014).…”

“…Under this theme, 5 of the 10 empirical studies (Basu & Ratcliffe, 2014;Boursell & Prosser, 2010;Choo et al, 2012;Kendall et al, 2009;Schrager et al, 2013) were investigating the use of different approaches for managing and referring DVA survivors. For example, two studies Basu and Ratcliffe (2014) and Boursell and Prosser (2010) tested an intervention that encompassed ED staff training, DVA 2 Perspectives on screening in ED (mothers and paediatric staff) They report that mothers felt it was appropriate to ask about IPV in ED but a fear existed that they would be reported to protection services.…”

Online alcohol interventions, sexual violence and intimate partner violence: A systematic review

“…Of these 18 were eliminated as they did not include a measure of sexual violence or intimate partner violence -these papers typically only included items relating to engaging in unsafe sex due to alcohol use. Two papers reported in-person rather than computerized intervention (Brahms et al, 2011;Stuart et al, 2013); one had no alcohol outcome measure (Salazar et al, 2014); two were purely descriptive (Hallett et al, 2012;Kiene et al, 2009) and one compared outcomes based on stage of change (Schrager et al, 2013) and did not allow comparison for different exposures to intervention (Appendix B). This left five eligible papers.…”