Overview of Secondary Prevention Strategies The overall goal of secondary prevention for IPV is to ensure the survivor’s safety, health, and well-being. This process is often lengthy and requires ongoing interprofessional collaboration between experts who have access to a wide Screening and Assessment Strategies While being aware and cognizant of red flags and warning signs for IPV is important for clinicians in varied settings, implementing appropriate screening and assessment strategies is the first step in identifying a person who is Clinical Practice Guidelines and Recommendations Since 2004, the Joint Commission (TJC) has required that accredited healthcare organizations have and apply written criteria to the identification of patients who may be victims of various types of violence and abuse, including IPV and SA (Cerulli, 2022) . Due to the increase in IPV during the COVID-19 pandemic, TJC has strengthened and amended recommendations to encompass telehealth settings, and now includes all of the following in guidance for healthcare providers: 1. Partner with your local domestic violence provider to engage in potential on-site training or training resources as well as potential advocacy. 2. Provide training to all employees who interact with patients, not just for licensed healthcare providers. Front desk staff, patient care technicians, and even transportation personnel within hospital settings have patient contact. All employees should be trained on the basics for how to identify IPV and next steps. Staff should be comfortable making referrals to appropriate providers within the healthcare settings. Training should include helping providers understand the prevalence of IPV, varying types of abuse, and how to intervene safely. 3. Create an interdisciplinary medical-law partnership which allows healthcare professionals to make immediate referrals where patients can receive integrated care Elements of Effective Screening In alignment with the TJC recommendations, some general recommendations for effective screening include use of: ● A systematic screening protocol Systematic Screening Protocol A written systematic protocol for each setting can help ensure that providers are effectively screening for IPV (Burton & Carlyle, 2020; Miller et al., 2021) . Recommendations for such protocols include the roles of all providers in the setting in the screening process, Strategies for Asking Screening Questions When asking individuals about IPV, both provider and patient need to feel comfortable in the encounter. It is, however, the provider’s responsibility to initiate the conversation and to follow TJC guidelines when applicable. The World Health Organization (WHO) recommends asking direct questions about specific acts, such as, “Has your Validated Screening Instruments Valid and reliable screening instruments have been tested through research and found to accurately identify individuals who have experienced IPV. Many of these tools have been identified in systematic reviews (Miller et al., 2021) and there are specific tools for different types of settings (Fang & Donley, 2022) . In addition, in 2007 the CDC compiled a free compendium of tools specific to health care settings on its website (Basile et al., 2007) . Some of the most commonly used screening instruments in healthcare settings include the Danger Assessment, which
range of health, legal, and community-based services. Ideally, the process involves five steps: (1) screening and assessment, (2) documentation, (3) provision of safety, (4) intervention/assurance, and (5) referral. experiencing IPV. Screening for IPV opens the conversation about a difficult topic and gives the survivor the opportunity to disclose. Guidelines, recommendations, and tools exist to help screen for IPV in an effective, evidence-based manner. from a team comprised of advocates, attorneys, and specialty-trained medical and mental health providers. 4. Consider ensuring patients receive evidence-based mental healthcare when they disclose IPV. An important aspect of care involves assessing immediate safety as well as future provider communications, including who can access the patient’s electronic medical record. 5. Explore different professional organization’s recommendations for your various providers to see what protocols exist for the type of patients your organization cares for. Your employees may be more familiar and comfortable with information from their own discipline organizations which detail how IPV screening, assessment, and referral are part of their specific discipline and often within their ethical duty. 6. Examine whether your screening questions are specific enough and your providers are asking the questions as indicated in your written policies. 7. For non-English-speaking patients, providers should rely on interpreters and not on family members or escorts when evaluating a patient. Consider privacy when discussing IPV. It is suggested that providers ask a patient whether they have headphones which can lend privacy to not just the inquiry for IPV but the entire healthcare visit. Some providers have been issuing headsets to patients during the pandemic. (Cerulli, 2022)
● Strategies for asking questions ● Validated screening instruments ● Assurance of privacy
identification of essential services for patients who disclose IPV and/or SA, clarification of patient flow for screening and subsequent needs, and coordination of care throughout the process (World Health Organization, 2021) .
partner ever threatened to hurt you or your children?” or “Are you afraid of your partner?” A validated screening instrument can also be used and may enhance provider comfort with screening.
offers a provider certification in its use (Johns Hopkins School of Nursing, 2019) , and the HITS tool, recommended by the United States Preventive Services Task Force (USPSTF) (De Marchis et al., 2021) . The HITS tool, named for the acronym of H urting, I nsulting, T hreatening, and S creaming, was developed in 1998 (Sherin et al., 1998) , and consists of four questions—making it simple and brief to use in a clinical encounter. The HITS screening tool questions help determine whether a person is being abused. Individuals can be asked to report on current
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