What are the screening recommendations for intimate partner violence?

Screening Recommendations for Intimate Partner Violence by Major Organizations

The U.S. Preventive Services Task Force (USPSTF) recommends screening all women of childbearing age (14 to 46 years) for intimate partner violence, while evidence remains insufficient to recommend for or against screening elderly and vulnerable adults. 1

USPSTF Recommendations (2013)

For Women of Childbearing Age (14-46 years):

• Screen routinely using validated screening instruments with demonstrated high diagnostic accuracy (sensitivity 81-100%, specificity 86-99%) 1
• The recommendation is based on evidence showing interventions can reduce exposure to abuse and improve outcomes in this population 1
• Most effective screening tools include HITS (English and Spanish), HARK, STaT, OVAT, and WAST 1, 2

For Elderly and Vulnerable Adults:

• The USPSTF issues an "I" statement (insufficient evidence), meaning they cannot recommend for or against routine screening 1
• This represents no change from their 2004 position, as no new evidence emerged demonstrating benefit of screening interventions in this population 1

Other Major Organization Recommendations

American Congress of Obstetricians and Gynecologists (ACOG):

• Screen all women for IPV at routine obstetric-gynecology visits, family planning visits, and preconception visits 1
• For pregnant women specifically: screen at first prenatal visit, at least once per trimester, and at postpartum checkup 1

American Medical Association (AMA):

• Routinely inquire about physical, sexual, and psychological abuse as part of the medical history for all patients 1
• Consider abuse as a factor in presentation of medical complaints 1
• Has specific position statements recommending screening elderly patients for abuse 1

American Academy of Family Physicians, American College of Emergency Physicians, American Academy of Pediatrics, and Emergency Nurses Association:

• All encourage clinicians to be aware of family violence dynamics and risk factors 1
• Recommend preparing to respond appropriately and refer to community resources 1

American Academy of Neurology:

• Has specific position statements on screening elderly patients for abuse 1

Key Differences Between Organizations

The primary divergence exists between the USPSTF's age-limited recommendation (14-46 years) versus ACOG and AMA's recommendation for universal screening of all women regardless of age 1. This reflects the USPSTF's evidence-based approach requiring demonstrated benefit from screening interventions, while other organizations take a broader clinical stance based on prevalence and clinical concern 1.

Practical Implementation Considerations

Validated Screening Tools with Best Performance:

• HITS (4 items): Sensitivity 86-100%, specificity 86-99% 1, 2, 3
• HARK (4 items): Sensitivity 81%, specificity 95% 1, 2
• STaT (3 items): Sensitivity 62-96%, specificity 37-100% 1, 2
• WAST: Sensitivity 47-88%, specificity 89-96% 1, 4, 3

Screening Method Preferences:

• Women prefer self-completed approaches (written or computer-based) over face-to-face questioning 4
• Written screens have fewest missing data compared to other methods 4
• Computer-based screening does not increase prevalence detection compared to written formats 4

Common Pitfalls to Avoid

• Do not conduct joint interviews with partners present, as this prevents disclosure of abuse 2
• Do not assume absence of physical violence means low risk, as psychological abuse and coercive control are forms of IPV 2
• Do not accept patient reassurance without structured inquiry, as many victims do not spontaneously disclose due to fear or shame 2
• Do not dismiss injuries as "just falls" in elderly patients, particularly those with cognitive impairment 5
• Screening rates in actual clinical practice remain very low (8.5% in one study), with high patient refusal rates (64.7%), indicating implementation challenges beyond the recommendation itself 6