Screening for intimate partner violence victimisation in emergency departments

About this review

This Intervention Review is primarily based on four systematic reviews and 14 primary studies, published in 22 documents.

The review draws on the best available impact evaluation evidence. The studies were selected against set selection criteria which is based on a rigorous and comprehensive search and screening process. This review includes impact evaluations of the intervention and, therefore, does not necessarily reflect all evidence on the intervention. Further materials on this intervention are listed under References and Further Reading.

Screening in other health settings such as general practice, maternity care, women’s and children’s health clinics, or dental clinics, will be the subject of other Intervention Reviews.

See the Early Intervention Evidence and Gap Map to explore similar interventions. For details about the individual studies, see the Included Studies section. For further information about the methods informing this review, please see the Intervention Review Technical Report (forthcoming).

Suggested citation: Australia’s National Research Organisation for Women’s Safety. (2024). Screening for intimate partner violence victimisation in emergency departments [Evidence Portal intervention review]. ANROWS.

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Date Created: 16 February, 2024
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At a glance

Intervention

Screening delivered in hospital emergency departments seek to identify intimate partner violence (IPV) victimisation

Key populations

Adult women presenting to hospital emergency departments

Outcomes studied

Detection of violence, screening and support; gender-based violence; health; behaviours; relationships; wellbeing and emotions; social and material support

Impact of the intervention

Of the 18 studies, nine outcomes received an effectiveness rating on our Effectiveness Estimate Tool

Australian Evidence

1 study presented findings from Australia and no studies reported on the experiences of Aboriginal and Torres Strait Islander peoples

Risk of bias

Of the studies with available quantitative data, we rated four as moderate risk of bias, six moderate-high risk of bias, three as high risk of bias on the Risk of Bias Tool

Intervention description

What are the key characteristics of the intervention?

Screening interventions seek to identify IPV victimisation (either current or past) in adult women presenting to emergency departments. Screening generally involves asking a series of questions about IPV or safety to ascertain whether women are experiencing violence.

Screening may involve “universal” or “routine” questioning, which can be offered to all adult women, or women of childbearing age (e.g. from 16 to 45 years), presenting to the emergency department for any reason. Alternatively, some approaches adopt “targeted” or “case-finding” identification that seeks to detect women who present with certain symptoms, specific injuries (such as non-fatal strangulation injuries), suicidality, certain demographic characteristics, or known risk factors for IPV (such as pregnancy).

Screening for IPV in emergency departments varies in modality. It is generally conducted face-to-face and is administered verbally by health professionals using an instrument with pre-specified questions. Some screening may also be self-administered by women themselves, via a computer or printed written survey. Generally, screening occurs in an examination room, as opposed to triage or waiting area. Women are screened privately rather than in the presence of the people who accompanied them to the emergency department.

Screening may be conducted by validated screening instruments or general interviewing. The screening instruments generally include a preamble and ask the woman to answer the questions in relation to a certain time period. Although others exist, the instruments identified in this review include:


Some screening interventions may only aim to identify IPV, while others may also offer additional information or support based on a positive disclosure of violence. Health provider responses to a positive screening result include conducting further risk assessments (e.g. of homicide, suicide, or danger to children), offering safety planning, referral to specialist services, education, or immediate social work care from the hospital.

Implementation generally involves health provider training support staff to deliver the IPV screening. Staff may be provided with materials such as identification and response protocols, and clinical supports such as help to navigate referral pathways, referral cards, display of visual tools, a body map to document injuries, pocket cards with question prompts, and specialist documentation for recording IPV assessments. In Australia, routine IPV screening in emergency departments is mandated in the Northern Territory and is currently in the second phase of pilot testing in New South Wales.


What does the intervention involve?

Where is the intervention set?

Emergency departments, both adult and paediatric

How is the intervention delivered?

Primarily face-to-face by emergency department nurses or physicians. Sometimes also via computer, paper-based survey, or non-verbal cue cards

How frequently is the intervention delivered?

Women are usually screened once for IPV in a brief, one-off interaction (often ranging between 3 to 12 minutes) and a secondary screening may occur to establish severe risk

What resources and costs are involved?

