Initial ED Screening and Assessment to address the stigma and under-reporting of IPV among South Asian women in Surrey, BC.

The question I asked was: “How will you prevent unintended consequences such as partners avoiding the hospital entirely once they learn EDs are screening women for IPV?” This question challenged the feasibility of the proposed ED-based solution by asking the presenter to confront a real-world behavioural response that could undermine the intervention and worsen access to care.

The presenter tried to address the concern by stating that the screening would be applied universally to all female patients, making it feel routine and non-targeted, similar to standard questions about allergies or medical history. While the intention was reasonable, the answer did not actually engage with the core issue I raised. Universal screening does not change how controlling partners interpret the interaction, nor does it mitigate the risk of avoidance or retaliation. The response focused on optics (“no one will feel singled out”) rather than addressing the behavioural and cultural dynamics that drive under-reporting and avoidance.

The presenter answered promptly and confidently, showing that she was familiar with the concept of universal IPV screening. She recognized the importance of avoiding the appearance of ethnic targeting, which shows awareness of equity considerations. Her response also demonstrated an understanding that routine processes can reduce stigma, which is a useful starting point.

First, the answer did not address the core unintended consequence I raised. In Surrey’s South Asian communities, abusive partners may avoid or restrict ED access regardless of whether screening is universal. Many partners are highly alert to anything that might expose private family matters. Routine screening will not change how they interpret a nurse separating the woman or asking personal questions. This behavioural and cultural reality was not acknowledged in the answer. Second, the response overlooked the practical limits of an ED environment. Nurses work under constant time pressure, often without private space or interpreter support. These conditions make meaningful IPV screening difficult. Disclosure is tied to fear of shame, community gossip, immigration dependency, and financial control. Comparing IPV screening to asking about allergies oversimplifies a situation shaped by fear and risk, not routine clinical questions. Third, the answer did not consider retaliation risk after discharge, or the need for a clear follow-up pathway. Many South Asian women return to multigenerational homes where privacy is limited and family influence is strong. Without a plan for safe referral or ongoing support, ED screening can leave women exposed with no protection once they leave the hospital. These missing elements weaken the overall feasibility and safety of the proposed intervention.

The presenter could strengthen the proposal by outlining strategies that reduce the likelihood that partners might avoid or restrict ED visits once screening becomes known. This may include embedding IPV questions within broader psychosocial assessments rather than presenting them as a separate or conspicuous screening activity. Developing discreet workflows may also help reduce perceived risk. These can place IPV questions alongside routine health items, which makes the screening feel less noticeable and less targeted. Together, these approaches may help maintain access to emergency services.

The intervention would benefit from a clearer recognition of the cultural realities that shape disclosure among South Asian women in Surrey. Factors such as immigration dependency, language barriers, and partner or family surveillance can significantly influence a woman’s willingness and ability to speak openly. Integrating culturally informed assessment tools and ensuring timely interpreter support would improve both the safety and feasibility of the screening process.

A critical component of any IPV intervention is ensuring that screening does not inadvertently increase risk once the woman leaves the ED. The proposal would be stronger with clear post-visit safety measures, such as brief safety planning consultations, or automatic linkage with culturally appropriate community organizations. A structured protocol for covert referral when a partner is present would also strengthen the intervention.