Injuries, both intentional and unintentional, are the leading causing of death among people between 1 and 44 years old, but preventing them isn’t routinely addressed in primary care. Intentional injuries, also known as violence, make up a substantial portion of these deaths.
Still, primary care providers spend much more time educating patients about non-communicable and infectious diseases instead of screening them for violence. For context, injury kills almost 60,000 people every year, compared to about 35,000 deaths from non-communicable diseases and 5,000 from infectious diseases, according to the CDC.
So why is violence left out of routine care? It requires time that many PCPs feel the don’t have, not to mention sensitivity and training. This is an oversight because PCPs have a closer relationship with their patients than other medical professionals and studies have found many victims visit their PCPs in times of distress.
For example, a study from the 80s found 62 percent of women who died by homicide from their partner had sought care but not been screened the week before their deaths, says Eileen Owen-Williams, PhD, DNP, FNP-BC, CNM, AFN- BC, FAANP, who’s set up several clinics devoted to recognizing violence. The ultimate result is “providers aren’t picking up on abuse — we’re not treating it and people are dying from abuse that’s preventable.”
Here are some of Dr. Owen-Williams’ most trusted resources to screen for violence for providers working in a busy primary care practice.
Interventions to Prevent Child Maltreatment, U.S. Preventive Services Task Force Recommendation Statement.
In 2016, more than 1,700 children died in the U.S. as a result of maltreatment. While this resource from the Journal of the American Medical Association acknowledges that more research is needed to develop thorough recommendations for preventing violence among children, it outlines ways PCPs can intervene.
This article from the American Academy of Pediatrics defines the most common risk factors for child violence, missed opportunities for diagnosing it, and clinical presentations. It also explains what to do once you’ve identified abuse.
This is a case-based interactive learning program for clinicians to increase accuracy and confidence in recognition and reporting of cases of physical child abuse.
Screening for Intimate Partner Violence (IPV), Elder Abuse, and Abuse of Vulnerable Adults, U.S. Preventive Services Task Force Final Recommendation Statement.
This guide concludes that screening for IPV in women of reproductive age and providing or referring women who screen positive to support services benefits them. It also recommends asking potential victims the questions listed in the HARK (Humiliation, Afraid, Rape, Kick); HITS (Hurt, Insult, Threaten, Scream); E-HITS (Extended-Hurt, Insult, Threaten, Scream); WAST (Woman Abuse Screening Tool); and PVS (Partner Violence Screen) tests.
While there’s limited information on validated screening tools related to older people with dementia, we know common risk factors include: cognitive impairment, including communication abilities, caregiver stress, a history of domestic violence between partners, mental illness, substance abuse and financial problems. A response of “yes” to one or more of the last five questions on EASI should raise concern about elder abuse.
Research from 1992 using this 3-question assessment found a 17 percent prevalence of physical or sexual abuse during pregnancy, which was more than double previous reports. It also found 60 percent of abused pregnant women reported two or more episodes.
A since expanded version of this screen includes these questions:
This test includes 11 items to assess the physical safety of patients who disclose current IPV. It’s most often administered by a clinician or self-reported in healthcare settings. This screener is applicable to all genders, including men.
This course from Futures Without Violence looks at moving beyond screening and referral to create responses to violence rooted in prevention, healing and wellness. Part of this is looking at patients as whole people rather than focusing on their trauma alone. The webinar took place in December 2018, but a recording of the lecture, as well as the slides, are available to download.
This is an evidence-based framework for intervention with the goal of supporting survivors and preventing further violence. CUES stands for: confidentiality, universal education/empowerment, and support.
This organization develops and promotes accessible, culturally relevant, and trauma-informed responses to domestic violence and other lifetime trauma. It creates online resources for providers and patients alike.
Tools for Transformation: Becoming Accessible, Culturally Responsive, and Trauma-Informed Organizations — An Organizational Reflection Toolkit.
This guide teaches organizations to become more accessible, culturally responsive, and trauma-informed (ACRTI) in their approach and services. Its recommendations come from the voices survivors, advocates, and clinicians; from the insights of social and political movements; and from research and science, including a growing body of research on child development and neurobiology.
What resources do you use to talk to your patients about violence in their lives?
Last updated on 10/8/19.