How can the Domestic Abuse Response Team (DART) programme provide support to individuals experiencing domestic violence and abuse?
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How can the Domestic Abuse Response Team (DART) programme provide support to individuals experiencing domestic violence and abuse?

Supporting individuals facing domestic violence through DART in emergency departments is crucial for prompt care and intervention.

Domestic violence and abuse (DVA) consists of violence and/or abuse between two or more people living in the same house, often with the goal of gaining power or control. Individuals experiencing DVA are at a higher risk for physical and mental health, money, housing, and relationship problems. Many people who experience DVA do not talk about it due to privacy concerns, fears of their partner fighting back, being misunderstood or stigmatized, and concerns related to money, housing, and children.

Nonetheless, emergency department (ED) settings can play a crucial role for individuals affected by DVA, as many seek care in EDs due to health issues stemming from their abusive experiences (e.g., injuries). With good resources and training, ED environments have the potential to facilitate DVA disclosure and provide prompt, patient-oriented care to those in need. Our team evaluated a collaboration between an ED and a Domestic Abuse Response Team (DART) programme using mixed methods.

How is the DART programme special?

The DART programme has three major goals: 1) to reach a patient at the time of crisis with the aim of preventing further injury or crisis; 2) to improve quick and appropriate access to other supports for ED patients experiencing DVA; and 3) to reduce the impact on ED staff. The setting for the DART evaluation was a regional ED in Red Deer, Alberta, Canada. At the time of this evaluation, DART had six staff members with 1) experience in safety planning and in supporting individuals who experienced DVA; 2) knowledge of community resources, substance use, mental health, trauma-informed care, danger assessments, and privacy of information review; and 3) successful completion of shadow shifts and a mock patient assessment.

These staff members are on-call 24 hours a day, seven days a week, providing direct support to ED staff. One important factor of the DART and ED collaboration is universal screening within the ED (screening everybody above 14 years of age), through which nurses, psychiatric crisis response team members, or physicians ask patients two screening questions (see next paragraph). Based on their answers, DART may be considered.

However, DART will not be contacted unless the patient is fine with it (gives informed consent). If the patient provides consent, DART staff will provide support to the patient in the ED within one hour. Crisis intervention is achieved through 24-hour and/or safety plans, quick patient referral and connection with outreach services in the areas of housing, legal aid and court support, the police and/or child protective services, the provision of violence shelter information, transportation to a shelter or hotel, and/or sending patients to mental health services. Follow-up is also attempted 3 and 6 months later.

Supporting individuals facing domestic violence through DART in emergency departments, crucial for prompt care & intervention.
Credit. Midjourney

Evaluation of the performance of the DART programme

Screening rates of 63.0% and 60.8% were achieved for screening questions 1 (“is abuse or violence a concern for you or your children?”) and 2 (“do you feel safe at home?”) over the evaluation period, respectively, which are higher than most reported ED screening rates for DVA. Of those screened, 1% disclosed exposure to DVA. Over the evaluation period, 133 patients were referred to DART and used their services. DART was most often called in the morning or early afternoon.

Unsurprisingly, women accounted for most of the individuals using DART services (~87%), followed by men and one self-identified trans individual. Intimate partners were most often the ones engaging in DVA. About two-thirds (~66%) of DART individuals had substance use concerns or mental health challenges (or both), and just over one-third (33%) had children involved. Nearly three-quarters (~75%) of DART individuals reported experiencing both physical and emotional violence and abuse, but emotional violence and abuse were most often reported alone out of all forms.

Most individuals (one quarter, ~25%) reporting physical violence experienced strangulation (severe choking). Of the services provided by DART, crisis intervention, safety plans, and outreach programmes were the most accessed. Importantly, all participants who accessed outreach programmes were contacted within 24 hours following their contact with DART. Follow-up contact was made with less than half of the DART clients at 3 months (53 clients) and 6 months (25 clients).

Interviews to understand what staff thought about the DART programme

Nearly all ED staff indicated they received sufficient training with the DART programme, with 100% expressing their understanding of their responsibilities concerning DART. They recognised the importance of accurately informing patients about DART and understood that referrals to DART required patient consent. Both ED and DART staff believed that DART effectively met its objectives, such as delivering timely and appropriate support, even amid the challenges posed by the COVID-19 pandemic (achieved through telephonic interactions).

ED staff understood and were content with the referral process to DART and felt comfortable discussing referrals with DART staff if there was uncertainty. While most DART staff (83%) were content with the referral process, one raised concerns about excessive information sharing and instances where patients who were unable to provide consent (such as when intoxicated) were referred. Fear, not being ready to disclose, and intoxication were cited by both ED and DART staff as reasons for some patients not accessing DART support.

Overall, both ED and DART staff believed that DART gave patients appropriate resources and safety plans, benefiting them and their children. All ED staff who had utilized DART reported positive impacts on their work, including increased confidence in screening for DVA, enhanced support for ED staff when DVA was disclosed, reduced workload, and smoother workflows. Lastly, all ED staff and 83% of DART staff expressed satisfaction with communicating between the two teams.   

The impact and potential of DART in an emergency department

Even if only 1% of patients who were screened for DVA said they experienced DVA, those who did not may have been exposed to support for DVA for the first time, maybe leading to future desires to look for help. It also means 500 people get help out of 50,000 people. DART could be improved by having more rural areas included, including money, staff members, public education, and educational documents in the ED to encourage disclosure, as well as clear DVA questions and referral processes.

However, DART showed positive impacts for ED patients experiencing DVA and for ED staff. Notably, DART provided rapid support and safety (within one hour), reducing the time for patients to regret their disclosure. Most patients used DART in the morning or early afternoon, reflecting a time when the abusive individual may not be at home (e.g., at work).

Furthermore, DART’s emphasis on training and patient-oriented care ensures that each patient’s needs and goals are prioritized; follow-up support is also a distinctive feature, countering the trend of symptom-focused care in busy ED environments. By alleviating the stress and workload of ED staff through collaboration and offering specialised expertise in DVA, DART facilitates more comfortable screening and clearer pathways for those disclosing DVA. DART stands as a model for optimizing DVA treatment in ED settings, with the potential for replication and adaptation in other hospital settings. 

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Journal reference

Kurbatfinski, S., Letourneau, N., Luis, M. A., Conlin, J., Holton, M., Biletsky, R., … & Barber, B. (2023). The Evaluation of a Domestic Abuse Response Team Program in an Emergency Department. Journal of Family Violence, 1-14. https://doi.org/10.1007/s10896-023-00562-2

A doctoral student pursuing a degree in Community Health Sciences and Public Health. I am interested in family and child health, with ambitions to examine 2SLGBTQQIA+ health longitudinally throughout my career.

A Professor in the Faculties of Nursing and Cumming School of Medicine (Departments of Pediatrics, Psychiatry, and Community Health Sciences). I am interested in longitudinal family and child health, gender-based violence, and perinatal health.