Screening:Why, Who, When, How

 *Screening Tools

WHY screen
IPV is prevalent.  Nearly one-third of American women (31%) report having experienced physical or sexual abuse and/or stalking by an intimate partner at some point in their lives, according to the National Intimate Partner and Sexual Violence Survey (NISVS): 2010 from the Centers for Disease Control (CDC) http://www.cdc.gov/violenceprevention/nisvs/
IPV impacts health IPV is associated with: adverse effects on women’s reproductive health, chronic medical conditions, behavioral health problems as well as acute injuries.  See Clinical Cues/Health Impact of IPV.
IPV assessment is recommended by medical professional organizations.  There is adequate evidence that available screening instruments can identify current and past abuse or increased risk for abuse. Organizations recommending IPV Screening:
  • American Academy of Pediatrics (AAP)
  • American College of Obstetricians and Gynecologists (ACOG)
  • American Medical Association (AMA)
  • American Nursing Association (ANA)
  • American Psychiatric Association (APA)
  • Institute of Medicine
  • U.S. Public Services Task Force (USPSTF)
IPV screening can prevent violence against women.  Screening is an opportunity for education and intervention. There is adequate evidence that effective interventions can reduce violence, abuse, and physical or mental harms for women of reproductive age. US Preventive Health Services Task Force: www.uspreventiveservicestaskforce.org/uspstf12/ipvelder/ipvelderfinalrs.htm#summary
WHO to screen 

Universal screening is recommended by USPSTF for all women of reproductive age (15 to 50, earlier if already dating). 
Screen anyone whenever signs or symptoms raise concerns.

WHEN to screen

Screen and assess for IPV during health care visits for primary care, obstetrics and gynecology, mental health, ED, pediatrics*
  • Initial visit
    • Interim  visit –whenever a routine medical history is taken or if visit is new for:
      physical injury
      sexually transmitted infection
      preconception or inter-conception care
      family planning or abortion
      mental health symptoms
      dental injuries
      smoking, alcohol or substance abuse
      chronic disorder complaints (gastrointestinal, headaches, pain)
  •  Urgent care/Emergency Department – all injuries, and whenever a routine medical history is taken. Over a third of all women seen in the emergency room for violence-related injuries were injured by a current or former intimate partner
  • Obstetrics - initial visit, each trimester and postpartum visit   
*option to assess mothers of patients during child visits as well as teens who are patients
HOW to screen
Screening should be done privately and with the patient alone.  If an interpreter is needed, use a professional interpreter in person or by phone.  Never use a family member or friend.
*Screening Tools

A number of screening tools have been evaluated and shown to be effective in identifying victims of intimate partner violence (IPV). In a recent systematic evidence review, the USPSTF noted several screening instruments with high sensitivity and specificity for identifying IPV in the health care setting. The Centers for Disease Control has published a compilation of assessment tools for IPV that compares the psychometric properties of existing tools.
 
Click here for a pdf version of sample IPV screening/assessment tool for health care providers. Click here for a pdf version of sample IPV screening/assessment tool to use when children are present.
   
*Relationship Safety Card
 
It is important to note that research also shows that using a safety-card approach to identify IPV has been proven to be an effective way to screen and provide brief counseling on IPV – resulting in improved health outcomes for women and creating opportunities for universal education about healthy relationships.
 
It is strongly recommended to combine any self-administered questionnaire or use of screening tools described above with a face-to-face discussion about IPV using a safety card as the most effective way to conduct both screening AND brief counseling for IPV.
 
Click here for a video on health care providers screening for reproductive coercion using a relationship safety card.
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Screening for Reproductive Coercion
 
Assess for reproductive coercion (family planning, abortion, pregnancy test discussions):
  • “Does your partner support your decision about when or if you want to become pregnant?”
  • “Has you partner ever interfered with your birth control or tried to get you pregnant when you didn’t want to be?”
 




There are many different safety cards available through intimate partner violence programs.  See resources section or information on ordering for your practice.