Forensic Healthcare Online

On-line continuing education information for forensic healthcare professionals

Universal Screening for IPV

with 2 comments

The IPV world is a bit up in arms right now with the publication of JAMA’s recent study that universal screening doesn’t improve health outcomes or reduce violence. Not everyone is praising this study, and I think there are reasons to look at it critically. However, in the process of doing so, if you’d like to earn yourself a little CE credit, Medscape has an offering right now based on the article (physicians net 0.25 credits for completing the article and posttest).

It’s important to not read this study as a wholesale call for abandoning universal screening. Family Violence Prevention Fund‘s response to the study, which you can read here, makes some important points about interpretation (ones with which I agree). It’s critical to note that in the same issue of JAMA there’s an editorial that also reminds readers to take a nuanced approach to interpreting the study:

“…there continues to be a lack of evidence that universal screening alone improves health outcomes for IPV survivors. It is certainly understandable that clinicians and health care facilities have implemented universal screening programs, given the prevalence and potential severity of IPV. However, the results of the study by MacMillan et al should dispel any illusions that universal screening with passive referrals to community services is an adequate response to violence in intimate relationships. Specific interventions to prevent the recurrence of abuse for women at risk of violence should be implemented and rigorously tested, preferably in randomized trials, without further delay.” (p. 569)

Screening alone will never be a good solution to any healthcare problem, including IPV. While the article’s premise may be misleading at first glance, it does make a few important points that are often overlooked. Not the least is the futility of asking the question if you’re prepared to do little more than hand someone a shelter or hotline number.

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Written by Jenifer

August 25, 2009 at 10:56 am

2 Responses

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  1. Hi Jennifer. As a forensic nurse examiner with a decade of experience, I admit I was taken aback by this study. I appreciate you taking the time to highlight some factors that contributed to their finding. It could be compared to a “Women’s Shelter” counselor who is asked to screen all her clients for signs of hypertension.
    Do you have a headache? “Yes”
    Do you have shortness of breath? “Yes”
    Do you have chest pain? “Yes”

    OK- I can get you a number to call. They should be able to help.

    If they were to screen clients for hypertension- they need to know more about the disease to make screening safe/matter.

    They know about as much about hypertension as health care professionals do about IPV.

    Thanks,
    Cyndi

    Cyndi

    September 12, 2009 at 9:16 pm

  2. Sadly, I think in many cases this is true. I’ve definitely seen some progress, but it’s in no means universal. I think not wanting to deal with the issue is as often the culprit as not knowing how to deal with it.

    Jenifer

    September 14, 2009 at 8:04 am


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