Emergency Department staff experiences of screening and response for intimate partner violence in a multi-site feasibility study: Acceptability, enablers and barriers

Published:December 24, 2021DOI:https://doi.org/10.1016/j.auec.2021.12.004



      Intimate partner violence is a lead cause of ill health and premature death among Australian women. Abused women are likely to present to Emergency Departments. Routine screening provides opportunities to identify and respond to intimate partner violence.


      A six-month screening feasibility study was conducted in two rural and one urban NSW Emergency Departments. Surveys with participating nurses, medical officers and social workers, as well as focus groups with nurses and social workers were conducted at each site to understand their experience.


      Survey respondents (n = 198) agreed it was appropriate (87%) and acceptable (91%) to screen for intimate partner violence in Emergency Departments. Overall 62% of respondents suggested screening had positive impacts on womens’ care. Focus group discussions with 39 nurses and social workers identified enablers of screening as: ease of use of the screening tool; availability of social work response within one hour (as per the study protocol); and executive support. Barriers were: high patient volume; lack of integration with existing processes; lack of privacy and brevity of training.


      Screening in Emergency Departments was strongly supported by health practitioners who responded to the survey. Work is needed to address competing demands, integration of screening processes, and staff training.


      To read this article in full you will need to make a payment


      Subscribe to Australasian Emergency Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Bricknell S. Homicide in Australia 2017–18. Canberra: Australian Institute of Criminology; 2020 05-05-2020. Contract No.: Statistical Report 23.

        • US Preventive Services Task Force
        Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: final recommendation statement.
        JAMA. 2018; 320: 1678-1687
        • World Health Organization
        Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. World Health Organization, Geneva2013
        • García-Moreno C.
        • Pallitto C.
        • Devries K.
        • Stöckl H.
        • Watts C.
        • Abrahams N.
        Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence.
        World Health Organization Department of Reproductive Health and Research, London School of Hygiene and Tropical Medicine, South African Medical Research Council, Geneva2013
        • Australian Institute of Health and Welfare
        Australian burden of disease study: impact and causes of illness and death in Australia 2015.
        AIHW, Canberra2019
        • Gartland D.
        • Woolhouse H.
        • Mensah F.
        • Hegarty K.
        • Hiscock H.
        • Brown S.
        The case for early intervention to reduce the impact of intimate partner abuse on child outcomes: results of an Australian cohort of first-time mothers.
        Birth. 2014; 41: 374-383
        • Sprague Goslings J.
        • Hogentoren C.
        • de Milliano S.
        • Simunovic N.
        • Madden K.
        • et al.
        Prevalence of intimate partner violence across medical and surgical health care settings: a systematic review.
        Violence Women. 2014; 20: 118-136
        • Rhodes K.
        • Kothari C.
        • Dichter M.
        • Cerulli C.
        • Wiley J.
        • Marcus S.
        Intimate partner violence identification and response: time for a change in strategy.
        J Gen Intern Med. 2011; 26: 894-899
      2. Boinville M. Screening for domestic violence in health care settings In: Office of the Assistant Secretary for Planning and Evaluation, editor. Washington: U.S. Department of Health and Human Services; 2013.

        • American College of Emergency Physicians
        American college of emergency physicians policy compendium 2017.
        American College of Emergency Physicians, Dallas, Texas2017: 168
        • Australian Institute of Health and Welfare
        Screening for domestic violence during pregnancy: options for future reporting in the National Data Collection [Cat no PER 71].
        AIHW, Canberra2015
      3. NSW Ministry of Health. Domestic violence routine screening november 2015 snapshot 13. In: NSW Ministry of Health, editor. North Sydney: NSW Ministry of Health; 2016. p. 47.

      4. Fanslow JL, Kelly P, Ministry of Health. Family violence assessment and intervention guideline: child abuse and intimate partner violence. In: Ministry of Health, editor. 2nd ed. Wellington: New Zealand Government; 2016. p. 132.

        • O’Doherty L.
        • Hegarty K.
        • Ramsay J.
        • Davidson L.
        • Feder G.
        • Taft A.
        Screening women for intimate partner violence in healtcare settings.
        Cochrane Database Syst Rev. 2015; ([7 Art No CD007007])
        • Feltner C.
        • Wallace I.
        • Berkman N.
        • Kistler C.
        • Middleton J.
        • Barclay C.
        • et al.
        Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: evidence report and systematic review for the US Preventive Services Task Force.
        JAMA. 2018; 320: 1688-1701
        • Heron R.
        • Eisma M.
        Barriers and facilitators of disclosing domestic violence to the healthcare service: a systematic review of qualitative research.
        Health Soc Care Community. 2021;
        • Spangaro J.
        • Vajda J.
        • Klineberg E.
        • Lin S.
        • Griffiths C.
        • Saberi E.
        • et al.
        Intimate partner violence screening and response in New South Wales emergency departments: a multi-site feasibility study.
        Emerg Med Australas. 2020; 32: 548-555
      5. NSW Health. Health information exchange – emergency department data collection In: Health NDo, editor. Sydney, NSW; 2018.

