MP07: Rate of return: prevalence and correlates of revictimization among sexual and domestic assault cases presenting to the emergency department

A. Drumm; K. Muldoon; F. Blaskovits; T. Leach; M. Heimerl; K. Sampsel

doi:10.1017/cem.2018.161

MP07: Rate of return: prevalence and correlates of revictimization among sexual and domestic assault cases presenting to the emergency department

CJEM ◽

10.1017/cem.2018.161 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S42-S42

Author(s):

A. Drumm ◽

K. Muldoon ◽

F. Blaskovits ◽

T. Leach ◽

M. Heimerl ◽

...

Keyword(s):

Emergency Department ◽

Domestic Violence ◽

Substance Use ◽

Sexual Assault ◽

Care Program ◽

Sexual Assaults ◽

Domestic Assault ◽

Ottawa Hospital ◽

High Prevalence ◽

Patients At Risk

Introduction: Many survivors of sexual and domestic assault return to violent environments following post-assault care. The objective of this study was to estimate the annual prevalence of revictimization and examine factors associated with return emergency department (ED) visits following their initial encounter for sexual or domestic assault. Methods: The Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital is the only program in Ottawa offering emergency and forensic care for survivors of sexual assault and domestic violence. Information on demographics, assailant characteristics and clinical presentation were extracted from the SAPACP case registry (January 1 2015- January 31 2016). We conducted descriptive analyses to describe the study sample, and bivariable and multivariable logistic regression modelling to assess factors most strongly associated with revictimization using odds ratios (OR), adjusted OR (AOR) and 95% confidence intervals (CI). Results: Among 377 unique patients seen at the SAPACP, there were 409 encounters for sexual and domestic violence. There were 24 revictimization cases (6.4%) with the number of repeat visits ranging from 2-6. There were 343 (91.0%) female patients and 182 (48.3) under the age of 25. There were 243 (64.5%) sexual assaults, 125 (33.2%) physical assaults, and 42 (11.1%) verbal assaults. Compared to patients who presented once, revictimized patients were more likely to have experienced violence from a current or former intimate partner (AOR:3.02, 95% CI:1.24-7.34), have a substance use disorder (AOR:5.57, 95% CI:2.11-14.68), and were more likely to be taking anti-depressants (AOR:3.34, 95% CI:1.39-8.01). Conclusion: This study has identified a high prevalence of revictimization, with some clients being revictimized as many as 6 subsequent times. Key factors to help identify patients at risk of revictimization are assaults by intimate partners, having substance use problems, and being on antidepressants. Reducing revictimization and preventing further violence is a critical component of care to ensure survivors are safe following their ED encounter.

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LO46: Lost to follow-up post-sexual and domestic assault: An evaluation of prevalence and correlates of cases presenting to the emergency department

CJEM ◽

10.1017/cem.2019.89 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S24

Author(s):

F. Blaskovits ◽

K. Muldoon ◽

A. Drumm ◽

T. Leach ◽

M. Heimerl ◽

...

Keyword(s):

Substance Use ◽

Sexual Assault ◽

Care Program ◽

Gender Based Violence ◽

Domestic Assault ◽

Sexual Assault Survivors ◽

Mental Health Functioning ◽

Gender Based ◽

And Gender

Introduction: Domestic violence (DV) and sexual assault (SA), together called sexual and gender-based violence (SGBV), are traumatic and life-changing events. Post-assault follow-up care is essential for survivor recovery through medical care, mental health functioning, and injury reassessment. The objective of this analysis was to determine the frequency of loss to follow-up (LTFU) in a SGBV population, and the characteristics most commonly associated with LTFU. Methods: The Sexual Assault and Partner Abuse Care Program (SAPACP) is the only Ottawa program for emergency/forensic care. Demographic and assault characteristics were abstracted from the SAPACP clinical case registry (1 Jan 2015 to 20 Dec 2017). Descriptive analyses and bivariable/multivariable logistic regression modelling assessed factors most strongly associated with LTFU using odds ratios (OR), adjusted OR (AOR), and 95% confidence intervals (CI). Results: Among 894 initial SAPACP visits, 482 (53.9%) were LTFU. Of those LTFU, 445 (92.3%) were female, 185 (38.4%) arrived by ambulance, 284 presented acutely (58.9%), 70 (14.5%) had substance use issues, and 82 (17.0%) were re-victimized. There were 229 (47.5%) sexual assaults, 201 (41.7%) physical assaults, and 92 (19.1%) verbal assaults. LTFU patients were more likely to arrive by ambulance (AOR: 1.09, 95% CI: 1.34-2.69), experience re-victimization (AOR: 1.94, 95% CI: 1.25-3.03), and have a substance use disorder (AOR: 1.67, 95% CI:1.02-2.73). Those more likely to attend follow-up included sexual assault survivors (AOR: 0.37, 95% CI: 0.27-0.50) and acute presenters (AOR: 0.58, 95% CI: 0.44-0.78). Conclusion: Over half of patients arriving for initial SAPACP visits did not follow-up. LTFU was more likely among cases that arrived by ambulance, and those involving revicitimization or substance use disorders. Follow-up is critical for maintaining mental and physical health post-trauma. While some characteristics increased follow-up likelihood, this study has identified groups that need attention to reduce LTFU.

