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Emergency Department
       Staff Survey on
      Intimate Partner
          Violence
                    2009



The Utah Department of Health Violence and Injury Prevention Program
                                and
     The Utah Domestic Violence Council Health Care Committee
For more information contact:
Utah Department of Health
Violence and Injury Prevention Program
288 North 1460 West
P.O. Box 142106
Salt Lake City, UT 84114-2106

Telephone: (801) 538-6141
Fax: (801) 538-9134
E-mail: vipp@utah.gov


This report is available at www.health.utah.gov/vipp.


Suggested Citation:
Utah Department of Health Violence and Injury Prevention Program 2009. Emergency Department Survey
on Domestic and Intimate Partner Violence 2009. Salt Lake City, UT: Utah Department of Health.
Emergency Department
    Staff Survey on
   Intimate Partner
       Violence
          2009




    The Utah Department of Health
Violence and Injury Prevention Program
                  and
  The Utah Domestic Violence Council
        Health Care Committee
Acknowledgments
Utah Department of Health Staff                          Participating Facilities
Teresa Brechlin, BS, SSW                                 Alta View Hospital
Anna Fondario, MPH                                       American Fork Hospital
Trisha Keller, MPH, RN                                   Ashley Valley Medical Center
Katie McMinn, BS                                         Bear River Valley Hospital
                                                         Brigham City Community Hospital
Review Committee                                         Castleview Hospital
Barbara Ferrara, Intermountain Healthcare                Central Valley Hospital
Kathy Franchek, University of Utah, School of Medicine   Delta Community Medical Center
Roger K. Keddington, Intermountain Healthcare            Dixie Regional Medical Center
Joanne McGarry, Utah Department of Health                Garfield Memorial Hospital
Rachelle Rhodes, Intermountain Healthcare                Gunnison Valley Hospital
Ned Searle, Office on Domestic and Sexual Violence       Intermountain Medical Center
                                                         Kane County Hospital
                                                         Lakeview Hospital
                                                         LDS Hospital
                                                         Logan Regional Hospital
                                                         McKay Dee Hospital
                                                         Mountain View Hospital
                                                         Mountain West Medical Center
                                                         Ogden Regional Medical Center
                                                         Orem Community Hospital
                                                         Pioneer Valley Hospital
                                                         Salt Lake Regional Medical Center
                                                         Sanpete Valley Hospital
                                                         Sevier Valley Hospital
                                                         St. Mark’s Hospital
                                                         Timpanogos Hospital
                                                         University of Utah Hospital
                                                         Utah Valley Regional Medical Center
                                                         Valley View Medical Center




           Emergency Department Staff Survey on Intimate Partner Violence
Table of Contents

     Background••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••2

     Demographics of Respondents•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••3

     Policies and Procedures•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••4

     Obstacles to Identifying Abuse••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••6

     Training of Providers••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••8

     Resources for Victims••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••9

     Conclusion•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••10

     Appendix A Resources for Providers••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••11

     Appendix B Survey Instrument••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••12




Emergency Department Staff Survey on Intimate Partner Violence
Findings
  2009                                    Background
 In 2003, the Utah Department of Health Violence (UDOH) and Injury Prevention Program (VIPP), in
 collaboration with the Utah Domestic Violence Council Health Care Committee, administered a survey
 seeking information from Utah’s hospital emergency department (ED) staff in their screening, assessment,
 and referral of patients ages 18 and older whom they suspected were victims of intimate partner violence.
 The survey consisted of questions regarding demographics of the respondent, ED polices and procedures,
 obstacles staff have faced, IPV training, and resources for victims.




 Purpose of the Survey

 The purpose of the 2003 and 2009 surveys were to:
 • Obtain ED staff memebers’ personal experiences in identifying individuals who may be abused, the type of
 intimate partner violence services victims ask for, and the options the ED staff have available to help their
 patients;
 • Identify ED polices and procedures related to intimate partner violence; and
 • Obtain results that will benefit health care providers and their community partners by identifying and
   enhancing existing services and programs to address intimate partner violence.

 Based on the results of the 2003 survey; new educational materials, training programs, and resources have
 been implemented throughout the state of Utah. The Emergency Department Staff Survey on Intimate
 Partner Violence was re-administered during the spring of 2009 to assess the impact of these activities.


 Data Points
 The surveys were delivered by postal and electronic mail to all 39 hospital ED Managers in Utah. They were
 asked to distribute the survey to the entire ED staff. The data were analyzed in a format that divided all
 hospitals into two categories-urban and rural areas. Hospitals in Davis, Salt Lake, Utah, and Weber counties
 were placed in the urban area category. The remaining hospitals were placed in the rural area category.

 Responses were received from 31 hospital EDs, resulting in a total of 102 surveys that consisted of 17 (45.2%)
 urban area hospitals and 14 (54.8%) rural area hospitals. Sixty-one (59.8%) of the respondents were
 from urban area hospitals and 41 (40.2%) were from rural area hospitals. The distribution of the respondents
 was proportional throughout the sample.




2            Emergency Department Staff Survey on Intimate Partner Violence
Findings
                                                                                   2009
                                                       Demographics of Respondents
       • In 2009, 64.6% of respondents were nurses, compared to 56.0% in 2003. This group represented the
         majority in both surveys (Figure 1).
       • The majority of the 2009 respondents were female (69.3%) compared to 59.0% in 2003 (Figure 2).
       • The majority of the 2009 respondents (72.2%) had more than five years experience working in an
         emergency department compared to 57.0% in 2003 (Figure 3).




                       Figure 1: Percent of emergency department staff by current                                                  Figure 2: Percent of emergency department staff by gender,
                                        position, Utah 2003,2009                                                                                         Utah 2003, 2009

                                                                                                                              80
                          Nurse        56.0                                                                                          2003*
                                       64.6                                                                                   70
                                                                                                                                     2009
Current Position




                                                                                                                              60
                                       9.0
                       Manager
                                                                                                                 Percentage



                                       24.0                                                                                   50

                                                                                                                              40
                       Physician       18.0
                                                                                                                              30
                                       10.4
                                                                                                                              20
                                       7.0                                                      2003*
                   Social Worker                                                                                              10
                                       1.0                                                      2009                                        32.0          30.7             59.0   69.3
                                                                                                                              0

                                   0          10          20         30       40         50   60    70                                             Male                      Female
                                                                     Percentage                                                                                   Gender




                                                                                         Figure 3: Length of time worked in an
                                                                                        emergency department, Utah 2003, 2009

                                                                                                                                                   2003*
                                                                                  7.0
                                                                   < 1 year                                                                        2009
                                                                              4.1
                                                   Years worked




                                                                                  32.0
                                                                  1-5 years
                                                                                  23.7


                                                                                  57.0
                                                                  > 5 years
                                                                                  72.2


                                                                              0                20           40                        60                     80
                                                                                                         Percentage




                                                                                                                                                                                          3
       * Figure 1 - The 2003 survey respondents also consisted of nurse practitioners, physician assistants, and case managers, as well
       as an unreported category. Figures 2 and 3 – The 2003 survey also consisted of an unreported category.

