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Lin SC, Chang KSG, Marjavi A, Chon KY, Dichter ME, DuBois Palardy J. Intimate Partner Violence and Human Trafficking Screening and Services in Primary Care Across Underserved Communities in the United States-Initial Examination of Trends, 2020-2021. Public Health Rep 2024:333549241239886. [PMID: 38562004 DOI: 10.1177/00333549241239886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES The Health Resources and Services Administration (HRSA) began collecting data on intimate partner violence (IPV) and human trafficking (HT) in the 2020 Uniform Data System (UDS). We examined patients affected by IPV and HT served by HRSA-funded health centers in medically underserved US communities during the COVID-19 pandemic. METHODS We established a baseline and measured trends in patient care by analyzing data from the 2020 (N = 28 590 897) and 2021 (N = 30 193 278) UDS. We conducted longitudinal ordinal logistic regression analyses to assess the association of care trends and organization-level and patient characteristics using proportional odds ratios (PORs) and 95% CIs. RESULTS The number of clinical visits for patients affected by IPV and HT decreased by 29.4% and 88.3%, respectively, from 2020 to 2021. Health centers serving a higher (vs lower) percentage of pediatric patients were more likely to continuously serve patients affected by IPV (POR = 2.58; 95% CI, 1.01-6.61) and HT (POR = 6.14; 95% CI, 2.06-18.29). Health centers serving (vs not serving) patients affected by IPV were associated with a higher percentage of patients who had limited English proficiency (POR = 1.77; 95% CI, 1.02-3.05) and Medicaid beneficiaries (POR = 2.88; 95% CI, 1.48-5.62), whereas health centers serving (vs not serving) patients affected by HT were associated with a higher percentage of female patients of reproductive age (POR = 15.89; 95% CI, 1.61-157.38) and urban settings (POR = 1.74; 95% CI, 1.26-2.37). CONCLUSIONS The number of clinical visits for patients affected by IPV and HT during the COVID-19 pandemic declined. Delayed care will pose challenges for future health care needs of these populations.
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Affiliation(s)
- Sue C Lin
- Bureau of Primary Health Care Office of Quality Improvement, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD, USA
| | | | - Anna Marjavi
- Futures Without Violence, San Francisco, CA, USA
| | - Katherine Y Chon
- Office of Trafficking in Persons, Administration for Children and Families, US Department of Health and Human Services, Washington, DC, USA
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Temple University School of Social Work, Philadelphia, PA, USA
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Dichter ME. Addressing intimate partner violence in healthcare: Implications for the inpatient setting. J Hosp Med 2023. [PMID: 37497668 DOI: 10.1002/jhm.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Melissa E Dichter
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- School of Social Work, Temple University, Phialdelphia, Pennsylvania, USA
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Huang D, Cogill S, Hsia RY, Yang S, Kim D. Development and external validation of a pretrained deep learning model for the prediction of non-accidental trauma. NPJ Digit Med 2023; 6:131. [PMID: 37468526 DOI: 10.1038/s41746-023-00875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/07/2023] [Indexed: 07/21/2023] Open
Abstract
Non-accidental trauma (NAT) is deadly and difficult to predict. Transformer models pretrained on large datasets have recently produced state of the art performance on diverse prediction tasks, but the optimal pretraining strategies for diagnostic predictions are not known. Here we report the development and external validation of Pretrained and Adapted BERT for Longitudinal Outcomes (PABLO), a transformer-based deep learning model with multitask clinical pretraining, to identify patients who will receive a diagnosis of NAT in the next year. We develop a clinical interface to visualize patient trajectories, model predictions, and individual risk factors. In two comprehensive statewide databases, approximately 1% of patients experience NAT within one year of prediction. PABLO predicts NAT events with area under the receiver operating characteristic curve (AUROC) of 0.844 (95% CI 0.838-0.851) in the California test set, and 0.849 (95% CI 0.846-0.851) on external validation in Florida, outperforming comparator models. Multitask pretraining significantly improves model performance. Attribution analysis shows substance use, psychiatric, and injury diagnoses, in the context of age and racial demographics, as influential predictors of NAT. As a clinical decision support system, PABLO can identify high-risk patients and patient-specific risk factors, which can be used to target secondary screening and preventive interventions at the point-of-care.