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Enacting an Improved Response to Sexual Assault: A Criminal Justice Practitioner’s Guide

10.3768/rtipress.2020.op.0066.2007 ◽

2020 ◽

Author(s):

Patricia A. Melton

Keyword(s):

Domestic Violence ◽

Criminal Justice ◽

Law Enforcement ◽

Sexual Assault ◽

Best Practices ◽

Violent Crime ◽

Sexual Assaults ◽

Law Enforcement Agencies ◽

Violent Crimes ◽

Serial Offenders

Sexual assault is a violent crime that traumatizes individual victims and endangers entire communities. Every victim of sexual assault deserves an opportunity for justice and access to the resources they need to recover from this trauma. In addition, many perpetrators of sexual assaults are serial offenders who also commit other violent crimes, including armed robberies, aggravated assaults, burglary, domestic violence, and homicides, against strangers and acquaintances. Criminal justice agencies have the power to create a strategic, sustainable plan for an improved response to sexual assault that aligns with current best practices and national recommendations. In this document, we define an “improved response” as an approach that supports effective investigation and prosecution of sexual assault cases, holds perpetrators accountable, and promotes healing and recovery for victims of sexual assault. This guide will help prosecutor and law enforcement agencies create a process with milestones, goals, and suggested actions, all designed to support a successful and sustainable approach for addressing sexual assault cases. Improving the criminal justice system’s response to sexual assault ultimately improves public safety and promotes trust between criminal justice agencies and the communities they serve.

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MP45: What to do with #MeToo: pre and post presenting patterns of intimate partner violence

CJEM ◽

10.1017/cem.2020.193 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S59-S59

Author(s):

A. Sobiesiak ◽

K. Muldoon ◽

L. Shipeolu ◽

M. Heimerl ◽

K. Sampsel

Keyword(s):

Intimate Partner Violence ◽

Sexual Assault ◽

Social Movement ◽

Emergency Care ◽

Partner Violence ◽

Care Program ◽

Intimate Partner ◽

Clinical Population ◽

Physical Assault ◽

Ottawa Hospital

Introduction: The #MeToo social media movement gained international status in October 2017 as millions disclosed experiences of sexual and intimate partner violence. People who experience violence from a former/current intimate partner may not present for care for many reasons, among them not knowing where to go for care, or not realizing they were experiencing abuse since the behavior was portrayed as ‘normal’. Empirical research identified increased police reporting, internet searches, and new workplace regulations on sexual assault/harassment after #MeToo. Less is known about how #MeToo has influenced hospital-based care, particularly among IPV cases. We aimed to investigate if the #MeToo social movement influenced patterns of IPV cases presenting for emergency care. Methods: This study took place at the Sexual Assault and Partner Abuse Care Program (SAPACP), within the Emergency Department of The Ottawa Hospital. Patients seen from November 1st, 2016 through to September 30th, 2017 was considered Pre-#MeToo and those seen November 1st, 2017 to September 30th, 2018 was considered Post-#MeToo. All patients seen in October 2017 were excluded. Analyses compare the proportion and characteristics of IPV cases seen Pre- and Post-#MeToo. Log-binomial regression models were used to calculate relative risk and 95% CI. Results: 890 cases were seen by the SAPACP during the total study period, of which 564 (63%) were IPV cases. 258 IPV cases were seen Pre-#MeToo and 306 IPV Post-#MeToo. The clinical presentation for IPV cases was similar between both periods where approximately 42% of IPV cases presented for sexual assault, 50% presented for physical assault. An increase in frequency and proportion of IPV cases was observed post-#MeToo. Post-#MeToo there were 48 additional cases of IPV, corresponding to almost a 20% increase in risk compared to the Pre-#MeToo period. (RR: 1.19, 95% CI: 1.07-1.31) Post-#MeToo, there were more presenting cases of IPV among male/trans cases (9 vs 26) and youth cases (82 vs 116). Conclusion: #MeToo is a powerful social movement that corresponded with a significant increase in IPV cases presenting for emergency care. While the assault characteristics among IPV cases remained similar, an important contribution of this research is the increase in youth, male/transgender patients who presented for care post-#MeToo. Continued investigations into pre- post-#MeToo trends is needed to understand more about the changing clinical population and to inform resource and service allocation.

