Researchers Test Intervention As Way to Prevent Repeat Domestic-Violence Injuries

BUFFALO, N.Y. -- Can identifying the victims of domestic violence in the emergency room and providing volunteer advocates on-the-spot to refer them to community services help prevent battered women from ending up in the hospital again?

Researchers at the University at Buffalo hope to find out, aided by a $350,000 grant from the New York State Department of Health.

Their study, called the Health Care Emergency Response Domestic Violence Project, is an outgrowth of a collaboration involving 12 hospitals in Western New York that wanted to develop a unified approach to decreasing domestic-violence injuries. It will be launched in the Department of Emergency Medicine at Erie County Medical Center, Western New York's only public hospital.

Statistics abound on the magnitude of the problem of domestic abuse: Battering accounts for one out of every five women seeking medical care, battering is a chronic problem that increases in severity and frequency over time, 75 percent of those first injured continue to experience ongoing abuse, and more than 50 percent of women murdered in the U.S. are killed by a current or former male partner.

Experts estimate that domestic violence accounts for 30 percent of the injuries women present within hospital emergency departments in the U.S., yet without an established protocol, physicians have been found to identify only one abuse victim in 35.

Battered women, if asked, almost always will admit they've been beaten, studies have shown. However, research also reveals that physicians are uncomfortable with the topic, are afraid of the time involved in such cases and feel powerless to intervene in them.

The new project hopes to overcome these barriers by training physicians and nurses to recognize possible domestic-violence injuries and by incorporating such assessments into standard procedures. Intervention will be handled by a cadre of trained volu nteer domestic-violence advocates who will staff the emergency department to provide emotional support and immediate referrals.

The project also will establish a 24-hour automated help-line in English and Spanish that women can access from their homes. Volunteer advocates will follow up with women who have been referred to community organizations in the emergency department. E ach aspect of the program will be assessed to document what is, and is not, effective.

The goal, said Margo Krasnoff, M.D., UB associate professor of internal medicine and director of the project, is to show that in-hospital intervention is a form of prevention in domestic-violence cases, and can decrease the number of women re-injured by their partners.

"We hope to increase identification of women who come to the emergency department suffering from domestic violence who might not have had the opportunity to discuss their situations with health-care providers," Krasnoff said.

"By having the domestic-violence advocate come right to the patient in the emergency department, we are demonstrating that we take this problem very seriously, and that we are concerned about the safety of our patients. We want to make sure they recei ve the help they need to prevent them from being injured again."

The approach is similar to that employed by in-hospital rape-counseling programs. Krasnoff tested the concept here at Millard Fillmore and Millard Fillmore Suburban hospitals before applying for the grant. Those programs continue, and a similar progra m exists at Sisters Hospital in Buffalo. In its third year, the project will be replicated in two more area hospitals.

In addition to the UB departments of Medicine and Emergency Medicine, the project will involve Crisis Services, Inc., of Buffalo, which will train medical personnel and volunteers; the UB Department of Psychiatry, and the UB School of Law.

The project is slated to begin in July after training is completed.