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Affiliation(s)
- David Huang
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | | | - Renee Y Hsia
- Department of Emergency Medicine, UCSF School of Medicine, San Francisco, CA, USA
| | - Samuel Yang
- Department of Emergency Medicine, Stanford University, Stanford, CA, USA
| | - David Kim
- Department of Emergency Medicine, Stanford University, Stanford, CA, USA.
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Differences in Sexual and Physical Abuse History by Presenting Chief Complaint in an Outpatient Urogynecology Population. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:344-350. [PMID: 36808928 DOI: 10.1097/spv.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
IMPORTANCE One in 3 women experience sexual or physical violence in their lifetimes. Health consequences for survivors are numerous, including urogynecologic symptoms. OBJECTIVES We aimed to determine prevalence and factors that predict a history of sexual or physical abuse (SA/PA) in outpatient urogynecology, specifically whether the chief complaint (CC) predicts a history of SA/PA. STUDY DESIGN This cross-sectional study analyzed 1,000 newly presenting patients to 1 of 7 urogynecology offices in western Pennsylvania from November 2014 to November 2015. All sociodemographic/medical data were retrospectively abstracted. Univariable and multivariable logistic regression analyzed risk factors based on known associated variables. RESULTS One thousand new patients had a mean age of 58.4 ± 15.8 years with a body mass index (BMI) of 28.8 ± 6.5. Nearly 12% reported a history of SA/PA. Patients with CC of pelvic pain were more than twice as likely to report abuse compared with all other CCs (odds ratio [OR], 2.690; 95% confidence interval [CI], 1.576-4.592). Prolapse was the most common CC (36.2%) but had the lowest prevalence of abuse (6.1%). Nocturia was an additional urogynecologic variable predictive of abuse (OR, 1.162 per nightly episode; 95% CI, 1.033-1.308). Increasing BMI and decreasing age both increased the risk of SA/PA. Smoking conferred the highest likelihood of abuse history (OR, 3.676; 95% CI, 2.252-5.988). CONCLUSIONS Although those with a CC of prolapse were less likely to report abuse history, we recommend routine screening for all women. Pelvic pain was the most common CC among women reporting abuse. Special efforts should be made to screen those at higher risk with complaints of pelvic pain who are younger, smokers, with higher BMI, and with increased nocturia.
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Tavrow P, Azucar D, Huynh D, Yoo C, Liang D, Pathomrit W, Withers M. Encouraging Asian Immigrant Women to Disclose Intimate Partner Violence in Primary Care Settings. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP5626-NP5648. [PMID: 32969305 DOI: 10.1177/0886260520959642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Risks of intimate partner violence (IPV) often are higher among immigrant women, due to dependency, language barriers, deportation fears, cultural beliefs, and limited access to services. In the United States, Asian immigrant women experiencing IPV often are reluctant to disclose abuse. Viewing videos that depict IPV survivors who have successfully obtained help might encourage disclosure. After conducting formative research, we created brief videos in four Asian languages (Korean, Mandarin Chinese, Thai, and Vietnamese) for use in primary care clinic consultation rooms. We then conducted in-depth interviews with 60 Asian immigrant women in California to get their perspectives on how helpful the videos might be in achieving disclosure. Most participants believed the videos would promote disclosure in clinics, although those who had been abused seemed more skeptical. Many had stereotyped views of victims, who they felt needed to be emotive to be credible. Videos should be upbeat, highlighting the positive outcomes of escaping violence and showing clearly each step of the process. Various types of IPV should be described, so that women understand the violence is not exclusively physical. Victims would need reassurance that they will not be arrested, deported, or forced to leave their abusers. Discussing the benefits of escaping violence to children could be influential. Victims also must be convinced that providers are trustworthy, confidential, and want to help. To assist immigrant populations to disclose IPV to a health provider, videos need to be culturally relevant, explain various types of violence, allay fears, and show clear processes and benefits.
