The Role of Emergency Medicine in Intimate Partner Violence: A Scoping Review of Screening,Survivor Resources,and Barriers

Abstract

At the front line of our medical system and population health, emergency medicine (EM) settings serve as a commonly perceived place for safety. Survivors of intimate partner violence (IPV) may present to the emergency department (ED) with injuries, illness, or specifically to seek help for IPV. In 2018, the U.S. Preventive Services Task Force (USPSTF) recommended screening women of reproductive age for IPV across all healthcare settings. Our objective was to examine the application of IPV interventions, resource allocation, and persistent barriers for screening within the EM setting following the USPSTF recommendation. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). Our initial search of two major databases, PubMed and CINAHL, found 259 articles. After screening for inclusion and exclusion criteria, 15 articles met the full study criteria. Inconsistencies in screening women for IPV in EM are still prevalent. No study used the same validated IPV screening tool and four did not specify the tool. Significant barriers to screening included time constraints, patient acuity, language barriers, staff education, and inability to connect patients to resources. There is a need for more consistent IPV screening in the EM setting, which may include the development of a standardized, inclusive screening tool, as well as additional research and sharing of best practices. Advancement of IPV identification must go beyond a recommendation with greater awareness and education changes at all levels: personal, institutional, and policy.

Keywords

domestic violence domestic violence and cultural contexts disclosure of domestic violence intervention/treatment

Introduction

Intimate partner violence (IPV), commonly referred to as domestic violence (DV), is defined by the World Health Organization (WHO) as violence or behaviors perpetrated by a former or current partner, inclusive of physical, sexual, or psychological harm including acts of physical aggression, sexual coercion, psychological abuse, and controlling behaviors (WHO, 2012). As a longstanding societal phenomenon across the globe, IPV has been documented to have profound, damaging impacts on health (Potter et al., 2021). Despite the international community’s acknowledgment of this problem as set out in the 1993 Declaration on the Elimination of Violence Against Women, a 2010 global health data analysis found that approximately 30% of women aged 15 and older have experienced IPV in their lifetime (Devries et al., 2013). More recently, in the United States, the prevalence of IPV has been found to range from 27.8% to 45.3% for women and 18.5% to 38.6% for men (Willie & Kershaw, 2019).

Across all subtypes, whether physical, psychological, or emotional abuse, IPV is associated with poorer self-reported physical and mental health and remains a significant risk to a woman’s burden of disease and injury (Potter et al., 2021; Vos et al., 2006). Yet IPV can remain undetected if there are no structural avenues to address its existence and no opportunity is provided for disclosure. Screening is essential for the detection of violence and provides survivors with help-seeking opportunities to procure resources and assistance from housing, medical, legal, or community advocate services.

Historically, there has been advocacy for improved targeted screening for IPV in healthcare settings, as well as advocating for universal screening measures (Poirer, 1997). However, rates of IPV disclosure and use of screeners may differ from one hospital setting to another due to the severity of a patient’s condition, the primary complaint, a clinician’s preconceived conceptions of a “typical battered woman” profile, or even the time of presentation to an emergency department (ED) or clinic (Larkin et al., 1999). In the United States, chart reviews and self-reported analysis studies have consistently found low, inadequate screening rates for IPV, while often only occurring in primary care settings (Klap et al., 2007; Perone et al., 2022). The geographical location and type of healthcare setting can also influence the likelihood of screening and the availability of resources (Adjognon et al., 2023; Agronsky et al., 2023; Davidov et al., 2023). In addition, there is still no national consensus on the most appropriate IPV screening instruments for distinct medical specialties and care settings.

For survivors presenting to the ED, IPV injuries or impacts can either be the primary reason for the visit or be a hidden experience within one’s home (Ernest & Weiss, 2002). EDs are often considered to be the loophole to universal care in the United States, acting not only as a guaranteed healthcare site, but also in many ways as a gateway for social services, which sees everyone regardless of insurance status, demographics, or citizenship status (Anderson et al., 2016; Gordon, 2000). At the interface of multiple systems, EDs act as the “safety net for the safety net,” treating the outcomes of longstanding structural violence while attempting to address the impact of social determinants of health (Gordon et al., 2001). Screening for IPV plays a significant role in evaluating a presenting patient’s health and safety. If IPV is properly identified, EDs can integrate successful referral systems that can connect victims with trained advocates, counselors, childcare, legal, and employment services (Ernest & Weiss, 2002). However, if there are no consistent screening protocols implemented, survivors will not receive the help and attention they may be seeking.

Guidelines and recommendations have failed to ensure hospital-based screening and resource allocation conventions for IPV survivors due to a lack of consensus on optimal protocol use in the ED (Anglin & Sachs, 2003). Many healthcare providers report that they lack confidence and knowledge on how to adequately screen for IPV in the ED and how to successfully refer women to support services (Heron & Kellermann, 2002). Less than 20 years ago, the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation found insufficient evidence to support any specific screening recommendations for women presenting with and experiencing IPV, yet screening instruments were noted to be an accurate tool in identifying IPV with minimal adverse effects on most women (Nelson et al., 2012). In 2013, the WHO published guidelines for clinicians to ask about IPV exposure only when assessing conditions that may have been caused by IPV, while that same year, the USPSTF published contradictory recommendations, suggesting that women of childbearing age routinely be screened for IPV (Feder et al., 2013). The WHO guidelines mentioned training providers to perform proper screening but did not expand further.

The most up-to-date United States guidelines are the 2018 USPSTF Statement titled, “Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults.” This statement provides a B-level recommendation for healthcare clinicians, across all settings, to screen for IPV in women of reproductive age and, if women do screen positive for experiencing IPV, to provide or refer them to support services. While this recommendation did acknowledge that available screening instruments can be used to identify IPV, there was no specific screener identified nor was there any additional detailed commentary about what kind of “support services” should be provided. The recommendation did note several effective screening instruments that accurately detect past-year IPV in adult women: Humiliation, Afraid, Rape, Kick (HARK); Hurt, Insult, Threaten, Scream (HITS); Extended-Hurt, Insult, Threaten, Scream (E-HITS); Partner Violence Screen (PVS); and Woman Abuse Screening Tool (WAST). Despite providing a range of tools, there was no conclusive commentary on which was the most appropriate to use or under what setting the implementation was most important (this recommendation predominantly noted primary care as a resource for IPV screening and data collection). Given the ambiguity of the 2018 USPSTF recommendations, further research is needed to guide the implementation of IPV screening in EDs.

Objective

The purpose of this scoping review is to provide a focused review of peer-reviewed literature on IPV screening in EDs published after the recommendation of the updated 2018 USPSTF Statement. We seek to identify whether the gap not addressed by the USPSTF recommendations regarding which screening tool to use in EDs and how to implement screening and referral programs has since been filled by relevant research.

The primary objective of this scoping review is to identify the prevalence, type of screener, and application of IPV screening for women in ED settings since 2018. Additionally, secondary objectives include (a) examining what barriers continue to exist for the implementation of IPV screening in emergency medicine (EM), and (b) identifying IPV survivor resources that are currently offered or are still needed.

Methods

This protocol was drafted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). Registration for this scoping review was not required.

Types of Sources and Search Strategy

We included only peer-reviewed articles published in English where the full text was available and excluded: theses, dissertations, editorials, and reviews. We searched both PubMed and CINAHL. We conducted the article searches in May of 2022. The search terms used for PubMed can be found in Appendix A and include terms for each concept pertinent to the research question, for example, setting (EDs), IPV, screeners, and interventions.

