Mandatory reporting of intimate partner violence to police: views of physicians in California

An educational intervention study on mandatory reporting of intimate partner violence: changes in knowledge and attitudes among healthcare providers

BACKGROUND

Intimate partner violence (IPV) is a major public health concern. Healthcare providers can play a crucial role in reporting cases of IPV or suspected IPV injuries to the police or the criminal justice system, commonly referred to as mandatory reporting. However, mandatory reporting of intimate partner violence (MR-IPV) is a debated topic that can pose complex challenges for healthcare providers. This underscores the importance of training programs to ensure that healthcare providers can fulfill their MR-IPV obligations.

METHODS

We developed an educational intervention on MR-IPV and assessed its impact on healthcare providers' knowledge and attitudes. The study used a pre- and post-test design with three measurement points: baseline (T0), immediately after the intervention (T1), and six months later (T2). The intervention was conducted at a university college in Norway, with data collected between October 2022 and May 2023. The intervention was delivered to 37 healthcare providers who were currently part-time students in mental healthcare. Changes in knowledge and attitudes between T0 and T1, and T0 and T2 were analyzed through nonparametric tests on related samples using the Marginal homogeneity (Stuart-Maxwell) test. Risk differences (RD), along with their corresponding 95% confidence intervals (CI), were calculated for selected categories.

RESULTS

The number of participants knowing the MR law increased from 2.9% at baseline to 62.9% at T1 (RD = 0.60, 95% CI: 0.41-0.79) and to 31.4% at T2 (RD = 0.29, 95% CI: 0.11-0.46). The number of participants reporting knowing relevant criteria increased from 0.0% at baseline to 68.6% at T1 (RD = 0.69, 95% CI: 0.50-0.87) and to 34.3% at T2 (RD = 0.34, 95% CI: 0.16-0.53). We observed several persistent changes in healthcare providers' attitudes towards MR, including finding MR to be a useful instrument and generally complying with MR requirements.

CONCLUSIONS

The findings suggest that this educational intervention can have a positive impact on healthcare providers' attitudes and compliance with MR-IPV. Before the intervention, few participants reported knowing the MR law and its application criteria, demonstrating the importance of continuous learning and evidence-based training programs.

Barriers and facilitators of the reporting by family doctors of cases of domestic violence - a qualitative study across Portugal

BACKGROUND

Domestic violence (DV) is a serious and prevalent public health problem with devastating consequences for the victims and their families. Whilst the number of cases reported to the authorities has risen in recent years, many victims still chose not to present a complaint. In Portugal, to address this, DV became a public crime. As victims of DV present multiple health problems and frequently seek professional help, family doctors are in a privileged position to detect and report cases of DV to the authorities. However, little is known about what motivates these professionals to report or not the DV cases they encounter in their practice to the authorities.

METHODS

We conducted semi-structured interviews with family doctors from all regional health administrations of continental Portugal. Interviews occurred between July 2020 and September 2022, were conducted in person or remotely, audio recorded, transcribed, and analysed using thematic analysis. Content analysis was conducted to assess the agreement or disagreement regarding mandatory reporting in each of the themes and subthemes.

RESULTS

Fifty-four family doctors took part in this study (n = 39 women, n = 15 men). The main themes that arose from the analysis were: "Barriers related to the physician's activity," "Barriers related to the victim or aggressor," "Facilitators related to the physician's activity," "Facilitators related to the victim or aggressor." Although different barriers were described, most doctors agreed with the mandatory reporting of DV cases.

CONCLUSIONS

Family doctors encounter multiple barriers and facilitators when considering reporting a DV case to the authorities. The results of this study can help develop new interventions to address the barriers described by the doctors, increasing their compliance with mandatory reporting, the protection of victims and the just persecution of the aggressor.

