VIOLENCE AGAINST WOMEN - PROVIDER BARRIERS TO INTERVENTION IN EMERGENCY DEPARTMENTS

Objective: To determine: 1) provider behavior in screening for domesti c violence (DV) and sexual assault (SA); 2) provider training in DV an d SA; 3) provider knowledge of available protocols for DV and SA; and 4) provider perception of barriers to intervention. Methods: Anonymous , structured surveys were distributed to physicians, nurses, and socia l workers at an adult ED trauma center, an affiliated pediatric ED, an d a women's urgent care center between July and September 1995. Result s: Of 207 staff members (59%) responding, 54% and 68% indicated that t hey never/rarely screen for DV or SA, respectively. Thirty-five percen t had received no DV training and 27% had received no SA training. Thi rty-one percent of the staff had knowledge of existing protocols for D V and 63% had knowledge of existing protocols for SA. Providers traine d in DV were more likely to screen for DV (RR 1.5, 95% CI 1.27-1.92, p less than or equal to 0.001) and SA (RR 1.49, 95% CI 1.24-1.79, p les s than or equal to 0.0018), and providers trained in SA were more like ly to screen for SA (RR 1.32, 95% CI 1.13-1.54, p = 0.0019) and DV (RR 1.35, 95% CI 1.13-1.60, p = 0.0007). Barriers that the majority of st aff experienced in the care of DV/SA victims included: frustration tha t the victim would return to an abusive partner, concerns about misdia gnosis, lack of time, personal discomfort, reluctance to intrude into familial privacy, and lack of 24-hour social service support. Conclusi on: Providers surveyed had received little training in and rarely scre en for violence, and there are a range of personal and institutional b arriers impeding intervention with victims of SA and DV. Institutional changes to enhance training and support providers working in the fron t line of this epidemic may improve services for victims of violence.