Article Selection

Inclusion criteria included the following: studies conducted in the United States, participants were at least 18 years or older, published in or after 2018, included an IPV screener(s) or resource referral, study setting was within the ED, and EM service/care utilization or outcomes for IPV were defined in the article’s primary outcomes. The target study population was identified as (a) women being screened for IPV or (b) EM clinicians. Studies with additional population demographics beyond our specific inclusion criteria were still included if the population of women experiencing IPV could be distinguished and analyzed in comparison to other groups. Reasons for exclusion included the incorrect population demographic (i.e., exclusively men, the elderly [ages >65], children/adolescents [ages<18]), and if the medical and/or healthcare settings did not solely focus on EM, such as primary care settings, urgent care centers, or general hospital visits.

Studies underwent abstract and full-text reviews for inclusion prior to data extraction. We used Covidence as a shared platform to track inclusion/exclusion and data extraction (Covidence Systematic Review Software, 2022). All four reviewers participated in each step of the article review process, two of whom have a strong background in IPV research and three having experience in emergency clinical care. The first step was study title and abstract screening, which was divided across the reviewers, with each study being reviewed by two team members. The second step was a full-text review, following the same reviewer format as step one. The final step was full-text extraction. During the study title and abstract screening, the researchers found it important to restrict the eligibility of studies to be included if they referenced retrospective chart reviews or studies that began before 2018. We added this refinement to the protocol to highlight the concentrated influence of policy and guidelines on clinical practice and referral programs. Data extraction/charting was performed in pairs by the four reviewers within the Covidence platform. Final consensus for an article was achieved through discussion between the two reviewers, and when necessary (and on rare occasions), the senior author made any final decisions if consensus was not mutually reached among the original reviewers. Inter-rater reliability was calculated using Cohen’s kappa. Cohen’s kappa was interpreted as having an average fair agreement [0.21–0.40] for the title and abstract review and moderate agreement [0.41–0.60] for the full-text review (McHugh, 2012).

Extraction and Synthesis

All the variables and themes included in the extraction form can be found in Appendix B. In the category “delivery of IPV screening intervention,” reviewers had the option to choose all that apply: person, computer/tablet, paper, audio/video. The authors decided to include the item “If performed in a culturally sensitive manner” under the criteria for IPV Screening to account for and acknowledge the researchers’ cultural relevance, contextuality, appropriateness, mutual respect, and flexibility with the study population. While this item was presumably subjective, the study authors noted the importance of including this variable as an appropriate measure to help determine the cultural knowledge or competency of the study, if any. If an article did not include a definition of IPV or made reference to an established definition of the term, it was assumed that the researchers used the definition identified by the screening tool within the study.

Extraction items were chosen based on the three main objectives of this review: IPV screening, survivor resources, and barriers for clinicians to screen and refer. Themes were analyzed based on the identification of this data, such as IPV prevalence, attitudes toward screening, systemic barriers to screening, and individual article recommendations. For articles that had missing data, two identifiers were used: (a) Unspecified if the articles did not clearly address the information, or (b) Not applicable if the information was not possible to extract given the study’s design or statistical analysis.

Results

Selection of Sources as Evidence

The search returned 259 articles for review. We removed 79 articles that were duplicates with an additional 132 articles excluded during the title and abstract screening. 48 articles remained for full-text review; 33 articles were further excluded in this stage, per inclusion and exclusion criteria. Ultimately, 15 articles met the study criteria for data extraction (Figure 1). Based on Covidence’s analysis software, title, and abstract inter-rater reliability between all four reviewers had a proportionate agreement ranging from 0.642 to 0.938, with Cohen’s kappa = 0.318 (95% confidence (CI) [−0.135, 0.683]), which corresponds with a fair agreement. The full-text review had a proportionate agreement ranging from 0.571 to 1.0, with Cohen’s kappa = 0.466 (95% CI [0.0, 1.0]), corresponding with a moderate agreement.

Figure 1.

Flow diagram for article screening and data extraction.

Out of the 15 final articles, 7 were cross-sectional surveys from a single, large-scale study (Caetano et al., 2019). All seven of these articles were included separately in the analysis of the characteristics as each article contributed differently to our main aims (Caetano et al., 2020; Cunradi et al., 2020a, 2020b, 2021a, 2021b, 2022). The other eight articles include quantitative and mixed-method study designs, including an observational analysis, cross-sectional surveys, retrospective electronic health records reviews, interviews, and cohort analyses. Appendix C includes an outline of the general extraction variables for all 15 articles and Table 1 describes the study design, setting, IPV definition used, IPV screener, key findings, and recommendations of each included article.

Table 1.

Individual Descriptive Data from Included Articles.