Ethical challenges in obstetric emergencies in low- and middle-income countries

Obstetric emergencies are challenging, requiring implementation of a rapid sequence of interventions in a very short time to optimize clinical outcome. Managing obstetric emergencies could evoke ethical dilemmas for the obstetrician because of limited time to adequately educate the patient about her condition; impaired consciousness of the patient to give consent; nonexistent prior patient -doctor relationship and the need to consider both the patient and the fetus. In Low- and middle-income countries (LMICs), poor access to appropriate emergency care, structural and financial barriers and a largely uneducated and a deeply cultural population contribute to the ethical challenges. In this article we review key ethical issues in obstetric emergencies in LMICs such as informed consent, refusal of life saving treatment, confidentiality, disclosure of patient medical information and discharge against medical advice. The duties and responsibilities of the state to disadvantaged pregnant women and the ethical imperative of the obstetrician to provide care under these circumstances are discussed.

The role of family doctors in the management of domestic violence cases - a qualitative study in Portugal

BACKGROUND

Domestic violence leads to multiple health problems in victims and their families. Family doctors are in a particularly privileged position to detect, follow up, refer and report cases of domestic violence. However, little is known about the perception of these physicians regarding their role in managing domestic violence cases.

METHODS

We conducted semi-structured interviews with family doctors from all regional health administrations of continental Portugal. Interviews were audio recorded, transcribed, and analysed using thematic analysis.

RESULTS

Fifty-four family doctors participated in this study (n = 39 women, n = 15 men). The themes and subthemes that emerged from the data analysis translated doctors' broad responsibilities when approaching victims and aggressors. These included: "Implement preventive measures", "Empower the victim leading them to recognize the violent situation", "Detect domestic violence cases", "Treat health problems related to violence", "Provide emotional support", "Refer victims to specialized services", "Register the episode on the victims and/or aggressor clinical records", "Incentivize the victim to report", "Report the case to the authorities", "Intervene with the aggressor", "Protect other individuals" and "Follow up the patient and the process".

CONCLUSIONS

The results of this study provide an overview of the current practical approaches being adopted by physicians and may provide a base for developing new interventions to support physicians to manage cases of domestic violence.

The limitations of hospital and law enforcement databases in characterizing the epidemiology of firearm injury

BACKGROUND

Current data on the epidemiology of firearm injury in the United States are incomplete. Common sources include hospital, law enforcement, consumer, and public health databases, but each database has limitations that exclude injury subgroups. By integrating hospital (inpatient and outpatient) and law enforcement databases, we hypothesized that a more accurate depiction of the totality of firearm injury in our region could be achieved.

METHODS

We constructed a collaborative firearm injury database consisting of all patients admitted as inpatients to the regional level 1 trauma hospital (inpatient registry), patients treated and released from the emergency department (ED), and subjects encountering local law enforcement as a result of firearm injury in Jefferson County, Kentucky. Injuries recorded from January 1, 2016, to December 31, 2020, were analyzed. Outcomes, demographics, and injury detection rates from individual databases were compared with those of the combined collaborative database and compared using χ2 testing across databases.

RESULTS

The inpatient registry (n = 1,441) and ED database (n = 1,109) were combined, resulting in 2,550 incidents in the hospital database. The law enforcement database consisted of 2,665 patient incidents, with 2,008 incidents in common with the hospital database and 657 unique incidents. The merged collaborative database consisted of 3,207 incidents. In comparison with the collaborative database, the inpatient, total hospital (inpatient and ED), and law enforcement databases failed to include 55%, 20%, and 17% of all injuries, respectively. The hospital captured nearly 94% of survivors but less than 40% of nonsurvivors. Law enforcement captured 93% of nonsurvivors but missed 20% of survivors. Mortality (11-26%) and injury incidence were markedly different across the databases.

DISCUSSION

The utilization of trauma registry or law enforcement databases alone do not accurately reflect the epidemiology of firearm injury and may misrepresent areas in need of greater injury prevention efforts.

LEVEL OF EVIDENCE

Epidemiological, level IV.

Should domestic violence be or not a public crime?

