abuse (“How often does your partner …”), short-term past or current abuse (“Over the last 12 months, how often did your partner …”), or long-term past abuse (“In your lifetime, how often has a current or former partner …”). Assessing for current abuse is important for identifying victims who may be in acute danger and may need immediate assistance. Assessing for lifetime abuse also can be helpful for understanding a person’s current clinical profile because abuse often has long-term health consequences, even when someone is no longer in the abusive relationship (Chandan et al., 2021; Hamel et al., 2023) .
HITS scores range from 4 to 20, and a score of 10 or higher is considered positive for IPV. The HITS tool has the benefit of gleaning information about both physical and verbal abuse. Verbal aggression is a very strong feature of IPV and is often one of the earliest forms of violence to appear in relationships, and to persist even after dissolution (Bounds et al., 2022) . Table 4 shows the HITS scoring tool completed for “Anita,” a fictional client, from the original publication. Note how verbal aggression alone can indicate a positive finding. The table shows how this woman, married for 10 years, scored after assuring her provider that she definitely was not a “battered” woman because her husband had never hit or threatened her.
Table 4: HITS Screening Tool Example Domestic Violence Screening for “Anita”: How often does your partner:
Never (1)
Rarely (2)
Sometimes (3)
Fairly Often (4)
Frequently (5)
Physically hurt you?
X
Insult you or talk down to you?
X
Threaten you with harm?
X
Scream or curse at you?
X
To Score: Give the following points for each answer: Never = 1 Rarely = 2
Sometimes = 3
Fairly often = 4
Frequently = 5
Add up the points. A score of 10 or more indicates Intimate Partner Violence. In this case, Anita scores 12. Sitting down and scoring the scale with Anita at your side is a very effective technique in letting Anita re-evaluate her situation in a new light. HITS = Hurting, Insulting, Threatening, and Screaming. Note. From Sherin, K. M., Sinacore, J. M., Li, X. Q., Zitter, R. E., & Shakil, A. (1998). HITS: A short domestic violence screening tool for use in a family practice setting. Family Medicine, 30(7), 508-512. © Kevin Sherin, MD, 2005. Reprinted with permission. An important point raised by this fictional case is the
violence resource center with referral information provided. This can reduce the need for provider direct intervention with affected patients, when used in combination with referral materials or resources such as the myPlan app, which offers decision tools as well as safety planning via smartphone or website (www.myPlanApp.org ) (Glass et al., 2022) . failure to maintain control over chronic illness, or vague systemic complaints (Chandan et al., 2021; Walker et al., 2022) . Box 1 presents some common indicators of abuse that may be observed in the healthcare setting. Although none of these characteristics in and of themselves confirm the occurrence of IPV in a relationship, their presence can indicate the need for further inquiry on the part of the provider. Individuals should be questioned about abuse in private. This may mean separating the person from his or her partner or from others. Otherwise, fear of reprisal may inhibit the person from being truthful about his or her situation.
choices of language used by the patient and the provider. For example, the term “forced sex” may be preferable to “rape” because a victim may assume that assault by a husband or domestic partner is not rape (Deosthali et al., 2022) . In addition, the HITS tool may be self-administered with the scoring explained as 10 or higher means the person should consider seeking counseling or help from a domestic Additional Considerations in Screening A further consideration for IPV-related screening is whether or not firearms are available to the abuser and/or the survivor and their children. Firearms are implicated in many IPV-related deaths, and their presence has been shown to increase both the prevalence and mortality rates of IPV (Lyons et al., 2021) . In fact, research suggests that survivors whose abusive partners possess firearms have poorer physical health than those whose partners do not (Lynch & Jackson, 2021) . This is a critical consideration in IPV screening because the clinical manifestations of abuse cover a wide spectrum, including both physical and behavioral symptoms. Patients can present with acute complaints,
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Book Code: SWFL1825
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