     Emergency Department Staff Survey on Intimate Partner Violence
Findings
  2009                                     Policies and Procedures
 • In 2009, 13.1% of respondents indicated that there was no written policy and procedure for
   intimate partner violence screening at their hospital.
 • In 2009, 73.3% of urban area ED staff reported that they were encouraged to ask routine questions about
   intimate partner violence. This was an increase of 35.8% from what was reported in 2003. The
   percentage remained the same in rural areas for both years of the survey (Figure 4).
 • In 2009, 58.3% of urban area ED staff reported that they routinely ask direct, specific questions regarding
   intimate partner violence. This was an increase of 32.6% from what was reported in 2003. However,
   the opposite was seen in rural areas, with a drop 15.0% from 2003 (Figure 5).




                                             Figure 4: Percent by department encouraged to ask
                                          routine questions about domestic/intimate partner abuse,
                                                 by Urban and Rural Areas, Utah, 2003,2009

                                                   54.0
                                       Urban
                                                   73.3
                               Areas




                                                   59.0
                                       Rural
                                                   58.5                                     2003
                                                                                            2009

                                               0            20            40          60       80
                                                                       Percentage




                      Figure 5: Percent routinely asking adult patients direct,
                     specific questions about whether they have been abused                   In 2009, approximately 80.0% of ED
                     or threatened by Urban and Rural Areas, Utah, 2003, 2009                           staff reported that
                                                                                                they would ask questions about
                                                                                                 intimate partner abuse with a
                               44.0                                                            patient when the patient presents
                   Urban                                                                        with injury that indicates abuse
                               58.3                                                                or force by another person.
           Areas




                                                                                                   However, only 44.1% of ED staff
                               50.0
                   Rural                                                                             reported that they will ask
                                                                                    2003            questions when the patient
                               42.5
                                                                                    2009               volunteers information
                                                                                                         about their abuse.
                           0                   20            40            60          80



4
                                                          Percentage



                   Emergency Department Staff Survey on Intimate Partner Violence
• In 2009, more than three fourths (78.3%) of urban area ED staff reported that
they have a person in their facility who functions to coordinate the referrals of
abused adult patients. This was an increase of 8.8% from 2003. In rural area
                                                                                                                     Findings
                                                                                                                       2009
hospitals, a drop 20.0% was observed (Figure 6).
• The 2009 survey indicated that:
        o When ED staff identified or suspected that a patient had been abused, 56.4% contacted law
        enforcement, 58.4% provided patients with information on community resources, and 32.7%
        reported that they referred patients to a shelter or safe-house.
        o Urban area ED staff were twice as likely to report that they have a designated professional within
         the facility they can debrief with after working with a suspected victim of abuse when compared to
         rural area ED staff (OR=2.2).
        o Urban area ED staff reported a slightly higher percentage of being able to debrief with someone
        after dealing with a suspected victim of abuse when compared to rural area ED staff. Conversely, a
                 slightly higher percentage of rural area ED staff reported that they don’t debrief with anyone
                 compared to urban area ED staff (18.0% and 22.0% respectively) (Figure 7).


                                                Figure 6: Percent of facilities that have a person who
                                                coordinates the referrals of abused adult patients by
                                                      Urban and Rural Areas, Utah, 2003, 2009



                                                         72.0
                                          Urban
                                                         78.3
                                 Areas




                                                         64.0
                                           Rural                                                        2003
                                                         51.2
                                                                                                        2009

                                                     0           20        40        60          80          100
                                                                            Percentage


                                           Figure 7: Resources relied upon for formal or informal debriefing after
                                           dealing with a suspected victim of domestic/intimate partner abuse by
                                                            Urban and Rural Areas, Utah, 2009*

                                                         57.4
                                         Colleague
                                                         53.7


                                  Designated             36.1
                     Resources




                                  professional           31.7


                                                         18.0
                                 Don't debrief
                                                         22.0


                                                         14.8                                                    Urban
                                 Family/Friend
                                                         12.2                                                    Rural

                                                     0          10    20        30        40      50        60           70
                                                                                Percentage

* Figure7-Respondents could select more than one option.

Emergency Department Staff Survey on Intimate Partner Violence
                                                                                                                              5
Findings
  2009 Obstacles to Identifying Abuse
  • In 2009, the top five obstacles to identifying abuse were: 1) patient doesn’t want to talk about the abuse
    (96.0%); 2) patient is under the influence of drugs or alcohol (92.1%); 3) patient fears repercussions (88.1%);
    4) ED staff not trained to interview victims of abuse (82.2%); and tied at 76.2% are 5) ED staff feel that it is
    frustrating to screen for abuse because they can do little to help and language barriers (Figure 8).




                                      Figure 8: Percent of ED staff reporting to what degree each
                                    obstacle to identifying abuse has been an issue in the past year,
                                                                Utah 2009


                                       Patient doesn't want to talk about the abuse         96.0


                                  Patient is under the influence of drugs or alcohol        92.1


                                                        Patient fears repercussions         88.1


                                           Not trained to interview victims of abuse        82.2


                                Frustrating to screen because I can do little to help       76.2


                                                                 Language barriers          76.2


                               Questioning about abuse may be too confrontational           58.0
                    Obstacle




                                         Patient denies abuse as a cause of injury          57.4


                                   Not trained to identify abuse as a cause of injury       57.0


                                      Concerned with primary diagnosis/complaint            55.6


                                                               Patient lacks privacy        46.5


                                                Lack of resources to assist victims         44.6


                                                     Abuse is a private family issue        33.3


                                       Identifying police agency is time consuming          19.0


                                      I fear the implications of mandatory reporting        16.0




6
                                                                                        0          20   40       60     80   100   120
                                                                                                             Percentage




               Emergency Department Staff Survey on Intimate Partner Violence
Findings
                                                                                                             2009
• In 2009, 49.2% of urban area ED staff reported that a patient’s denial of partner abuse as a cause of injury
  was an obstacle, a drop of 48.2% from 2003. Seventy percent of rural area ED staff reported
  this was an obstacle, a decrease of 21.4% from 2003 (Figure 9).
• Furthermore, in 2009, rural area ED staff were twice as likely to report the patient’s denial of partner abuse
  as a cause of injury compared to urban area ED staff (OR=2.4).
• In 2009, 86.9% of urban area ED staff reported that they were not adequately trained to interview
  suspected victims of abuse, an increase of 73.8% from 2003. The percentage remained the same
  in rural areas for both years of the survey (Figure 10).
• However, in 2009, urban area ED staff were twice as likely to report that they were not adequately trained
  to interview suspected victims of abuse, compared to rural area ED staff (OR=2.2).




                              Figure 9: Percent of patients denying abuse as a cause of
                                  injury by Urban and Rural Areas, Utah, 2003, 2009



                                       95.0
                           Urban
                                       49.2
                   Areas




                                       89.0
                           Rural
                                       70.0                                                         2003
                                                                                                    2009
                                   0                  20              40        60        80          100

                                                                      Percentage


                                                           Figure 10: Percent of ED staff who reported that they have not
                                                             been adequately trained to interview suspected victims of
                                                                 abuse by Urban and Rural Areas, Utah, 2003, 2009
    The Utah Health Code
    Title 26-Chapter 23 a-2                                        50.0
                                                      Urban
        Injury Reporting
                                                                   86.9
         Requirements
                                              Areas




   by Health Care Providers
      can be found in the                                          72.0
      Conclusion section                               Rural                                                     2003
          of this report.                                          75.0                                          2009

                                                               0           20        40        60           80       100




                                                                                                                            7
                                                                                     Percentage



Emergency Department Staff Survey on Intimate Partner Violence
Findings
  2009                                    Training of Providers
 • In 2009, when asked about training and education on intimate partner violence in the past two
   years, 40.2% of ED staff reported that they received training through in-service sessions.
 • In 2009, urban area ED staff were three times more likely to report that they received in-service training
   compared to rural area ED staff (OR=2.6). Compared to 2003, urban area ED staff were six times more likely
   to report that they received in-service training compared to rural area ED staff (OR=5.7) (Figure 11).
 • In 2009, rural area ED staff were five times more likely to report that they did not receive any training
   compared to urban area ED staff (OR=4.5). In 2003, rural area ED staff were twice as likely to
   report that they did not receive any training compared to urban area ED staff (OR=2.3) (Figure 11).




