Access to domestic violence advocacy by race, ethnicity and gender: The impact of a digital warm handoff from the emergency department

BackgroundRacial/ethnic minority survivors of domestic violence (DV) referred from emergency departments (EDs) face barriers connecting with advocacy services due to systemic inequities. This study assesses the impact of Domestic Violence Report and Referral (DVRR), a digital mandatory reporting compliance system with integrated direct-to-advocacy referrals sent with patient consent, on survivors' likelihood of receiving advocacy by race/ethnicity and gender.MethodsWe assessed ED charts between 2014-2018 in an urban, Level 1 trauma center for DV-related positive screening, chief concern, or documentation in medical/social work notes. We matched these visits by name to local DV advocacy agency records. Using logistic regression, we assessed survivor odds of reaching advocacy by DVRR receipt, race/ethnicity and gender. We used predicted probabilities to identify between-group differences in advocacy services received.ResultsOf the 1366 visits, 740 received the DVRR intervention; 323 received advocacy services Without DVRR, compared to white, female survivors (n = 87), male survivors (n = 132) had 0.20 (95% CI: 0.07-0.56) times the odds of reaching advocacy compared to female survivors; Latinx survivors (n = 136) had 2.53 (95% CI: 1.58-4.07) times the odds of reaching advocacy compared to white survivors. With DVRR, the odds and predicted probabilities of reaching advocacy increased significantly for all survivors. White, female survivors (n = 74) who received DVRR experienced 2.60 (95% CI: 1.66-4.07) times the odds of connecting with advocacy. Compared to this reference group, Black survivors (n = 480) who received DVRR experienced 4.66 additional times the odds of reaching advocacy services (95% CI: 3.09-7.04) and male survivors (n = 84) experienced 8.96 additional times the odds (95% CI: 2.81-28.56). Overall, we predict 43% (95% CI: 38-53%) of Latinx survivors (n = 177), 36% (95% CI: 31-40%) of Black survivors (n = 480) and 23% (95% CI: 14-32%) of white survivors (n = 83); 37% (95% CI: 33-40%) of women (n = 656) and 29% (95% CI: 18-42%) of men (n = 84) received advocacy services with DVRR.ConclusionDirect-to-advocacy ED referrals facilitated by eHealth technology improve access to advocacy care for all survivors in this sample; marginalized racial and ethnic groups most often victimized by DV appear to have the highest rates of connection to advocacy.