Videoconferencing for Domestic Violence Victims — Providing Access to the Judicial System
By Karen Possessky, MSW, LSW
Social Work Today
Vol. 5 No. 5 P. 33

• Temperature

• Pulse

• Respiration

• Blood Pressure

• Domestic Violence Screen?

Go to the emergency department (ED) and a nurse will check your vital signs during triage. From there, a physician will examine you and order additional tests. Most of us trust that this process will pinpoint our ailment. But what if the ailment is domestic violence?

Estimates show that the United States spends $4.1 billion every year on direct healthcare costs related to domestic violence (National Center for Injury Prevention and Control, 2003). Healthcare settings cannot ignore the prevalence of domestic violence when costs are so high and victims so plentiful. Roughly 22% to 35% of all women seeking treatment in the ED are abused by a partner, husband, or ex-boyfriend (American Medical Association). Most will not volunteer information about the abuse.

Today, many healthcare facilities use a screening tool to identify victims. The domestic violence screening practice grew in the 1990s when the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) developed standards for identifying victims in EDs. However, the broad guideline fails to instruct EDs on how to specifically identify and assess victims. Providers are left to interpret the standard and develop a screening process on their own. The result tends to be a written policy that complies with JCAHO requirements but lacks a provision for ensuring that screening for abuse is adequately done.

Luckily, a resource exists to help develop screening systems through consultation and technical assistance. Domestic Violence HELP is a national nonprofit agency with a goal and purpose to reduce domestic violence through:

• H — healthcare consultation;

• E — education;

• L — legal systems advocacy; and

• P — promoting awareness.

According to President and Cofounder Betsy Burke, starting a screening protocol can take a short or lengthy period of time depending on administrative support. Based on her past experience, she states that it takes a “synergistic combination of the right people in the right place at the right time.” Therefore, success begins with administrative support but also requires written policy and procedure, a valid screening tool, and education for staff conducting the screening.

Mercy Hospital in Pittsburgh successfully developed their screening system for domestic violence in this way. A five-point questionnaire is completed during triage for every patient who passes through the ED. Lorrie Bonaccorsi, RN, BSN, states, “I believe if you approach it in a caring way, the patient will open up” about abuse. The aid of a reliable questionnaire and trained staff helps identify victims, which in turn, creates an opportunity for providing help.

More Than Identifying Victims
Identifying patients who are victims of domestic violence requires healthcare workers to link them to the right resources for protection from abuse. Offering phone numbers and educating patients on the dangers of domestic violence may not be enough for abolishing the malignancy of domestic violence—it’s like partially removing a tumor. We can do more to ensure that these patients get the necessary protection by helping them access the judicial system.

The Allegheny County judicial system, like most, spins a web of complexities that makes it difficult for victims to know how to file for a protection order. Protection from Abuse (PFA) orders can be filed after hours and on weekends at a single location in the downtown area of Pittsburgh. For some, getting to the location requires several buses that may not operate in the middle of the night and for others, presenting themselves at a location known for filing PFA orders can be hazardous.

Victims risk danger when they appear at the courthouse because abusers may be there. The highest risk of death and injury occurs when victims leave their abuser. Petitioning the court for a PFA order can be intimidating.

Technology Trends
PFA orders benefit victims, but only if the orders are accessible and enforceable. A legal document that protects against abuse provides partial peace of mind and the knowledge that a serious step has been taken to leave the abuser and end the relationship. The accessibility of protection orders must improve because without it, there is no enforceability. The conundrum is how to improve victims’ access to the judicial system without increasing their risk of harm and vulnerability.

District Attorney, Stephen A. Zappala, Jr., sees a solution to this problem and currently promotes the operation of several remote PFA stations at various hospitals in Allegheny County. Zappala, a supporter of domestic violence prevention, believes strongly in the use of technology. Roughly three years ago, the project for installing videoconferencing equipment to create remote stations began. The inspiration for using technology for PFA hearings stems from the state’s use of videoconferencing equipment for arraignments. With two different distributors for the equipment and a cash donation from Verizon Wireless, the project eased its way toward implementation.