                               Figure 11: Resources relied upon for education or training on
                            domestic/intimate partner abuse by Urban and Rural Areas, Utah, 2009*

                 60
                            Urban
                 50         Rural
    Percentage




                 40

                 30

                 20

                 10
                        13.1 12.2    29.5 29.3     16.4 17.1    49.2 26.8    34.4 22.0    14.8 43.9     24.6 12.2
                  0
                        Academic     CEU/CME      Conference    In-service   Literature   No Training    Training
                         Center       Classes                                                             Class
                                                           Education/Training



                                                                     In 2009, approximately half of ED staff
                      From 2003 to 2009, the percent of rural         reported that they felt they were not
                       area ED staff who reported that they        adequately trained to screen, assess, and
                        received in-service training tripled,     make referrals for victims of abuse. This was
                          while the percent of those who           similar to responses in 2003. In addition,
                             received training through                84.2% of the 2009 respondents were
                            CEU/CME classes doubled.             interested in receiving additional training on
                                                                    abuse, an increase of 12.3% from 2003.




8
    * Figure11-Respondents could select more than one option.


                       Emergency Department Staff Survey on Intimate Partner Violence
Findings
                                                                                                                                                                                                                                 2009
                                                                           Resources for Victims
    • In 2009, 81.4% of urban area ED staff reported that their ED had printed information about local domestic
      violence resources available for patients. This was an increase of 19.7% from 2003. In rural area hospitals,
       an increase of 53.1% was observed (Figure 12).
    • In 2009, 63.3% of urban area ED staff reported that they gave printed information to patients they
      suspected were being abused. This was a decrease of 26.4% from 2003. In rural area hospitals, an increase
      of 37.2% was observed (Figure 13).
    • In 2009, urban area ED staff were 13 times more likely to refer patients they suspected were being abused
      to a hospital-based social worker compared to rural area ED staff (OR=12.9) (Figure 14).
    • In 2009, rural area ED staff were three times more likely to refer patients they suspected were being abused
      to a victim advocate compared to urban area ED staff (OR=2.7) (Figure 14).



            Figure 12: Percent of EDs with printed information about                                                                                                 Figure 13: Percent of EDs that reported giving printed
            local domestic violence resources available for patients                                                                                                domestic/intimate partner abuse information to patients
                   by Urban and Rural Area, Utah, 2003, 2009                                                                                                         suspected of being abused by Urban and Rural Area,
                                                                                                                                                                                       Utah, 2003, 2009


                     68.0                                                                                                                                                      86.0
         Urban                                                                                                                                          Urban
                     81.4                                                                                                                                                      63.3
                                                                                                                                                Areas
 Areas




                     43.0                                                                                                                                                      48.0
         Rural                                                                                                                                           Rural
                                                                                                       2003                                                                                                                                        2003
                     65.9                                                                                                                                                      65.9
                                                                                                       2009                                                                                                                                        2009

                 0          20                 40                    60                    80                     100                                                      0                    20                   40                 60    80      100

                                                   Percentage                                                                                                                                                           Percentage


                                                            Figure 14: Type of services abused patients are referred to according the ED staff
                                                                                  by Urban and Rural Areas, Utah, 2009*


                                                      100
                                                                                                    90.2




                                                                                                                                                                                                                               Urban
                                                                                                                        83.6
                                                                                                                               82.9




                                                       90                                                                                                                                                                      Rural
                                                                    77.1
                                                                           73.2




                                                       80
                                                                                    68.7




                                                                                                                                                                                                                        65.9
                                                                                           63.4




                                                                                                                                                                                                                                       63.4




                                                       70
                                                                                                                                                                                                                 57.4
                                 Percentage




                                                       60
                                                       50
                                                                                                           41.5




                                                                                                                                                                                                                                39.3




                                                       40
                                                                                                                                                                                 23.0




                                                       30
                                                                                                                                                                                        17.1
                                                                                                                                                             16.4




                                                       20
                                                                                                                                                                    12.2




                                                       10
                                                                                                                                          4.9




                                                                                                                                                                                                          4.9
                                                                                                                                                2.4




                                                                                                                                                                                                    0.0




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* Figure14-Respondents could select more than one option.


   Emergency Department Staff Survey on Intimate Partner Violence
                                                                                                                                                                                                                                                            9
Findings
  2009                                       Conclusion
 Since 1994, the Family Violence Prevention Fund, a national domestic violence advocacy organization, has
 promoted routine screening for domestic violence by health care providers. Concurring with the policy
 are the American Medical Association, American Nurses Association, and the Utah Department of Health
 (UDOH). The Utah Domestic Violence Fatality Review Committee also recommends all health care providers
 routinely screen for abuse.

 Screening for domestic violence provides a critical opportunity for disclosure of domestic violence and
 provides an abused patient and their health care provider the chance to develop a plan to protect the
 patient’s safety and improve the patient’s health. It is critical that providers understand how to respond to
 victims of intimate partner violence once they are identified. Policies and protocols on domestic violence
 should include clinical guides on effective assessment, intervention, documentation, and referral.

 Utah Law
 The Utah Health Code 26-23a-2, Injury Reporting Requirements, mandates that all health care providers
 treating a person suffering from an injury caused by another person shall immediately report to a law
 enforcement agency the facts regarding the injury. This law also protects health care providers from being
 discharged, suspended, disciplined, or harassed for making a report pursuant to the law. Additionally, the
 UDOH Violence and Injury Prevention Program encourages health care providers to routinely screen for and
 document abuse in a patient’s medical record. Medical records may be a resource for victims who eventually
 choose to prosecute their abuser and escape the abusive situation.


   26-23a-2 Injury Reporting Requirements by Health Care Providers

   (1) (a) Any health care provider who treats or cares for any person who suffers from any wound or
   other injury inflicted by the person’s own act or by the act of another by means of a knife, gun, pistol,
   explosive, infernal device, or deadly weapon, or by the violation of any criminal statute of this state, shall
   immediately report to the law enforcement agency the facts regarding the injury.

   (1) (b) The report shall state the name and address of the injured person, if known, the person’s
   whereabouts, the character and extent of the person’s injuries, and the name, address, and telephone
   number of the person making the report.




10           Emergency Department Staff Survey on Intimate Partner Violence
Appendix
                                                                             Findings
                                                                              2009
                Apendix A: Resources for Providers
The Utah Department of Health Violence and Injury Prevention Program and the Utah Domestic Violence
Council Health Care Committee have developed a manual to help health care providers screen and assess
patients suspected of being victims of domestic/intimate partner violence. The manual, “The Clinical
Guidelines for Assessment and Referral for Victims of Domestic Violence: A Reference for Utah Health Care
Providers,” is avilable online at http://health.utah.gov/vipp.




