Domestic violence: Diurnal mismatch between need and availability of services

Objective: To determine whether a diurnal discordance exists between need and availability of services for victims of domestic violence. Methods: A consecutive sample of women presenting to a municipal hospital ED with physical injuries suspected to be related to domestic violence were entered into a registry. Date and time of presentation and perceived need for services information were collected from all patients who answered affirmatively a screening question for domestic violence and whose conditions did not preclude administration of the data collection instrument. The Social Service Departments of all of the 53 911-receiving hospitals in New York City were contacted to ascertain availability of social services for victims of domestic violence by time of day. Results: Twenty-eight of 32 (88%; 95% CI: 71%, 97%) victims of domestic violence presented to the ED during hours other than weekday 9 AM to 5 PM. Of these, 63% desired counseling, 32% lacked a safe place to go, and 82% had children. Of those who had children, 48% were concerned for the children's safety. In-hospital social services were universally available weekday daytime (9 AM to 5 PM) but were available in only 11% of hospitals (95% CI: 4%, 23%) at other times. Conclusion: Approximately nine of ten victims of domestic violence presented to the ED during hours when only about one hospital in ten can provide the special services these patients require. A marked diurnal mismatch appears to exist between availability of domestic violence services in New York City and the need for these services as measured by a representative sample drawn from an ED population.