BACKGROUND

Domestic violence has been addressed in public policies and law reforms in many countries to target its identification and provide increased support to those affected. In some countries, reporting domestic violence is mandatory, which means that anyone not only 'can' but also 'must' file a report, which is enough to progress the criminal proceedings, even against the victim's will. This article provides an overview about the importance of the clinicians' duty of care, debating whether or not domestic violence should be a public crime.

METHODS

A narrative review on the subject of mandatory reporting of domestic violence, conducting a search of PubMed.

RESULTS

Twenty studies were retrieved. Commonly victims agree with mandatory reporting. However, there are still several concerns voiced by both victims and health care workers that need to be further addressed.

CONCLUSION

This article addresses the importance and limitations of mandatory reporting while acknowledging the impact of these measures in both the victim and the accused.

Mandatory Reporting of Intimate Partner Violence: A Mixed Methods Systematic Review

As one of the efforts to prevent intimate partner violence (IPV) and intimate partner homicide, countries have adopted legislation requiring professionals to report cases of IPV, or suspected IPV injuries, to the police or the criminal justice system. The term for this is mandatory reporting. In spite of its good intention, mandatory reporting of IPV is a controversial issue. The objective of this review was to systematically search for, appraise the quality of, and synthetize the evidence from quantitative and qualitative studies on mandatory reporting of IPV. A systematic review of the scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A comprehensive search was conducted through Ovid MEDLINE, PsycINFO, Scopus, Criminal Justice Abstracts, and SveMed+. Articles were included if they (a) were peer-reviewed empirical studies rather than theories or discussions, (b) described mandatory reporting of IPV, and (c) were written in English or Scandinavian languages. No time limit was applied. Twenty-five research studies met the criteria for review. Victims were generally supportive of a law requiring professionals to report IPV, although subsamples' attitudes opposing mandatory reporting were presented as main findings in a substantial number of studies. Group differences between abused or nonabused women and knowledge about mandatory reporting of IPV among professionals was mixed and inconclusive. Few professionals had actually reported IPV under mandatory reporting. Empirical research appears to be scarce, with moderate to high degree of bias and with only limited recent development.

Mandatory Reporting of Domestic Violence: What Do Abuse Survivors Think and What Variables Influence Those Opinions?

For decades, states have passed legislation to mandate reporting of criminal conduct and the abuse of vulnerable persons. Four types of mandatory reporting laws have been enacted, including laws that require reports of injuries associated with crime or due to use of certain weapons, abuse of children, abuse of vulnerable adults, and reporting of domestic violence. While studies have been conducted to evaluate the effectiveness of mandatory reporting laws in domestic violence cases, methodological weaknesses in this body of literature make it difficult to make broad statements about whether mandatory reporting laws advance women's protection or actually place them at additional risk. This study's sample is based on 388 surveys administered in-person to women who had sought services from one of Kentucky's 15 regional domestic violence shelters. In addition to querying women regarding their own experience with mandatory reporting laws, the survey explored the factors that influenced women's views. The study advances research into women's decisions to access shelters, medical, or mental health services and how they are influenced by advance knowledge that their case would be reported if they disclosed abuse. A new and troubling finding was that almost two in five women reported they would have been less likely to contact a domestic violence shelter if they knew in advance that a mandatory report would be made. Future research on mandatory reporting is needed with an eye toward changing state policies and laws to ensure that women feel free to seek the type of assistance they need for themselves and their children.

Understanding the Needs and Preferences of Domestic and Sexual Violence Education for Health Profession Students

This study examined health profession students' comfort levels, perceived knowledge, attitudes, and preferences for domestic and sexual violence education at an academic medical center. Students indicated their perceived knowledge of community resources was poor, whereas comfort, attitudes, and perceived knowledge of the topic remained fair. A majority of students (83.2%) reported receiving less than 3 hr of training in their coursework, which remained consistent for students with more years of education. Students preferred content be incorporated into existing curricula or presented in lunch seminars. Study results reveal opportunities for improvement in domestic and sexual violence education.