              Utah                                                  National
                                                      American Bar Association Commission on Domestic Violence
Commission on Criminal and Juvenile Justice                 www.abanet.org/domviol.home.html
     www.justice.utah.gov
                                                      American Institue on Domestic Violence
                                                            www.aidv-usa.com
Family Support Center
       www.familysupportcenter.org                    Bureau of Justice Statistics
                                                            www.ojp.usdoj.gov/bjs
Men’s Anti-Violence Network                           Choose Respect
       www.manutah.org                                      www.chooserespect.org
                                                      Domestic Violence 50 State Resource
Utah Coalition Against Sexual Assault                      www.dv911.com/dv50state.htm
      www.ucasa.org
                                                      End Abuse, Family Violence Prevention Fund
                                                            endabuse.org
Utah Department of Health
      www.health.utah.gov/vipp                        National Coalition Against Domestic Violence
                                                            www.ncadv.org
Utah Department of Public Safety                      National Center for Victims of Crime
      www.bci.utah.gov                                      www.ncvc.org
                                                      National Domestic Violence Hotline Website
Utah Domestic Violence Council                              www.ndvh.org/index.html
      www.udvc.org
                                                      National Network to End Domestic Violence
                                                            www.abanet.org/domviol.home.html
Utah Office of Domestic and Sexual Violence
      www.nomoresecrets.gov                           National Sexual Violence Resource Center
                                                            www.nsvrc.org
211-Information and Referral
       www.informationandreferral.org/DV.htm          Office of Victims and Crime
                                                              www.ojp.usdoj.gov/ovc
                                                      U.S. Office on Violence Against Women
                                                              www.ojp.usdoj.gov/vawo/welcome/html




Emergency Department Staff Survey on Intimate Partner Violence
                                                                                                      11
Appendix
 2009 Apendix B: Survey Instrument

                                                                                      Utah Domestic Violence Council

                                        Emergency Department Survey on
                                      Domestic and Intimate Partner Violence


                                           PURPOSE OF THIS SURVEY:
   In response to the increased incidence in family violence and intimate partner homicides, we are seeking information from
   Emergency Department staff members on their assessment, treatment and referral of adult patients who they suspect are being
   abused. Health care providers are often the first professionals to see a battered person. Emergency Departments can be a refuge
   for an abused patient who is seeking assistance and support. The results from this survey will benefit health care providers and
   their community partners by identifying and enhancing existing services and programs to address family and intimate partner
   violence. Questions in this survey are referring to domestic/intimate partner abuse patients ages 18 and over.

   We are interested in your personal experiences in identifying individuals who may be abused, the kinds of help they ask for, and
   the options you have available to help them. We are interested in the day-to-day workings of the emergency department, how
   things really work which we all know is sometimes different than official policies. Your candidness is greatly appreciated and
   all surveys will be confidential and de-identified.

   We are very interested in your opinions and suggestions. Please write any comments you have directly on the questionnaire.


                                                 Gender:     9 Male      9 Female

                    Current position: 9 ED Mgr 9 ED Physician 9 ED Physician Assistant
                    9 ED Nurse 9 Nurse Practitioner 9 Social Worker 9 Case Mgr 9 Other

            How long have you worked in an Emergency Department?                     9 <1 yr. 9 1-5 yrs. 9 >5 yrs.

                      County of this Facility_____________________________________________


                                                       DEFINITIONS
   Partner Abuse:                      The actual or threatened physical, sexual, and/or emotional abuse of an individual, age 18
                                       or older, by someone with whom they have or have had an intimate or romantic
                                       relationship. Also known as domestic or intimate partner abuse.

   Screening for Abuse:                Asking patients direct, specific questions about abuse. Examples of such questions are:
                                       “Have you ever been hurt or afraid when there are fights at home?” or “Has your partner
                                       ever hurt or threatened you?” or “Are you safe at home?”


  1.       What written policy and procedure for screening for domestic/intimate partner abuse do you rely upon?



12       Emergency Department Survey on Domestic and Intimate Partner Violence
Appendix
                                                                                          2009
              “ Hospital-wide policy            “ Emergency Department Policy
              “ There is no written policy      “ Other policy, please specify____________________________

2.   Does your department encourage you to ask routine questions about domestic/intimate partner abuse?
            “ Yes
            “ No

3.   Do you routinely ask adult patients direct, specific questions (see definition on first page) about whether
     they have been abused or threatened?
             “ Yes
             “ No

4.   Under what circumstances do you bring up the question of domestic/intimate partner abuse with a patient?
     Mark as many as apply.
            “ Never, I do not bring up the question
            “ During intake (included on patient intake form)
            “ When patient volunteers information
            “ When no one else is in the room
            “ When patient presents with injury that indicates abuse or force by another person
            “Other (please specify)____________________________________________________________
            _______________________________________________________________________________

5.   Healthcare providers have different options available to respond to adult victims of abuse. When you
     identify or suspect that a patient has been abused, how often do you do each of the following? Circle one
     answer for each statement below:
                                                                        Most                                Not
                                      Never         Sometimes          of Time          Always            Available
a.    Contact law enforcement           1                2                3                4                 NA

b.    Provide patients with information
      on community resources            1                2                3                4                 NA

c.    Refer patient to a shelter or
      safe-house                        1                2                3                4                 NA

6.   Is there a person within the ED, or elsewhere in the facility, that functions to coordinate the referrals
      of abused adult patients?
               “ Yes
               “ No

7.   Is there a designated professional within the facility that you can debrief with after working with a
     suspected victim of domestic/intimate partner abuse?
              “ Yes
              “ No

8.   Which of the following resources do you rely upon for formal or informal debriefing after dealing with a
     suspected victim of domestic/intimate partner abuse (check all that apply)?
              “ Colleague              “ Designated professional w/in the facility       “ Family/Friend
              “ Other                  “ I don’t debrief with anyone                     “ N/A
9.   There are many obstacles to the identification of adult patients who have been abused. For each obstacle



                                                                                                                      13
     listed below, please indicate to what degree this has been an issue for you in the past year:


Emergency Department Survey on Domestic and Intimate Partner Violence
Appendix
 2009                                                                         Not a           Minor             Major
                                                                              Problem        Problem            Problem
     a.      Language Barriers                                                  1               2                   3

     b.      The patient is under the influence of drugs or alcohol             1               2                   3

     c.      The patient doesn’t want to talk about the abuse                   1               2                   3

     d.      I am more concerned with the patient’s primary
             diagnosis/complaint                                                1               2                   3

     e.      I have not been adequately trained to clinically identify
             domestic/intimate partner abuse as a cause of injury               1               2                   3

     f.      Patient lacks privacy (i.e. accompanied by partner or children)    1               2                   3

     g.      Patient denies partner abuse as cause of injury                    1               2                   3

     h.      Patient fears repercussions of being identified as “battered”      1               2                   3


     i.      I have not been adequately trained to interview
             suspected victims of domestic/intimate partner abuse               1               2                   3


     j.      It is frustrating to screen for abuse because I can do
              little to help                                              1             2                3

     k.      There is a lack of local resources to assist abuse victims
             in this area of the state                                          1               2                   3


     l.      Direct questioning about abuse may be too
             confrontational for my patients                                    1               2                   3

     m.      Domestic/intimate partner abuse is a private
             family issue                                                       1               2                   3


     n.      I fear the implications of mandatory reporting                      1              2                   3


     o.      Identifying the proper law enforcement agency is too               1               2                   3
              time consuming when abuse is identified

     10.     During the past 2 years, which of the following have you relied upon for education or training on
             domestic/intimate partner abuse? (Check all that apply, please be specific for class, conference...)