No studies commented on the costs associated with the intervention

Theory of change

How is the intervention designed or theorised to work?

Screening interventions are part of a concerted effort to identify IPV among women who have presented to emergency departments. Women who are currently experiencing IPV may present to the emergency department with complaints, symptoms or injuries related to IPV, and may seek support and services in emergency department settings.

Screening interventions in the emergency department represents a type of systems-based approach recommended by the World Health Organization for sustained change in health practice in relation to violence against women.

The rationale for screening interventions centres on the recognition of the emergency departments as a unique, critical point of access to women, coupled with widespread missed opportunities to identify victimisation and support women in a safe and confidential environment.

Emergency department screening and response interventions were developed to address low IPV detection rates, underscored by a lack of relevant policy to guide and support health providers to manage positive IPV disclosures.

By screening for IPV, victims and survivors may disclose experiences of current or past violence, and in turn, be offered information or support, which may otherwise remain undetected in emergency department settings.


Impact

This section speaks to the effectiveness of the studies.

The outcomes measured by the included studies are: detection of violence, screening and support (e.g. disclosures and identification for IPV, discussions and referral to support), gender-based violence (e.g. IPV exposure), behaviours (e.g. safety self-efficacy), social and material support (e.g. use of specialist resources), health (e.g. depression, PTSD, substance use), and wellbeing and emotions (e.g. quality of life).

Fourteen primary studies had available quantitative data and were assessed for risk of bias on the ANROWS-IRIS tool. Of these, four received a rating of moderate risk of bias, six received a rating of moderate-high, three received a rating of high, and one study was not able to be rated. Of the four systematic reviews, one contained a meta-analysis which was critically appraised on the AMSTAR 2 tool, and received a rating of high confidence.

Overall, four moderate-bias primary studies and one high-quality systematic review with meta-analysis were used for the effectiveness estimates. The outcomes that these studies measured are: identification of IPV, IPV exposure, safety behaviours, referral to IPV services, discussion about IPV, receipt of IPV services, use of specialist resources, disclosure of IPV, and documentation of IPV.


Overall effectiveness of the intervention

The table below shows the effectiveness of the intervention.

✅ = Most systematic reviews and studies show effectiveness
🟢 = Most studies show effectiveness
🟨 = Most systematic reviews and studies show no effect
🟡 = Most studies show no effect
⛔ = Potentially harmful
🔵 = Mixed evidence
✖ = Insufficient causal evidence
🕓 = Not yet rated

Effectiveness rating
Outcome
Description



Identification
of IPV

One high-quality systematic review with a meta-analysis examined the effect of screening on the identification of IPV by type of healthcare setting. Findings showed the intervention was effective for identifying IPV compared to usual care, based on the combined results of three primary studies with 2,608 participants.



IPV
exposure



One randomised controlled trial found a brief IPV screening intervention, when compared to usual emergency department care, did not significantly reduce self-reported IPV exposure at 3-month follow-up.



Disclosure
of IPV



One randomised controlled trial examined the effect of computer-based screening on the rates of disclosure of IPV in two settings. In both an urban and suburban emergency department, the rates of women’s disclosure of IPV to the health care provider was higher following the computer-based screening intervention than in usual emergency department care.



Documentation
of IPV



One quasi-experimental study found that computer-based screening resulted in greater rates of physician chart documentation of IPV when compared to usual emergency department care (9.5% of patients versus 0.6%, respectively).



Discussion
about IPV



One randomised controlled trial examined the effect of computer-based screening on the rates of discussions about IPV in two settings, an urban emergency department and a suburban emergency department. In both settings, rates of discussion about IPV were higher in the treatment group than in the usual care group. Among the subset of women who disclosed IPV, there was a significantly higher likelihood of IPV discussions in the intervention group, compared to the usual care group, across both urban and suburban emergency departments.



Safety
behaviours



One randomised controlled trial found no increase in women’s use of safety behaviours after the brief IPV screening intervention, compared with women receiving usual emergency department care during the 3-month follow-up.



Referral to
IPV services



One quasi-experimental study found that referral to social work for IPV services was higher among those who received the computer-based screening intervention compared to usual emergency department care. The study observed a 9.7% difference immediately following the intervention.