The Potential for Screening for Intimate Partner Violence in Community Pharmacies: An Exploratory Study of Female Consumers' Perspectives

Intimate partner violence (IPV) is a substantial public health problem. The U.S. Preventive Services Task Force recently updated guidelines to recommend IPV screening for all women of childbearing age. Expansion of screening efforts to the community pharmacy setting could provide an opportunity to substantially impact the health of consumers. To date, no research has explored consumers' perspective on IPV screening in the community pharmacy environment. To address this gap, a descriptive survey research study was conducted to examine female consumers' attitudes and preferences for IPV screening in community pharmacies. Female pharmacy customers ( N = 60) completed an online survey assessing knowledge of and attitudes about community pharmacies as sources of health care advice, beliefs about IPV and IPV screening, and perspectives on IPV screening in the community pharmacy environment. Consumers who utilized pharmacies with more patient care services were more likely to report interest in IPV screening in the pharmacy environment. The majority of respondents thought IPV screening is an important thing to do (85.0%), and 33.3% agreed that it should happen in a pharmacy. A statistically significant relationship between the belief that the pharmacy is a good place for health education and preference for IPV screening in the community pharmacy environment was found, r(58) = .43, p < .001. Concern regarding the time required to conduct screenings and about the availability of appropriate space were identified as potential barriers to screening in the pharmacy environment.

Improving Intimate Partner Violence Protocols for Emergency Departments

A Protocol Assessment Tool (PAT) was developed to assess emergency departments's (EDs's) protocols regarding treatment of patients sustaining partner violence. Using this tool, project staff members evaluated the content of written protocols submitted by ED nurse managers in California and in a national sample in 1992-1993 and in 1996-1997. The number of protocols and their overall content improved significantly in California between 1992-1993 and 1996-1997, and there was a suggestion of improvement in the national sample. Advocacy efforts influenced Joint Commission on Accreditation of Healthcare Organizations guidelines and California laws, which in turn may have stimulated increases in the quantity and quality of protocols. The PAT permits readers to evaluate their local facility's protocols.

Understanding the Impact of Intimate Partner Violence Mandatory Reporting Law

Intimate partner violence is a pervasive, complex problem affecting the lives and health of a large percentage of women and children. This report provides data from an evaluation designed to address questions and concerns expressed about possible unintended effects of the mandatory reporting law on victims. Case reviews were completed on 631 adult protective service cases resulting from reports of intimate partner violence. Results indicate that following a report of suspected intimate partner violence made under Kentucky mandatory reporting law, all victims who could be located received at a minimum safety planning and information about community resources. Regardless of official case status, nearly half of all cases received services.

Nurse home visitors' perceptions of mandatory reporting of intimate partner violence to law enforcement agencies

In the United States, there is an ongoing debate about requiring health care professionals to report intimate partner violence (IPV) to law enforcement agencies. A comprehensive examination of the perspectives of those required to report abuse is critical, as their roles as mandated reporters often pose legal, practical, moral, and ethical questions. Even so, the perspective of health care professionals who are required to report is often overlooked and research is scarce on mandated reporters who work outside of clinical settings, such as nurses who engage in home visitation with clients. The purpose of this study was to examine nurse home visitors' perspectives regarding the mandatory reporting of IPV, specifically focusing on their attitudes toward reporting, perceived awareness of reporting requirements, and intended reporting behaviors. A web-based survey was administered to nurses in the Nurse-Family Partnership home visitation program across the United States. A total of 532 completed surveys were returned (response rate = 49%). In terms of support for reporting IPV, 40% of nurses indicated that they should "always" be required to report. Almost half of the sample indicated that they would report a case of IPV, yet less than one-third of participants were aware of a legal mandate. Attitudes and support toward reporting as well as the perception of a reporting requirement significantly predicted intention to report. Furthermore, 29% of participants did not know if they were required to report IPV perpetrated against their clients. Comprehensive information about mandatory reporting duties is needed for health care professionals in home visitation settings. The findings of the current study highlight the need to reduce variation among practitioners and establish consistent program practices that are grounded in the program's principals, supported by existing research, and compliant with existing state policies.