14
                     “ University/ Academic Center- Medical, Nursing, Physician Assistant School, etc.
                     “ CEU/CME classes

          Emergency Department Survey on Domestic and Intimate Partner Violence
Appendix
                                                                                                  2009
                  “ Literature- text books, journals, etc.
                  “ Training Class: ______________________________________________________________
                  “ Conference: _________________________________________________________________
                  “ In-service: __________________________________________________________________
                  “ Other: _____________________________________________________________________
                  “ No training or education on this topic in the past 2 years
 11.     Do you feel you are adequately trained to screen, assess, and make referrals for victims of abuse?
                  “ Yes
                  “ No

 12.     Would you be interested in additional training specific for health care providers on domestic/intimate
         partner abuse? (You may write training suggestions below, if any)
                 “ Yes
                 “ No

 13.      Does your ED have printed information (discharge sheets, brochures, phone numbers) about local domestic
          violence resources available for patients?
                  “ Yes
                  “ No

 14.      Do you give printed domestic/intimate partner abuse information to patients you suspect are being abused?
                 “ Yes
                 “ No, explain____________________________________________________________________

 15.      Below is a list of services to which abused patients could be referred, please check those to which you refer
          patients you suspect are being abused.
           a. Hospital-based social service or                             f. Prosecutor’s office                    _______
              crisis worker                              _______
                                                                           g. Legal aid, private attorney or other
           b. Public mental health, social service                            legal assistance agency                _______
              or public health agency outside            _______
                                                                           h. Other community-based agency           _______
           c. Battered women’s shelter or domestic
              violence program                           _______           i. Victim Advocate                        _______

           d.   Adult Protective Services                _______           j.   Link Line 1-800-897-LINK (8465)      _______

           e. Police                                     _______           k. Other:__________________________ _______



  Comment Box: Your opinion matters. Please write additional comments in this section




Emergency Department Survey on Domestic and Intimate Partner Violence
                                                                                                                          15
Appendix
 2009




16                     www.health.utah.gov/vipp
     Emergency Department Survey on Domestic and Intimate Partner Violence

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Emergency Department Staff Survey on Intimate Partner Violence

