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.
InterventionScreening delivered in hospital emergency departments seek to identify intimate partner violence (IPV) victimisation |
Key populationsAdult women presenting to hospital emergency departments |
Outcomes studiedDetection of violence, screening and support; gender-based violence; health; behaviours; relationships; wellbeing and emotions; social and material support |
Impact of the interventionOf the 18 studies, nine outcomes received an effectiveness rating on our Effectiveness Estimate Tool |
Australian Evidence1 study presented findings from Australia and no studies reported on the experiences of Aboriginal and Torres Strait Islander peoples |
Risk of biasOf 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 |
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.
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 |
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.
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 |
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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. |
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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. |
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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. |
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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). |
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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. |
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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. |
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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. |
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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. |
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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. |
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 studiesPopulation | What do we know about this group? | Degree of knowledge |
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Aboriginal and Torres Strait Islander communities |
0 studies |
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Culturally and linguistically diverse (CALD) groups |
4 studies included women from CALD backgrounds, specifically African American and Māori women |
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Sexuality and gender diverse / LGBTIQA+ |
0 studies |
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Specific age groups (including older people, children and young people) |
4 studies included adolescents aged 15–16 years and over |
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Migrants and refugees |
0 studies |
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People with disability |
0 studies |
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.
Available evidence considerations:
Implementation considerations:
Study and location | Design | Intervention | Sample | Risk of bias rating |
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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 v 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 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 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 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 |
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 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 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 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 Adult women presenting to the emergency department, average age 33.3 years, 60% African American |
Detection of violence, screening and support |
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.