Trauma- and Violence-Informed Care Practices in the Emergency Department for Survivors of Intimate Partner Violence.

Abstract

Intimate partner violence (IPV) impacts the health of IPV survivors and their children. Survivors frequently seek care in emergency departments (EDs) and are best served by trauma- and violence-informed care (TVIC), which emphasizes safety, trust building, and collaboration. However, the extent to which ED care aligns with TVIC is underexplored. To examine the alignment between TVIC principles and ED care provided to IPV survivors. This qualitative study was performed in 1 general academic, 1 general community, and 1 pediatric ED using a focused ethnographic approach from November 16, 2022, to June 30, 2024. Participants included a purposive sampling of English- or Spanish-speaking IPV survivors who sought care in the ED. Data included observations of social worker (SW)-survivor interactions and follow-up interviews with IPV survivors within 1 week. ED visit. Data generated from observation notes and interview transcripts were analyzed deductively (informed by principles of TVIC) and inductively. Codes were created and revised until reaching a stable list, then interpretation of the data was checked with a family violence community advisory board. Of 31 patient encounters (29 female [94%]; mean [SD] age, 29.0 [8.7] years), 29 included observations and 13 included follow-up interviews. Twenty-one patients presented to the general EDs following IPV-related injuries; most of the 10 encounters in the pediatric ED were disclosed during a child's medical visit. Six patients preferred Spanish. Findings were clustered into 4 TVIC domains: recognizing the impacts of trauma, prioritizing safety, connectiveness and choice, and fostering development. In recognizing the impacts of trauma, survivors described complex trauma histories that influenced how they navigated IPV and sought help. Safety was prioritized in encounters that were private, calm, and culturally and linguistically responsive, while noise and lack of privacy undermined care. Survivors engaged with SWs who emphasized autonomy and collaboration over directive communication to foster connectedness and choice, particularly when discussing sensitive topics such as child protective services referrals. SWs fostered capacity development by providing resources and handoffs to IPV advocates to address survivors' basic needs and help them navigate care systems. In this qualitative study of TVIC for IPV survivors in the ED, alignment with TVIC was facilitated by acknowledging past experiences, prioritizing collaboration, and addressing comprehensive needs. Lack of privacy, language barriers, and directive communication styles hindered TVIC alignment. Without TVIC, EDs may retraumatize IPV survivors, undermining their potential to serve as critical points of intervention.