  • 1. Emergency Department Staff Survey on Intimate Partner Violence 2009 The Utah Department of Health Violence and Injury Prevention Program and The Utah Domestic Violence Council Health Care Committee
  • 2. For more information contact: Utah Department of Health Violence and Injury Prevention Program 288 North 1460 West P.O. Box 142106 Salt Lake City, UT 84114-2106 Telephone: (801) 538-6141 Fax: (801) 538-9134 E-mail: vipp@utah.gov This report is available at www.health.utah.gov/vipp. Suggested Citation: Utah Department of Health Violence and Injury Prevention Program 2009. Emergency Department Survey on Domestic and Intimate Partner Violence 2009. Salt Lake City, UT: Utah Department of Health.
  • 3. Emergency Department Staff Survey on Intimate Partner Violence 2009 The Utah Department of Health Violence and Injury Prevention Program and The Utah Domestic Violence Council Health Care Committee
  • 4. Acknowledgments Utah Department of Health Staff Participating Facilities Teresa Brechlin, BS, SSW Alta View Hospital Anna Fondario, MPH American Fork Hospital Trisha Keller, MPH, RN Ashley Valley Medical Center Katie McMinn, BS Bear River Valley Hospital Brigham City Community Hospital Review Committee Castleview Hospital Barbara Ferrara, Intermountain Healthcare Central Valley Hospital Kathy Franchek, University of Utah, School of Medicine Delta Community Medical Center Roger K. Keddington, Intermountain Healthcare Dixie Regional Medical Center Joanne McGarry, Utah Department of Health Garfield Memorial Hospital Rachelle Rhodes, Intermountain Healthcare Gunnison Valley Hospital Ned Searle, Office on Domestic and Sexual Violence Intermountain Medical Center Kane County Hospital Lakeview Hospital LDS Hospital Logan Regional Hospital McKay Dee Hospital Mountain View Hospital Mountain West Medical Center Ogden Regional Medical Center Orem Community Hospital Pioneer Valley Hospital Salt Lake Regional Medical Center Sanpete Valley Hospital Sevier Valley Hospital St. Mark’s Hospital Timpanogos Hospital University of Utah Hospital Utah Valley Regional Medical Center Valley View Medical Center Emergency Department Staff Survey on Intimate Partner Violence
  • 5. Table of Contents Background••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••2 Demographics of Respondents•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••3 Policies and Procedures•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••4 Obstacles to Identifying Abuse••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••6 Training of Providers••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••8 Resources for Victims••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••9 Conclusion•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••10 Appendix A Resources for Providers••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••11 Appendix B Survey Instrument••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••12 Emergency Department Staff Survey on Intimate Partner Violence
  • 6. Findings 2009 Background In 2003, the Utah Department of Health Violence (UDOH) and Injury Prevention Program (VIPP), in collaboration with the Utah Domestic Violence Council Health Care Committee, administered a survey seeking information from Utah’s hospital emergency department (ED) staff in their screening, assessment, and referral of patients ages 18 and older whom they suspected were victims of intimate partner violence. The survey consisted of questions regarding demographics of the respondent, ED polices and procedures, obstacles staff have faced, IPV training, and resources for victims. Purpose of the Survey The purpose of the 2003 and 2009 surveys were to: • Obtain ED staff memebers’ personal experiences in identifying individuals who may be abused, the type of intimate partner violence services victims ask for, and the options the ED staff have available to help their patients; • Identify ED polices and procedures related to intimate partner violence; and • Obtain results that will benefit health care providers and their community partners by identifying and enhancing existing services and programs to address intimate partner violence. Based on the results of the 2003 survey; new educational materials, training programs, and resources have been implemented throughout the state of Utah. The Emergency Department Staff Survey on Intimate Partner Violence was re-administered during the spring of 2009 to assess the impact of these activities. Data Points The surveys were delivered by postal and electronic mail to all 39 hospital ED Managers in Utah. They were asked to distribute the survey to the entire ED staff. The data were analyzed in a format that divided all hospitals into two categories-urban and rural areas. Hospitals in Davis, Salt Lake, Utah, and Weber counties were placed in the urban area category. The remaining hospitals were placed in the rural area category. Responses were received from 31 hospital EDs, resulting in a total of 102 surveys that consisted of 17 (45.2%) urban area hospitals and 14 (54.8%) rural area hospitals. Sixty-one (59.8%) of the respondents were from urban area hospitals and 41 (40.2%) were from rural area hospitals. The distribution of the respondents was proportional throughout the sample. 2 Emergency Department Staff Survey on Intimate Partner Violence
  • 7. Findings 2009 Demographics of Respondents • In 2009, 64.6% of respondents were nurses, compared to 56.0% in 2003. This group represented the majority in both surveys (Figure 1). • The majority of the 2009 respondents were female (69.3%) compared to 59.0% in 2003 (Figure 2). • The majority of the 2009 respondents (72.2%) had more than five years experience working in an emergency department compared to 57.0% in 2003 (Figure 3). Figure 1: Percent of emergency department staff by current Figure 2: Percent of emergency department staff by gender, position, Utah 2003,2009 Utah 2003, 2009 80 Nurse 56.0 2003* 64.6 70 2009 Current Position 60 9.0 Manager Percentage 24.0 50 40 Physician 18.0 30 10.4 20 7.0 2003* Social Worker 10 1.0 2009 32.0 30.7 59.0 69.3 0 0 10 20 30 40 50 60 70 Male Female Percentage Gender Figure 3: Length of time worked in an emergency department, Utah 2003, 2009 2003* 7.0 < 1 year 2009 4.1 Years worked 32.0 1-5 years 23.7 57.0 > 5 years 72.2 0 20 40 60 80 Percentage 3 * Figure 1 - The 2003 survey respondents also consisted of nurse practitioners, physician assistants, and case managers, as well as an unreported category. Figures 2 and 3 – The 2003 survey also consisted of an unreported category. Emergency Department Staff Survey on Intimate Partner Violence
  • 8. Findings 2009 Policies and Procedures • In 2009, 13.1% of respondents indicated that there was no written policy and procedure for intimate partner violence screening at their hospital. • In 2009, 73.3% of urban area ED staff reported that they were encouraged to ask routine questions about intimate partner violence. This was an increase of 35.8% from what was reported in 2003. The percentage remained the same in rural areas for both years of the survey (Figure 4). • In 2009, 58.3% of urban area ED staff reported that they routinely ask direct, specific questions regarding intimate partner violence. This was an increase of 32.6% from what was reported in 2003. However, the opposite was seen in rural areas, with a drop 15.0% from 2003 (Figure 5). Figure 4: Percent by department encouraged to ask routine questions about domestic/intimate partner abuse, by Urban and Rural Areas, Utah, 2003,2009 54.0 Urban 73.3 Areas 59.0 Rural 58.5 2003 2009 0 20 40 60 80 Percentage Figure 5: Percent routinely asking adult patients direct, specific questions about whether they have been abused In 2009, approximately 80.0% of ED or threatened by Urban and Rural Areas, Utah, 2003, 2009 staff reported that they would ask questions about intimate partner abuse with a 44.0 patient when the patient presents Urban with injury that indicates abuse 58.3 or force by another person. Areas However, only 44.1% of ED staff 50.0 Rural reported that they will ask 2003 questions when the patient 42.5 2009 volunteers information about their abuse. 0 20 40 60 80 4 Percentage Emergency Department Staff Survey on Intimate Partner Violence
  • 9. • In 2009, more than three fourths (78.3%) of urban area ED staff reported that they have a person in their facility who functions to coordinate the referrals of abused adult patients. This was an increase of 8.8% from 2003. In rural area Findings 2009 hospitals, a drop 20.0% was observed (Figure 6). • The 2009 survey indicated that: o When ED staff identified or suspected that a patient had been abused, 56.4% contacted law enforcement, 58.4% provided patients with information on community resources, and 32.7% reported that they referred patients to a shelter or safe-house. o Urban area ED staff were twice as likely to report that they have a designated professional within the facility they can debrief with after working with a suspected victim of abuse when compared to rural area ED staff (OR=2.2). o Urban area ED staff reported a slightly higher percentage of being able to debrief with someone after dealing with a suspected victim of abuse when compared to rural area ED staff. Conversely, a slightly higher percentage of rural area ED staff reported that they don’t debrief with anyone compared to urban area ED staff (18.0% and 22.0% respectively) (Figure 7). Figure 6: Percent of facilities that have a person who coordinates the referrals of abused adult patients by Urban and Rural Areas, Utah, 2003, 2009 72.0 Urban 78.3 Areas 64.0 Rural 2003 51.2 2009 0 20 40 60 80 100 Percentage Figure 7: Resources relied upon for formal or informal debriefing after dealing with a suspected victim of domestic/intimate partner abuse by Urban and Rural Areas, Utah, 2009* 57.4 Colleague 53.7 Designated 36.1 Resources professional 31.7 18.0 Don't debrief 22.0 14.8 Urban Family/Friend 12.2 Rural 0 10 20 30 40 50 60 70 Percentage * Figure7-Respondents could select more than one option. Emergency Department Staff Survey on Intimate Partner Violence 5
