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Maryland Department of Health
Maternal and Child Health Bureau (MCHB)
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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)
https://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.html
IP
V 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
.
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
.
Click here to read the
CDC’s review: Intimate partner violence and sexual violence victimization assessment instruments for use in health care settings.
Click here to read the
U.S. Preventive Services Task Force (USPSTF) recommendations on screening for family and intimate partner violence
which includes a review of screening tools
.
*
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
.
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.
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IPV LINKS
Definitions
Screening
Why, Who, When, How
*Sample Too
l
Clinical Cues/Health Impact of IPV
Responding
When the Answer is
Yes or No
Safety Assessment
Reporting Requirements
Referring
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Violence Programs
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Privacy Issues
EMRs, HIPAA
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