Article	Study Design/Population	Article’s Purpose	Definition of IPV/IPV Screener Used	Key Findings Related to IPV Prevalence and Screening	Recommendations
Aboutanos et al. (2019)	Quantitative Methodology: Cross-sectional survey, Observational analysis Setting: Single, urban Level 1 trauma center emergency department (ED) Sampling Strategy: Present to hospital for intimate partner violence (IPV) or patients disclose IPV when screened by a trained provider	Describes the 10-year initial development, sustainability, and growth (as well as processes, outcomes, and impact) of a hospital-based IPV/DV intervention program at a Level 1 trauma center	IPV: Physical violence, psychological and verbal harm, and stalking by a current or former intimate partner Screener: Hurt, Insult, Threaten, Scream (HITS) Language(s) available: Unspecified	– Identifies 5% (926/18,648) incidence of IPV in the EM population, which initiated them to be seen by their in-house “Project Referral” program, and 799 (719 women, 8 transgender) patients were then further evaluated by the IPV intervention team– A significant increase in primary IPV identification occurred when hospital staffing increased, when the in-house hospital-wide campaign was rolled out, and when the HITS screening tool was introduced	– Advocates for combined hospital-based screening and intervention efforts, such as being seen by a trained provider and an IPV intervention member who assists in advocation and direct prevention efforts by IPV-trained general staff– Presents a program with a more comprehensive model program with direct intervention, prevention efforts, and trained staff – not to just screen and referral IPV positive patients - which can be adopted by other institutions
Brignone and Gomez (2022)	Quantitative Methodology: Retrospective electronic health record review Setting: Single, urban Level 1 trauma center ED Sampling Strategy: Identified using screening form, International Classification of Diseases (ICD)-9 or ICD-10 code, or chief concern related to IPV	To assess the impact of a digital warm handoff referral program on survivors’ odds and predicted probabilities of receiving advocacy services after an ED visit for DV by race, ethnicity, and gender	IPV: Violence perpetrated by a current or former intimate partner as well as first-degree family members or roommates Screener: UnspecifiedScreening question: “Are you being physically hurt or threatened by someone close to you in your living situation?” Language(s) available*: Not applicable	– The program, Domestic Violence Report and Referral (DVRR), identified 84.2% (1,150) women survivors in the ED and 33% of women who reached advocacy when a resource connection was initiated for them– A majority of survivors were female (84.2%), Black (63.5%), and did not experience sexual assault during an IPV episode (85.1%)- DVRR was associated with a significant increase in survivor odds of receiving advocacy services with greater change among Black survivors than for white or Latinx survivors (4.67-fold)	– A digital warm handoff intervention can be particularly meaningful for members of groups at the greatest risk of DV and inequities in care
Caetano et al. (2019)	Quantitative Methodology: Cross-sectional survey Setting: Single, urban Level 1 trauma center ED Sampling Strategy: Identified using an electronic patient information system, non-emergent patients in the ED waiting room	To examine ethnicity-specific 12-month rates of victimization, perpetration, and mutual physical IPV and their association with drinking and other sociodemographic and personality correlates in an urban ED sample	IPV: Physically abusive events between partners Screener: Revised Conflict Tactics Scale (CTS-2) 12-item, specifically related to physical IPV Language(s) available: English and Spanish	– Reports victimization across ethnicities (Hispanic, 5%; Asian American, 4%; Black, 8%; white, 10%; Multiethnic, 9%)– Any IPV experience was significantly higher among Multiethnic patients, followed by Black and white patients- Multiethnic, Black, and white patients reported higher levels of moderate and severe IPV compared to Asian Americans and Hispanic patients	– The need for the development and integration of more personalized and culturally appropriate assessments of patients who have screened positive for IPV–The need for more specialized approaches for the identification of certain population groups experiencing IPV within and outside the ED
Caetano et al. (2020)	Quantitative Methodology: Cross-sectional survey Setting: Single, urban Level 1 trauma center ED Sampling Strategy: Identified using an electronic patient information system, non-emergent patients in the ED waiting room	To examine the association between an index representing the cumulative effect of seven different risk factors (depression, post-traumatic stress disorder, impulsivity, drug use, adverse childhood experiences, at-risk drinking, and partner hazardous drinking) and physical IPV	IPV: Physically abusive events between partners Screener: Revised CTS-2 12-item, specifically related to physical IPV Language(s) available: English and Spanish	– 23% of the sample (241/1,029) reported any incidence of IPV, including perpetration, victimization, and mutual violence– Of the 241, 26% experienced victimization only, 48% experienced severe IPV, and 57% experienced mutual violence (perpetration and victimization), but it is unknown exactly what proportional breakdown is female, despite the report that 53.4% of 1,029 were female– Patients reporting any type of IPV significantly increased with the number of behavioral risk factors reported– Black and Multiethnic individuals were 1.8–2 times more likely to report IPV than Hispanic patients	– Not discussed
Cunradi et al. (2020a)	Quantitative Methodology: Cross-sectional survey Setting: Single, urban Level 1 trauma center ED Sampling Strategy: Identified using an electronic patient information system, non-emergent patients in the ED waiting room	To test if drinking contexts are associated with the frequency of physical IPV perpetration and victimization among a sample of urban ED patients	IPV: Physically abusive events between partners Screener: Revised CTS-2 12-item, specifically related to physical IPV Language(s) available: English and Spanish	– 17.3% (90/521) of the women report at least one incidence of IPV victimization in the past 12 months– Average IPV victimization events in the past 12 months were 2.09 (SD: 9.90) for women– No context-specific frequencies or volumes of drinking were associated with the frequency of IPV victimization	– IPV underreporting could be mitigated by ED providers separately interviewing each partner/spouse
Cunradi et al. (2020b)	Quantitative Methodology: Cross-sectional survey Setting: Single, urban Level 1 trauma center ED Sampling Strategy: Identified using an electronic patient information system, non-emergent patients in the ED waiting room	To determine the associations of problem drinking and marijuana use with risk for unidirectional (perpetration or victimization only) and bidirectional (perpetration and victimization) IPV among a sample of urban ED patients	IPV: Physically abusive events between partners Screener: Revised CTS-2 12-item, specifically related to physical IPV Language(s) available: English and Spanish	– Black and Multiracial patients were at elevated risk for bidirectional IPV compared to white patients (note: ethnicities were not stratified by gender)– 6.2% of the sample reported only victimization (both genders)– 4.0% of women reported victimization in the total sample of any IPV [23% (241/1,037) of men and women who reported unidirectional or bidirectional IPV	– ED providers should consider asking patients who are married, cohabiting, or in a dating relationship about their experience with past-year IPV perpetration and victimization, inquire about their substance use patterns, as well as those of their partner/spouse, and share information in a non-judgmental way about the potential linkage
Cunradi et al. (2021a)	Quantitative Methodology: Cross-sectional survey Setting: Single, urban Level 1 trauma center ED Sampling Strategy: Identified using an electronic patient information system, non-emergent patients in the ED waiting room	To analyze the extent to which individual, household, and neighborhood-related factors are associated with the frequency of IPV and severe IPV among a sample of married/partnered male and female urban ED patients.	IPV: Physically abusive events between partners Screener: Revised CTS-2 12-item, specifically related to physical IPV Language(s) available: English and Spanish	– In a total of 496 eligible women, the mean IPV victimization frequency of IPV incidences for women was 12.8 (SD: 21.5) and severe IPV frequency was 9.27 (SD: 12.39) – Statistically significant greater rates of IPV and severe IPV were reported among Black women. For Black women, the average IPV frequency was 23.050 (P<0.01) and severe IPV frequency was 10.783 (P<0.01) – Being fired or laid off from a job associated with the frequency of IPV and severe IPV among women – Food insufficiency positively associated with the frequency of IPV and severe IPV among women – Among women, the percentage of families below 150% of the poverty level was positively associated with the frequency of severe IPV – Median household income was positively associated with the frequency of IPV and severe IPV	– Addressing food insecurity in an underserved population may be a pathway to IPV prevention
Cunradi et al. (2021b)	Quantitative Methodology: Cross-sectional survey Setting: Single, urban Level 1 trauma center ED Sampling Strategy: Identified using an electronic patient information system, non-emergent patients in the ED waiting room	To analyze the interrelationships of economic stressors, mental health problems, substance use, and IPV among a sample of Hispanic ED patients and to assess if Spanish language preference has a protective effect	IPV: Physically abusive events between partners Screener: Revised CTS-2 12-item, specifically related to physical IPV Language(s) available: English and Spanish	– 9.6% (25/262) of women who were screened reported victimization – No association was observed between women’s substance use and IPV perpetration or victimization – There was no protective effect of the Spanish language for IPV victimization	– Importance of ensuring low proficiency English patients receive appropriate Spanish language assistance during their ED visit
Cunradi et al. (2022)	Quantitative Methodology: Cross-sectional survey Setting: Single, urban Level 1 trauma center ED Sampling Strategy: Identified using an electronic patient information system, non-emergent patients in the ED waiting room	To highlight the risk profiles of at-risk drinking only, cannabis use only, and both at-risk drinking and cannabis use for physical IPV perpetration and victimization among a sample of underserved urban ED patients seeking nonemergent care	IPV: Physically abusive events between partners Screener: Revised CTS2 12-item, specifically related to physical IPV Language(s) available: English and Spanish	– 17% (93/550) of women report IPV victimization – Women who reported at-risk drinking had a 2-fold increase in odds of IPV victimization, the magnitude of the effect greatest among those who report both cannabis and at-risk drinking	– Training ED nurses to screen for IPV is an important first step for increasing IPV identification and providing patients with appropriate referrals and resources, as well as the incorporation of brief substance screeners – Consider asking about cannabis use, may be at elevated risk for IPV involvement
DiVietro et al. (2018)	Quantitative Methodology: Cross-sectional survey Setting: Single, urban Level 1 trauma center ED Sampling Strategy: Admitted trauma patients	To report the results of a project designed to improve IPV screening through the implementation of a dual-method screening system	IPV: Physical abuse, severe psychological abuse, and sexual cohesion Screener: Revised CTS-2, Extended-Hurt, Insult, Threaten, Scream (E-HITS) Language(s) available: English and Spanish	– 34.8% (87/250) of women completed the survey – CTS-2: In one’s lifetime, 79% of women experienced any IPV victimization, 75.9% psychological aggression, 31% severe psychological aggression, 46% physical assault, 21.8% severe physical assault, 35.6% sexual coercion, 11.5% severe sexual coercion, 32.2% physical injury, 16.1% severe physical injury – CTS-2: Within the past year, 66.7% of women experienced any IPV victimization, 59.8% psychological aggression, 19.5% severe psychological aggression, 31% physical assault, 11.5% severe physical assault, 27.6% sexual coercion, 4.6% severe sexual coercion, 21.8% physical injury, 8% severe physical injury – Dual method identified more IPV exposure than either screening strategy would on their own – 50.6% of women screened positive from either tablet or face screen, but only 7.6% identified themselves as victims – Tablet CTS-2 identified more IPV than in-person E-HITS/HITS screen	– Consider having a systematic protocol for screening with validated tools and clear links to services for positive disclosures, universal education for primary prevention, and tablet use to describe IPV behaviors and allow patients to consider their experiences before talking to a healthcare provider
Loza-Avalos et al. (2022)	Mixed methods Methodology: Cross-section survey, Interviews Setting: Urban pediatric ED Sampling Strategy: Clinician-focused departmental email, self-selection interviews	To assess pediatric ED health care providers' knowledge, attitudes, and behaviors surrounding the IPV screening program four years after it was implemented	IPV: Unspecified Screener: Unspecified Use a nonverbal system; laminated card given to patients at ED triage Language(s) available*: Unspecified	– All nurses who participated in the study have administered an IPV screener, but only 78% of advanced practice providers/physicians and 9% of social workers and clinical laboratory scientists have – A significant majority of clinician interviewers had positive interests in more training, across all roles, to increase IPV screening and identification	– Calls for the identification of when refresher training should happen for ED staff and what the training should consist of to be effective – Identifies the need to improve documentation about screening status to reduce the ambiguity around whether a patient has been screened
Murray et al. (2022)	Quantitative Methodology: Prospective observational cohort analysis Setting: Single, urban hospital ED Sampling Strategy: Pre-pandemic: In-person ED, Post-pandemic: Phone call to ED exam room	To quantify successful screenings in a busy urban ED prior to and during the initial peak of the pandemic	IPV: Interpersonal safety, includes exposure to IPV, elder abuse, child abuse Screener: Accountable Health Communities Health-Related Social Needs Screening Tool (AHC HRSN) Language(s) available: Unspecified	– Average interpersonal safety positivity, including men and women, pre-pandemic was 90.4% (859/1,258) and post-pandemic was 80.8% (383/474) – 1% of women were screened out of the entire ED population – Need for assistance with interpersonal safety decreased during the post-period from 80.1% to 75.5%	Not discussed
Samuels-Kalow et al. (2021)	Quantitative Methodology: Cross-sectional survey Setting: 166 New England EDs Sampling Strategy: Survey all EDs in New England	To identify the prevalence of ED screening for health-related social needs (HRSN), understand the factors associated with screening, and understand how screening patterns for HRSN differ from those for violence, substance use, and mental health needs	IPV: Unspecified Screener: Unspecified Language(s) available: Not applicable	– 39% of the 166 EDs perform any HRSN screening – 95% screen for IPV, but tools and prevalence are unknown – 93% (155/166) report availability of social worker staffing, 25% report 24/7 social work availability, 32% report ED-based social worker, and 49% report a hospital social worker who responds to the ED	– Advocates for the integration of HRSN data collection into patients’ electronic medical records to reduce barriers to collecting information and providing resources
Straus et al. (2020)	Quantitative Methodology: Prospective cohort comparison Setting: Single, urban hospital ED Sampling Strategy: ED systematic days/times sampling that reflects	To compare recently/currently abused women's ratings of varied abuse events compared to ratings from never-abused women	IPV: Unspecified Screener: Abuse Assessment Screen (AAS) Language(s) available: Only English	– Study sample of 954 women, 9% of whom have experienced or are experiencing abuse, accounting for 86% of the original study population – Those who were abused rated non-physical abuse events (name-calling, put-downs, threats, extreme jealousy, controlling behaviors) as generally worse than never abused women	– There is a need for better clinician understanding and incorporation of the viewpoints of abused women, especially underrepresented women, into research planning and policy formation and practice focus priorities and guides improved resource utilization
Sun et al. (2022)	Quantitative Methodology: Retrospective electronic health record review Setting: Two Level 1 trauma centers Sampling Strategy: Trauma surgery consult, documentation of IPV or abuse, self-reported IPV on ED screening, or IPV highly suspected	To describe and characterize imaging and non-imaging patterns of IPV-related injuries specifically in patients presenting to an ED with trauma surgery consultation who required hospital admission because of the severity of their injuries	IPV: Unspecified Screener: Unspecified Language(s) available: Not applicable	– Self-disclosed confirmation of IPV in 93.1% (27/29) of the trauma service sample, 90% of women – 45% of patients reported a prior history of IPV – The most common injury was soft tissue injuries – The most common mechanism of injury was blunt force trauma	– Address underreporting from the perspective of a radiologist’s role, advocating for close communication with clinician teams, especially with suspicious imaging encounters, with thorough physical exams and history gathering for IPV – Need for effective screening and high vigilance for IPV in vulnerable populations