Receipt of
IPV services



Two studies examined the effect computer-based screening on the rates of IPV services provided during the emergency department visit. One randomised controlled trial found that the rates of women who received IPV services (defined as a safety assessment, counselling, or referral to specialist resources) were higher among those who received the computer-based screening than usual emergency department care. One quasi-experimental study found that a higher rate of women received IPV services (defined as social work care) among those screened by the computer-based intervention compared to usual care.



Use of
specialist
resources



One randomised controlled trial found no difference between women’s use of formal or informal specialist family violence resources in the 3 months following the brief IPV screening intervention or usual emergency department care.

Key populations

Has the impact of this intervention been tested with certain key populations?

This Intervention Review assessed the impact of screening interventions to identify IPV victimisation in women presenting to emergency departments. The intervention was not designed for any specific cultural or ethnic groups, or for people with physical or mental disabilities or health conditions. Women were generally English-speaking, ranging in age from 15 to 65 years, and presented for emergency care with a non-urgent complaint.

Some studies did not test screening interventions for certain women presenting to the emergency departments. For example, common exclusion criteria included women who:


The table below gives an overview of whether or not the intervention was examined with some key populations. The inclusion of these populations was guided by the National Plan to End Violence against Women and Children 2022–2032 and The Australian National Research Agenda to End Violence against Women and Children 2023–2028.

🔴 = no studies
🟡 = at least 1 study mentions that population, but effectiveness was not tested with that population
🟢 = at least 1 study tests effectiveness with the population

Population What do we know about this group? Degree of knowledge
Aboriginal and Torres Strait Islander communities

0 studies

Culturally and linguistically diverse (CALD) groups

4 studies included women from CALD backgrounds, specifically African American and Māori women

Sexuality and gender diverse / LGBTIQA+

0 studies

Specific age groups (including older people, children and young people)

4 studies included adolescents aged 15–16 years and over

Migrants and refugees

0 studies

People with disability

0 studies

Key considerations

This section summarises factors that may contribute to study results, factors that may be considered to facilitate better outcomes, and the transferability of the intervention to an Australian context.

What do we know about the intervention in Australia?

What should Australian stakeholders consider?

Available evidence considerations:


Implementation considerations:

