Domestic Violence Health Initiative (DVHI) Listserv is Now
Health e-News!
MARCH 15, 2004
In this issue...
News
Experts Challenge Federal Task Force Conclusion on Screening & Intervention
Intervention by Nurses Can Help Battered Women: Study
Study Links ER Visits and Domestic Violence
Call for a Hearing on Crucial Health Bill
Announcements
FVPF’s National Health Initiative on Domestic Violence Seeks Graduate Intern
Events
Conference on Medical Standard of Care for Gun Injury Prevention
2004 National Health Care for the Homeless Conference
Query Corner
Questions for Health e-News Subscribers
NEWS
EXPERTS & PROVIDERS CHALLENGE FEDERAL TASK FORCE CONCLUSION, SUPPORT SCREENING & INTERVENTION
Leading medical and domestic violence experts have challenged the U.S. Preventive Services Task Force conclusion that there is insufficient evidence to screen patients for domestic violence. Medical leaders from diverse fields asserted that the Task Force used the wrong criteria to assess screening, and warned that more victims and their children will be harmed if health care providers stop assessing for abuse.
The Task Force recommendation was published in the March 2nd issue of the Annals of Internal Medicine. Experts from across the medical and domestic violence communities immediately rejected it as deeply flawed.
“We agree that there should be more research exploring the best ways to screen for abuse and help victims,” said Family Violence Prevention Fund (FVPF) President Esta Soler. “But the Task Force conclusion is wrong and, worse, potentially very harmful. The Task Force assessed screening for abuse as a medical screen rather than a behavioral assessment tool, which was a mistake. Furthermore, they ignored hundreds of studies on this topic, simply because researchers did not use control groups. But highly respected researchers around the world have expressed concern about using control groups, because they raise ethical questions about withholding help from patients in danger. The Task Force should have recognized that and examined existing research more fully.”
“We stand by our existing policy of routine inquiry about abuse,” said American Medical Association President-Elect John Nelson. “Our experience confirms what common sense tells us: When doctors and other health care providers talk to patients about domestic violence and offer referrals and help to those who are victims, battered patients are more likely to take steps to protect themselves and their children. It would be a tragedy if any provider stopped inquiring about family violence as a result of this new recommendation.”
Task Force Errors
“There is strong, clear evidence that health care providers can improve women’s safety by intervening to help those who are battered,” said FVPF Managing Director Debbie Lee, who runs the organization's pioneering health program. “The Task Force would have been wise to look more carefully at other studies on screening for abuse. Health care providers across this nation – some of whom were once reluctant to ask about abuse – can speak to the life-saving benefits of intervention to help victims of domestic violence.”
Specifically, experts criticized the Task Force for relying on an evidence report by the Oregon Health Services University which:
Used an overly narrow approach by examining screening for domestic violence as a medical screen rather than a behavioral assessment tool, like assessment for substance abuse, unintended pregnancy and safety practices;
Excluded from their analysis all studies that look at patients presenting with trauma;
Dismissed all studies that look at pregnant women;
Discounted a tremendous body of existing research – all but two of 667 studies on intervention, and all but 14 of 806 studies on screening – on the topic;
Failed to recognize or account for the fact that legitimate ethical considerations led many researchers conducting the aforementioned studies to reject control groups; and
Misapplied a study that examined mandatory reporting for domestic violence to reach a conclusion about screening for domestic violence.
Experts Endorse Screening and Intervention
“Evidence-based medicine is not yet mature regarding behavioral health issues,” said Carden Johnston, MD, FAAP, and President, American Academy of Pediatrics. “Practitioners have to rely on experiences that work and can be replicated. We know that early screening has real positive effects even though some aspects of emotional and psychological stress of child abuse won’t show up in evidence-based studies. We should never minimize the positive things that we can do to help.”
“Screening for domestic violence can save lives,” said Gail Kincaide, Executive Director of the Association of Women’s Health, Obstetric and Neonatal Nurses. “AWHONN strongly urges nurses to take the time to ask their patients whether they are safe in their homes. This screening is every bit as important as screening for heart disease, breast cancer or cervical cancer and should be an integral part of routine health care.”
“Sometimes humanity trumps evidence,” wrote Mark S. Lachs, MD, MPH in an editorial accompanying the United States Preventive Services Task Force report in the Annals of Internal Medicine. “For some conditions that clinicians regularly encounter, robotic devotion to evidence-based medicine risks dehumanizing certain aspects of doctoring. Any clinician who has extricated a family violence victim from an abusive situation understands this … We should also act because it’s difficult to read about the dizzying prevalence of family violence and simply conclude that there’s nothing to do because of a lack of proof. What proof is required? ... Our patients and families are suffering, and the relief of suffering is among our mandates.”
