In recent years, health care providers have begun to implement procedures for addressing domestic violence in health care settings. This is particularly true in hospital emergency rooms, but is becoming more true in community health settings as well. The Joint Commission on the Accreditation of Hospitals (JACH) now requires emergency rooms to have a protocol for screening for domestic violence, but many emergency rooms still do not routinely do this. Understanding the recent changes in the health care response was one objective of this study and several sites were selected because of their efforts in this area. Many of the health sector programs in the study communities have been established within the past couple of years. Though these programs are relatively new and many are not fully implemented, this study provides some interesting examples of integrating health care providers into the community's response.
In four sites (Baltimore, Kansas City, San Diego, and San Francisco), some hospitals have formulated a response to domestic violence. Sinai Hospital in Baltimore has developed screening protocol and has staff to provide advocacy services to battered women identified by through the screening. In Kansas City, Truman Medical Center has teamed up with a local shelter to provide advocacy services to victims seen in the emergency room. In San Diego and San Francisco, hospital initiatives have grown out of the work of the Family Violence Prevention Fund. San Diego and Kansas City have programs located in children's hospitals to provide services to battered women with children.
Community clinics have also begun to formulate responses to domestic violence among their clients. In two of the sites (Baltimore and San Francisco) public health clinics have begun to develop domestic violence screening protocol, although they are not fully implemented in either of these sites. Unlike emergency room patients, community health clinic clients are not usually seeking treatment for injuries directly resulting from the abuse. However, providers may identify domestic violence during a routine physical or preventive health care visit. Battered women may also seek care from community clinics for depression, chronic headaches, back problems, or other conditions that may be related to the domestic violence. A practitioner who is trained and knowledgeable about available services, may be able to link the woman with domestic violence services much earlier than would otherwise be true. However, the woman may not yet be ready to use these services, which can be frustrating to the health professional. Baltimore's Healthy Start Program is also developing protocol to screen program participants for domestic violence.