The definition of IPV and delivery of IPV screening varied across the articles (Appendix D). No two individual studies used the same definition of IPV, with the exclusion of the seven interrelated sub-analysis articles. Furthermore, only 20% of the articles had a primary aim explicitly related to IPV screening. The articles also varied in their definition of sex/gender. For the context of female identity, the seven interrelated sub-analysis articles coded gender as dichotomous (excluding three transgender patients), four articles mentioned self-reported gender, one article only included sex as a variable but not gender, and three did not specify how a patient’s sex or gender identity was derived. While Table 1 shows that eight articles had the option of Spanish or English IPV screening, this language inclusion is represented in only two broader studies (Caetano et al., 2019; DiVietro, 2018). Additionally, the seven interrelated articles are the only ones to touch on the topic of encompassing a culturally sensitive delivery, incorporating an aspect of language accessibility by the dual offering of languages and hiring bilingual research assistants, but there is no other information given beyond this description. No studies indicated the use of a trauma-informed approach when screening.

Screening Tools and Questions

The application of IPV screening tools and identification questions also varied throughout all the articles. The validated screening tools used were AAS, HITS, E-HITS, CTS-2, and the AHC health-related social needs (HRSN); three articles were missing screener information. Out of the 15 articles, 8 articles used the Revised CTS-2 (including the 7 sub-analysis articles) which is specifically designed for physical IPV. Each of the remaining validated tools listed was used in one of the remaining articles.

