USPSTF Maintains Advice to Screen Women for Intimate Partner Violence

By Will Boggs MD

October 25, 2018

NEW YORK (Reuters Health) - Women of reproductive age should be screened for intimate partner violence, and those who screen positive should be referred to ongoing support services, according to updated recommendations from the U.S. Preventive Services Task Force (USPSTF).

"Intimate partner violence (IPV) can have devastating consequences to one's health and wellbeing, and people experiencing IPV often do not tell others about it and do not ask for help," said Dr. John W. Epling, Jr., a task force member from Virginia Tech Carilion School of Medicine in Roanoke.

"Doctors can make a real difference for women suffering from IPV by helping identify them and getting them the support they need through the use of various screening tools," he told Reuters Health by email.

The final recommendation statement, along with the evidence report and systematic review supporting it, appear in the October 23/30 edition of JAMA.

The updated recommendation incorporates new evidence since the 2013 USPSTF recommendation, but the recommendation remains the same: based on grade B evidence of a moderate to substantial benefit, clinicians should screen for IPV in women of reproductive age without recognized signs and symptoms of abuse and provide or refer women who screen positive to ongoing support services.

Among the useful screening instruments are Humiliation, Afraid, Rape, Kick (HARK); Hurt/Insult/Threaten/Scream (HITS); Extended HITS (E-HITS); Partner Violence Screen (PVS); and Woman Abuse Screening Tool (WAST).

Evidence did not support the effectiveness of brief interventions or merely providing information about referral options in the absence of ongoing supportive interventions, the authors say.

"If a doctor finds that a woman is experiencing IPV, it is important to arrange for ongoing support services for her," Dr. Epling said. "These services can include things like counseling, home visitation, and social-work assistance."

There was insufficient evidence to recommend valid, reliable screening tools to identify abuse of older or vulnerable adults without recognized signs and symptoms of abuse. So the USPSTF reiterated its 2013 position, that the current evidence is insufficient to address the balance of benefits and harms of screening for abuse and neglect in these individuals.

"Therefore, the Task Force is calling for more research to help inform what works in screening for these populations," Dr. Epling said. "Doctors should use their best judgment when deciding who should be screened."

Dr. Cynthia Feltner from RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, who co-authored the evidence report supporting these recommendations, told Reuters Health by email, "Physicians (or healthcare systems) who plan to implement an IPV-screening program should choose a validated screening tool that has good accuracy. Informally asking about abuse, or use of a tool that hasn't been validated, is unlikely to identify women who will benefit from additional services."

"Screening women presenting for routine clinical services is only one of many prevention strategies to address IPV," she said. "The Community Preventive Services Task Force (CPSTF) recently made recommendations on the primary prevention of IPV. A review for the CPSTF found benefit for interventions that combine educational information about intimate partner violence and sexual violence with one or more of the following three strategies: (1) teach healthy relationship skills, (2) promote social norms that protect against violence, and (3) create protective environments. Physicians, particularly pediatricians, who are involved with school-based or community programs should consider ways to promote these interventions."

Dr. Tami P. Sullivan from Yale University, in New Haven, Connecticut, who has researched various aspects of IPV, said, "Routine screening is important for at least two reasons. The first is that patients may feel more comfortable disclosing over time rather than at the time of the first screening, and they may need a prompt each time to consider the opportunity to disclose. The second is that patients' relationships change over time and what could have been a non-aggressive relationship at the time of the last visit easily could have changed."

"In addition to using the screening measures suggested by the USPSTF, clinicians should consider integrating a focus on patients' relationships into the questions they regularly ask so that it becomes clear to patients that their relationships can impact their health, and further, that such a conversation is a normal part of their relationships with health care providers," she told Reuters Health by email.

"Clinicians need to be aware of the ongoing services in the area so that they can refer the patient, but clinicians also need to know how to respond in the moment when the actual disclosure of victimization is made to reduce the likelihood of the potential harms to the patient," said Dr. Sullivan, who was not involved in the new recommendations.

Dr. Susie DiVietro from Connecticut Children's Medical Center, in Hartford, who has studied IPV screening in settings from hair salons to trauma centers, told Reuters Health by email, "Physicians have to prioritize effectively screening their patients. However, screening for intimate partner violence is not sufficient; it must be coupled with clear interventions for patients who screen positive."

"There are limits to the screening model, which is why many organizations are moving toward a universal education model, where a patient receives information about intimate partner violence and its impact on health prior to any screening questions," said Dr. DiVietro, who also was not part of new work. "The universal education model assures that each patient receives important referral information, so connection to resources does not hinge on the patient disclosing their abuse. "

SOURCE: https://bit.ly/2PSYfmU, https://bit.ly/2yVi71q and https://bit.ly/2Ap2gu1

JAMA 2018.

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