  • 10. Findings 2009 Obstacles to Identifying Abuse • In 2009, the top five obstacles to identifying abuse were: 1) patient doesn’t want to talk about the abuse (96.0%); 2) patient is under the influence of drugs or alcohol (92.1%); 3) patient fears repercussions (88.1%); 4) ED staff not trained to interview victims of abuse (82.2%); and tied at 76.2% are 5) ED staff feel that it is frustrating to screen for abuse because they can do little to help and language barriers (Figure 8). Figure 8: Percent of ED staff reporting to what degree each obstacle to identifying abuse has been an issue in the past year, Utah 2009 Patient doesn't want to talk about the abuse 96.0 Patient is under the influence of drugs or alcohol 92.1 Patient fears repercussions 88.1 Not trained to interview victims of abuse 82.2 Frustrating to screen because I can do little to help 76.2 Language barriers 76.2 Questioning about abuse may be too confrontational 58.0 Obstacle Patient denies abuse as a cause of injury 57.4 Not trained to identify abuse as a cause of injury 57.0 Concerned with primary diagnosis/complaint 55.6 Patient lacks privacy 46.5 Lack of resources to assist victims 44.6 Abuse is a private family issue 33.3 Identifying police agency is time consuming 19.0 I fear the implications of mandatory reporting 16.0 6 0 20 40 60 80 100 120 Percentage Emergency Department Staff Survey on Intimate Partner Violence
  • 11. Findings 2009 • In 2009, 49.2% of urban area ED staff reported that a patient’s denial of partner abuse as a cause of injury was an obstacle, a drop of 48.2% from 2003. Seventy percent of rural area ED staff reported this was an obstacle, a decrease of 21.4% from 2003 (Figure 9). • Furthermore, in 2009, rural area ED staff were twice as likely to report the patient’s denial of partner abuse as a cause of injury compared to urban area ED staff (OR=2.4). • In 2009, 86.9% of urban area ED staff reported that they were not adequately trained to interview suspected victims of abuse, an increase of 73.8% from 2003. The percentage remained the same in rural areas for both years of the survey (Figure 10). • However, in 2009, urban area ED staff were twice as likely to report that they were not adequately trained to interview suspected victims of abuse, compared to rural area ED staff (OR=2.2). Figure 9: Percent of patients denying abuse as a cause of injury by Urban and Rural Areas, Utah, 2003, 2009 95.0 Urban 49.2 Areas 89.0 Rural 70.0 2003 2009 0 20 40 60 80 100 Percentage Figure 10: Percent of ED staff who reported that they have not been adequately trained to interview suspected victims of abuse by Urban and Rural Areas, Utah, 2003, 2009 The Utah Health Code Title 26-Chapter 23 a-2 50.0 Urban Injury Reporting 86.9 Requirements Areas by Health Care Providers can be found in the 72.0 Conclusion section Rural 2003 of this report. 75.0 2009 0 20 40 60 80 100 7 Percentage Emergency Department Staff Survey on Intimate Partner Violence
  • 12. Findings 2009 Training of Providers • In 2009, when asked about training and education on intimate partner violence in the past two years, 40.2% of ED staff reported that they received training through in-service sessions. • In 2009, urban area ED staff were three times more likely to report that they received in-service training compared to rural area ED staff (OR=2.6). Compared to 2003, urban area ED staff were six times more likely to report that they received in-service training compared to rural area ED staff (OR=5.7) (Figure 11). • In 2009, rural area ED staff were five times more likely to report that they did not receive any training compared to urban area ED staff (OR=4.5). In 2003, rural area ED staff were twice as likely to report that they did not receive any training compared to urban area ED staff (OR=2.3) (Figure 11). Figure 11: Resources relied upon for education or training on domestic/intimate partner abuse by Urban and Rural Areas, Utah, 2009* 60 Urban 50 Rural Percentage 40 30 20 10 13.1 12.2 29.5 29.3 16.4 17.1 49.2 26.8 34.4 22.0 14.8 43.9 24.6 12.2 0 Academic CEU/CME Conference In-service Literature No Training Training Center Classes Class Education/Training In 2009, approximately half of ED staff From 2003 to 2009, the percent of rural reported that they felt they were not area ED staff who reported that they adequately trained to screen, assess, and received in-service training tripled, make referrals for victims of abuse. This was while the percent of those who similar to responses in 2003. In addition, received training through 84.2% of the 2009 respondents were CEU/CME classes doubled. interested in receiving additional training on abuse, an increase of 12.3% from 2003. 8 * Figure11-Respondents could select more than one option. Emergency Department Staff Survey on Intimate Partner Violence
  • 13. Findings 2009 Resources for Victims • In 2009, 81.4% of urban area ED staff reported that their ED had printed information about local domestic violence resources available for patients. This was an increase of 19.7% from 2003. In rural area hospitals, an increase of 53.1% was observed (Figure 12). • In 2009, 63.3% of urban area ED staff reported that they gave printed information to patients they suspected were being abused. This was a decrease of 26.4% from 2003. In rural area hospitals, an increase of 37.2% was observed (Figure 13). • In 2009, urban area ED staff were 13 times more likely to refer patients they suspected were being abused to a hospital-based social worker compared to rural area ED staff (OR=12.9) (Figure 14). • In 2009, rural area ED staff were three times more likely to refer patients they suspected were being abused to a victim advocate compared to urban area ED staff (OR=2.7) (Figure 14). Figure 12: Percent of EDs with printed information about Figure 13: Percent of EDs that reported giving printed local domestic violence resources available for patients domestic/intimate partner abuse information to patients by Urban and Rural Area, Utah, 2003, 2009 suspected of being abused by Urban and Rural Area, Utah, 2003, 2009 68.0 86.0 Urban Urban 81.4 63.3 Areas Areas 43.0 48.0 Rural Rural 2003 2003 65.9 65.9 2009 2009 0 20 40 60 80 100 0 20 40 60 80 100 Percentage Percentage Figure 14: Type of services abused patients are referred to according the ED staff by Urban and Rural Areas, Utah, 2009* 100 90.2 Urban 83.6 82.9 90 Rural 77.1 73.2 80 68.7 65.9 63.4 63.4 70 57.4 Percentage 60 50 41.5 39.3 40 23.0 30 17.1 16.4 20 12.2 10 4.9 4.9 2.4 0.0 0 cy cy r ey t s e r e te en te ke ice fic in en en ca rn el em or -L of rv ag ag sh to vo lw nk se at 's rc ad 's lth ed Li or cia fo te en e ea t as en im iv cu iva so m ct lh -b ct se w wo pr te ed ity Vi ta La o ro , Pr en as un id d tp re la l-b m m ul tte ga m ta lic Ad Ba co pi Le b Pu os er H th O Services * Figure14-Respondents could select more than one option. Emergency Department Staff Survey on Intimate Partner Violence 9
  • 14. Findings 2009 Conclusion Since 1994, the Family Violence Prevention Fund, a national domestic violence advocacy organization, has promoted routine screening for domestic violence by health care providers. Concurring with the policy are the American Medical Association, American Nurses Association, and the Utah Department of Health (UDOH). The Utah Domestic Violence Fatality Review Committee also recommends all health care providers routinely screen for abuse. Screening for domestic violence provides a critical opportunity for disclosure of domestic violence and provides an abused patient and their health care provider the chance to develop a plan to protect the patient’s safety and improve the patient’s health. It is critical that providers understand how to respond to victims of intimate partner violence once they are identified. Policies and protocols on domestic violence should include clinical guides on effective assessment, intervention, documentation, and referral. Utah Law The Utah Health Code 26-23a-2, Injury Reporting Requirements, mandates that all health care providers treating a person suffering from an injury caused by another person shall immediately report to a law enforcement agency the facts regarding the injury. This law also protects health care providers from being discharged, suspended, disciplined, or harassed for making a report pursuant to the law. Additionally, the UDOH Violence and Injury Prevention Program encourages health care providers to routinely screen for and document abuse in a patient’s medical record. Medical records may be a resource for victims who eventually choose to prosecute their abuser and escape the abusive situation. 26-23a-2 Injury Reporting Requirements by Health Care Providers (1) (a) Any health care provider who treats or cares for any person who suffers from any wound or other injury inflicted by the person’s own act or by the act of another by means of a knife, gun, pistol, explosive, infernal device, or deadly weapon, or by the violation of any criminal statute of this state, shall immediately report to the law enforcement agency the facts regarding the injury. (1) (b) The report shall state the name and address of the injured person, if known, the person’s whereabouts, the character and extent of the person’s injuries, and the name, address, and telephone number of the person making the report. 10 Emergency Department Staff Survey on Intimate Partner Violence
