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48 Vol. 67, No. 1 2016 Northeast Florida Medicine DCMS online . org
CME
screening asymptomatic females for IPVmay provide ben-
efits with minimal adverse effects. 34 The Affordable Care
Act passed in August 2012 required insurance companies
to cover IPV screening and counseling as part of eight
essential health services for women at no additional cost
to the patient.35 Based on this information, all primary
care providers should screen females 12 years of age and
older for IPV. Additional red flags that suggest screening
is necessary include but are not limited to trauma, chronic
or recurrent sexually transmitted disease infections and
injuries in the elderly.
Primary care providers can include screening ques-
tions in their initial assessment. Asking questions in a
non-threatening and non-judgmental manner is imper-
ative. Using phrases such as, ‘I ask all of my patients
about violence in the home’ allows the provider to ask
the necessary questions without singling out the patient.36
The healthcare provider should never ask the patient
why they have allowed the abuse to happen or why they
have not left as this re-victimizes the patient. Raising
questions about potential abuse should occur only if
the patient is alone. If the questions are asked when the
partner is present the patient may deny that abuse occurs
and the potential for escalation of violence at home is
increased. Victims should be assured that information
will be kept confidential unless there is a lethal weapon
involved. This reassurance may help to put them at ease.
Providing resources in restrooms or other private areas of
the clinical setting allows women to obtain information
without directly speaking to someone. Reasons cited
for the lack of routine screening for IPV by healthcare
providers include physician comfort levels, awareness of
the various techniques, fear of offending the patient and
perceived lack of effective interventions.
Several effective screening tools for intimate partner
violence have been developed. A widely utilized screen-
ing tool is the HITS (Hurt, Insult, Threaten, Scream)
Figure 4:
Safety Packing List by the U.S. Department of Health and
Human Services, Office of Women’s Health
Figure 3:
Campbell, JC. (2004). Danger Assessment. Retrieved May 28, 2008,
from
Campbell JC, Webster DW, Glass N. (2009). The danger assessment: validation of a
lethality risk assessment instrument for intimate partner femicide.
Journal of Interpersonal Violence, 24(4):653-74