As the U.S. Preventive Services Task Force recommendation becomes better known, lawmakers, journalists and health care providers may ask advocates about the value of screening for domestic violence and intervening to help victims. You may wish to use the following talking points as you discuss this topic, and to submit the sample letter-to-the-editor below:
Talking Points
Victims of abuse seek routine and emergency medical care every day. Doctors, nurses and other health care providers can do a tremendous amount to help simply by asking patients if anyone is hurting them, and offering support and referrals if the answer is “yes.”
Years of experience and many studies confirm that screening and intervention by health care providers is tremendously effective. Increased identification improves women’s safety and provides a lifeline to those in need.
For the U.S. Preventive Services Task Force to conclude that there is insufficient evidence to recommend screening for domestic violence is misguided and dangerous. It would be a tragedy if any health care provider stopped screening because of the Task Force’s conclusion.
The Task Force made serious errors. It used an overly narrow approach by examining screening for domestic violence as a medical screen rather than as a behavioral assessment. It dismissed the vast majority of studies on this issue, including all those that looked at pregnant women and patients presenting with trauma. And it failed to recognize the ethical considerations that prevent researchers from using control groups in studies on this topic.
Health care providers who screen for domestic violence and aid victims have helped countless battered women protect themselves and their families. That work must continue.
We join domestic violence experts and leaders from the American Medical Association, the American Academy of Pediatrics and other top medical associations in challenging this recommendation.
Sample Letter to the Editor
[Date]
To The Editor:
Last week, a federal task force concluded that there is insufficient evidence to recommend that doctors, nurses and other health care providers screen their patients for domestic violence. The U.S. Preventive Services Task Force recommendation already has been challenged by the Family Violence Prevention Fund, American Medical Association, American Academy of Pediatrics and other highly regarded experts. We at [your agency] add our support to that challenge.
Screening for abuse improves the safety of women and children who are experiencing violence in the home. Every health care provider has a responsibility to assess patients for domestic violence and offer referrals and support to those who are being battered. And every victim of abuse should know that help is available from a doctor, clinic or hospital, as well as from the domestic violence shelters and programs in this community.
[Your Name, Title, Agency and daytime phone number]
To see The Family Violence Prevention Fund’s full response to the Task Force recommendation Click Here.
The Task Force recommendation is available at www.annals.org.
INTERVENTION BY NURSES CAN HELP BATTERED WOMEN, STUDY FINDS
Six telephone calls over eight weeks from nurses to women experiencing domestic violence can significantly increase their safety-promoting behaviors, with impact that lasts for at least 18 months. That is the conclusion of a new study published in the March edition of the American Journal of Nursing. It provides the strongest evidence yet that health care providers who intervene with women who are battered can help save their lives.
Researchers randomly assigned battered women who sought civil protection orders to treatment and control groups, using a 15-item checklist to probe their safety-promoting behaviors at six intervals over eight weeks. These behaviors include removing weapons from the home, hiding a set of car keys, asking neighbors to call police if they hear an altercation, and copying down bank account numbers.
Follow-up at three, six, 12 and 18 months after intake determined that the average number of safety-promoting behaviors practiced by women in the treatment group increased by two from intake to three months later. An average increase of nearly two safety-promoting behaviors was sustained over 18 months.
“This is the first study to take a long-term look at the effect of intervention by health care providers,” said Family Violence Prevention Fund Managing Director Debbie Lee, who runs the organization’s pioneering health program. “Six phone calls totaling less than one hour had a dramatic impact on a woman’s ability to protect herself and her children from domestic abuse. This study provides the most compelling evidence yet that intervention by health care providers can help battered women escape abuse.”
Funded by the U.S. Department of Justice, the study was conducted by Judith McFarlane, DrPH, RN, FAAN; Ann Malecha, PhD; Julia Gist, PhD, RN; Kathy Watson, MS; Elizabeth Batten, BA; Iva Hall, PhD, RN; and Sheila Smith, PhD, RN.
The American Journal of Nursing study will be available shortly, for a fee, at www.nursingcenter.com.
STUDY SHOWS LINKS BETWEEN ER VISITS AND DOMESTIC VIOLENCE
Results of a recent study in a Utah hospital show that at least one in three women who sought emergency treatment at the hospital had been victims of domestic violence at some point during their lives. The study was published in the December issue of the Utah State Department of Health’s journal Utah Health: An Annual Review.
