Sexual Health and Reproductive Equity Program (SHARE), University of California, Berkeley, Berkeley, California, United States of America.
PLoS One. 2022 Mar 18;17(3):e0264814. doi: 10.1371/journal.pone.0264814. eCollection 2022.
Racial/ethnic minority survivors of domestic violence (DV) referred from emergency departments (EDs) face barriers connecting with advocacy services due to systemic inequities. This study assesses the impact of Domestic Violence Report and Referral (DVRR), a digital mandatory reporting compliance system with integrated direct-to-advocacy referrals sent with patient consent, on survivors' likelihood of receiving advocacy by race/ethnicity and gender.
We assessed ED charts between 2014-2018 in an urban, Level 1 trauma center for DV-related positive screening, chief concern, or documentation in medical/social work notes. We matched these visits by name to local DV advocacy agency records. Using logistic regression, we assessed survivor odds of reaching advocacy by DVRR receipt, race/ethnicity and gender. We used predicted probabilities to identify between-group differences in advocacy services received.
Of the 1366 visits, 740 received the DVRR intervention; 323 received advocacy services Without DVRR, compared to white, female survivors (n = 87), male survivors (n = 132) had 0.20 (95% CI: 0.07-0.56) times the odds of reaching advocacy compared to female survivors; Latinx survivors (n = 136) had 2.53 (95% CI: 1.58-4.07) times the odds of reaching advocacy compared to white survivors. With DVRR, the odds and predicted probabilities of reaching advocacy increased significantly for all survivors. White, female survivors (n = 74) who received DVRR experienced 2.60 (95% CI: 1.66-4.07) times the odds of connecting with advocacy. Compared to this reference group, Black survivors (n = 480) who received DVRR experienced 4.66 additional times the odds of reaching advocacy services (95% CI: 3.09-7.04) and male survivors (n = 84) experienced 8.96 additional times the odds (95% CI: 2.81-28.56). Overall, we predict 43% (95% CI: 38-53%) of Latinx survivors (n = 177), 36% (95% CI: 31-40%) of Black survivors (n = 480) and 23% (95% CI: 14-32%) of white survivors (n = 83); 37% (95% CI: 33-40%) of women (n = 656) and 29% (95% CI: 18-42%) of men (n = 84) received advocacy services with DVRR.
Direct-to-advocacy ED referrals facilitated by eHealth technology improve access to advocacy care for all survivors in this sample; marginalized racial and ethnic groups most often victimized by DV appear to have the highest rates of connection to advocacy.
从急诊科（ED）转介的少数族裔和少数民族家庭暴力幸存者由于系统的不平等而在与倡导服务联系方面面临障碍。本研究评估了家庭暴力报告和转介（DVRR）的影响，这是一种数字强制报告合规系统，具有集成的直接转介服务，可在患者同意的情况下发送给倡导服务。这对幸存者的种族/族裔和性别获得倡导服务的可能性有何影响。
我们评估了 2014 年至 2018 年期间在城市一级创伤中心的与 DV 相关的阳性筛查、主要关注点或医疗/社会服务记录中的文档的 ED 图表。我们通过姓名将这些就诊与当地 DV 倡导机构的记录相匹配。使用逻辑回归，我们评估了幸存者通过 DVRR 获得、种族/族裔和性别获得倡导的几率。我们使用预测概率来确定不同群体之间获得倡导服务的差异。
在 1366 次就诊中，740 次接受了 DVRR 干预；与白人女性幸存者（n = 87）相比，323 次未接受 DVRR 干预的幸存者获得了倡导服务，男性幸存者（n = 132）获得倡导服务的几率是女性幸存者的 0.20（95%CI：0.07-0.56）；拉丁裔幸存者（n = 136）获得倡导服务的几率是白人幸存者的 2.53（95%CI：1.58-4.07）。通过 DVRR，所有幸存者获得倡导服务的几率和预测概率均显著增加。接受 DVRR 的白人女性幸存者（n = 74）获得倡导服务的几率是 2.60（95%CI：1.66-4.07）。与该参考组相比，接受 DVRR 的黑人幸存者（n = 480）获得倡导服务的几率增加了 4.66 倍（95%CI：3.09-7.04），男性幸存者（n = 84）获得倡导服务的几率增加了 8.96 倍（95%CI：2.81-28.56）。总体而言，我们预测 43%（95%CI：38-53%）的拉丁裔幸存者（n = 177）、36%（95%CI：31-40%）的黑人幸存者（n = 480）和 23%（95%CI：14-32%）的白人幸存者（n = 83）；37%（95%CI：33-40%）的女性（n = 656）和 29%（95%CI：18-42%）的男性（n = 84）将通过 DVRR 获得倡导服务。
通过电子健康技术提供的直接转介倡导服务，改善了本研究中所有幸存者获得倡导服务的机会；最常成为家庭暴力受害者的边缘化种族和族裔群体似乎与倡导服务的联系率最高。