Facilitators and barriers to disclosing abuse among women with disabilities

An anonymous audio computer-assisted self-interview (A-CASI) designed to increase awareness of abuse was completed by 305 women with diverse disabilities. Data were also collected about lifetime and past year abuse; perpetrator risk characteristics; facilitators and barriers to disclosing abuse; abuse disclosure to a health provider, case manager, or police officer; and whether a health provider had ever discussed abuse or personal safety. A total of 276 (90%) women reported abuse, 208 (68%) reported abuse within the past year. Women who reported the most abuse experiences in the past year and the most dangerous perpetrators endorsed fewer facilitators and more barriers, but were also more likely to have ever disclosed abuse. Only 15% reported that a health provider had ever discussed abuse and personal safety.

Intimate partner violence: implications for critical care nursing

IPV presents a serious health risk to many women. Emergency and critical care nurses are in a prime position for identification of and intervention with these women. Careful assessment and recognition of symptoms and conditions associated with IPV helps nurses to identify victims and potential victims. Building a trusting and supportive environment, where women feel comfortable disclosing abuse, precedes effective intervention. Nursing practice can incorporate the myriad resources and successful programs to provide victims with quality care. Before discharge from the critical care unit or ED, nurses can help women to identify their risk and plan for safety. Effective nursing care in IPV combines the traditional critical care nursing skills synergistically with provision for the biopsychosocial needs of patients.

Privacy and confidentiality in emergency medicine: obligations and challenges

Respect for privacy and confidentiality have been professional responsibilities of physicians throughout recorded history. This article reviews the moral, religious, and legal foundations of privacy and confidentiality and discusses the distinction between these two closely related concepts. Current federal and state laws are reviewed, including HIPAA regulations and their implications for research and care in the emergency department. In the emergency department, privacy and confidentiality often are challenged by physical design, crowding, visitors, film crews, communication, and other factors. These problems are reviewed, and advice and guidelines are offered for helping preserve patients' dignity and rights to privacy and confidentiality.

Mandatory reporting of elder abuse: between a rock and a hard place

PURPOSE

Despite mandated reporting laws that require physicians to report elder abuse, physicians have low rates of reporting. The purpose of this study was to identify physician's perspectives on mandated reporting of elder abuse.

METHODS

Individual, semistructured interviews were conducted with 20 primary care physicians practicing in a variety of settings and caring for a diverse patient population in the Los Angeles area. Interviewers collected information on physicians' perspectives about factors that may influence physicians' likelihood to report elder abuse. The interviews were recorded and transcribed verbatim. Transcripts were analyzed using a grounded theory approach based on the constant comparative method and the emergence of the core category of paradox to best account for the most problematic elder abuse situations faced by physicians.

RESULTS

During the interviews 3 paradoxes were expressed by physicians about the mandatory reporting of elder abuse. Specifically, mandatory reporting was related to both perceptions of increases and decreases in physician-patient rapport, patient quality of life, and physician control or ability to decide what is in the best interest of the patient. These paradoxes appear to be primarily hidden or unconscious, yet they influence the conscious decision process of whether to report.

CONCLUSIONS

Primary care physicians appear to be subject to paradoxes of reporting that contribute to the underreporting of elder abuse. These paradoxes and alternative modes of managing paradoxes are important and should be addressed in educational and training programs for physicians, and systematic evaluation of these issues may help to inform future legislation in this area. Further studies are needed to assess the generalizability of these findings to other groups of clinicians.

