Domestic Violence Screening: Education and Institutional Support Correlates
Tower, Leslie E., Journal of Social Work Education
Because domestic violence is a serious threat to women's lives and well-being, social workers are encouraged to screen, assess, and implement intervention. National Association of Social Workers members from Florida were surveyed in order to understand their screening barriers and behaviors. Participants with more Continuing Education Units, agency inservice hours, and additional training perceived fewer barriers to screening, screened more, and identified more domestic violence victims. Multiple regression analysis showed that perceived self-efficacy, paperwork screening reminders, and inservice training hours explained 38.5% (35.8% adjusted) of the variability in screening behaviors. Screening is an important component in the process of helping battered women.
DOMESTIC VIOLENCE SCREENING is a significant issue for social work education because domestic violence is a serious threat to women's health, and education has the potential to influence social workers' response. An important aspect of this response must include screening for domestic violence and offering help, but this may not be happening in health care settings. The lack of screening behavior appears to be related to barriers that prevent health care professionals from reaching out to potential victims.
Researchers began investigating this issue with qualitative studies that asked physicians what prevented them from comfortably screening for domestic violence (Sugg & Inui, 1992). Their responses were labeled "barriers" and became part of larger quantitative studies about provider perceptions as well as comparisons of these barriers with screening behaviors (Parsons, Zaccaro, Wells, & Stovall, 1995). Waalen, Goodwin, Spitz, Petersen, and Saltzman (2000) reviewed 12 such studies and reported that barriers (e.g., provider education, lack of time, and ineffective interventions) are similar for physicians across diverse specialties and settings. Furthermore, Waalen et al. concluded that education without additional support (e.g., providing screening questions) does not affect screening behaviors. The influence of these barriers on the screening behavior of medical social workers is the focus of this study.
Opportunities to educate social workers about domestic violence are present at various points on professional social workers' lifelong learning continuum: professional education, continuing education, inservice training, and other educational experiences. Little is known about where social workers are exposed to domestic violence content, or whether they are exposed at all.
Domestic Violence as a Health Threat
The deleterious effects of domestic violence on women's health are so serious that it has been recognized as a public health crisis (Koop & Lundberg, 1992). Nationally representative studies indicate that up to 4.4 million women are physically abused by their husbands of live-in partners each year, yet only 9% of these individuals have discussed such abuse with their physicians (Plichta, 1996). Women rarely spontaneously disclose victimization to health care practitioners, and it can be assumed that women are no more likely to bring up such abuse with medical social workers. Thus, domestic violence is an underdetected and undertreated etiology that leads to death, physical injury, and mental and somatic diagnoses.
The lack of domestic violence screening by health care professionals marks a lost opportunity for reducing these consequences as well as the possibility of preventing them entirely. Wadman and Muelleman (1999) reported that 44% (n = 15) of all female victims of domestic violence homicide had been in the emergency room less than 2 years before their deaths; these 15 patients made a total of 48 visits during this time period, for an average of more than 3 visits each. An examination of their medical records revealed documentation suggesting domestic violence for eight of the victims; however, there was no record of a single referral to a domestic violence agency or of any domestic violence information being given to these patients. …