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Affiliation(s)
- Paula Tavrow
- University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Danny Azucar
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Dan Huynh
- University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Caroline Yoo
- University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Di Liang
- University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Wanda Pathomrit
- University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Mellissa Withers
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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Tavrow P, Bloom B, Withers M. Challenges of Using Videos in Exam Rooms of Safety-Net Clinics to Encourage Patient Self-Disclosure of Intimate Partner Violence and to Increase Provider Screening. Violence Against Women 2021; 27:2990-3010. [PMID: 33860700 DOI: 10.1177/10778012211000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Identifying intimate partner violence (IPV) in clinics allows for early intervention. We tested a comprehensive approach in five safety-net clinics to encourage female victims to self-identify and providers to screen. The main components were (a) short, multilingual videos for female patients; (b) provider training; and (c) management tools. Although videos were viewed 2,150 times, only 9% of eligible patients watched them. IPV disclosure increased slightly (6%). Lack of internal champions, high turnover, increased patient load, and technological challenges hindered outcomes. Safety-net clinics need feasible methods to encourage IPV screening. Management champions and IT support are essential for video-based activities.
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Affiliation(s)
| | - Brittnie Bloom
- San Diego State University, CA, USA.,University of California, San Diego, USA
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Middle-aged Women's Experiences of Intimate Partner Violence Screening and Disclosure: "It's a private matter. It's an embarrassing situation". J Gen Intern Med 2020; 35:2655-2661. [PMID: 32514900 PMCID: PMC7458990 DOI: 10.1007/s11606-020-05947-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND National guidelines indicate that healthcare providers should routinely screen women of reproductive age for experience of intimate partner violence. We know little about intimate partner violence (IPV) screening and disclosure experience among women older than reproductive age. OBJECTIVE To examine the perspectives of middle-aged women who had experienced past-year IPV regarding IPV screening and disclosure in the healthcare setting. DESIGN Individual semi-structured qualitative interviews were conducted in-person as part of a larger study examining IPV screening and response services through the Veterans Health Administration. PARTICIPANTS Twenty-seven women aged 45-64 (mean age 53) who experienced past-year IPV and received care at one of two Veterans Affairs Medical Centers. APPROACH Interviews were digitally recorded and transcribed. Data were sorted and analyzed using templated notes and line-by-line coding, based on codes developed by the study team through an initial review of the data. Themes were derived from further analysis of the data coded for "screening" and "disclosure" for respondents aged 45 and older. KEY RESULTS Barriers to disclosure of IPV to a healthcare provider included as follows: (a) feelings of shame, stigma, and/or embarrassment about experiencing IPV; (b) screening context not feeling comfortable or supportive, including lack of comfort with or trust in the provider and/or a perception that screening was conducted in a way that felt impersonal and uncaring; and (c) concerns about privacy and safety related to disclosure. Provider demonstrations of care, empathy, and support facilitated disclosure and feelings of empowerment following disclosure. CONCLUSIONS Middle-aged women may benefit from routine IPV screening and response in the healthcare setting. Such interventions should be sensitive to concerns regarding stigma and privacy that may be prevalent among this population.
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Cole TB, Grennan D. Incorporating Intimate Partner Violence Interventions in Nurse Home Visitation Programs-Reply. JAMA 2019; 322:1104-1105. [PMID: 31529004 DOI: 10.1001/jama.2019.10606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Ballan MS, Freyer M. Addressing intimate partner violence with female patients with chronic physical disabilities: the role of physical therapists. Disabil Rehabil 2019; 43:1404-1409. [PMID: 31524531 DOI: 10.1080/09638288.2019.1664648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Women with disabilities are at heightened risk of intimate partner violence, experiencing higher rates of physical and sexual violence than women without disabilities. Women with disabilities are also at risk of sustaining additional chronic injuries and debilitating conditions associated with intimate partner violence. Physical therapists strive to enhance the well-being and quality of life of individuals experiencing impairments, activity limitations, and/or participation restrictions due to physical health concerns. This professional focus places physical therapists in an important position to identify adverse life situations such as intimate partner violence which seriously degrades the well-being, quality of life, and physical health of patients. PURPOSE Physical therapists encounter numerous individuals with disabilities in their practice, and given the high rates of intimate partner violence within this population, it is important that physical therapists are aware of how to identify and respond to this issue. CONCLUSION This article provides background on the problem of intimate partner violence among women with chronic physical disabilities, and explores assessment, practice, and education guidelines intended to assist physical therapists address intimate partner violence with their patients.IMPLICATIONS FOR REHABILITATIONWomen with disabilities are at a heightened risk of intimate partner violence compared to women without disabilities, and are also at risk of sustaining associated chronic injuries and debilitating conditions.Given the high rates of intimate partner violence among individuals with chronic physical disabilities, it is important that physical therapists are able to identify and respond to this issue.Physical therapists possess specialized skills to improve the functioning and overall health of patients, and could assist patients with chronic physical disabilities to escape abusive relationships. Knowledge of intimate partner violence-focused screening, assessment, and trauma-informed practice skills would strengthen skills in this area.
