KY: Domestic ViolencePage 13 of 17

11. Screening for Domestic Violence

Many healthcare and social services professionals are already involved with screening and assessment of clients for domestic violence, including intimate partner violence. Numerous professional associations have taken positions advocating screening of most, if not all, adults. As with all aspects of domestic violence, there are gaps in the research, sometimes resulting in contradictory findings and positions, and more research is needed.

In 2011 the Institute of Medicine (IOM) released a report on preventive services with recommendations that were quickly adopted by the U.S. Department of Health and Human Services. One of the recommendations was to provide screening and counseling to women regarding “interpersonal and domestic violence” (ASPE, 2013).

In January 2013 the U.S. Preventive Services Task Force (USPSTF) changed its recommendations regarding screening for IPV in women of childbearing age and screening for abuse and neglect in the elderly. The task force “recommends that clinicians screen women of childbearing age for intimate partner violence, such as domestic violence, and provide or refer women who screen positive to intervention services.” The task force also “concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening all elderly or vulnerable adults (physically or mentally dysfunctional) for abuse and neglect” (USPSTF, 2013).

Prior to January 2013, the recommendation regarding IPV had been similar to the current one for abuse and neglect of the elderly. The research and reasoning that goes into recommendations, as well as suggestions for implementing recommendations, are discussed in detail on the USPFSTF website.

In discussing specific tools for screening, the task force notes that several instruments can be used to screen women for IPV. Those with the highest levels of sensitivity and specificity for identifying IPV are:

  • Hurt, Insult, Threaten, Scream (HITS)—includes four questions, can be used in a primary care setting, and is available in both English and Spanish versions. It can be self- or clinician-administered.
  • Ongoing Abuse Screen/Ongoing Violence Assessment Tool (OAS/OVAT)
  • Slapped, Threatened, and Throw (STaT)—three-item self-report instrument that was tested in an emergency department setting
  • Humiliation, Afraid, Rape, Kick (HARK)—a self-administered four-item instrument
  • Modified Childhood Trauma Questionnaire, Short Form (CTQ-SF)
  • Woman Abuse Screen Tool (WAST)

In regard to elderly and vulnerable adults, the task force found no valid, reliable screening tools to identify abuse of elderly or vulnerable adults in the primary care setting. However, the accompanying discussion reveals that this may be more about a lack of data, many variables, and the need for more research and practice (USPSTF, 2013).

The CDC has supported at least two studies that have evaluated assessment tools, and their reports can be consulted via the CDC website by anyone looking for more information about available screening tools for varying practice settings:

  • Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings: Version 1 (pub. 2007)
  • Measuring Intimate Partner Violence Victimization and Perpetration: A Compendium of Assessment Tools (pub. 2006)

Healthcare professionals should make sure they understand and are trained to use any procedures, tools, and forms their institution already has in place for screening and assessment. In addition, it is important to be up to date on your state’s requirements for reporting and documenting domestic violence information. Kentucky’s reporting requirements are discussed in a later section.

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