Domestic violence: an approach to identification and intervention

DV encompasses a wide variety of actions that coerce, control, or demean the victim. Victims of DV suffer many physical and mental health consequences that cause emergency physicians to encounter them knowingly or unknowingly in the medical setting. Physicians who are aware of the prevalent problem of DV are able to help victims the most. A physician should be educated to recognize the physical and emotional presentations of victims, but, more importantly, the physician should be knowledgeable about the need for screening of all patients to reach the greatest number of victims. Victims often are not ready or able to disclose DV because of patient and physician barriers. Clinicians should work to overcome these barriers by initiating screening, ensuring patient comfort and safety, and understanding the many stages involved in behavioral change that a victim must traverse. The emergency physician would experience less frustration and more success if he or she would change their role from problem solver to listener and empowerer. This approach allows the survivor to make informed choices. Patients who are ready to make changes must be provided with protection,treatment, resources, and support. Informed, active physicians have great potential for improving DV victims' lives, reducing the effects of violence,and facilitating the patient's progression from victim to survivor.

Sex differences in the perpetrator-victim relationship among emergency department patients presenting with nonfatal firearm-related injuries

STUDY OBJECTIVE

I examine whether female and male emergency department (ED) patients are equally likely to have been nonfatally shot or struck with a gun by someone they know versus by a stranger.

METHODS

This case-control study examined patient records from US hospital EDs from 1993 to 1999. The records of patients aged 15 years or older who presented with nonfatal firearm-related injuries were accessed from the National Electronic Injury Surveillance System. Patients were classified according to 2 firearm-related injury types (penetrating or nonpenetrating [eg, struck with gun] trauma) and 5 perpetrator types (injury inflicted by spouse or ex-spouse, other relative, friend or acquaintance, self, or stranger).

RESULTS

Compared with male patients, female patients were 3.6 times (95% confidence interval [CI] 2.5 to 5.3) more likely to have been shot and 3.9 times (95% CI 1.6 to 9.4) more likely to have been struck with a gun wielded by a spouse or ex-spouse than by a stranger. Conversely, women were considerably less likely than men to have been struck with a gun or shot by another relative, to have been struck with a gun by a friend or acquaintance, or to have a gunshot injury that was self-inflicted.

CONCLUSION

The cause of firearm-related injuries varies by sex. Before releasing firearm-injury victims from the ED, health care providers should consider 2 important factors: (1). the patient's relationship to the perpetrator, and (2). the availability and previous use of firearms in the victim's home. This information may be helpful in formulating posttreatment plans to enhance the victim's safety.

Screening for intimate partner violence when children are present: the victim's perspective

Although intimate partner violence (IPV) is routinely encountered in health care, it often goes undetected. Medical organizations recommend routine screening of women alone without children of partner. Separating a mother from her children may not be feasible in busy practices. Therefore, screening may not occur. Little research has examined women's desires about IPV screening in front of their children. This study interviewed 32 mothers/survivors who were in either an IPVshelter or support group regarding their wishes about IPV screening and discussions in front of their children. Interviews were audio taped, transcribed, and analyzed using thematic analysis techniques. Major themes included mothers'comfort with the use of general IPV screening questions in front of children ages 3 to 12 years. In summary, most mothers/survivors were comfortable with physicians using general questions to screen for IPV but preferred in-depth discussions about the abuse and resource sharing in private.

Development of a screen for ongoing intimate partner violence

A five-question Ongoing Abuse Screen (OAS) was developed to evaluate ongoing intimate partner violence. Our hypothesis was that the OAS was more accurate and more likely to reflect ongoing intimate partner violence than the AAS when compared to the Index of Spouse Abuse (ISA). The survey included the ISA, the OAS, and the AAS. During the busiest emergency department hours, a sampling of 856 patients completed all aspects of the survey tool. Comparisons were made between the two scales and the ISA. The accuracy, positive predictive value, and positive likelihood ratio were 84%, 58%, and 6.0 for the OAS and 59%, 33%, and 2.0 for the AAS. The OAS was more accurate, had a better positive predictive value, and was three times more likely to detect victims of ongoing intimate partner violence than the AAS. Because the OAS was still not accurate enough, we developed a new screen, based on the ISA, titled the Ongoing Violence Assessment Tool (OVAT).

Abused patient's attitudes about mandatory reporting of intimate partner abuse injuries to police

OBJECTIVES

This study examines abused women's preferences regarding medical clinician reporting of intimate partner abuse injuries to police. It also examines the influence of specific demographic factors on abused women's reporting preferences.