  • 15. Appendix Findings 2009 Apendix A: Resources for Providers The Utah Department of Health Violence and Injury Prevention Program and the Utah Domestic Violence Council Health Care Committee have developed a manual to help health care providers screen and assess patients suspected of being victims of domestic/intimate partner violence. The manual, “The Clinical Guidelines for Assessment and Referral for Victims of Domestic Violence: A Reference for Utah Health Care Providers,” is avilable online at http://health.utah.gov/vipp. Utah National American Bar Association Commission on Domestic Violence Commission on Criminal and Juvenile Justice www.abanet.org/domviol.home.html www.justice.utah.gov American Institue on Domestic Violence www.aidv-usa.com Family Support Center www.familysupportcenter.org Bureau of Justice Statistics www.ojp.usdoj.gov/bjs Men’s Anti-Violence Network Choose Respect www.manutah.org www.chooserespect.org Domestic Violence 50 State Resource Utah Coalition Against Sexual Assault www.dv911.com/dv50state.htm www.ucasa.org End Abuse, Family Violence Prevention Fund endabuse.org Utah Department of Health www.health.utah.gov/vipp National Coalition Against Domestic Violence www.ncadv.org Utah Department of Public Safety National Center for Victims of Crime www.bci.utah.gov www.ncvc.org National Domestic Violence Hotline Website Utah Domestic Violence Council www.ndvh.org/index.html www.udvc.org National Network to End Domestic Violence www.abanet.org/domviol.home.html Utah Office of Domestic and Sexual Violence www.nomoresecrets.gov National Sexual Violence Resource Center www.nsvrc.org 211-Information and Referral www.informationandreferral.org/DV.htm Office of Victims and Crime www.ojp.usdoj.gov/ovc U.S. Office on Violence Against Women www.ojp.usdoj.gov/vawo/welcome/html Emergency Department Staff Survey on Intimate Partner Violence 11
  • 16. Appendix 2009 Apendix B: Survey Instrument Utah Domestic Violence Council Emergency Department Survey on Domestic and Intimate Partner Violence PURPOSE OF THIS SURVEY: In response to the increased incidence in family violence and intimate partner homicides, we are seeking information from Emergency Department staff members on their assessment, treatment and referral of adult patients who they suspect are being abused. Health care providers are often the first professionals to see a battered person. Emergency Departments can be a refuge for an abused patient who is seeking assistance and support. The results from this survey will benefit health care providers and their community partners by identifying and enhancing existing services and programs to address family and intimate partner violence. Questions in this survey are referring to domestic/intimate partner abuse patients ages 18 and over. We are interested in your personal experiences in identifying individuals who may be abused, the kinds of help they ask for, and the options you have available to help them. We are interested in the day-to-day workings of the emergency department, how things really work which we all know is sometimes different than official policies. Your candidness is greatly appreciated and all surveys will be confidential and de-identified. We are very interested in your opinions and suggestions. Please write any comments you have directly on the questionnaire. Gender: 9 Male 9 Female Current position: 9 ED Mgr 9 ED Physician 9 ED Physician Assistant 9 ED Nurse 9 Nurse Practitioner 9 Social Worker 9 Case Mgr 9 Other How long have you worked in an Emergency Department? 9 <1 yr. 9 1-5 yrs. 9 >5 yrs. County of this Facility_____________________________________________ DEFINITIONS Partner Abuse: The actual or threatened physical, sexual, and/or emotional abuse of an individual, age 18 or older, by someone with whom they have or have had an intimate or romantic relationship. Also known as domestic or intimate partner abuse. Screening for Abuse: Asking patients direct, specific questions about abuse. Examples of such questions are: “Have you ever been hurt or afraid when there are fights at home?” or “Has your partner ever hurt or threatened you?” or “Are you safe at home?” 1. What written policy and procedure for screening for domestic/intimate partner abuse do you rely upon? 12 Emergency Department Survey on Domestic and Intimate Partner Violence
  • 17. Appendix 2009 “ Hospital-wide policy “ Emergency Department Policy “ There is no written policy “ Other policy, please specify____________________________ 2. Does your department encourage you to ask routine questions about domestic/intimate partner abuse? “ Yes “ No 3. Do you routinely ask adult patients direct, specific questions (see definition on first page) about whether they have been abused or threatened? “ Yes “ No 4. Under what circumstances do you bring up the question of domestic/intimate partner abuse with a patient? Mark as many as apply. “ Never, I do not bring up the question “ During intake (included on patient intake form) “ When patient volunteers information “ When no one else is in the room “ When patient presents with injury that indicates abuse or force by another person “Other (please specify)____________________________________________________________ _______________________________________________________________________________ 5. Healthcare providers have different options available to respond to adult victims of abuse. When you identify or suspect that a patient has been abused, how often do you do each of the following? Circle one answer for each statement below: Most Not Never Sometimes of Time Always Available a. Contact law enforcement 1 2 3 4 NA b. Provide patients with information on community resources 1 2 3 4 NA c. Refer patient to a shelter or safe-house 1 2 3 4 NA 6. Is there a person within the ED, or elsewhere in the facility, that functions to coordinate the referrals of abused adult patients? “ Yes “ No 7. Is there a designated professional within the facility that you can debrief with after working with a suspected victim of domestic/intimate partner abuse? “ Yes “ No 8. Which of the following resources do you rely upon for formal or informal debriefing after dealing with a suspected victim of domestic/intimate partner abuse (check all that apply)? “ Colleague “ Designated professional w/in the facility “ Family/Friend “ Other “ I don’t debrief with anyone “ N/A 9. There are many obstacles to the identification of adult patients who have been abused. For each obstacle 13 listed below, please indicate to what degree this has been an issue for you in the past year: Emergency Department Survey on Domestic and Intimate Partner Violence
  • 18. Appendix 2009 Not a Minor Major Problem Problem Problem a. Language Barriers 1 2 3 b. The patient is under the influence of drugs or alcohol 1 2 3 c. The patient doesn’t want to talk about the abuse 1 2 3 d. I am more concerned with the patient’s primary diagnosis/complaint 1 2 3 e. I have not been adequately trained to clinically identify domestic/intimate partner abuse as a cause of injury 1 2 3 f. Patient lacks privacy (i.e. accompanied by partner or children) 1 2 3 g. Patient denies partner abuse as cause of injury 1 2 3 h. Patient fears repercussions of being identified as “battered” 1 2 3 i. I have not been adequately trained to interview suspected victims of domestic/intimate partner abuse 1 2 3 j. It is frustrating to screen for abuse because I can do little to help 1 2 3 k. There is a lack of local resources to assist abuse victims in this area of the state 1 2 3 l. Direct questioning about abuse may be too confrontational for my patients 1 2 3 m. Domestic/intimate partner abuse is a private family issue 1 2 3 n. I fear the implications of mandatory reporting 1 2 3 o. Identifying the proper law enforcement agency is too 1 2 3 time consuming when abuse is identified 10. During the past 2 years, which of the following have you relied upon for education or training on domestic/intimate partner abuse? (Check all that apply, please be specific for class, conference...) 14 “ University/ Academic Center- Medical, Nursing, Physician Assistant School, etc. “ CEU/CME classes Emergency Department Survey on Domestic and Intimate Partner Violence
  • 19. Appendix 2009 “ Literature- text books, journals, etc. “ Training Class: ______________________________________________________________ “ Conference: _________________________________________________________________ “ In-service: __________________________________________________________________ “ Other: _____________________________________________________________________ “ No training or education on this topic in the past 2 years 11. Do you feel you are adequately trained to screen, assess, and make referrals for victims of abuse? “ Yes “ No 12. Would you be interested in additional training specific for health care providers on domestic/intimate partner abuse? (You may write training suggestions below, if any) “ Yes “ No 13. Does your ED have printed information (discharge sheets, brochures, phone numbers) about local domestic violence resources available for patients? “ Yes “ No 14. Do you give printed domestic/intimate partner abuse information to patients you suspect are being abused? “ Yes “ No, explain____________________________________________________________________ 15. Below is a list of services to which abused patients could be referred, please check those to which you refer patients you suspect are being abused. a. Hospital-based social service or f. Prosecutor’s office _______ crisis worker _______ g. Legal aid, private attorney or other b. Public mental health, social service legal assistance agency _______ or public health agency outside _______ h. Other community-based agency _______ c. Battered women’s shelter or domestic violence program _______ i. Victim Advocate _______ d. Adult Protective Services _______ j. Link Line 1-800-897-LINK (8465) _______ e. Police _______ k. Other:__________________________ _______ Comment Box: Your opinion matters. Please write additional comments in this section Emergency Department Survey on Domestic and Intimate Partner Violence 15
  • 20. Appendix 2009 16 www.health.utah.gov/vipp Emergency Department Survey on Domestic and Intimate Partner Violence