Screening

Universal screening for IPV in primary care settings is controversial. Multiple major medical organizations recommend universal screening, including the American Association of Family Physicians (AAFP), despite the US Preventive Services Task Force (USPSTF) finding that there is "insufficient evidence to recommend for or against routine screening of women for IPV." Proponents believe that screening is widely acceptable to patients, and that the availability of reliable screeners, the opportunity for intervention in identified victims, and the high prevalence and costs of IPV are good reasons for universal screening (MacMillan et al., 2009). Evidence overall is equivocal for the efficacy of advocacy interventions (Cochrane review; Ramsay, 2009).

Although evidence does not support universal screening, many physicians may still want to screen their patients. When using routine screening, begin with framing questions: "As violence is a major factor in people's lives, I have begun to inquire about this with every patient"; or, "I am concerned that some of your symptoms may be a result of someone hurting you." This should be followed with direct questions that focus on behavior: "Has someone physically harmed you: hit, slapped, kicked, or thrown something at you? Threatened you? Forced you to have sex when you did not want to? Do you feel controlled or isolated by your partner?" Several empirically validated screening tools focus on physical abuse by an intimate partner. The SAFE questions screen for nonphysical aspects of abuse provides a logical framework for interventions: The physician can inquire about stress and safety in patient's relationships (S), if the patient feels afraid or abused (A), awareness and support of friends and family (F), and emergency plans (E) (Neufeld, 1996).

• Evidence shows the efficacy of legal interventions and batterer's treatment.

• Safety and safety planning are critical, regardless of stage of abuse.

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