Background

Racial/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.

Methods

We 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.

Results

Of 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.

Conclusion

Direct-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.

Objective

The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents by evaluating evidence for the depersonalization/derealization dissociative subtype of PTSD as defined by the DSM-5 and then examining a broader set of dissociation symptoms.

Method

A sample of treatment-seeking, trauma-exposed adolescents 12 to 16 years old (N = 3,081) from the National Child Traumatic Stress Network Core Data Set was used to meet the study objectives. Two models of PTSD/dissociation co-occurrence were estimated using latent class analysis, one with 2 dissociation symptoms and the other with 10 dissociation symptoms. After model selection, groups within each model were compared on demographics, trauma characteristics, and psychopathology.

Results

Model A, the depersonalization/derealization model, had 5 classes: dissociative subtype/high PTSD; high PTSD; anxious arousal; dysphoric arousal; and a low symptom/reference class. Model B, the expanded dissociation model, identified an additional class characterized by dissociative amnesia and detached arousal.

Conclusion

These 2 models provide new information about the specific ways PTSD and dissociation co-occur and illuminate some differences between adult and adolescent trauma symptom expression. A dissociative subtype of PTSD can be distinguished from PTSD alone in adolescents, but assessing a wider range of dissociative symptoms is needed to fully characterize adolescent traumatic stress responses.