Screening and Counseling for Intimate Partner and Domestic Violence

The Women’s Preventive Services Initiative recommends screening adolescent and adult women for intimate partner and domestic violence, at least annually, and, when needed, providing intervention services. Intimate partner and domestic violence includes physical violence, sexual violence, stalking and psychological aggression (including coercion), reproductive coercion, neglect, and the threat of violence, abuse, or both. Intervention services include, but are not limited to, counseling, education, harm reduction strategies, and appropriate supportive services.

The Women’s Preventive Services Initiative recommends screening patients when privacy is assured (eg, alone or unaccompanied) whether at an in-person or virtual visit. All patients may benefit from universal education and resources about intimate partner and domestic violence regardless of disclosure. Rates are high among all women of all ages, and in particular highest among American Indian and Alaska Native, Black, and multiracial women; pregnant and postpartum women, particularly those with unintended pregnancies; adolescent girls; and members of the LGBTQ+ community. Several physical, mental health, and social conditions predispose women to additional vulnerability, such as disability, immigration status, food and housing insecurity, illicit drug use, HIV infection, and involvement in sex work. There are multiple screening tools that have shown adequate sensitivity and specificity for identifying intimate partner and domestic violence in specific populations of women. Minimum screening intervals are unknown; however, based on the prevalence of intimate partner and domestic violence as well as evidence demonstrating that many cases are not reported, it is reasonable to conduct screening at least annually, although the frequency and intensity of screening may vary depending on a particular patient’s situation.

• Studies of the effectiveness and harms of screening methods and interventions that consider
  patient preferences; patients’ culture, ethnicity, language, age, and other individual factors; and
  the timing and context of screening including the type of screening modality (in-person, virtual,
  electronic, others) and screening during pregnancy and postpartum.
• Research on facilitators and barriers to screening and interventions from clinician, patient, and
  health system perspectives.
• Studies of interventions outside health systems that can be accessed through screening in
  clinical settings.
• Research reporting patient outcomes including clinical outcomes (physical and mental health),
  and validated measures of safety, violence, and well-being (eg, quality of life, patient experience,
  health care utilization).