Appendix 3. Screening Instruments

Intimate Partner Violence Against Women

The Partner Abuse Interview49

"Many people, at one time or another, get physical with their partner when they're angry. For example, some people threaten to hurt their partners, some push or shove, and some slap or hit. I'm going to ask you about a variety of common behaviors, and I'd like you to tell me if your partner did these during the past year."

For each behavior answered "no," put a "zero" in the appropriate box and ask if the patient was bruised or injured in any other way.

If the answer is "yes," code "1" for no injury, "2" for possible injury, and "3" for injury.

Has your partner... Yes/No Injury Codes
1. Thrown something at you (   ) 1   2   3
2. Pushed, grabbed, or shoved you (   ) 1   2   3
3. Slapped you (   ) 1   2   3
4. Kicked, bit, hit you with a fist (   ) 1   2   3
5. Hit or tried to hit you with an object (   ) 1   2   3
6. Beat you up (   ) 1   2   3
7. Threatened you with a gun or knife (   ) 1   2   3
8. Used a gun or knife (   ) 1   2   3
9. Forced you to have sex when you didn't want to (   ) 1   2   3
10. Other (   ) 1   2   3

Ask the following question if the answer to any of the above questions is anything other than "zero."

11. "Some people are afraid that their partners will physically hurt them if they argue with their partners or do something their partners don't like. How much would you say you are afraid of this happening to you?"

(   ) Not at all (1)
(   ) A little (2)
(   ) Quite a bit/Very afraid (3)

Screening Questions for Domestic Violence50

Have any of the following ever happened to you? Answer "yes" or "no."

  1. Has your male partner (husband, boyfriend) hit, slapped, kicked or otherwise physically hurt you?
  2. If you are pregnant, has your male partner hit, slapped, kicked, pushed, or otherwise physically hurt you since you've been pregnant?
  3. Has your male partner forced you to have sexual activities?
  4. Are you afraid of your male partner?

A "yes" response to any question is considered positive for partner violence.

Domestic Abuse Assessment Questionnaire51

Answer "yes" or "no."

  1. Have you ever been emotionally or physically abused by your partner or someone important to you?
  2. Within the last year, have you been hit, slapped, kicked, or otherwise physically hurt by someone?
  3. Since your pregnancy began, have you been hit, slapped, kicked, or otherwise physically hurt by someone?
  4. Within the last year, has anyone forced you to have sexual activities?
  5. Are you afraid of your partner or anyone else?

A "yes" response on any question is considered positive for partner violence.

Abuse Assessment Screen (AAS) for Use in Pregnancy52

  1. Have you ever been emotionally or physically abused by your partner or someone important to you?

    Yes   No

  2. Within the last year, have you been hit, slapped, kicked or otherwise physically hurt by someone?

    Yes   No

    If yes, by whom? (circle all that apply)

    Husband
    Ex-husband
    Boyfriend
    Stranger
    Other
    Multiple
    No. of times

  3. Since you've been pregnant, have you been hit, slapped, kicked or otherwise physically hurt by someone?

    Yes   No

    If yes, by whom? (circle all that apply)

    Husband
    Ex-husband
    Boyfriend
    Stranger
    Other
    Multiple
    No. of times

    Mark the area of injury on the body map (map included).

    Score the most severe incident to the following scale:

    1 = Threats of abuse including use of a weapon
    2 = Slapping, pushing; no injuries and/or no lasting pain
    3 = Punching, kicking, bruises, cuts, and/or continuing pain
    4 = Beaten up, severe contusions, burns, broken bones
    5 = Head, internal, and/or permanent injury
    6 = Use of weapon, wound from weapon

  4. Within the past year, has anyone forced you to have sexual activities?

    Yes   No

    If yes, by whom? (circle all that apply)

    Husband
    Ex-husband
    Boyfriend
    Stranger
    Other
    Multiple
    No. of times

  5. Are you afraid of your partner or anyone you listed above?

    Yes   No

Responses are recorded on a data collection form, no other scoring information was provided.

Partner Violence Screen (PVS)53

  1. Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom?
  2. Do you feel safe in your current relationship?
  3. Is there a partner from a previous relationship who is making you feel unsafe now?

A "yes" response on any question is considered positive for partner violence.

The HITS Scale54

The HITS scale is a paper-and-pencil instrument that is comprised of the following 4 items: "How often does your partner: physically Hurt you, Insult you or talk down to you, Threaten you with harm, and Scream or curse you?"

Patients respond to each of these items with a 5-point frequency format: never, rarely, sometimes, fairly often, and frequently. Score values could range from a minimum of 4 to a maximum of 20.

Emergency Department Domestic Violence Screening Questions55

  1. Does anyone in your family have a violent temper?
  2. During an argument at home, have you ever worried about your safety or the safety of your children?
  3. Many women who present to the emergency department with similar injuries or complaints are victims of violence at home. Could this be what has happened to you?
  4. Would you like to speak to someone about this?
  5. Were any of the previous visits to the emergency department prompted by an injury or symptom suffered as a victim of violence at home?

A "yes" response to question 3 or "yes" to 1 or 2 and 4 would classify a person as being a victim of partner violence. A "yes" response to question 1 or 2 or both would classify a person as probably being a victim of partner violence. A "yes" response to question 5 would classify the person as having been a victim of partner violence.

