Health care screening & follow-up for intimate partner violence
Health care professionals screen female patients about past or present experience of intimate partner violence (IPV) by asking focused questions. Providers may use a structured screening tool, directly ask one question, or ask a series of questions. Screening can occur via in-person communication or computer-based methods and be administered for all female patients or only for high-risk patients. Follow-ups such as counseling, home visiting, mentoring, or referrals for other services are provided to women with positive screening results (Cochrane-O’Doherty 2015).
Expected Beneficial Outcomes (Rated)
Reduced intimate partner violence
Reduced unhealthy relationships
Other Potential Beneficial Outcomes
Increased awareness of intimate partner violence
Evidence of Effectiveness
There is some evidence that health care screening for intimate partner violence (IPV) paired with follow-ups such as counseling and home visitation reduce IPV recurrence rates (USPSTF-Nelson 2012). Routine screening with counseling can also increase the likelihood that victims will end unhealthy relationships (USPSTF-Nelson 2012). Routine screening without follow-up has been shown to increase IPV victim identification (Cochrane-O’Doherty 2015). Additional evidence on best intervention practices is needed to confirm effects.
Women are more likely to disclose IPV when completing a self-administered assessment such as a computerized questionnaire than when questioned face-to-face. HITS (Hurt, Insult, Threaten Scream), the Woman Abuse Screening Tool (Rabin RF, Jennings JM, Campbell JC, Bair-Merritt MH. Intimate partner violence screening tools: A systematic review. American Journal of Preventive Medicine. 2009;36(5):439-45.e4.
Link to original source (journal subscription may be required for access)), the Ongoing Violence Assessment Tool (Ernst AA, Weiss SJ, Cham E, Hall L, Nick TG. Detecting ongoing intimate partner violence in the emergency department using a simple 4-question screen: The OVAT. Violence and Victims. 2004;19(3):375-84.
Link to original source (journal subscription may be required for access)), HARK (Humiliation Afraid, Rape, Kick) (Sohal 2007), and Slapped, Threatened and Throw (Paranjape 2006, USPSTF-Nelson 2012) are examples of screening instruments that accurately identify IPV victims.
Client-centered and supportive IPV screening, prompt follow-up services, culturally sensitive screening plus counseling, and staff and clinician training are recommended in a system-level approach (IOM-Preventive women services 2011, Miller 2015b).
Impact on Disparities
No impact on disparities likely
As of 2012, California, New York, Pennsylvania, and Virginia require health care professionals to provide universal screening for intimate partner violence (FVPF 2012).
USPSTF-IPV screening - US Preventive Services Task Force (USPSTF). Intimate partner violence (IPV) and abuse of elderly and vulnerable adults: Screening.
Citations - Evidence
* Journal subscription may be required for access.
IOM-Preventive women services 2011 - Institute of Medicine (IOM), Board on Population Health and Public Health Practice (BPH). Clinical preventive services for women: Closing the gaps. Washington, DC: National Academies Press; 2011.
USPSTF-Nelson 2012 - Nelson HD, Bougatsos C, Blazina I. Screening women for intimate partner violence: A systematic review to update the 2004 US Preventive Services Task Force (USPSTF) recommendation. Annals of Internal Medicine. 2012;156(11):796-808.
Rabin 2009* - Rabin RF, Jennings JM, Campbell JC, Bair-Merritt MH. Intimate partner violence screening tools: A systematic review. American Journal of Preventive Medicine. 2009;36(5):439-45.e4.
Ernst 2004* - Ernst AA, Weiss SJ, Cham E, Hall L, Nick TG. Detecting ongoing intimate partner violence in the emergency department using a simple 4-question screen: The OVAT. Violence and Victims. 2004;19(3):375-84.
Sohal 2007 - Sohal H, Eldridge S, Feder G. The sensitivity and specificity of four questions (HARK) to identify intimate partner violence: A diagnostic accuracy study in general practice. BMC Family Practice. 2007;8:49.
Paranjape 2006 - Paranjape A, Rask K, Liebschutz J. Utility of STaT for the identification of recent intimate partner violence. Journal of the National Medical Association. 2006;98(10):1663–9.
Cochrane-O’Doherty 2015 - O’Doherty L, Hegarty K, Ramsay J, et al. Screening women for intimate partner violence in healthcare settings. Cochrane Database of Systematic Reviews. 2015;(7):CD007007.
Miller 2015b - Miller E, McCaw B, Humphreys BL, Mitchell C. Integrating intimate partner violence assessment and intervention into healthcare in the United States: a systems approach. Journal of Women's Health. 2015;24(1):92-99.
Citations - Implementation Examples
* Journal subscription may be required for access.
FVPF 2012 - Family Violence Prevention Fund (FVPF). Compendium of state statutes and policies on domestic violence and health care. Washington DC: Administration for Children and Families (ACF); 2012.