The study, conducted at the Latter Day Saints Hospital in Salt Lake City, UT, found that nearly 10 percent of the women treated in the hospital's emergency room _ for reasons ranging from flu to strokes _ had said that they had been the victim of intimate partner abuse within the previous year. Nearly 40 percent of these women said they had considered killing themselves during that year. Only two of the women had come to the ER seeking treatment for an immediate domestic violence injury.
Researchers questioned 500 women visiting the hospital's emergency room during March 2001. Of the 500 women, 360 agreed to answer questions. The women were surveyed through written questionnaires. Family members were kept out of the room to ensure privacy and confidentiality.
The researchers found that 20 to 30 percent of the women reporting domestic violence were frequently seen in the ER. The study concludes that screening all women who come into the ER for domestic violence can help identify victims of abuse.
Talking to the Associated Press, Dr. Todd Allen, the study's lead investigator and associate director of research for LDS Hospital's trauma service, said that intimate partner abuse is the number one reason women are injured and is one of the top three "co-factors" leading to other diseases. According to Allen, the study was first of its kind in Utah and the first one nationally to link domestic abuse with suicidal ideation in adults.
The study was suggested by Utah physician and American Medical Association president-elect Dr. John Nelson, who as an obstetrician has heard many stories about domestic abuse, Allen said.
Source: The Associated Press
CALL FOR A HEARING ON CRUCIAL HEALTH BILL
Approximately 1 million women each year are physically abused by their spouses or boyfriends and between 3 and 10 million children witness that abuse. More than 1 in 3 women who seek care in emergency rooms for violence-related injuries were injured by a boyfriend or spouse, and about 324,000 pregnant women are battered each year. In fact, homicide is the leading cause of death for pregnant and recently pregnant women.
Consequently, the health care system has a responsibility and a unique opportunity to address domestic violence, particularly to prevent family violence before it becomes life threatening. To improve the health care system’s response to domestic violence, Reps. Capps (D-CA) and LaTourette (R-OH), introduced in 2003 the Domestic Violence Screening, Treatment and Prevention Act, H.R. 1267. This legislation would ensure that trained health care providers routinely screen female patients for domestic violence and guarantee that needed services will be covered when domestic violence is identified.
The Domestic Violence Screening, Treatment and Prevention Act, H.R. 1267 would:
Establish research centers to conduct research and disseminate information on family violence, broadly defined to include child, domestic and elder abuse. Centers would be required to coordinate with domestic violence advocates to ensure that research is relevant to the needs of the field and at least two centers would be linked to the National Institutes of Health and the Agency for Health Care Research and Quality. Authorizes $15 million in FY ’04 and such sums as necessary in FY 2005-2008.
Train health care professionals in how to properly identify and treat family violence and develop education materials and curricula for expanding the training and education of health care providers. Provides for $5 million FY ’04 and such sums as necessary in FY 2005–2008.
Fund 10 demonstration projects at the state level and 10 at the local level to develop comprehensive strategies to improve the health care system’s response to domestic violence. State or local health programs and state or local domestic violence programs working in collaboration would be eligible to receive the grants. Funds could be used to hire domestic violence experts or train staff, develop on site policies and procedures or implement practice guidelines for routine screening to identify domestic violence. Authorizes $5 million.
Provide for Services through Federal Health Programs, including:
Medicaid – allow Medicaid to cover domestic violence screening and services as an optional service;
FEHBP – require the Federal Employees Health Benefits Plan to cover the costs of domestic violence screening and treatment;
MCHBP - require State and Maternal Child Health programs to improve their response to domestic violence with their state block grant and provides new funds for domestic violence identification and treatment services;
FQHCs – allows for grants to community health centers to improve their response to domestic violence.
Contact your Representative to call for a hearing on the Domestic Violence Screening, Treatment, and Prevention Act, H.R. 1267. To take action, Click Here.
For additional information, call Kiersten Stewart at the Family Violence Prevention Fund: (202) 682-1212.
ANNOUNCEMENTS
FVPF’S NATIONAL HEALTH INITIATIVE ON DOMESTIC VIOLENCE SEEKS GRADUATE INTERN
The Family Violence Prevention Fund’s (FVPF) National Health Initiative on Domestic Violence encourages medical, nursing, public health, health care administration, or other health care related graduate level students (includes law, media, policy, or business students with a health care focus) to apply for its 2004 Health Care and Domestic Violence Graduate Internship Program. The program allows a student to spend between two and three months at the FVPF working on a specific project.