Several articles used screening questions based on non-validated measurement tools. Brignone and Gomez (2022) included the question for IPV incidence: “Are you being physically hurt or threatened by someone close to you in your living situation?.” DiVietro (2018) utilized the Revised CTS-2 and E-HITS screener but also noted that 6 months into the study, the hospital’s EMR system added mandatory abuse screening questions for the ED which included: “Do you feel that you are treated well? What happens when you argue or fight? Are you or have you been threatened? Has anyone ever threatened to hurt you? Does anyone try to keep you from having/contacting friends or doing things outside the home? Do you feel unsafe going back to your home?.” These additional questions were study-specific, and no specific screener was cited as their origin.

Information for in-person/face-to-face IPV screening was limited given the small number of articles that utilize in-person screener delivery. Within the seven sub-analysis articles, the face-to-face screening approach and script used are detailed as follows: “The next section concerns resolving couple conflict. No matter how well a couple gets along, there are times when they disagree, get annoyed with the other person, want different things from each other, or just have spats or fights because they are in a bad mood, are tired, or for some other reason. Couples also have many ways of trying to settle their differences. Please tell me how many times in the past 12 months your spouse or partner did each of these things to you, and how many times you did them to your spouse or partner. . .” (Cunradi et al., 2020b). DiVietro (2018) also noted that at the end of each study screening, the research associate would always offer the option for the patient to speak with a member of the social work team regardless of the patient’s IPV status. For the non-validated measurement tools, the delivery of screening questions was most often administered by an individual (study personnel or hospital staff) or self-reported through a computer/tablet system.

IPV Prevalence

The methods for the analysis of the incidence of IPV types (victimization, perpetration, and mutual) and the percentage of the population experiencing IPV varied depending on the article’s purpose and the methodology by which the authors reported the results. For six of the articles, the IPV victimization and incidence rates could not be broken down by gender, even when the number of women in the study was included. Disclosure of positive IPV identification across all articles for women ranged from 4.0% to 84.2% depending on the chosen study sample demographics, size, and methodological approach. The only study that asked participants whether they identified as “victims” themselves was DiVietro (2018), and they reported a 7.6% response among all participants without specifying statistics specific to gender.

Emergency Clinicians and IPV Screening

Only one article (Loza-Avalos, 2022) focused on clinicians’ feelings or attitudes toward IPV screening. Findings from Loza-Avalos (2022) indicated that most providers who voluntarily participated in the study felt that screening should occur whenever possible. However, many advanced practice providers/physicians indicated discomfort with performing the screening due to a lack of training and knowledge about both IPV screening and proper referrals. Overall, the entire ED staffing community in this survey favored registered nurses (RNs) performing the screening, including the RNs themselves. This study also identified four main reasons that providers gave to not screen: patient acuity, the presence of multiple caregivers, language barrier, and ongoing medical assessment. Of note, in Brignone and Gomez (2022) providers were significantly less likely to administer the IPV intervention that directly connected patients to referral services for patients experiencing sexual assault but did not explore further the reasons behind this disparity.

The consequence of human bias about IPV is acknowledged in multiple articles. Brignone and Gomez (2022) discussed how provider bias in IPV screening and delivery may also involve stereotyping and dismissiveness of experiences, especially among racial and ethnic minorities. Similarly, Loza-Avalos (2022) indicated that a few providers in the study reported subconscious biases that influenced who they chose to screen for IPV/DV. DiVietro (2018) noted that the EMR mandatory screening questions identified significantly less IPV than the dual method, which included both face-to-face screening using HITS and a tablet-based self-administered screening using CTS-2. This was potentially the nature of how the questions were asked, with the clinician looking at the computer screen, thus discouraging disclosure of a sensitive topic. Straus (2020) ultimately argued that clinicians may also tend to lean toward a “never abused” women perspective when screening, which underestimates the harm of non-physical assaults of IPV, including emotional and psychological abuse.

Systemic Barriers

The issue of systemic barriers to IPV screening is sparingly discussed. Cunradi et al. (2020a, 2021a) identified the systemic barrier of time constraints as contributing to the lack of data concerning psychological abuse, injury, and sexual coercion among patients. Similarly, Samuels-Kalow (2021) highlighted that busy, high-acuity, high-need EDs may reduce screening due to time and priority constraints, which would thereby reduce the use of appropriate interventions. Sun et al. (2023) discussed the significant underreporting of IPV in the trauma registry due to poor patient disclosure and underdiagnosis by clinicians, which is further amplified among non-white or non-English-speaking patients who are more likely to encounter barriers to healthcare access, are less inclined to present at a hospital or may not feel comfortable disclosing IPV to law enforcement or social workers. Recommendations to address these issues include improving clinician training, incorporating behavior questions regarding related IPV risk factors into screening protocols, developing more personalized and culturally appropriate measures, and increasing proper documentation/education for both the providers and patients.

Survivor Resources

Five of the 15 articles discussed social needs referrals, including social work, community referrals, food security resources, and counseling. Four articles indicated that resources or referrals were offered to the survivors who disclosed an IPV experience, two of which had referrals to resources outside of the ED. One article (Samuels-Kalow, 2021) indicated that the application of HRSN screening was limited because of the restricted availability of social workers in the ED.

Aboutanos et al. (2019) had a significant focus on referrals and resources for survivors. These referrals included resources outside of the ED but also prioritized connecting patients with resources within the hospital. The types of services that were provided to IPV patients included educational materials (i.e., information packet on IPV, education on IPV and sexual violence), mental health (i.e., in-house and community counseling/case management, and private counseling), legal support (i.e., victim witness, court accompaniment for protective orders, and police involvement), community programs (i.e., PERK, community referrals, and Virginia Victims Fund), safety planning (i.e., crisis intervention, hotline referral, and Fear to Freedom kit), and social service resources (i.e., shelter, transportation, and Victim Crisis Fund). Brignone and Gomez (2022) had an automated referral process to a local DV agency, of which 32.7% of women who screened positive were connected to services. DiVietro (2018) had the option for patients to speak with the social work team at the end of the study.

Discussion

The 2018 USPSTF recommendation encouraging all healthcare providers to screen for IPV among women of reproductive age was intended to improve and guide IPV screening in clinical settings. However, due to the great ambiguity of this statement, this has not come to fruition. In our review focused on identifying the latest research trends or changes for IPV screening in the field of EM, we found limited literature on this subject. The 15 publications assessed, representing eight independent studies and seven articles that utilized the same data source for analysis, show limited progress in IPV screening standardization. The variation in the articles’ methodologies, key findings around IPV prevalence, and how EM systems are currently designed to screen for IPV reinforces that this issue still faces great barriers in practice, policy, and inclusivity (Tables 2 and 3).

Table 2.

Critical Findings.

Prevalence	• Intimate partner violence (IPV) prevalence varied greatly based on the specificity of each study’s target population and the focus of findings within the individual article, ranging from 4.0% to 93.1% • Trends of high rates of IPV were most often reported among Black and multiethnic groups • Each individual study reports a different approach in screening women for IPV or did not define the approach in the methodology, and each uses a different screening tool for identification
Barriers	• Common systemic barriers that often limit the possibility for proper screening and IPV resource and referral allocation include time restraints, basic accessibility to healthcare, absence of standardized policies, and minimal resource availability • Failure to identify and assist non-white, non-English speaking patients may be due to barriers embedded within healthcare access, such as being less inclined to present at a hospital, seeking or receiving care in a non-native language • Potential interpersonal barriers of clinicians that may limit the screening of certain groups include constructed perspectives and subconscious biases
Resources	• Resources range from the opportunity to connect with a social worker during the emergency department visit to referrals for outside IPV agencies

Table 3.

