Statement of Purpose To compare the prevalence of violence against persons (VAP) across racial/ethnic and primary language among patients seeking care at an integrated, safety-net hospital system.
Methods/Approach In 2021, the largest safety-net emergency department (ED) in the United States implemented a trauma informed care model, which included systematic VAP screening (physical, sexual, psychological victimization, control of food/money, and observational signs of abuse [explicit, contextual, appearance, injury]) and strengthening referral pathways for victims. Patients who screened positive were referred to the Victim Intervention Program (VIP). Analysis of electronic health records used univariate and bivariate statistics to assess screening rates across sample characteristics.
Results Between January 1 to July 30, 2021, 66,125 encounters with 43,318 unique adults were screened for VAP. Of the patients screened, 52% were Hispanic and 33% were primary Spanish speakers. Two percent of encounters had a positive screen for VAP (n=1,265) and, of those seen by VIP 85.8% (n=1,175) received services. Of the positive screens, (76.4%) were physical victimization, followed by psychological (41.4%), sexual (33.5%) and control (19.9%). Hispanic patients and Spanish speakers had the greatest odds for any racial/ethnic group of screening positive for all types of victimization as well as all signs of abuse compared to NH white. Black patients had higher odds of appearance (OR=3.42) and injury-based (OR=2.14) signs of abuse. Among patients with multiple encounters, consistent positivity ranged from 1.7% to 100% (mean= 88.4%).
Conclusion Trauma informed care implementation had the greatest benefit of detection among Hispanic ethnicity and Spanish speaking populations for all types of VAP. Victimization disparities across racial/ethnic groups is disproportionately identified in health systems.
Significance Addressing disparities in screening processes can aid in identifying missed victims and improving access to services amongst our diverse communities.
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