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P114: Geographies of sexual assault: using geographic information system analysis to identify neighbourhoods affected by violence

CJEM ◽

10.1017/cem.2019.305 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S105

Author(s):

K. Muldoon ◽

L. Galway ◽

A. Drumm ◽

T. Leach ◽

M. Heimerl ◽

...

Keyword(s):

Sexual Assault ◽

Geographic Distribution ◽

Hot Spots ◽

System Analysis ◽

Partner Abuse ◽

Care Program ◽

High Income ◽

Spatial Analyses ◽

Census Tracts ◽

Ottawa Hospital

Introduction: Emergency Departments are a common point of access for survivors of sexual and gender-based violence (SGBV), but very little is known about where survivors live and the characteristics of the neighbourhoods. The objective of this study was to use hospital-based data to characterize sexual and domestic assault cases and identify geographic distribution across the Ottawa-Gatineau area. Methods: Data for this study were extracted from the Sexual Assault and Partner Abuse Care Program (SAPACP) case registry (Jan 1-Dec 31, 2015) at The Ottawa Hospital. Spatial analyses were conducted using 6-digit postal codes converted to Canadian Census Tracts to identify potential geographic areas where SGBV cases are clustered. Hot-spots were defined as Census Tracts with seven or more assaults within a single calendar year.Data for this study were extracted from the Sexual Assault and Partner Abuse Care Program (SAPACP) case registry (Jan 1-Dec 31, 2015) at The Ottawa Hospital. Spatial analyses were conducted using 6-digit postal codes converted to Canadian Census Tracts to identify potential geographic areas where SGBV cases are clustered. Hot-spots were defined as Census Tracts with seven or more assaults within a single calendar year. Results: In 2015, there were 406 patients seen at the SAPACP, 348 had valid postal codes from Ottawa-Gatineau and were included in the analyses. Over 90% of patients were female and 152 (43.68%) were below 24 years of age. Eight hot-spots were identified including 3 in the downtown entertainment district, 3 lower income areas, 1 high income neighbourhood, and 1 suburb more than 20km from downtown. Conclusion: This study is of the first to use hospital-based data to examine the geographic distribution of SGBV cases, with key findings including the identification of high-income neighbourhoods and suburbs as SGBV hot-spots. Alongside efforts like the #MeToo movement, this evidence challenges stereotypes of assault survivors and highlights the breadth and widespread nature of SGBV.

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LO49: Achieving just outcomes: forensic evidence collection in sexual assault cases

CJEM ◽

10.1017/cem.2018.111 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S23-S24

Author(s):

K. Sampsel ◽

K. Muldoon ◽

A. Drumm ◽

T. Leach ◽

M. Heimerl

Keyword(s):

Sexual Assault ◽

Care Program ◽

Access Point ◽

Cross Sectional Study ◽

Forensic Evidence ◽

Cross Sectional ◽

Logistic Regression Models ◽

Ottawa Hospital ◽

Evidence Collection ◽

Care And Justice

Introduction: Achieving just outcomes in sexual assault cases is one of the most serious and complex problems facing the health care and justice systems. The objectives of this analysis were to determine the prevalence and correlates of Sexual Assault Evidence Kit (SAEK) completion and release to police among sexual assault cases presenting at the hospital emergency department. Methods: Data for this cross-sectional study come from the Sexual Assault and Partner Abuse Care Program (SAPACP) case registry (Jan1-Dec31, 2015) at The Ottawa Hospital, a unique medical-forensic access point and the only facility offering SAEK collection in Ottawa. Bivariable and multivariable logistic regression models were conducted using odds ratios (OR), adjusted ORs, and 95% confidence intervals (CI). Results: In 2015 406 patients were seen by the SAPACP and 202 (77.10%) were eligible for a SAEK. Among eligible cases, 129 (63.86%) completed a SAEK and only 60 (29.70%) released the SAEK to police for investigation. Youth cases below 24 years of age (AOR:2.23, 95% CI: 1.18-4.23) and presenting within 24h (AOR:0.93-3.40) were the strongest independent factors contributing to SAEK completion. Cases who were uncertain of the assailant (AOR:3.62, 95% CI:1.23-10.67) and assaults that occurred outdoors (AOR:3.14, 95% CI:1.08-9.09) were the cases most likely to release the SAEK to police. Conclusion: Our study has shown high attrition levels along the continuum of care and justice for sexual assault case. Even with access to specialized forensic evidence collection, many do not complete a SAEK and even fewer release the evidence to police for legal investigation.