Implications and Recommendations.

Practice	• Recommendations to address barriers to intimate partner violence (IPV) screening in emergency medicine are highly centered on structural and hospital-based changes to improve the identification of patients experiencing IPV, increase clinician knowledge of and comfort in screening, incorporate culturally appropriate assessments, and mitigate underreporting through validated tools and protocols • There is a need for validation of IPV screeners in languages other than English, the lack of which limits the ability to identify many survivors
Policy	• The evident application gap between the U.S. Preventive Services Task Force’s recommendation and practical integration indicates that set guidelines and higher-level policy changes may be needed to encourage consistent implementation of screening
Future research	• Available evidence supports the improvement of continuing education and training among clinicians and nursing staff regarding IPV knowledge and familiarity with IPV screening and resources • Research on IPV screening and referral in the emergency department is limited in its representation of survivors from different races, ethnicities, and language preferences, and future study design must be more inclusive in design and recruitment

The USPSTF recommendation was a step forward for the formalization of screening practices and resource management; however, the lack of evidence and investigative literature creates challenges for measurable change and impact. This statement offers five different validated screening tools for healthcare utilization (HARK, HITS, E-HITS, PVS, and WAST), but that variance alone fosters vague guidance for sensitivity and specificity. Only two out of the eight independent studies used one of the aforementioned screening tools. Additionally, in Caetano et al. (2019), the researchers use a revised version of an unmentioned screener (CTS-2), which only examines physical IPV, thus discounting and arguably minimizing the identification of other domains/types of violence that a survivor may be experiencing.

Inconsistent definitions of IPV across the studies included in this review may hinder researchers’ ability to compare IPV screening tools across populations and settings, limiting our ability to improve future screening tools and provide recommendations for improving implementation. Given the diversity of EM settings and the populations they serve, we believe further discussion to support the recommendation of a single standardized, inclusive IPV screening tool is warranted. To ensure inclusivity and cultural relevancy, this tool should be validated across diverse populations and multiple languages, and be adaptable to the variation of resource availability across different ED settings. We recognize that there are limitations that can occur with the use of a single standardized IPV screener, including potentially missing culturally specific understandings and experiences of violence. In addition, broader systemic barriers to screening and IPV resource and referral allocation include time restraints, accessibility to healthcare services, and minimal resource availability, which should be considered as part of the development of any future IPV screening tools. Clinical practices must also discuss the acceptable and responsible delivery of screeners in the ED, whether that be done through trained hospital staff or personnel, the option for self-reported mechanisms, or other technological means. To support the vision of the USPSTF recommendation, the use of a standardized IPV screening tool would allow for more consistency in reporting IPV prevalence and related outcomes, which in turn could provide stronger support for policies that affect both survivors and the healthcare system they access for care.

Beyond the IPV screening tool itself, many of the issues discussed around the barriers to screening survivors for IPV in EM are due to the provider’s lack of knowledge or confidence around the subject of DV. Furthermore, interpersonal barriers of clinicians, such as implicit biases, may influence the patients who are screened, and in turn, affect the inclusion of historically marginalized participants in research. A potential solution to this could be addressed through hospital-directed education protocols and module requirements for the ED clinical staff. Other notable constraints to screening include systemic barriers within the ED, limitations of the broader medical system, or underlying social issues that present in ED environments. Recommendations for responses to these barriers within the studies reviewed seem to weigh toward restructuring individual hospitals’ delivery and response systems, including increased collaboration with administration and consistent implementation at all hospital levels. Such restructuring will require attention to the setting context (e.g., urban vs rural) and the necessary resources for implementation. Encouraging education and subject knowledge for EM practitioners and staff can also prompt a change in the clinical ED culture concerning IPV competency, the delivery of the screening, and overcoming barriers that may be unknowingly present in personal biases and systemic frameworks.

Finally, there is a need to address the lack of diversity in research participant inclusion, the paucity of IPV screening tools available in languages other than English, and the limited diversity of ED settings in the available research. There is evidence that specific population groups, often non-white or from marginalized communities, are at high risk of experiencing IPV (Dutton et al., 2000; Erez et al., 2009; Lee & Hadeed, 2009). Yet, there is a gap in research on IPV screening and referrals in the ED specific to historically marginalized groups, such as racial/ethnic minority and/or non-English language preference survivors. To address this gap, inclusivity in research must be a priority from study design through recruitment, analysis, and eventual implementation stages (Ruzycki & Ahmed, 2022). Furthermore, policy-level regulations, whether hospital-based or governmental, can assist in the progress of inclusive IPV screening. Solutions include the adoption of screeners that are offered in an assortment of languages, or by the funding of trained medical translators, either in-person or with technological assistance. Lastly, the majority of studies included in this review occurred in urban settings and/or in EDs in hospitals that are trauma centers. To better understand and characterize the experiences of IPV happening across our country, future research should examine IPV screening in a broader range of ED settings, which may include EDs in rural environments and community-based hospitals.

Limitations

The main limitation of this scoping review is primarily the number of included articles. The articles analyzed here represent only 5.8% (15/259) of the original article search pool. It is possible that excluded articles had information that could have been potentially beneficial to the study’s purpose but did not provide data in a form that allowed for clear extraction per the inclusion criteria. For instance, studies that examined IPV screening or prevalence in many sectors of healthcare, including EM, but did not provide distinct setting statistics were excluded because the data specific to the ED could not be isolated. There were also cases where the information or intervention took place too far back in time for the data to be reflective of the potential influence of the 2018 USPSTF. Another limitation is the publication time frame, as recent or current research in EM would not yet be available in the peer-reviewed literature. It is also critical to acknowledge that this review focused on women of reproductive age. The IPV survivor population also includes men, non-binary gender-conforming individuals, youth, and geriatric populations.

Conclusion

This scoping review gathers the most recent evidence on IPV screening in EM since the USPSTF 2018 recommendations. Clinically, there remains a need for ongoing emergency physician and nursing staff training concerning IPV screening as well as referral program development to address barriers such as time, provider confidence, and access to resources. Moreover, there is a large gap in practice and research regarding the incorporation of trauma-informed, culturally specific, and linguistically accessible screening. Our findings suggest that a strong, validated protocol for IPV screening accompanying a respected and established guideline is needed for communities to reduce under-screening and increase resource connections. The solution to identifying IPV in EM will need to be multi-faceted, inclusive of institutions, political administration, and hospital-based regulations, to ensure satisfactory screening, resources, and referrals so that every patient in need can be connected to services that can assist them through their healing and safety journey.

Footnotes

Appendix A

Appendix B

Extraction Variables.

General Information

Title

Primary author (last, first)

Year of publication

Article design

Primary aim/study purpose

If the primary aim is explicitly stated to be related to intimate partner violence (IPV) screening

Sample size

Study setting

If a screener is administered in the emergency department (ED) specifically or as part of a study

Population demographics

Methodology

Sampling strategy

The definition used for IPV

Definition of female identity

IPV screening

Name of screener used

If no screener is identified, list questions below

How many screeners were used or if singular?