Included studies

Characteristics of primary studies included in the Intervention Review
Study and location Design Intervention Sample Outcome categories
Anglin (2003) Systematic review
Type of analysis: Narrative synthesis
Search period: 1980 to 2002
Screening interventions for IPV in emergency departments
N included studies: 20
Included research design: No restrictions
Countries: Any country
Adults and adolescents presenting to the emergency department, all genders Detection of violence, screening and support
Choo et al. (2015) Systematic review
Type of analysis: Narrative synthesis
Search period: 1990 to 2013
Screening and additional educational interventions for IPV in emergency departments
N included studies: 3
Included research design: Randomised controlled trials
Countries: Any country
Adult women presenting to the emergency department Detection of violence, screening and support; health
DeFehr (1997) Canada Single group pre-post study
Comparison: N/A
Qualitative data: No
Routine screening protocol for identifying IPV, a 45-minute training for staff with instructions and tick sheets; if a positive IPV disclosure was received, women were offered resources and referral to social work
Duration and format: Delivered face-to-face individually by nurses and physicians
Setting: Emergency department
Cost: Not reported
N = 119
Adult women presenting to the emergency department
Detection of violence, screening and support
Fanslow et al. (1998; 1999) New Zealand Quasi-experimental study
Comparison: Treatment as usual
Qualitative data: No
A protocol for IPV screening of women when staff had “reasonable suspicion that abuse had taken place”, including staff training, questioning about physical and sexual violence, assessment of risk of homicide, suicide and danger to children; if a positive IPV disclosure was received, women were offered safety planning and referral to specialist services
Duration and format: Delivered face-to-face individually by medical, nursing and reception staff trained for 1 or 4 hours. Staff were provided with materials such as printed forms, checklists, a body map to document injuries, and referral cards
Setting: Emergency department
Cost: Not reported
N = 4,044
NExp = 2,276
NComp = 1,768
Adult women and girls aged 15 years and older presenting to the emergency department, 17% Māori
Detection of violence, screening and support
Furbee et al. (1998) United States Quasi-experimental study
Comparison: Active intervention, a pre-recorded taped questionnaire
Qualitative data: No
A 9-item screening questionnaire for identifying IPV and a private interview
Duration and format: Delivered face-to-face individually by a single designated female physician
Setting: Emergency department
Cost: Not reported
N = 715
NExp = 92
NComp = 83
Adult women presenting to the emergency department, mean age 34 years
Detection of violence, screening and support
Glass et al. (2001) United States Quasi-experimental study
Comparison: Another active intervention, self-administered survey
Qualitative data: No
An 18-item screening questionnaire for identifying IPV, called the Patient Satisfaction and Safety Survey (PSSS)
Duration and format: Delivered face-to-face individually by trained off-duty emergency department nurses in an examination room
Setting: Emergency department
Cost: Not reported
N = 3,455
Adult women presenting to the emergency department
Detection of violence, screening and support
Hoelle et al. (2014) United States Randomised controlled trial
Comparison: Active intervention
Qualitative data: No
Two brief screening interventions for identifying IPV, including the 4-item Ongoing Violence Assessment Tool (OVAT) and a single-question instrument
Duration and format: Delivered face-to-face individually by trained health professionals
Setting: Emergency department
Cost: Not reported
N = 200
Adult women presenting to the emergency department
Detection of violence, screening and support
Koziol-McLain et al. (2010) New Zealand Randomised controlled trial
Comparison: Treatment as usual (standard ED care)
Qualitative data: No
A brief 3-item screening intervention for identifying IPV, based on the Partner Violence Screen (PVS) and the Abuse Assessment Screen (AAS), including risk assessment; if a positive IPV disclosure was received, women were asked a series of high-risk questions and offered safety planning and referral to the hospital social worker or specialist IPV services
Duration and format: Delivered face-to-face individually by trained health professionals, 3 minutes for screening only and 7 minutes for high-risk cases
Setting: Emergency department
Cost: Not reported
N = 344
NExp = 167
NComp = 177
Adult women, aged 16 years and over, presenting to the emergency department, median age 40 years, 37.6% Māori
Detection of violence, screening and support; gender-based violence; behaviours; social and material support
MacMillan et al. (2006) Canada Randomised controlled trial
Comparison: Two active interventions: 1) self-completed screening; and 2) self-completed written screening
Qualitative data: No
Brief screening for identifying IPV, based on two instruments: the Woman Abuse Screening Tool (WAST) and the Partner Violence Screen (PVS); if a positive IPV disclosure was received, women were offered usual care
Duration and format: Delivered face-to-face individually by trained health professionals
Setting: Emergency departments, family practices and women’s health clinics
Cost: Not reported
N = 2461 (n = 768 emergency department)
Adult women presenting to the emergency department
Detection of violence, screening and support
Morrison et al. (2000) Canada Quasi-experimental study
Comparison: No treatment
Qualitative data: No
Brief 5-item screening questionnaire for identifying IPV; if a positive IPV disclosure was received, women were offered specialist referrals, printed resources and an appointment with a social worker
Duration and format: Delivered face-to-face individually by a research assistant in a private examination room after triage
