As the COVID-19 pandemic persists, unemployment and shelter-in-place orders have created conditions for a hidden surge in domestic and intimate partner abuse. Social isolation requires abusers and victims to stay in confined quarters and many local shelters have ceased operations, limiting opportunities to find safety. Compared to last year, counties across the nation have reported 20-80% increases in domestic abuse emergency calls from the beginning of March to the beginning of April.
Patient profile: A 38-year old woman showed up at an emergency room in a California health system presenting with confusion and signs of physical abuse. The emergency room was overwhelmed with COVID-19 patients, and while normal protocol dictated calling the nearest shelter to get her to safety, it was now closed. So instead, she was sent home, only to revisit the same emergency room just days later. This time, she had injuries consistent with being beaten severely with a chair.
Emergency rooms are universally recognized places to seek care and shelter for people suffering an immediate crisis of domestic violence, but COVID-19 is pushing them to the limits of capacity and resource.They’re currently unable to provide the necessary help. But there’s a fix.
Health systems can turn to virtual solutions to efficiently and effectively route victims to safety and to prevent severe injuries and avoidable hospitalizations. Here are five things health systems can do now to help victims of the rising domestic abuse epidemic:
- Digitally screen incoming patients, through both on-site and virtual visits, for signs of domestic abuse. These tools can be integrated directly into a virtual telemedicine platform or into a digital intake form connected with the EHR. Victims may be hesitant to respond to questions that are blatantly screening for domestic abuse or questions that will identify their partners as potential abusers. The following examples are indirect questions used by health systems that may encourage candid responses. Please account for cultural and language barriers.• Do you feel stress in your home environment?|
• Are you concerned for your own safety due to a relationship when at home?
• How do you characterize the way you are treated by your partner?
• Are you having any problems with your partner?
- Maintain and update a robust online directory of domestic abuse resources that are accessible for referral during the COVID-19 pandemic. Many shelters and non-profits may not be operating on normal schedules; however, many states have leveraged health departments as proxy domestic abuse centers or are utilizing vacant hotel rooms and other types of shelter to temporarily house victims. Health systems can connect with state health departments or local non-profits to find current information on alternative shelters available.
- Integrate specialized, automated chatbots on the health system website and texting platforms to identify domestic abuse victims. Chatbots that use AI by asking targeted questions can automatically identify victims of domestic abuse and present possible solutions to save health system resources. It’s important to use chatbots that have specific safety features, like one-click window closing and masking if the abuser approaches the screen. The ability to translate common languages in the community is also important. These tools are readily available as stand-alone apps or as integrated add-ons. Many of these tools are being offered for free or at a discounted rate due to COVID-19.
- Provide non-emergency medical transportation (NEMT) to bring victims to safety. Victims may be unable to leave their homes or find transportation services to find safe shelter. If a health system identifies a victim on-site or through remote screening who needs transportation to safety, they can utilize an on-demand NEMT network to digitally summon a safe ride. Some health systems have external partnerships with Lyft or Uber specifically for domestic abuse victim transport.
- Crisis management digital solutions can help domestic violence victims achieve a calmer state of mind and connect them to resources that provide local shelter and relief. Digital text solutions, such as Crisis Text Line, can be shared via the health system website or in-person for victims to use. In light of COVID-19, other digital crisis management solutions are offering free services for patients to use and for health systems to list as a reference.
Domestic abuse victims, along with other vulnerable population groups, will require additional resources in the wake of, and after, the COVID-19 pandemic. AVIA has strategic advisors and proven resources to help care for vulnerable populations through the Medicaid Transformation Project. Please reach out to us at medicaidtransformationproject@avia.health or access the AVIA COVID-19 Response Hub for more information.
