One-hour Introduction to Best Practice Screening: Addressing Intimate Partner Violence in Healthcare Settings
This training serves as an introduction to the full training and is open to healthcare providers and domestic violence advocates. Participants will leave this training with the necessary information, tools and materials to assess and respond to intimate partner violence, reproductive and sexual coercion using an evidence-based intervention.
Did you know? The Affordable Care Act (ACA) mandates that women and adolescents receive certain preventive health services at no additional cost to the patient. Among the eight core preventive health services covered by this guidance was interpersonal and domestic violence screening and counseling.
The Affordable Care Act defines screening as: “screening may consist of a few, brief, open-ended questions. Screening can be facilitated by the use of brochures, forms, or other assessment tools including chart prompts.” The US Preventive Services Task Force recommends universal screening at least once a year for all women of child-bearing age.
The ACA defines counseling as: “provides basic information, including how a patient’s health issues may relate to violence and referrals to local domestic violence specialists when patients agree to referrals. Easy-to-use tools such as patient brochures, safety plans, and provider educational tools, as well as training materials, are available through the HHS-funded Domestic Violence Resource Network, including the National Resource Center on Domestic Violence (www.acf.hhs.gov/programs/fysb/programs/family-violence-prevention-services/programs/centers) (link is external).”
- Oregon is home to many service professionals with expertise in serving those affected by domestic violence. A list of providers can be found at http://www.ocadsv.org/find-help
One of the most common screens for Intimate Partner Violence (IPV) that healthcare providers use is “do you feel safe at home?”. However, no published studies have found a one-question screen to be a reliable and valid intimate partner violence screening tool.
Recommended IPV Screening and Assessments
In a recent systematic evidence review, the U.S. Preventive Services Task Force noted several screening instruments with high sensitivity and specificity for identifying IPV in the health care setting.
- The U.S. Preventive Services Task Force recommendations for healthcare providers: http://www.uspreventiveservicestaskforce.org/3rduspstf/famviolence/famviolrs.htm (link is external)
- The Centers for Disease Control also published a compilation of assessment tools for IPV that compares existing tools, and can be found here: http://www.cdc.gov/ncipc/pub-res/images/ipvandsvscreening.pdf (link is external) .
However, a 2014 meta analysis showed that while screening for IPV was successful in identifying victims, it had no effect on rates of violence, health, or follow-up for support. This highlights the importance of clinical settings designing interventions that go beyond just asking screening questions.
Disclosure-based IPV screening tools—or, tools whose purpose is to identify survivors of domestic violence– on their own are not helpful in improving the health and safety of women. A screen for IPV must be accompanied by an appropriate, supported response beyond a cold referral. To address this gap in practice, new tools are being developed and evaluated.
One of the more up-to-date tools that the American Congress of Obstetricians and Gynecologists recommends is a brochure-based intervention facilitating a conversation between the clinician and the patient that takes less than a minute, unless IPV is disclosed. If IPV is disclosed, the clinician is trained to respond appropriately and to partner with a community-based advocate.
Unlike many of the older tools reviewed by USPSTF, this is not a disclosure-based screen, but is a universal education based assessment on healthy and unhealthy relationships, that is specific to a reproductive health visit and provides guidance on tailoring the conversation to the content of the visit.
- The intervention’s online toolkit, provided free of charge by Futures Without Violence’s National Health Resource Center on Domestic Violence (HRC) with support of the Department of Health and Human Services (DHHS), Administration for Children and Families, can be found here: http://www.healthcaresaboutipv.org (link is external)
However, when a patient does disclose IPV during this assessment, one study found that among those with recent IPV, there was a 71% reduction in the odds of pregnancy pressure and coercion (a form of IPV) at the follow-up, 12 to 24 weeks later. Additionally, women who received information about safety were more likely to report ending a relationship because the relationship was unhealthy or because they felt unsafe regardless of whether they had disclosed a history of IPV.
This intervention has been piloted in Oregon at several sites through Project Connect (2012-2015, Contact: Julie McFarlane, Oregon Health Authority) and Safer Futures (2013-2017, Contact: Christine Heyen, Oregon Department of Justice), in partnership with OCADSV.
This intervention also serves as primary prevention, as it sets a norm that safe and healthy relationships are an important part of a person’s health. People trust their healthcare providers, so discussing relationships provides a critical point of intervention that may not otherwise occur. For full information on implementing this intervention, please contact Sarah Keefe at email@example.com (link sends e-mail) or 503-230-1951 or Futures Without Violence at www.healthcaresaboutipv.org (link is external).
 O’Doherty Lorna J, Taft Angela, Hegarty Kelsey, Ramsay Jean, Davidson Leslie L, Feder Gene et al. Screening women for intimate partner violence in healthcare settings: abridged Cochrane systematic review and meta-analysis BMJ 2014; 348:g2913
 Miller E, Decker MR, McCauley HL, Tancredi DJ, Levenson RR, Waldman J, Schoenwald P, Silverman JG. A Family Planning Clinic Partner Violence Intervention to Reduce Risk Associated with Reproductive Coercion. Contraception. 2011;83:274-280.
 McFarlane J, Groff JY, O’Brien JA, Watson K. Secondary Prevention of Intimate Partner Violence: A Randomized Controlled Trial. Nursing Research. 2006;55(1):52-61