Project coordinator Art Keenan acts as a liaison between the district attorney’s office and the community, and he works with interested area hospitals to establish remote PFA stations. Currently, there are six hospitals in and around the Pittsburgh area that have fully operating PFA stations. The first step toward implementing a PFA station is gaining approval from the hospital administration. The next requirement is to establish a binding contract between the hospital and the district attorney’s office. A formal written policy for PFA station use helps hospital workers know when and how to operate the videoconferencing equipment. Finally, installation of the equipment in a private area or room allows court hearings to be held with the use of standard courtroom etiquette—a quiet atmosphere free of commotion.

Womensplace, an agency providing assistance to victims of domestic violence, works with McKeesport and Braddock Hospitals in Allegheny County to operate the remote PFA project. The hospitals host the PFA stations while agency employees facilitate the process for getting the court order. The project has been operating since April 2004 in the area of Allegheny County known as the Mon Valley, allowing victims greater access to the judicial system. Previously, the area had geographical barriers caused by the need to take several buses to get to night court in downtown Pittsburgh. Womensplace Executive Director, Laurie MacDonald, estimates that prior to implementation of the remote PFA project, 30% of its clients endured the risk of traveling downtown to get orders. Since the initiation of the project, MacDonald reports that there has been a 70% increase in the number of PFA orders filed in any given month. The process of getting a permanent PFA order is lengthy, but a “surprising number of people continue the process because they have the opportunity to get it started,” says MacDonald.

Ellen Tomko, medical/legal advocate at Womensplace, facilitates a great number of the videoconferencing PFA orders. She reports that in one year, she conducted 145 PFA orders, 13 of which occurred during the week between Christmas and New Year’s. “It’s scary to a lot of [victims] because they don’t realize they’re going to be on TV until we turn it on,” says Tomko. While waiting for the judge to come on screen, Tomko makes valuable use of the down time. Recognizing that her clients are in a state of trauma, Tomko talks to them about their fears and reassures them that filing a PFA order is the right thing to do.

The impact of Zappala’s videoconferencing PFA project especially benefits the domestic violence victims of the Mon Valley. Tomko points out that many of the women do not have vehicles or money of their own, so it is nearly impossible for them to trek several miles to the downtown Pittsburgh Night Court building. Videoconferencing capability allows victims to utilize resources that are close and known to them. According to Tomko, the reality settles in with victims when the “judge says he or she is going to sign the order and fax it to us.” Victims respond with mixed emotions once the emergency PFA is in their hands. “It’s empowering, but scary too,” states Tomko.

Making a Difference
Maria* presented to the ED, leaving her abusive boyfriend in the middle of the night. She was at home sleeping soundly until her boyfriend came home drunk and eager to fight. She defended herself the best she could before escaping the house with only minor injuries. Talking to the ED social worker, Maria indicates interest in getting a PFA order. She looked confused and surprised when the social worker said she could file a PFA order right in the hospital. “Nah-uh, are you serious?” she asked.

Bethany* came to the ED by ambulance after her fiance punched her in the face during an argument over money. Separated from her children while in the ED, she worried about their protection as well as her own. The social worker offered her the opportunity to file a PFA order on the hospital premises for both her and her children. She took it. When asked whether she would have filed a PFA order if she had to go to the court building, she responded, “Probably not.”

The outcome for domestic violence victims improves with triage screening and collaborative efforts such as those in Allegheny County between the district attorney’s office, hospitals, and community agencies. These services offer easy access to a complex judicial system and the opportunity for victims to speak out about the violence in their life. Opportunity leads to an increase in the number of victims taking action against domestic violence, which hopefully will lead to a decrease in abusive relationships.

— Karen Possessky, MSW, LSW, works as a clinical social worker at Allegheny General Hospital in Pittsburgh. Prior to that, she worked as a social worker in the emergency department at Mercy Hospital and helped establish the Protection from Abuse (PFA) videoconferencing project there. She continues to work at Mercy on an as needed basis and facilitates emergency PFA orders on occasion.

* Indicates anonymous interviews with actual victims of domestic violence who filed Protection from Abuse orders via videoconferencing equipment.

For additional information regarding setting up a domestic violence screening tool at your healthcare facility, contact DV HELP at 412-361-4357.

Art Keenan, project coordinator in the Allegheny County District Attorney’s Office, is available for brief consultation on establishing remote Protection from Abuse stations by calling 412-350-4447.