        • Feder G.
        • Ramsay J.
        • Dunne D.
        • Rose M.
        • Arsene C.
        • Norman R.
        • et al.
        How far does screening women for domestic (partner) violence in different health-care settings meet criteria for a screening programme? Systematic reviews of nine UK National Screening Committee criteria.
        NIHR Health Technology Assessment Programme, Winchester, England2009 ([March 2009. Contract No.: 16])
        • Sherin K.
        • Sinacore J.
        • Xiao-Qiang L.
        • Zitter R.
        • Shakil A.
        HITS: a short domestic violence screening tool for use in a family practice setting.
        Fam Med. 1998; 30: 508-512
        • Chen P.
        • Rovi S.
        • Vega M.
        • Jacobs A.
        • Johnson M.
        Screening for domestic violence in a predominantly hispanic setting.
        Fam Pract. 2005; 22: 617-623
        • Wolff J.
        • Cantos A.
        • Zun L.
        • Taylor A.
        Enhanced versus basic referral for intimate partner violence in an urban emergency department setting.
        J Emerg Med. 2017; 53: 771-777
        • Ritchie J.
        • Spencer L.
        Qualitative data analysis for applied policy research.
        in: Bryman A. Burgess R.G. Analysing qualitative data. Routledge, London1994: 173-194
        • Watts C.
        • Heise L.
        • Ellsberg M.
        • Garcia Moreno C.
        Putting women first: ethical and safety recommendations for research on domestic violence against women.
        Department of Gender and Women’s Health, WHO, Geneva2001
      6. Irwin J., Waugh F. Unless they’re asked: routine screening for domestic violence in NSW health-evaluation report of the pilot project NSW Health; 2001.

        • Arkins B.
        • Begley C.
        • Higgins A.
        Measures for screening for intimate partner violence: a systematic review.
        J Psychiatr Ment Health Nurs. 2016; 23: 217-235
        • Webster S.
        • Pedrosa C.
        • Lopez V.
        Domestic violence against women: incidence and prevalence in an emergency department population.
        J Nurs Educ Pract. 2012; 2: 145-153
        • Zakrison T.
        • Ruiz X.
        • Gelbard R.
        • Cline J.
        • Turay D.
        • Luo-Owen X.
        • et al.
        Universal screening for intimate partner and sexual violence in trauma patients: an EAST multicenter trial.
        J Trauma Acute Care Surg. 2017; 83: 105-110
        • DiVietro S.
        • Beebe R.
        • Grasso D.
        • Green C.
        • Joseph D.A.
        • Lapidus G.D.
        A dual-method approach to identifying intimate partner violence within a Level 1 trauma center.
        J Trauma Acute Care Surg. 2018; 85: 766-772
        • Boxall H.
        • Morgan A.
        Experiences of coercive control among Australian women.
        Australian Institute of Criminology, Canberra2021
        • Sprague S.
        • Madden K.
        • Simunovic N.
        • Godin K.
        • Pham N.
        • Bhandari M.
        • et al.
        Barriers to screening for intimate partner violence.
        Women Health. 2012; 52: 587-605
        • Miller C.
        • Adjognon O.
        • Brady J.
        • Dicther M.
        • Iverson K.
        Screening for intimate partner violence in healthcare settings: an implementation oriented systematic review.
        Implement Res Pract. 2021; 2 ([Jan–Dec 2021]): 1-47
        • Dawson A.
        • Rossiter C.
        • Doab A.
        • Romero B.
        • Fitzpatrick L.
        • Fry M.
        The Emergency Department response to women experiencing intimate partner violence: insights from interviews with clinicians in Australia.
        Acad Emerg Med. 2019; 26: 1052-1062
        • Hamberger L K.
        • Rhodes K.
        • Brown J.
        Screening and intervention for intimate partner violence in healthcare settings.
        Creat Sustain Syst-Lev Prog J Women’s Health. 2015; 24: 86-91
        • Stayton C.
        • Duncan M.
        Mutable influences on intimate partner abuse screening in health care settings: a synthesis of the literature.
        Trauma Violence Abus. 2005; 6: 271-285
        • Saberi E.
        • Eather N.
        • Pascoe S.
        • McFadzean M.
        • Doran F.
        • Hutchinson M.
        Ready, willing and able? A survey of clinicians’ perceptions about domestic violence screening in a regional hospital emergency department.
        Australas Emerg Nurs J. 2017;
        • DeBoer M.I.
        • Kothari R.
        • Kothari C.
        • Koestner A.
        • Rohs T.
        What are barriers to nurses screening for intimate partner violence?.
        J Trauma Nurs. 2013; 20: 155-160
        • Hammock A.
        • Palermo T.
        • Keogler R.
        • Francois P.
        • Schiavone F.
        • Taira B.
        Evaluation of a short intervention on screening for intimate partner violence in an ED.
        Am J Emerg Med. 2017; 35: 171-173
        • Hinsliff-Smith K.
        • McGarry J.
        Understanding management and support for domestic violence and abuse within emergency departments: a systematic literature review from 2000 to 2015.
        J Clin Nurs. 2017; 26: 4013-4027
        • Cleak H.
        • Hunt G.
        • Hardy F.
        • Davies B.
        • Bell J.
        Health staff responses to domestic and family violence: the case for training to build confidence and skills.
        Austral Soc Work. 2021; 74: 42-54
      7. Hamberger L., Ambuel B., Guse CE, Phelan MB, Melzer-Lange M., Kistner A. Effects of a systems change model to respond to patients experiencing partner violence in primary care medical settings. J Fam Violence; 2014 (Pagination): No Pagination Specified.

        • Hegarty K.
        • McKibbin G.
        • Hameed M.
        • Koziol-McLain J.
        • Feder G.
        • Tarzia L.
        • et al.
        Health practitioners’ readiness to address domestic violence and abuse: a qualitative meta-synthesis.
        PLoS One. 2020; 15e0234067