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Identifying Domestic Violence (DV) and sexual assault (SA) presentations and referral pathways at John Hunter Hospital Emergency Department: comparative analysis of DV and SA cases

10.21203/rs.3.rs-665031/v1 ◽

2021 ◽

Author(s):

Nafiseh Ghafournia

Keyword(s):

Health Care ◽

Emergency Department ◽

Domestic Violence ◽

Early Intervention ◽

Sexual Assault ◽

Health Care Professionals ◽

Goodness Of Fit ◽

Study Data ◽

Goodness Of Fit Test ◽

Cross Sectional

Abstract Background: There are a number of negative and often long-term mental and physical health consequences of Domestic violence (DV) and Sexual assault (SA). Women experiencing DV and SA visit their health care professional more frequently than women not experiencing these abuses. Health care professionals in any health care settings can play crucial roles in identifying, managing and preventing DV and SA. In particular, those who work in emergency departments (EDs) are in a unique position to identify patients and initiate early interventions as they are often the first point of contact to access help. Methods: This is a retrospective observational cross-sectional study. Data was extracted from the site ED electronic information system (ipm) for all eligible females (alleged assault) who presented within the study period. Statistical analyses were programmed using SAS v9.4 (SAS Institute, Cary, North Carolina, USA). All data were checked for completeness and discrepancies before analysis. Descriptive statistics are reported for all relevant variables. The Hosmer-Lemeshow goodness of fit test was used to determine the adequacy of fit between the final model and the data. Results: Study findings indicate the high level of mental health issues among women presenting with both DV and SA. More than half of the victims had recurrent presentations to ED. The majority of victims were referred to the related support services within hospital or external services. Most of injuries in the sample were sever physical injuries. Conclusions: As the first point of contact, ED health professionals have a crucial role to identify and respond to SA and DV cases. If identified early, the recurrent admissions can be prevented and any early intervention can have a positive benefit for the longer-term health of the DV and SA victims. It can also save health care system spending. The development of a DV/SA flowchart for identification of these cases in ED as well as a clear referral pathway and ideally mandatory DV routine screening at EDs in all hospitals would be some practical strategies for achieving early intervention. Keywords: Domestic Violence, Sexual assault, Emergency Department, Domestic Violence screening, recurrent presentations

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COVID-19 pandemic and violence: rising risks and decreasing urgent care-seeking for sexual assault and domestic violence survivors

BMC Medicine ◽

10.1186/s12916-020-01897-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Katherine A. Muldoon ◽

Kathryn M. Denize ◽

Robert Talarico ◽

Deshayne B. Fell ◽

Agnes Sobiesiak ◽

...

Keyword(s):

Domestic Violence ◽

Sexual Assault ◽

Urgent Care ◽

Physical Assault ◽

Care Seeking ◽

Chi Square ◽

Ottawa Hospital ◽

Count Ratio ◽

Case Count ◽

Domestic Violence Program

Abstract Background There is little information on care-seeking patterns for sexual assault and domestic violence during the COVID-19 pandemic. The objective of this study was to examine the changes in emergency department (ED) admissions for sexual assault and domestic violence since the COVID-19 pandemic was declared. Methods Observational ED admissions data from The Ottawa Hospital were analyzed from March 4 to May 5 (62 days) in 2020 (COVID-19 period) and compared to the same period in 2018 (pre-COVID-19). Total and mean weekly admissions were calculated for all-cause ED admissions and for sexual and domestic violence cases. A Poisson regression (without offset term) was used to calculate the weekly case count ratio and 95% confidence intervals (CI) between the two time periods. Case characteristics were compared using chi-square tests, and percent differences were calculated. Results Compared to pre-COVID-19, total ED admissions dropped by 1111.22 cases per week (32.9% reduction), and the Sexual Assault and Domestic Violence Program cases dropped 4.66 cases per week. The weekly case count ratio for sexual assault cases was 0.47 (95% CI 0.79–0.27), equivalent of 53.49% reduction in cases, and 0.52 (95% CI 0.93–0.29), equivalent to a 48.45% reduction in physical assault cases. The characteristics of presenting cases were similar by age (median 25 years), sex (88.57% female), assault type (57.14% sexual assault, 48.57% physical assault), and location (31.43% patient’s home, 40.00% assailant’s home). There was a significant increase in psychological abuse (11.69% vs 28.57%) and assaults occurring outdoors (5.19% vs 22.86%). Conclusion This study found a decrease in ED admissions for sexual assault and domestic violence during COVID-19, despite societal conditions that elevate risk of violence. Trends in care-seeking and assault patterns will require ongoing monitoring to inform the provision of optimal support for individuals experiencing violence, particularly as countries begin to re-open or lock-down again.

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