Setting screening took place

Delivery of IPV screener

Characteristics of face-to-face screening

Personnel conducting the screen

Languages offered for screening

Discussion of IPV training for clinicians

If a trauma-informed approach was specified

If performed in a culturally sensitive manner

Outcomes

IPV Application

Reported incidence and disclosure of IPV

Number of women screened OR % of patient population screened

Key findings related to IPV screening application

Clinician Awareness and Attitudes

Discussion of clinical opinions/attitudes toward screening

Reasonings provided NOT to screen

Documentation of IPV

Resource Availability

Resources offered to survivors and/or practitioners

Utilization of IPV resources by survivors

Referral to IPV resources outside of ED

Social need referral discussion

Limitations due to resources

Barriers to Screening/Disclosure

Interpersonal barriers of clinicians

Systemic barriers

Discussion of recommendations to address limitations or barriers to IPV screening

Appendix C

Characteristics of Extracted Articles.

Characteristic	Number (n = 15) (%)
Publication year
2018	1(6.7)
2019	2(13.3)
2020	4(26.7)
2021	3(20.)
2022	5(33.3)
Article type
Quantitative	9(60.)
Quantitative	2(13.3)
Quantitative	3(20.)
Mixed methods	1(6.7)
Primary aim explicitly related to intimate partner violence (IPV) screening
Yes	3(20.)
Total sample size
<100	2(13.3)
100–1,000	4(26.7)
<1,000	9(60.)
Setting
Single, urban level 1 trauma center emergency department (ED)	11(73.3)
Single urban, unspecified hospital ED	2(13.3)
Two level 1 trauma center EDs	1(6.7)
Pediatric ED	1(6.7)
Unspecified ED	1(6.7)
Methods
Cross-sectional survey	11(73.3)
Electronic health records review	2(13.3)
Cohort comparison	1(6.7)
Cross-sectional survey and interviews	1(6.7)
Sampling strategy
Identified via electronic patient information system, non-emergent patients in the ED waiting room	7(46.7)
Identified using screening form, ICD-9 or ICD-10 code, or chief concern related to IPV	1(6.7)
Admitted trauma patients	1(6.7)
In-person in ED (pre), phone call to ED examination room (post)	1(6.7)
All New England EDs	1(6.7)
ICD code or IPV chief complaint	1(6.7)
Trauma surgery consult, documentation of IPV or abuse in record, and self-reported IPV on ED screening, in-patient, or highly suspected	1(6.7)
ED systematic sampling of days and times of the week that reflect consensus patterns	1(6.7)
Not applicable	1(6.7)

Appendix D

IPV Application and Screening within Extraction Articles.

Characteristic	Number (n = 15) (%)
Definition of intimate partner violence (IPV)
Physically abusive events between partners	7(46.7)
Violence perpetrated by current or former intimate partner as well as first-degree family members or roommates	1(6.7)
Interpersonal safety includes exposure to IPV, elder abuse, child abuse	1(6.7)
Physical violence, psychological and verbal harm, and stalking by current or former partner	1(6.7)
Sexual or physical violence	1(6.7)
Unspecified	5(33.3)
IPV screener used
Revised Conflict Tactics Scale (CTS2), specifically physical IPV	7(46.7)
CTS2, Extended-Hurt, Insult, Threaten, Scream (E-HITS)	1(6.7)
Accountable Health Communities Health-Related Social Needs (AHC HRSN)	1(6.7)
Hurt, Insult, Threaten, Scream (HITS)	1(6.7)
Abuse Assessment Screen (AAS)	1(6.7)
Unspecified	4(26.7)
Number of screeners used
1	11(73.3)
2	1(6.7)
Unspecified	3(20.)
Setting IPV screening took place
Eligibility is assessed in the ED waiting room or treatment cubicle, face-to-face screening in the patient’s room without others present	7(46.7)
Emergency department (ED) personal room, alone	1(6.7)
ED, unspecified exact location	7(46.7)
Delivery of IPV screening
Computer/Tablet	1(6.7)
Computer/Tablet; Person	7(46.7)
Paper	1(6.7)
Person	3(20.)
Unspecified	1(6.7)
Not applicable	2(13.3)
Personnel conducting the screen
Nurse	1(6.7)
Study personnel	9(60.)
Patient navigator services	1(6.7)
Unspecified	2(13.3)
Not applicable	2(13.3)
Languages offered
English and Spanish	8(53.3)
Only English	2(13.3)
Unspecified	3(20.)
Not applicable	2(13.3)
Clinician training for IPV discussed
Yes	4(26.7)
Specification of a trauma-informed approach
Yes	0(0)
Culturally sensitive delivery
Mention of language accessibility for Spanish-speaking patients and bilingual RAs	7(46.7)
Unspecified	8(53.3)

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Elizabeth A. Ziola

Michelle A. Gimenez

Jennifer A. Newberry

Author Biographies

Elizabeth Ziola, MS, is a recent graduate of Stanford University studying Community Health and Prevention Research. She has an extensive background in the field of EMS and is currently working as an ED Technician at Stanford Health Care and SCVMC. Her research background is centered around social epidemiology and intervention with an interest in the expansion of social emergency medicine.

Michelle Gimenez, MA, is a Social Science Researcher for the Department of Emergency Medicine at Stanford’s School of Medicine. Her multidisciplinary research experience centers on intersectional qualitative research areas within public health and intimate partner violence. Her current research and community-supported work focus on raising awareness of mental health help-seeking and domestic violence survivors within the immigrant community.

Ashley Palmer Stephenson is a current medical student at Stanford University School of Medicine. Her research interests include community health work with survivors of intimate partner violence, health equity, and narrative medicine.

Jennifer A. Newberry, MD, JD, MSc, is an Associate Professor of Emergency Medicine at Stanford University. Her research focuses on strengthening crisis support systems for women experiencing gender-based violence and other medical emergencies. Dr. Newberry uses qualitative methods, quantitative methods, and community-based participatory to better understand the system-level barriers to survivors seeking help.

References

Aboutanos

M. B.

Altonen

Vincent

Broering

Maher

Thomson

N. D.

(2019). Critical call for hospital-based domestic violence intervention: The Davis challenge. Journal of Trauma and Acute Care Surgery, 87(5), 1197–1204.

Adjognon

O. L.

Brady

J. E.

Iverson

K. M.

Stolzmann

Dichter

M. E.

Lew

R. A.

Gerber

M. R.

Portnoy

G. A.

Iqbal

Haskell

S. G.

Bruce

L. A. E

Miller

C. J.

(2023). Using the Matrixed Multiple Case Study approach to identify factors affecting the uptake of IPV screening programs following the use of implementation facilitation. Implementation Science Communications 4(1), 145. https://doi.org/10.1186/s43058-023-00528-x

Agronsky

Alfayumi-Zeadna

Sergienko

Daoud

(2023). Inequalities in intimate partner violence screening and receiving information among diverse groups of women: An online survey during COVID-19 lockdowns. Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention, ip-2023-045100. Advance online publication. https://doi.org/10.1136/ip-2023-045100

Anderson

E. S.

Lippert

Newberry

Bernstein

Alter

H. J.

Wang

N. E.

(2016). Addressing social determinants of health from the emergency department through social emergency medicine. Western Journal of Emergency Medicine, 17(4), 487.

Anglin

Sachs

(2003). Preventive care in the emergency department: Screening for domestic violence in the emergency department. Academic Emergency Medicine, 10(10), 1118–1127.

Brignone

Gomez

A. M.

(2022). Access to domestic violence advocacy by race, ethnicity and gender: The impact of a digital warm handoff from the emergency department. PLoS One, 17(3), e0264814.

