Taking a Fresh Look at Routine Screening for Intimate Partner Violence: What Can We Do About What We Know?

Abstract

I ntimate partner violence (IPV) is defined as "any behavior within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship." 1 Its role as a major public health issue affecting both men and women, regardless of social class, sexual orientation, or racial/ethnic group, was reinforced by the recently released population-based 2010 National Intimate Partner and Sexual Violence Survey. 2 Results indicate that women have a lifetime IPV prevalence rate of 29%, with 1 in 7 injured by an intimate partner. With a lifetime prevalence rate of 10% (1 in 25 injured as a result of IPV), 2 men are significantly less likely than women to experience physical or sexual IPV. 3 While less is known about the long-term impact of IPV among male victims, both male and female victims of IPV experience high rates of adverse physical, social, emotional, and mental health outcomes. [2][3][4][5] Being a victim of IPV is strongly associated with a host of behavioral risks such as sexually transmitted diseases, human immunodeficiency virus infection, and the use of tobacco, alcohol, and drugs and is linked to all other forms of violence. 1 As a significant contributor to health, social, and economic disparities, IPV jeopardizes the fabric of families and transcends all levels of socioeconomic status. Due to high rates of health care utilization by both victims and perpetrators of IPV, 6,7 health care settings have abundant opportunities for early identification, intervention, and secondary prevention of IPV-but have consistently failed in these endeavors.What We Know A recent report, Clinical Preventive Services for Women: Closing the Gaps, that was published through the Institute of Medicine (IOM) recommends that IPV screening become part of routine preventive services for women. 8 The IOM report is the latest in almost 20 years of similar clinical recommendations and guidelines targeted at improving IPV screening and response in health care settings. In 1992, the American Medical Association recommended screening all women for IPV, 9 and other professional medical organizations widely endorsed these recommendations. 10-13 However, the professional practice guidelines preceded both the evidence of effectiveness and the considerable implementation challenges. Studies that tried to assess the effectiveness of IPV screening quickly found that physicians were unable or unwilling to integrate IPV screening into their practice. 14 Substantial barriers were identified that span the spectrum of physicians' knowledge, attitudes, beliefs, and behaviors. [15][16][17][18][19][20] Even system-level interventions with extensive physician education demonstrated marked improvements in screening without an increase in IPV identification. 21 During this time, the movement for the use of evidence to guide clinical practice was also developing. With the realization that many of our current treatment recommendations lacked high-quality evidence of effectiveness, the level of enthusiasm for IPV screening began to ...

Intimate Partner and Domestic Violence

“…Cognitive variables are hypothesised to play an important role in IPV aetiology and intervention. A recent American assessment of attitudes toward gender, violence and the association between gender and violence among 50 men enrolled in an IPV treatment programme and a comparison sample of 40 non-violent men showed no group differences on explicit attitudinal measures (Rhodes 2012). However, IPV men exhibited more positive implicit attitudes regarding violence, and a more rapid association between women and violence.…”

“…Studies from the USA revealed that domestic violence survivors shared many views with service seekers and recipients (Coker et al 2002;MacMillan et al 2009;Kulkami et al 2012;Rhodes 2012). National hotline advocates explored relationships between service providers and survivors based on their interactions with both.…”

Dating Violence: Outcomes Following a Brief Motivational Interviewing Intervention Among At‐risk Adolescents in an Urban Emergency Department

“…Due to the unique opportunity for staff at the ED to intervene on dating violence, the Joint Commission and the American Medical Association have standards, recommendations, and guidelines for the universal screening of patients over the age of 14 years in the ED for dating and intimate partner violence . Despite these guidelines, low numbers of patients are actually being screened . This lack of screening by medical staff in the ED has reportedly been due to a lack of dating violence knowledge, time constraints, lack of belief in the patient's ability to change behavior, and a lack of available interventions or resources for dating violence victims after a positive screen is conducted .…”

“…Despite these guidelines, low numbers of patients are actually being screened . This lack of screening by medical staff in the ED has reportedly been due to a lack of dating violence knowledge, time constraints, lack of belief in the patient's ability to change behavior, and a lack of available interventions or resources for dating violence victims after a positive screen is conducted . To date, no ED‐based intervention studies focusing on preventing dating violence among adolescents have been reported.…”