Intimate partner violence screening and response in New South Wales emergency departments: A multi‐site feasibility study

Abstract

ObjectiveTo test feasibility of a systematic approach to routine screening and response for intimate partner violence among women presenting to three New South Wales EDs.MethodsThis prospective feasibility study was conducted over 6 months in two rural and one major tertiary metropolitan ED in New South Wales. Women aged 16–45 years triaged category 3–5 (treat within 30 min/1 h/2 h), who could be approached privately, were screened for intimate partner violence using the validated HITS (Hurts, Insults, Threatens and Screams or Swears) tool. The follow‐up protocol for patients who disclosed abuse, specified a social work/psychology (psychosocial) response within 1 h. Outcomes of interest were screening rates of eligible presentations, disclosures of abuse, psycho‐social referral and responses. Interviews conducted with ED medical directors and nurse unit managers at each site explored barriers and facilitators.ResultsA total of 1047 women (11.4% of eligible presentations) completed screening at their first or subsequent presentation. Of 868 women screened on first presentation, 18% (n = 154) disclosed intimate partner violence, with no significant differences by age group, country of birth, triage category or time/day of arrival. Key barriers to screening were high patient volume, absence of electronic prompts and lack of privacy. Of those who screened positive 49% (n = 75) received an immediate, on‐site psycho‐social response.ConclusionThe present study demonstrates that it is both possible and relevant, given the 18% disclosure rate, to screen women in relation intimate partner violence in EDs and provide a psycho‐social response within 1 h. More needs to be done to address barriers to screening to provide opportunities for early intervention.

Family violence screening and disclosure in a large metropolitan hospital: A health service users’ survey

“…In this study, participants were asked if they had disclosed family violence concerns at any time-point during their involvement with the health service, not just a single or initial presentation. In the Spangaro et al 7 study, the 18% disclosure rate occurred in women screened on a single presentation to the emergency department at the health service. Spangaro et al also utilized the Hurts, Insults, Threatens and Screams or Swears (HITS) tool, which asks four questions designed to capture current/active intimate partner violence situations.…”

“…The rates of disclosure of family violence concerns to hospital staff in this study are higher than those reported in a recent study of targeted screening in Australian emergency departments in the state of New South Wales. 7 However, the difference in the tools and time-point capture may have contributed to this variation. In this study, participants were asked if they had disclosed family violence concerns at any time-point during their involvement with the health service, not just a single or initial presentation.…”

“…6 Differences also exist between regions within countries when a coherent national response has not been formulated such as in Australia. 7 For example, while one state in Australia (New South Wales) has implemented routine targeted family violence screening for specific at-risk groups (women attending antenatal services, child and family health services, those aged 16 years and above attending mental health or drug and alcohol services), 8 this is not the case in other jurisdictions. A recent study also indicated that routine targeted screening in emergency departments in that state is likely to be both feasible and useful, with an 18% disclosure rate reported in the targeted group (women aged 16-45 years, triaged as category 3-5 priority).…”

“…A recent study also indicated that routine targeted screening in emergency departments in that state is likely to be both feasible and useful, with an 18% disclosure rate reported in the targeted group (women aged 16–45 years, triaged as category 3–5 priority). 7 …”

“…A recent study also indicated that routine targeted screening in emergency departments in that state is likely to be both feasible and useful, with an 18% disclosure rate reported in the targeted group (women aged 16-45 years, triaged as category 3-5 priority). 7 In addition to information about whether and how screening is being conducted, the acceptability of screening to health service users is also an important consideration. Much of the research into healthcare screening rates and acceptability has been conducted in the area of general practice, antenatal, maternal child health, or outpatient specialist clinic settings.…”