Abstract. Objectives:The main purpose of this study was to determine whether any clinical or demographic characteristics could identify adult female patients presenting to the emergency department (ED) with a history of domestic abuse. A second objective was to describe the frequency, types, and severity of this abuse. Methods: This study was a crosssectional survey of 611 women conducted in an academically-affiliated, urban ED. Domestic abuse was described as ''recent'' (within the preceding 12 months) or ''lifetime'' (recent or past). This included emotional, physical, and sexual abuse. Results: Recent (7.9%, n = 48) and lifetime (38%, n = 232) domestic abuse was reported. For recently abused women, violence had been severe (87.5%, n = 42) and was associated with 1) trauma (OR 5.4, 95% CI = 2.6 to 11.6), 2) obstetrical and gynecological syndromes (OR 5.6, 95% CI = 2.4 to 13.2), and 3) psychiatric symptoms and substance use (OR 7.3, 95% CI = 2.4 to 22.0). The sensitivities and positive predictive values of these risk factors individually (<27.1% and <25.0%, respectively) and in aggregate (56.3% and 20.9%, respectively) were low. These indicators predicted only 27 (56.3%) of recently abused women. Lifetime domestic violence was more likely in homeless women (OR 5.8, 95% CI = 2.2 to 15.0), although less likely in immigrants (OR 0.4, 95% CI = 0.3 to 0.7). Conclusions: Clinical presentations and demographic characteristics of women presenting to the ED may not be sensitive or predictive indicators of domestic abuse. In the absence of typical clinical or demographic findings, asking all women in the ED about domestic abuse remains a necessary priority. Key words: domestic violence; screening; physician's role; risk factors; partner abuse. ACADEMIC EMER- GENCY MEDICINE 2001; 8:796-803 I N 1992, the American Medical Association published guidelines recommending that medical providers routinely ask all women direct, specific questions about abuse.1 Subsequently, many national medical associations have developed similar guidelines.2-6 Despite these intentions, these recommendations have been fraught with difficulty and remain largely unrealized. Most physicians in the emergency department (ED), as in most settings, do not routinely ask their patients about domestic abuse.7,8 A recent study showed that fewer than 10% of primary care physicians in California routinely take a history about abuse. 9 In the ED, clinicians may be more likely to ask about abuse in women who present with assault-related inju- 10,11 However, women with acute presentations of domestic abuse often do not present with injuries. 12-14The complexity of routinely inquiring about domestic abuse in medical settings has been described. 10,15 Asking all women about this problem may be unrealistic, screening standards are not uniform, and few studies have evaluated the effectiveness of these efforts. However, several programs have achieved the goal of universal screening. 16 In addition, experts assert, and a small body of evidence suggests, that wome...

Providing intimate partner violence (IPV)-related services to women enrolled in substance abuse treatment programs has the potential to reach a population disproportionately affected by IPV. Integrating basic IPV services into substance abuse treatment, however, poses challenges to organizations and staff. Using focus groups, the authors examined the experiences and attitudes of substance abuse treatment staff towards clients with IPV victimization experiences in order to elucidate factors that might affect the implementation of IPV services within substance abuse treatment. Seven focus groups were conducted with staff members from substance abuse treatment programs in New York City. Although participants believed that IPV is common and negatively affects client recovery, they felt competing time demands, complex confidentiality issues, insufficient training and lack of agency leadership would impede their provision of IPV-services. The study suggests that system-level assessment and change is needed to provide IPV-related services in substance abuse treatment settings.