After the questions: outcomes of routine screening for domestic violence in NSW Health services

Primary Research Stream

Health Services & Systems

Full Project Title

After the questions: outcomes of routine screening for domestic violence in NSW Health services.

Project Period

2006 - 2009

Rationale / Background

Approximately one in four women will experience some form of abuse by a partner in their lifetime, (Mirlees-Black 1999; Tjaden and Thoennes 2000; Mouzos and Makkai 2004) and 8-10% experience it each year (Canadian Centre for Justice Statistics 2000; Mouzos and Makkai 2004; Thompson R, Bonomi A et al. 2006). The serious and diverse health effects of IPV have been well documented (Garcia-Moreno, Jansen et al. 2005). Using the WHO Global Burden of Disease framework, one Australian study calculated IPV to be the leading contributor to death, disability and illness for women aged 15-44 years (VicHealth 2004).

Routine screening for intimate partner violence has been introduced in many health settings over the past 15 years to aide identification and intervention. This relatively new tool has significant capacity to prevent injury and the chronic illnesses associated with ongoing domestic violence. Currently NSW Health services screen over 4,000 women each month, identifying 300 cases of domestic violence with this tool. There remains considerable debate however about the evidence for screening for intimate partner violence, with systematic reviews suggesting there is to date insufficient evidence for universal screening and a lack of research on whether screening has adverse effects.

Aim and Objectives

This study aims to determine the impact of routinely screening women for domestic violence at the point of presentation to antenatal, mental health, and Alcohol and Other Drugs services within the NSW Health system.

It aim s to determine whether women who answer positively to either of the two screening questions regarding violence or fear of violence from a partner have experienced any change to the level or frequency of violence or threats being experienced, whether they have taken any steps or actions in respect of the violence, and whether the screening had any unanticipated adverse effects. It seeks to identify the elements within the screening process that are most effective or influential on women’s attitude to violence and health service responses.

Additionally the study considers the situation of women who do not report abuse to determine possible preventive effects of screening and the level of under identified abuse.

Method and Study Design

The study is a mixed methods project. Approximately 300 women from 10 participating health services are being surveyed six months post screening. The surveys aim to measure processes , attitudes and changes to levels of abuse experienced six months after screening. A separate survey administered to women who did not disclose abuse aims to measure processes, attitude changes and false negatives.

The qualitative elements of the study comprise interviews with a sub group of positively screened patients and focus groups with staff at the participating sites.

Key Findings (to Date)

Data gathering underway until July 2008.

Publications and Resources

Spangaro, J."Eleven obstacles to translating research into policy on gender-based violence" Evidence and Policy Journal Vol 3, (4) 2007
Spangaro, J. “Preventing domestic violence through routine screening: a report on the NSW Health program” NSW Public Health Bulletin Vol 18 (5-6) May-June 2007
Spangaro, J & Cosier, G “One tool, four programs: Report on an Australian statewide screening strategy in antenatal, well-baby, substance abuse and mental health services" - Conference proceedings Family Violence Prevention Fund Conference, San Francisco, 16 March 2007