Setting: Emergency department
Cost: Not reported
NExp = 302
NComp = 1,000
Adult women presenting to the emergency department
Detection of violence, screening and support
Nelson et al. (2012); Wilbur et al. (2013) Systematic review
Type of analysis: Narrative synthesis
Search period: 2002 to 2012
Screening interventions for IPV in various health settings N included studies: 15 (6 in emergency department settings)
Included research design: Randomised controlled trials and quasi-experimental studies with a control group
Countries: United States only
Adult women presenting to the emergency department Detection of violence, screening and support; health
O’Doherty et al. (2014; 2015) Systematic review
Type of analysis: Meta-analysis
Search period: Database start date to 2012
Screening interventions for IPV in various health settings N included studies: 13
Included research design: Randomised controlled trials and quasi-experimental studies with a control group
Countries: Any country
Adult women presenting to the emergency department Detection of violence, screening and support; health; social and material support; wellbeing and emotions
Olson et al. (1996) United States Quasi-experimental study
Comparison: Treatment as usual
Qualitative data: No
A brief screening intervention, based on either a: 1) a medical chart modification, involving a stamp on patients’ medical chart with a question to remind physicians to enquire about IPV; or 2) a medical chart modification and a 1-hour educational lecture for ED staff with information on improving identification, treatment and referral options for IPV
Duration and format: Delivered face-to-face individually by medical professionals
Setting: Emergency department
Cost: Not reported
N = 2,717
NExp = 1,444
NComp = 1,273
Adult women and girls aged 15 years and older presenting to the emergency department, mean age 28.5 years
Detection of violence, screening and support
Power et al. (2007; 2011) Australia Single group pre-post study
Comparison: N/A
Qualitative data: Yes
Domestic Violence Identification Tool, adapted brief 3-item screening intervention for identifying IPV; if a positive IPV disclosure was received, women were offered three options: 1) an informational pamphlet only; 2) information and referrals to specialist services; or 3) counselling with a social worker
Duration and format: Delivered face-to-face individually by trained nurses
Setting: Emergency department
Cost: Not reported
N = 109
Adult women, over 16 years, presenting to the emergency department
Detection of violence, screening and support
Rhodes et al. (2002) United States Quasi-experimental study
Comparison: Treatment as usual
Qualitative data: No
Adapted questions from the Partner Violence Screen (PVS) and the Abuse Assessment Screen (AAS), administered computer-based screening for identifying IPV, including a health and lifestyle risk assessment, with the screening results attached to the patient’s chart during their hospital visit to act as a prompt for staff; if a positive IPV disclosure was received, women were offered referral options
Duration and format: Delivered individually via computer, 17 minutes on average to complete
Setting: Emergency department
Cost: Not reported
N = 470
NExp = 248
NComp = 222
Adults, all genders presenting to the emergency department, 69% female, 91% African American, average age 33 years
Detection of violence, screening and support
Rhodes et al. (2006) United States Randomised controlled trial
Comparison: Treatment as usual
Qualitative data: No
Self-administered computer-based health and lifestyle risk assessment tool called Promote Health Survey, with the screening results attached to the patient’s chart during their hospital visit to act as a prompt for staff; if a positive IPV disclosure was received, women were offered usual care referral options
Duration and format: Delivered individually via computer
Setting: Emergency department
Cost: Not reported
N = 1,281
NExp = 637
NComp = 644
Adult women presenting to the emergency department, average age 33.3 years, 60% African American
Detection of violence, screening and support
Svavarsdottir (2010) Iceland Single group pre-post study
Comparison: N/A
Qualitative data: No
Self-administered written questionnaire for identifying IPV, based on the Woman Abuse Screening Tool (WAST) and an interview of 9 open-ended questions with a nurse, based on the Women Abuse: Screening and First Response. Evaluation Interview Frame for Nurses and Midwives, both instruments were translated from English to Icelandic
Duration and format: Delivered face-to-face individually with nurses, with the self-completed questionnaire answered within 4–12 minutes, and interviews lasting between 10–54 minutes
Setting: Emergency department
Cost: Not reported
N = 101
Adult women presenting to the emergency department, mean age 38 years, 98% Icelandic
Detection of violence, screening and support; relationships; wellbeing and emotions
Trautman et al. (2007) United States Quasi-experimental study
Comparison: Active intervention, a self-administered computer-based health survey with no IPV-related questions
Qualitative data: No
Partner Violence Screen (PVS), a self-administered computer-based health survey 4-items specific to identifying IPV, with a report attached to the patient’s medical record; if a positive IPV disclosure was received, women were offered a social work referral
Duration and format: Delivered individually via computer, approximately 6 minutes
Setting: Emergency department
Cost: Not reported
N = 1,006
NExp = 411
NComp = 594
Adult women presenting to the emergency department, average age 33.3 years, 60% African American
Detection of violence, screening and support

References and further reading

Included studies

Additional evidence on the intervention

This list contains other evidence that was not eligible for the Intervention Review based on our selection criteria but may provide further information regarding the intervention.