Interns must work on-site at the FVPF’s San Francisco office during their internships although preparation work and follow-up work to internship can be undertaken from other locations. Interns receive a stipend of $1,100 per month of internship to help defer living and travel costs during their internship.
For more information, Click Here or call Anna Marjavi, Program Specialist, at (415) 252-8900.
EVENTS
CONFERENCE ON MEDICAL STANDARD OF CARE FOR GUN INJURY PREVENTION
The HELP Network’s 8th conference entitled Defining a Medical Standard of Care for Gun Injury Prevention will be held on April 16-18, 2004 at the Northwestern Memorial Hospital in Chicago, IL. The conference is jointly sponsored by Northwestern University, Feinberg School of Medicine.
The 2004 conference will consolidate progress from the past decade of gun injury prevention work and promote national consensus regarding the emerging medical standard of care. This educational event is designed especially for primary care physicians, pediatricians, internists, family practitioners and emergency physicians. Other interested health professionals and advocates are also encouraged to attend.
The conference will provide Continuing Medical Education credits for physicians.
To view and print conference schedule and registration forms, visit the HELP Network’s website: www.helpnetwork.org. For more information contact Theresa Merwald: (773) 880-8122 or tmerwald@childrensmemorial.org.
NATIONAL CONFERENCE ON HEALTH CARE FOR THE HOMELESS
The 2004 National Health Care for the Homeless Conference will be held on June 17-19, 2004 at the Hyatt Regency New Orleans, LA. The Health Resources and Services Administration’s (HRSA) Bureau of Primary Health Care will sponsor the conference. The theme of the conference is The Health Care Solution to Homelessness.
Experts from around the country will present current information, innovative approaches, and challenging ideas on a wide rage of topics related to providing health care to individuals who are homeless. The conference will feature workshops, including special policy sessions, poster presentations, a resource area, and tours of local programs. A pre-conference institute, sponsored by the National HCH Council and HCH Clinicians' Network, will be held on Wednesday, June 16, 2004.
HCH professionals, including administrative, clinical and support staff, board members, and clients are encouraged to attend the conference. The event will also be of value to others who provide health care and support services to homeless people, as well as government officials and advocates.
For more information on the conference and registration, Click Here or contact Jason DeStafano, Conference Registrar at jdestafano@prainc.com or (888) 439-3300, x 242.
QUERY CORNER
QUESTIONS FOR HEALTH E-NEWS SUBSCRIBERS
1. This question was sent to us by Ann Rausch of the Alaska Network on Domestic Violence and Sexual Assault. We would like to encourage responses to this question from our Health e-News subscribers:
“The Alaska Network on Domestic Violence and Sexual Assault is working with four communities within the state who are developing coordinated community response (CCR) teams. The team’s focus will be on primary prevention of domestic violence in their community. We are trying to develop a survey tool that will measure CCR member attitudes and knowledge about prevention in general, domestic violence, and prevention of domestic violence. We would like to develop the survey tool in order to measure any changes in member attitude and knowledge over time.
I am wondering if there are any existing survey measures that address some or all of these areas. I would be interested in reviewing surveys that measure individual attitudes/knowledge about prevention in general, attitudes/knowledge about domestic violence and/or prevention of domestic violence specifically. Thank you for you assistance.”
2. This question was posed to us by one of our allies. We would like to encourage responses to this question from our Health e-News subscribers:
“I want to know if any of the universities in the San Francisco area have a screening tool for their student health centers. I am working with the University of Alabama to develop a screening tool and cannot find any that are appropriate to model. My colleagues and I have all of the tools provided in the FVPF’s Resource and Training manuals, but we are specifically interested in learning more about college related tools.
I would also like to connect with a university health center that could answer several procedural questions I have regarding reporting and insurance billing at the college level. Thank you.”
Please e-mail your replies to the above questions to HealthE-News@endabuse.org.
Health e-News is a bi-weekly electronic news digest focusing on health care and domestic violence policy, research, prevention and advocacy. Health e-News is available in both text and html formats. To subscribe Click Here.
To post an announcement or ask a question, send an e-mail to HealthE-News@endabuse.org. The digest is monitored by Vibhuti Mehra, Program Assistant with the Family Violence Prevention Fund. Thank you for your ongoing commitment to end domestic violence!
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This publication is funded in part by U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Family and Youth Services Bureau.
Copyright © 2003 Family Violence Prevention Fund
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