Caetano

Cunradi

C. B.

Alter

H. J.

Mair

Yau

R. K.

(2019). Drinking and intimate partner violence severity levels among US ethnic groups in an urban emergency department. Academic Emergency Medicine, 26(8), 897–907.

Caetano

Cunradi

C. B.

Alter

H. J.

Mair

(2020). Co-occurrence of multiple risk factors and intimate partner violence in an urban emergency department. Western Journal of Emergency Medicine, 21(2), 282.

Covidence Systematic Review Software. (2022). Veritas health innovation, Melbourne, Australia. Available at www.covidence.org.

10.

Cunradi

C. B.

Ponicki

W. R.

Alter

H. J.

Caetano

Mair

Lee

(2020a). Drinking context–specific dose-response models of intimate partner violence among an urban emergency department sample. Journal of Studies on Alcohol and Drugs, 81(6), 780–789.

11.

Cunradi

C. B.

Dellor

Alter

H. J.

Caetano

Mair

(2020b). Problem drinking and marijuana use as risks for unidirectional and bidirectional partner violence. Partner Abuse, 11(1), 57–75.

12.

Cunradi

C. B.

Ponicki

W. R.

Caetano

Alter

H. J.

(2021a). Frequency of intimate partner violence among an urban emergency department sample: A multilevel analysis. International Journal of Environmental Research and Public Health, 18(1), 222.

13.

Cunradi

C. B.

Caetano

Ponicki

W. R.

Alter

H. J.

(2021b). Interrelationships of economic stressors, mental health problems, substance use, and intimate partner violence among Hispanic emergency department patients: The role of language-based acculturation. International Journal of Environmental Research and Public Health, 18(22), 12230.

14.

Cunradi

C. B.

Caetano

Alter

H. J.

Ponicki

W. R.

(2022). Association of cannabis use and at-risk alcohol use with intimate partner violence in an urban ED sample. Journal of Emergency Nursing, 48(5), 504–514.

15.

Davidov

D. M.

Gurka

K. K.

Long

D. L.

Burrell

C. N.

(2023). Comparison of intimate partner violence and correlates at urgent care clinics and an emergency department in a rural population. International Journal of Environmental Research and Public Health, 20(5), 4554. https://doi.org/10.3390/ijerph20054554.

16.

Devries

K. M.

Mak

J. Y.

Garcia-Moreno

Petzold

Child

J. C.

Falder

Watts

C. H.

(2013). The global prevalence of intimate partner violence against women. Science, 340(6140), 1527–1528.

17.

DiVietro

Beebe

Grasso

Green

Lapidus

G. D.

(2018). A dual-method approach to identifying intimate partner violence within a Level 1 trauma center. Journal of Trauma and Acute Care Surgery, 85(4), 766–772.

18.

Dutton

Orloff

L. E.

Aguilar Hass

(2000). Characteristics of help-seeking behaviors, resources and services needs of batter immigrant Latinos: Legal and policy implications. Georgetown Journal on Poverty Law & Policy, 7, 245–305.

19.

Erez

Adelman

Gregory

(2009). Intersections of immigration and domestic violence: Voices of battered immigrant women. Feminist Criminology, 4(1), 32–56.

20.

Ernst

A. A.

Weiss

S. J.

(2002). Intimate partner violence from the emergency medicine perspective. Women & Health, 35(2–3), 71–81.

21.

Feder

Wathen

C. N.

MacMillan

H. L

. (2013). An evidence-based response to intimate partner violence: WHO guidelines. Jama, 310(5), 479–480.

22.

Gordon

J. A.

(2000). Emergency care as a safety net. Health Affairs, 19(2), 277–277.

23.

Gordon

J. A.

Billings

Asplin

B. R.

Rhodes

K. V.

(2001). Safety net research in emergency medicine proceedings of the academic emergency medicine consensus conference on “The Unraveling Safety Net”. Academic Emergency Medicine, 8(11), 1024–1029.

24.

Heron

S. L.

Kellermann

A. L.

(2002). Screening for intimate partner violence in the emergency department: Where do we go from here? Annals of Emergency Medicine, 40(5), 493–495.

25.

Klap

Tang

Wells

Starks

S. L.

Rodriguez

(2007). Screening for domestic violence among adult women in the United States. Journal of General Internal Medicine, 22(5), 579–584.

26.

Larkin

G. L.

Hyman

K. B.

Mathias

S. R.

D’Amico

MacLeod

B. A.

(1999). Universal screening for intimate partner violence in the emergency department: Importance of patient and provider factors. Annals of Emergency Medicine, 33(6), 669–675.

27.

Lee

Y. S.

Hadeed

(2009). Intimate partner violence among Asian immigrant communities: Health/mental health consequences, help-seeking behaviors, and service utilization. Trauma, Violence, & Abuse, 10(2), 143–170.

28.

Loza-Avalos

S. E.

Thompson

Beulah

Murray

(2022). What are we missing?: Evaluating an intimate partner violence screening program in a pediatric emergency department. Pediatric Emergency Care, 38(2), e462–e467.

29.

McHugh

M. L.

(2012). Interrater reliability: The kappa statistic. Biochemia Medica, 22(3), 276–282.

30.

Nelson

H. D.

Bougatsos

Blazina

(2012). Screening women for intimate partner violence: A systematic review to update the US Preventive Services Task Force recommendation. Annals of Internal Medicine, 156(11), 796–808.

31.

Perone

H. R.

Dietz

N. A.

Belkowitz

Bland

(2022). Intimate partner violence: Analysis of current screening practices in the primary care setting. Family Practice, 39(1), 6–11.

32.

Poirier

. (1997). The importance of screening for domestic violence in all women. The Nurse Practitioner, 22(5), 105–108.

33.

Potter

L. C.

Morris

Hegarty

García-Moreno

Feder

(2021). Categories and health impacts of intimate partner violence in the World Health Organization multi-country study on women’s health and domestic violence. International Journal of Epidemiology, 50(2), 652–662.

34.

Ruzycki

S. M.

Ahmed

S. B.

(2022) Equity, diversity and inclusion are foundational research skills. Nature Human Behavior, 6, 910–912.

35.

Samuels-Kalow

M. E.

Boggs

K. M.

Cash

R. E.

Herrington

Mick

N. W.

Rutman

M. S.

Camargo

C. A.

Jr (2021). Screening for health-related social needs of emergency department patients. Annals of Emergency Medicine, 77(1), 62–68.

36.

Straus

H. E.

Guonjian

E. H.

Christian

Roberts

R. R.

(2020). Assessment of intimate partner violence abuse ratings by recently abused and never abused women. BMC Women’s Health, 20, 1–5.

37.

Sun

E. X.

Goralnick

Salim

Khurana

(2023). Imaging and non-imaging findings of intimate partner violence on the trauma service: A retrospective analysis of two level 1 trauma centers. Academic Radiology, 30(2), 312–321.

38.

Vos

Astbury

Piers

L. S.

Magnus

Heenan

Stanley

Webster

(2006). Measuring the impact of intimate partner violence on the health of women in Victoria, Australia. Bulletin of the World Health Organization, 84, 739–744.

39.

Willie

T. C.

Kershaw

T. S.

(2019). An ecological analysis of gender inequality and Intimate partner violence in the United States. Preventive Medicine, 118, 257–263.

40.

World Health Organization. (2012). Understanding and addressing violence against women: Intimate partner violence (No. WHO/RHR/12.36).