METHODS

Telephone interviews were conducted with a random sample of women patients attending one of three public primary care clinics associated with the San Francisco Community Health Network. Participants reporting a history of abuse were asked to identify their preferences regarding the reporting of abuse by medical clinicians to police.

RESULTS

Of the 358 abused women interviewed in this study, the majority of them (n = 243, 68%) did not prefer a domestic violence injury reporting system that was mandatory even if against patient wishes. However, almost all women (n = 329, 92%) favored some form of police reporting by medical clinicians. Women who had been abused within the past year were more likely to oppose mandatory reporting than women who had been abused more than one year ago. Younger women were more likely than older women to oppose mandatory reporting requirements, and women whose primary language was English were more likely to oppose mandatory reporting requirements than women whose primary language was Spanish. Current abuse was independently predictive of decreased likelihood to select mandatory reporting in all situations. There were no significant differences in reporting preferences by ethnicity, marital status, education, employment, or the presence of children at home.

CONCLUSIONS

Despite broad support among abused women for medical clinician reporting of intimate partner abuse injuries to police, most women do not support mandatory reporting requirements that do not allow for consideration of the abused patients' wishes. More research is needed to ascertain whether the benefits of mandatory reporting outweigh the risks to those intended to benefit from the law.

Intimate partner violence from the emergency medicine perspective

BACKGROUND

The incidence of acute cases of intimate partner violence (IPV) in the Emergency Department (ED) patients is between 2 and 7.2%. Ongoing IPV may be an immediate cause of presentation for medical care, or it may not be readily apparent. Over the last two decades efforts to improve identification of IPV in the ED have been successful.

METHODS

A medline literature search from 1981-2001 was performed. A review of intimate partner violence from the emergency department provider perspective is performed. A discussion of the screening/detection of intimate partner violence and the barriers to improving detection rates is provided.

RESULTS

The review of the current literature shows that IPV is a frequent cause of illness or injury in patients presenting in the ED. Screening programs for intimate partner violence have shown to increase the identification of patients experiencing acute episodes of abuse and seeking treatment. The difficulty has been in sustaining the programs and improving the screening of patients. Patient, provider and systems barriers prevent adequate recognition and management of the problem.

CONCLUSION

Detection of IPV in patients presenting to the ED can be improved by providing educational programs and screening tools to health care providers. Sustaining the screening programs is more difficult and requires a health care system-wide effort.

Domestic violence: what do nurse practitioners think?

PURPOSE

To examine factors that influence nurse practitioners' (NPs) ability to incorporate universal domestic violence screening practices (e.g., asking, identifying, referring and reporting) into their practices.

DATA SOURCES

A stratified random survey of certified NPs in New York state was conducted in 1999. There were 118 family, women's health, OB/GYN, and adult NPs in the survey. Chi-square and ANOVA were used to analyze the data.

CONCLUSIONS

There were significant differences in the domestic violence screening practices among women's health, OB/GYN, adult, and family NPs. Women's health and OB/GYN NPs were more likely to ask screening questions and identify victims of domestic violence than their other NP counterparts.

IMPLICATIONS FOR PRACTICE

There is a need to identify strategies that encourage all NPs to incorporate universal domestic violence screening behaviors into their practices.

Nursing practice and statutory rape. Effects of reporting and enforcement on access to care for adolescents

Changes over the past decade in statutory rape laws and their enforcement have created anxiety and confusion for nurses and other health care providers in jurisdictions across the country. Mandated reporting of statutory rape as child abuse potentially has the unsought effect of deterring some of the adolescents most in need of confidential health care from seeking that care. Knowledge and advocacy on the part of nurses can help mitigate the harms of overly inclusive reporting and enforcement.

Violence-inflicted injuries: reporting laws in the fifty states

STUDY OBJECTIVE

Physicians have an important role in the diagnosis, treatment, and documentation of violence-inflicted injuries. Physicians may also be legally mandated to report these assault-related injuries to law enforcement. Previous studies have shown that physicians may not be aware of the reporting laws in their state. The objective of this study was to review the reporting laws for violence-inflicted injuries in adults in the 50 states and the District of Columbia, with particular emphasis on domestic violence.

