Screening for domestic violence in IHS hospitals and clinics: why bother?

Studies in the general US population show that 95% of violence among intimates is perpetrated against women by a partner or former partner. Studies conducted in AI/AN communities show that domestic violence is at least as prevalent in Indian communities as in the general population. Although several professional organizations recommend screening and both the Joint Commission on the Accreditation of Healthcare Organizations and Government Performance and Improvement and Results Act require screening, without policies and procedures in place routine screening for domestic violence in the clinical setting does not occur. The criteria for screening for domestic violence includes: (1) the violence having a high prevalence and posing serious consequences in the population to be screened, (2) the natural history of the disease being understood and treatment made available, (3) the screening test being sensitive and specific for violence and reliable in different settings, and (4) the test being safe, acceptable to the patient, and low cost. The author discusses each of the above criteria and its applicability in the IHS setting. Examples of three screening tools are given.