Click  to expand category
|
HRET Health Research & Educational Trust of New Jersey
ResearchCompleted Projects
Domestic Violence
Domestic Violence: Medical and Social Management of Care for Victims
Table of Contents:
Project Overview
Battering is one of the most common yet least identified health problems that women present to healthcare professionals, making domestic violence a primary healthcare and mental health issue for women. These women come from all ages, cultures, races, occupations and income levels. National statistics provided by law enforcement agencies, antiviolence and victim advocacy groups indicate that every year an estimated 2 to 4 million women are battered by their partners. A woman is beaten every 6 minutes and 22 seconds in New Jersey. From 1994 to 1997, cases of domestic violence increased 60 percent statewide with a continuing increase of 5 to 10 percent per year. In 1998, there were more than 81,000 domestic violence-related offenses reported to the police, and there was a 24 percent increase in murders to this type of offense in that year.
Despite these numbers, domestic violence is still a greatly under-reported crime both in New Jersey and nationally. Victims of abuse come into contact with the healthcare system, but healthcare providers frequently treat only the physical injuries and fail to identify injuries as abuse. Even when recognized, providers rarely have had adequate training in dealing with the complex needs of these victims and do not have the resources to address their needs or refer them to services in a timely manner.
From 1997 to 1999, HRET developed and implemented a study to better understand and improve the process of providing care for victims of domestic violence in hospitals and community agencies. The ultimate goal was to improve access and quality of care for victims by objectively assessing the needs, developing targeted educational programs to equip providers with skills to better serve victims and devising/recommending new organizational practices for effective identification of victims and enhanced coordination between medical, mental and social service systems.
The specific objectives of the study were to:
- Describe the process of identification and documentation of cases of domestic violence in hospitals
- Determine difficulties and psychosocial/organizational obstacles clinicians face in providing coordinated care and referring victims to different service systems; and assess their unmet service and training needs to improve access and quality of care for victims
- Describe the available community resources and services to help victims
- Determine difficulties and barriers community providers face in coordinating care for victims across different service systems including criminal justice, mental healthcare, social welfare, housing and transportation
- Assess victims' unmet service and educational needs
Implementation of this study was supported by a grant from the Robert Wood Johnson Foundation.
Methodology
The study surveyed providers in hospital emergency departments and county domestic violence programs on the process of identification of victims, the psychosocial/organizational obstacles they face in providing coordinated care and referring victims as well as their unmet service and training needs. Eighty-two hospitals agreed to participate (88% response rate), and 67 medical directors, 80 nurse managers and 75 social workers were interviewed face-to-face; 18 community providers completed a self-administered instrument (78% response rate).
Top of Page
Major Findings
Only 38% of hospitals reported working with their local community domestic violence programs, suggesting a need for more coordination between hospitals and community agencies and a stronger link between different service systems to provide needed services to victims. The problematic obstacles to identify victims were patient-related factors and staff's lack of training, time and knowledge. Only one-third of physicians and nurses had any training on domestic violence. The barriers to victims' referrals and problematic agencies were also identified, with physicians consistently reporting more barriers. Education/training needs of providers were assessed and information on barriers due to ethnicity and cultural response to domestic violence and forensic aspects of healthcare were highly reported as needed.
Selected Recommendations
This study indicated a significant need for the development and implementation of services for treating and responding to the needs of battered patients. To assist providers in identifying abuse, breaking the cycle of violence and facilitating timely help for victims, it is strongly recommended that hospitals:
- Create a centralized office and/or designate knowledgeable personnel to perform domestic violence tasks as part of their job responsibility, e.g., establish domestic violence protocols, training programs for all hospital staff addressing identified needs, collect all needed manuals and make them available as needed, keep all necessary directories and referral resources updated, etc.
- Improve ongoing communications between hospital and community service providers (shelters and outreach programs) and develop stronger working relationships.
- Develop a consistent tracking system throughout the hospital to record instances of domestic violence for more accurate statistics.
- Increase social worker coverage of the emergency department to include evenings and weekends for care management of domestic violence, elder abuse and child abuse/neglect.
- Provide a private room to encounter domestic violence victims.
- Routinely screen all patients for domestic violence and document signs of abuse in medical records.
- Develop cultural competency guidelines to help healthcare providers improve screening and intervention services for victims from diverse backgrounds.
- Develop a Domestic Violence Community Education/Awareness Campaign for hospital internal and external audiences.
- Serve as a gateway to assist victims of violence through development of response team for onsite crisis counseling, follow-up, link to in-house and community resources.
Top of Page
Publications
For more information please call 609-275-4145.
- Press Release: Grant To Help N.J. Hospitals Improve Services For Domestic Violence Victims September 26, 1997
Domestic Violence: Medical and Social Management of Care for Victims. Princeton: HRET, January 1999.
- Healthcare New Jersey, "NJHA Collaboration Raises Curtain on Domestic Violence," Vol. 10, No. 3, March 2001. [.pdf file size 64 KB 4 pgs.]
- Shaping Healthier Tomorrows, "Education, Communication: Keys to Curbing Domestic Violence," Vol. 1, No. 1, Summer 1999. [.pdf file size 126 KB 6 pgs.)
Top of Page
Related Links
Family Violence Prevention Fund
New Jersey Coalition for Battered Women Toll free: 800-572-7233
Top of Page
|
|