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Affiliation(s)
- Michelle S Ballan
- School of Social Welfare, Stony Brook University, Stony Brook, NY, USA
| | - Molly Freyer
- School of Social Welfare, Stony Brook University, Stony Brook, NY, USA
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Leone M, Lapucci E, De Sario M, Davoli M, Farchi S, Michelozzi P. Social network analysis to characterize women victims of violence. BMC Public Health 2019; 19:494. [PMID: 31046717 PMCID: PMC6498634 DOI: 10.1186/s12889-019-6797-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Europe, it is estimated that one third of women had experienced at least one physical or sexual violence after their 15. Taking into account the severe health consequences, the Emergency Department (ED), may offer an opportunity to recognize when an aggression is part of the spectrum of violence. This study applies Social Network analysis (SNA) to ED data in the Lazio region with the objective to identify patterns of diagnoses, within all the ED accesses of women experiencing an aggression, that are signals for gender-based violence against women. We aim to develop a risk assessment tool for ED professionals in order to strength their ability to manage victims of violence. METHODS A cohort of 124,691 women aged 15-70 with an ED visit for aggression between 2003 and 2015 was selected and, for each woman, the ED history of diagnoses and traumas was reconstructed. SNA was applied on all these diagnoses and traumas, including also 9 specific violence diagnoses. SNA community detection algorithms and network centrality measures were used to detect diagnostic patterns more strongly associated to violence. A logistic model was developed to validate the capability of these patterns to predict the odds for a woman of having an history of violence. Model results were summed up into a risk chart. RESULTS Among women experiencing an aggression, SNA identified four communities representing specific violence-related patterns of diagnoses. Diagnoses having a central role in the violence network were alcohol or substance abuse, pregnancy-related conditions and psychoses. These high-risk violence related patterns accounted for at most 20% of our cohort. The logistic model had good predictive accuracy and predictive power confirming that diagnosis patterns identified through the SNA are meaningful in the violence recognition. CONCLUSIONS Routine ED data, analyzed using SNA, can be a first-line warning to recognize when an aggression related access is part of the spectrum of gender-based violence against women. Increasing the available number of predictors, such procedures may be proven to support ED staff in identifying early signs of violence to adequately support the victims and mitigate the harms.
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Affiliation(s)
- Michela Leone
- Department of Epidemiology of Lazio Regional Health Service - ASL Roma 1, Via Cristoforo Colombo, 112, Rome, 00147, Italy
| | - Enrica Lapucci
- Department of Epidemiology of Lazio Regional Health Service - ASL Roma 1, Via Cristoforo Colombo, 112, Rome, 00147, Italy.
| | - Manuela De Sario
- Department of Epidemiology of Lazio Regional Health Service - ASL Roma 1, Via Cristoforo Colombo, 112, Rome, 00147, Italy
| | - Marina Davoli
- Department of Epidemiology of Lazio Regional Health Service - ASL Roma 1, Via Cristoforo Colombo, 112, Rome, 00147, Italy
| | - Sara Farchi
- Hospital network and risk management area of the Lazio Region, Via Rosa Raimondi Garibaldi 7, Rome, 00145, Italy
| | - Paola Michelozzi
- Department of Epidemiology of Lazio Regional Health Service - ASL Roma 1, Via Cristoforo Colombo, 112, Rome, 00147, Italy
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