Within the last year, have you been hit, slapped, kicked or otherwise physically hurt by your partner or ex-partner?
Do you feel safe in your current relationship?
Do you have guns in your home? Has your partner ever threatened to use them when he was angry?
Are you presently forced to have sexual activities?
These sample questionnaire items are taken from the HARK (Humiliation, Afraid, Rape, Kick) screen, Partner Violence Screen, the American Medical Association screen and the Ongoing Abuse Screen, respectively.
If a doctor or nurse practitioner asks you questions like these during a routine visit, don’t be surprised. Your clinician is looking out for your health and safety by following the latest recommendations on screening patients for intimate partner violence, also known as domestic violence.
On Tuesday, the U.S. Preventive Services Task Force released its draft recommendation statement on routine screening for intimate partner violence, which encompasses physical or sexual violence, psychological aggression and coercive tactics or stalking by a current or former partner in a close personal relationship.
The influential panel recommends that clinicians screen all women of reproductive age. This group, previously referred to as women of childbearing age, ranges from 12 to 49. The purpose is to identify women who might otherwise not ask for help.
For women who screen positive, the USPSTF recommends that clinicians provide them with ongoing support services. That could involve multiple contacts through community or home-based visits, rather than a single counseling session or referral. Brief interventions alone have not proven effective in stemming partner violence, according to the independent, volunteer panel of national health experts on prevention and evidence-based medicine.
The USPSTF did not find enough evidence to recommend routine screening in men, who can also be victims of intimate partner violence. In addition, the task force found insufficient evidence to determine benefit or harms of routine screening for elder abuse or among vulnerable adults with disabilities.
This draft recommendation updates the original 2013 guidance for clinicians, which had similar findings. The latest report focuses on screening for people who do not have symptoms, complaints or obvious signs of abuse, such as physical injuries.
The USPSTF analyzed the combined results of 30 randomized controlled trials and other studies involving nearly 15,000 participants. These studies evaluated screening and treatment for domestic violence, accuracy of screening tests and potential harms of screening or treatment for abuse.
[See: How Social Workers Help Your Health.]
Dr. John Epling Jr., a professor of family and community medicine at the Virginia Tech Carilion School of Medicine in Roanoke, is a USPSTF member. In his own clinical primary care practice, he sees the value of screening firsthand.
Unfortunately, it’s not surprising when screening reveals that a patient is experiencing violence. “Intimate partner violence is a really important problem in our society that physicians have a certain interface with,” Epling says. These issues come to the surface because physicians have the ability to talk with patients about their health and what matters most to them, he says.
“Asking about intimate partner violence, in my personal opinion, also gets it out from a under a certain amount of stigma,” Epling adds. “It enables a little bit more conversation about the topic generally.”
More research is needed on the benefits of routine screening for young children, older women, men or older, disabled or vulnerable adults. “At the U.S. Preventive Services Task Force, we make recommendations based on evidence,” Epling says. “An important point is we don’t fill those gaps with our opinions.”
A variety of clues and risk factors can prompt clinicians to assess patients at any age. “Intimate partner violence can cause a number of symptoms from mental illness to substance abuse to chronic pain,” Epling says. “If those are present, it could be part of the routine recommended workup to ask about intimate partner violence.”
A booklet from the Centers for Disease Control and Prevention includes a collection of tools that doctors and nurses can use to screen for intimate partner and sexual violence in health care settings.
[See: 7 Ways Pain Is Sometimes Misdiagnosed.]
Routine screening for intimate partner violence takes different approaches. Your doctor might ask you about it in a private, face-to-face discussion. You could fill out an online questionnaire or a pen-and-paper form. Secondary screening tools are also used once abuse is revealed.
Dr. Kathy Franchek-Roa, an assistant professor of pediatrics at the University of Utah School of Medicine, heads the school’s domestic violence committee, which provides guidelines for physicians and staff members on how to intervene with patients.
When working with families, Franchek-Roa says, she tends to start off with open statements rather than screening questions. “We just want to make sure that all the families at our clinic are safe,” she tells women. “If you ever feel you’re not safe, or someone’s harmed you, or someone’s going to harm you or your children, I want you to know you can come to us for help.”
When it comes to screening women for abuse, “It’s most important that it’s in a caring, empathetic way — and not in a judgmental way,” Franchek-Roa says.
Women are appreciative, not offended, when asked about intimate partner violence, says Dr. Brigid McCaw, medical director of the Family Violence Prevention Program with Kaiser Permanente. “I’ve had some people be surprised that a doctor cared and was interested in that part of her life, but that’s much less so now,” she says.
McCaw, who is based in Northern California, is encouraged by the number of women who say, “Thank you for asking me. This isn’t an issue in my life now, but it was in the past.” Even women who haven’t been affected by intimate partner violence are grateful she’s addressed the topic. “When it’s part of a routine inquiry during an encounter, women really appreciate the question,” she says.
Screening is only the beginning, McCaw emphasizes. With responses indicating abuse, immediate steps include affirming what patients have said and thanking them for sharing the information. A safety assessment comes next.
Identifying the most helpful referrals for that patient, including the National Domestic Violence Hotline (800-799-7233) and local advocacy groups and services is essential. Finally, McCaw says, health providers follow up and make sure the patient has had a chance to reach out for the services.
[See: What Only Your Partner Knows About Your Health.]
“One in four women will experience severe physical violence in her lifetime,” McCaw says. “This can really happen to anyone, regardless of their education, income, religious background or age. That’s another reason why it’s important to do routine inquiry.”
Franchek-Roa points out that leaving an abusive relationship is not a single event, but rather a process, because it’s such a dangerous time. When screening reveals a woman is being abused, team clinicians go through an algorithm to determine whether she’s in immediate danger, including asking about the current location of her perpetrator, and then recommend trusted resources like local rape recovery centers.
McCaw wants fellow clinicians to realize that screening patients for abusive relationships is a chance to save a life. Even if women can’t act instantly, she says, eventually they end those relationships. “There’s a message of hope as well for women who are experiencing and struggling with intimate partner violence,” she says. “People actually reach out for resources. It takes a while — things get better.”
More from U.S. News
12 Questions You Should Ask Your Kids at Dinner
9 Extra Safety Assignments for Hospital Patients
Women Should Be Screened for Intimate Partner Violence, U.S. Panel Advises originally appeared on usnews.com
