The Controversy on Screening for Intimate Partner Violence: A Question of Semantics?

Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Journal of Women's Health (Impact Factor: 2.05). 03/2009; 18(2):143-5. DOI: 10.1089/jwh.2008.1252
Source: PubMed


In this paper, we review the basis of the U.S. Preventive Services Task Force's recommendations related to routine screening for intimate partner violence (IPV), focus on two of the arguments of those who have rejected these recommendations, and based on these, suggest that this controversy has occurred, in part, as a result of different interpretations of the meaning of "screening." We differentiate screening from situations in which asking about IPV is essential for differential diagnosis, that is, exploring exposure to IPV when there are signs and symptoms that might result from this exposure. Finally, we describe the randomized, controlled trial CDC is conducting to contribute to the evidence the U.S. Preventive Services Task Force requries to make its recommendations.

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Available from: Joanne Klevens, Apr 02, 2014
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    • "Despite the health implications for women who have experienced domestic violence and the plethora of research undertaken around the feasibility and/or appropriateness, or otherwise, of routine screening for domestic violence in health settings (Barata, 2011; Hawkins, Pearce, Skeith, Dimitruk, & Roche, 2009; Klevens & Saltzman, 2009; MacMillan et al., 2006; Moracco & Cole, 2009; Wathen, Jamieson, & MacMillan, 2008), and barriers to it (Colarossi, Breitbart, & Betancourt, 2010; Minsky-Kelly, Hamberger, Pape, & Wolff, 2005), only a minority of women experiencing violence are identified by health professionals (Feder, Hutson, Ramsay, & Taket, 2006a). The absence of a strategic screening program (Edin & Hogberg, 2002; Shadigian & Bauer, 2004) in many countries including the United Kingdom may be a contributory factor in this low rate of identification. "
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    ABSTRACT: This study explored women's experiences of their responses from health professionals following disclosure of domestic violence within a health setting. The existence of health-based policies guiding professionals in the provision of appropriate support following disclosure of domestic violence is only effective if health professionals understand the dynamics of violent relationships. This article focuses on the findings from the interviews conducted with 15 women living in the United Kingdom who disclosed their experiences of domestic violence when accessing health care. Following thematic analysis, themes emerged that rotated around their disclosure and the responses they received from health professionals. The first two themes revealed the repudiation of, or recognition of and failure to act upon, domestic violence. A description of how the health professional's behavior became analogous with that of the perpetrator is discussed. The final theme illuminated women's receipt of appropriate and sensitive support, leading to a positive trajectory away from a violent relationship. The findings suggest that the implicit understanding of the dynamics of violent relationships and the behaviors of the perpetrator of domestic violence are essential components of health care provision to avoid inadvertent inappropriate interactions with women.
    Journal of Interpersonal Violence 10/2014; 30(13). DOI:10.1177/0886260514552449 · 1.64 Impact Factor
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    • "The barriers at the levels of knowledge, attitudes and practices, which were identified in this study, are similar to those identified in research on screening for intimate partner violence by healthcare workers [11,15,16,19,37]. Bearing in mind current opinion on women’s perceptions of being asked about sexual violence, a first challenge on this prevention level seems to be awareness-raising and adequate training of healthcare workers in order to help them understand the behaviour and needs of victims of sexual violence [19,20]. "
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    ABSTRACT: Background Sub-Saharan transmigrants in Morocco are extremely vulnerable to sexual violence. From a public health perspective, the healthcare system is globally considered an important partner in the prevention of sexual violence. The aim of this study is twofold. In a first phase, we aimed to identify the current role and position of the Moroccan healthcare sector in the prevention of sexual violence against sub-Saharan transmigrants. In a second phase, we wanted these results and available guidelines to be the topic of a participatory process with local stakeholders in order to formulate recommendations for a more desirable prevention of sexual violence against sub-Saharan transmigrants by the Moroccan healthcare sector. Methods Knowledge, attitudes and practices of healthcare workers in Morocco concerning sexual violence against sub-Saharan transmigrants and its prevention were firstly explored in semi-structured interviews after which they were discussed in a participatory process resulting in the formulation of recommendations. Results All participants (n=24) acknowledged the need for desirable prevention of sexual violence against transmigrants. Furthermore, important barriers in tertiary prevention practices, i.e. psychosocial and judicial referral and long-term follow-up, and in secondary prevention attitudes, i.e. active identification of victims were identified. Moreover, existing services for Moroccan victims of sexual violence currently do not address the sub-Saharan population. Thus, transmigrants are bound to rely on the aid of civil society. Conclusions This research demonstrates the low accessibility of existing Moroccan services for sub-Saharan migrants. In particular, there is an absence of prevention initiatives addressing sexual violence against the sub-Saharan transmigrant population. Although healthcare workers do wish to develop prevention initiatives, they are dealing with structural difficulties and a lack of expertise. Recommendations adapted to the context of sub-Saharan transmigrants in Morocco are suggested.
    BMC Health Services Research 02/2013; 13(1):77. DOI:10.1186/1472-6963-13-77 · 1.71 Impact Factor
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    • "Current guidelines from the U.S. Preventive Services Task Force (USPSTF) state that routine screening for IPV is not recommended (U.S. Preventive Services Task Force, 2004). Following its release, the USPSTF's statement and the methodology used were heavily criticized by medical associations, advocates, and in an Annals of Internal Medicine Editorial (Klevens & Saltzman, 2009). Similarly, authors of a 2009 study published in the prestigious Journal of the American Medical Association reported that the results of their trial did not support IPV screening in health care settings (MacMillan et al., 2009). "
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    ABSTRACT: Health care providers play a vital role in the detection of intimate partner violence among their patients. Despite the recommendations for routine intimate partner violence screening in various medical settings, health care providers do not routinely screen for intimate partner violence. The authors wanted to identify barriers to intimate partner violence screening and improve the understanding of intimate partner violence screening barriers among different health care providers. The authors conducted a systematic review to examine health care providers' perceived barriers to screening for intimate partner violence. By grouping the studies into two time periods, based on date of publication, they examined differences in the reported barriers to intimate partner violence screening over time. The authors included a total of 22 studies in this review from all examined sources. Five categories of intimate partner violence screening barriers were identified: personal barriers, resource barriers, perceptions and attitudes, fears, and patient-related barriers. The most frequently reported barriers included personal discomfort with the issue, lack of knowledge, and time constraints. Provider-related barriers were reported more often than patient-related barriers. Barriers to screening for intimate partner violence are numerous among health care providers of various medical specialties. Increased education and training regarding intimate partner violence is necessary to address perceptions and attitudes to remove barriers that hinder intimate partner violence screening by health care providers.
    Women & Health 08/2012; 52(6):587-605. DOI:10.1080/03630242.2012.690840 · 1.05 Impact Factor
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