METHODS

Members of a domestic violence research interest group contacted individual state legislatures regarding mandated reporting by health providers of violence-inflicted injuries in adults. This information was then verified by each state's domestic violence coalition. Statutes regarding child abuse or sexual assault and statutes concerning injuries in incapacitated adults were not included in this study.

RESULTS

Five states (Alabama, New Mexico, South Carolina, Washington, and Wyoming) have no specific reporting requirements for health providers treating patients with assault-related injuries. Forty-two states have reporting requirements for injuries resulting from firearms, knives, or other weapons. Twenty-three states have reporting requirements for injuries resulting from crimes. Seven states have statutes that specifically require health providers to report injuries resulting from domestic violence.

CONCLUSION

Forty-five states have laws that mandate physician reports of injuries caused by weapons, crimes, or domestic violence. Physicians need to be aware of the existence of these laws and of their state's specific requirements.

Intimate partner violence screening and intervention: data from eleven Pennsylvania and California community hospital emergency departments

OBJECTIVE

To provide clinical practice recommendations for screening and interventions for intimate partner violence (IPV) in ED settings.

SETTING

Eleven mid-sized community-level hospital emergency departments (20,000 to 40,000 admissions annually) in Pennsylvania and California.

PARTICIPANTS

All women (4641) aged 18 years or older who came to the emergency department during 309 selected shifts.

METHODS

An anonymous survey inquiring about physical, sexual, and emotional IPV was conducted from 1995 through 1997. In addition, medical records were abstracted for every woman (18 years and older) seen in the 11 participating emergency departments during the study period.

RESULTS

The vast majority of both abused and nonabused women supported routine screening for IPV; however, fewer than 25% of women said they were asked about IPV by ED staff. ED screening rates for IPV were higher among women who came to the emergency department because of acute trauma from abuse (39%) than for women who reported that they had been abused within the past year (13%). The prevalence of past year and lifetime IPV was significantly higher when the questionnaire was self-administered than when it was administered by a nurse. More than a third of women who had recently been abused and 76% of women who acknowledged experiencing physical or sexual IPV within the past year reported that they did not come to the emergency department for treatment of an injury. Although the majority of women (76% to 90%) agreed with the concept of health care providers reporting IPV to the police, women abused recently were significantly less likely to support this practice.

CONCLUSION

The study provides evidence supporting standard protocols for routine screening for IPV among women who come to emergency departments and chart prompts for both screening and interventions. These actions are acceptable to the majority of both abused and nonabused women seen in the emergency department and should be considered in systematic repeated training of health care professionals in emergency departments. This information is important for health care providers who are seeking to improve their identification of and care for abused women.

Future directions for violence against women and reproductive health: science, prevention, and action

Despite the recognition that violence may be associated with serious consequences for women's reproductive health, the understanding of the relationship between the two remains limited, as does our understanding of the most effective role for reproductive health care providers and services. This paper briefly summarizes the history of the nexus of public health, health care, and violence against women in the United States. In addition, we present some considerations for future directions for research, health care practice, and policy that will advance the understanding of the complex relationship between violence and reproductive health.

Mandatory reporting of intimate partner violence: safety or retaliatory abuse for women?

We wished to ascertain abused women's perspectives on mandatory reporting of intimate partner violence. A consecutive sample of 161 abused women accessing the criminal justice system were asked six questions. Most women (81%) thought there should be a law making the nurse or doctor report the abuse, with less than half of the women (45%) reporting they would have been at greater risk for abuse following a mandatory report. Although these 161 abused women support mandatory reporting of partner abuse, it remains unclear if such a law would deter further abuse. Outcome and evaluation studies of mandatory reporting laws are urgently needed.

California's mandatory reporting of domestic violence injuries: does the law go too far or not far enough?

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