Penn studies unidentified domestic violence survivors

More than three-quarters of domestic violence victims go unidentified when seeking medical care in emergency rooms, a new Penn study shows.

The study, led by Emergency Medicine professor Karin Rhodes, followed the domestic abuse victims of 993 assault cases from 1999 in a rural county in Michigan. The researchers looked at how many times these victims sought treatment at emergency departments during the four year time span of the study.

Rhodes found that assault victims went to emergency departments an average of seven times after the recorded police incident in which they were abused. However, almost 75 percent of them were never identified by the medical system as victims of intimate domestic violence.

“We are putting a lot of resources into sending police, writing reports and taking care of them in the emergency department without them ever having their underlying problems addressed,” said Rhodes. “It’s inefficient and it’s not good care.”

Although the study was conducted in a rural county in Michigan, Rhodes believes these results can be generalized. “I suspect that this rural county is actually a best-case-scenario,” Rhodes said. She explained that the county’s criminal justice system is well-integrated with its health system and all eight emergency departments in the study were trained to identify domestic violence cases.

“I have been working in the emergency room for 20 years and I’m not at all surprised by [the results],” said Emergency Medicine professor Elizabeth Datner. “We know that many more women have been in abusive situations than disclose that information, and we know that providers don’t routinely ask those questions despite the fact that we would want them to.”

Nina Harris, the violence prevention educator at Penn Women’s Center, was also not surprised by the findings. She explained that one of the main challenges for patients is “understanding the connection between providing information and the resources that they will be connected with.” For example, questions about domestic abuse can feel irrelevant to someone who is at the emergency department because of the flu, she explained.

However, when domestic abuse victims are properly identified in the emergency department, they receive both legal help and personal guidance. Assault related injuries are reported to the police and social workers can help the victim through the situation by identifying ways to stay safe and providing referrals to community-based shelters.

Properly identifying victims can be as simple as giving patients “the opportunity to self-disclose if they’ve had a lot of conflict or abuse going on in their relationship,” Rhodes said.

Yet as Datner explained, clinicians and patients often have reservations about questioning. The Department of Emergency Medicine at Penn is pilot testing a computer-based system to help solve this problem of disclosure.

The system allows patients to enter their own information in response to questions about social health issues such as depression, drinking problems and domestic violence into a computer. The patients will then automatically receive social health referrals with their discharge instructions.

“We are trying to provide a simple way for patients to be able to give information to the clinicians without all the questioning and people feeling uncomfortable,” Datner said.

Rhodes agreed that there is a need for “a systems approach instead of an individual approach.”

“A light should go off in the social work office, and they should come out and just sort of approach the patient … regardless of whether or not the provider gets to it,” Rhodes said.

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