Women's Experience with Battering (WEB) Scale56

Description of How Your Partner Makes you Feel Agree Strongly Agree Somewhat Agree a Little Disagree a Little Disagree Somewhat Disagree Strongly
1. He makes me feel unsafe even in my own home. 6 5 4 3 2 1
2. I feel ashamed of the things he does to me. 6 5 4 3 2 1
3. I try not to rock the boat because I am afraid of what he might do. 6 5 4 3 2 1
4. I feel like I am programmed to react a certain way to him. 6 5 4 3 2 1
5. I feel like he keeps me prisoner. 6 5 4 3 2 1
6. He makes me feel like I have no control over my life, no power, no protection. 6 5 4 3 2 1
7. I hide the truth from others because I am afraid not to. 6 5 4 3 2 1
8. I feel owned and controlled by him. 6 5 4 3 2 1
9. He can scare me without laying a hand on me. 6 5 4 3 2 1
10. He has a look that goes straight through me and terrifies me. 6 5 4 3 2 1
Scoring: To score WEB Scale, sum responses for items 1-10. Range of scores is 10-60. Score > 20 indicates battering.

Index of Spouse Abuse, Partner Abuse Scale: Physical (ISA-P)56

Question All of the Time Most of the Time A Good Part of the Time Some of the Time A Little of the Time Very Rarely None of the Time
1. My partner pushes and shoves me around violently. 7 6 5 4 3 2 1
2. My partner hits and punches my arms and body. 7 6 5 4 3 2 1
3. My partner threatens me with a weapon like a gun or a knife. 7 6 5 4 3 2 1
4. My partner beats me so hard I must seek medical help. 7 6 5 4 3 2 1
5. My partner beats me when he drinks. 7 6 5 4 3 2 1
6. My partner hits, punches, or kicks my face and head. 7 6 5 4 3 2 1
7. My partner beats me in the face so badly that I'm ashamed to be seen in public. 7 6 5 4 3 2 1
8. My partner tries to choke, strangle, or suffocate me. 7 6 5 4 3 2 1
9. My partner knocks me down and then kicks or stomps me. 7 6 5 4 3 2 1
10. My partner throws dangerous objects at me. 7 6 5 4 3 2 1
11. My partner has injured me with a weapon like a gun, knife, or other object. 7 6 5 4 3 2 1
12. My partner has broken 1 or more of my bones. 7 6 5 4 3 2 1
13. My partner physically forces me to have sex. 7 6 5 4 3 2 1
14. My partner badly hurts me while we are having sex. 7 6 5 4 3 2 1
15. My partner injures my breast or genitals. 7 6 5 4 3 2 1
Scoring: Sum the responses, subtract the number of questions actually answered (n = 15) and multiply by 100, then divide by 90. Scores > 2 indicate physical interpersonal violence.

Woman Abuse Screening Tool (WAST)57

  1. In general, how would you describe your relationship?

    a lot of tension   some tension   no tension

  2. Do you and your partner work out arguments with...

    great difficulty   some difficulty   no difficulty

  3. Do arguments ever result in you feeling put down or bad about yourself?

    often   sometimes   never

  4. Do arguments ever result in hitting, kicking, or pushing?

    often   sometimes   never

  5. Do you ever feel frightened by what your partner says or does?

    often   sometimes   never

  6. Has your partner ever abused you physically?

    often   sometimes   never

  7. Has your partner ever abused you emotionally?

    often   sometimes   never

  8. Has your partner ever abused you sexually?

    often   sometimes   never

To score this instrument, the responses are assigned a number. For the first question, "a lot of tension" gets a score of 1 and the other 2 get a 0. For the second question, "great difficulty" gets a score of 1 and the other 2 get 0. For the remaining questions, "often" gets a score of 1, "sometimes" gets a score of 2, and "never" gets a score of 3.

Domestic Violence Screening Tool58

  1. Have you ever been threatened, hit, punched, slapped, or injured by a husband, boyfriend, or significant other you had at any point in the past?
  2. Have you ever been hurt or frightened so badly by a husband, boyfriend, or significant other that you were in fear for your life?
  3. Have you been hit, punched, slapped, or injured by a husband, boyfriend, or significant other within the last month?
  4. Are you currently involved in a close relationship with a husband, boyfriend, or significant other?
  5. Are you here today for injuries received from your husband, boyfriend, or significant other?
  6. Do you often feel stressed due to fear of threats or violent behavior from your current husband, boyfriend, or significant other?
  7. Has your current husband, boyfriend, or significant other ever hit, punched, slapped, or injured you?
  8. Do you think it is likely that your husband, boyfriend, or significant other will hit, slap, punch, kick, or otherwise hurt you in the future?
  9. Do you think you will be safe if you go back home to your husband, boyfriend, or significant other at this time?

A "yes" response to any question is considered positive for partner violence.

Elder Abuse and Neglect

Brief Abuse Screen for the Elderly (BASE)59

Please respond to every question (as well as you can estimate) concerning all clients ___ years or over who are caregivers (give regular help of any kind) or care receivers:

  1. Is the client an older person or caregiver?     Yes___  No___
  2. Is the client a caregiver of an older person?     Yes___  No___
  3. Do you suspect abuse? (see also #4 and #5)     Yes___  No___

    i) By caregiver (comments)____________________________

    1 2 3 4 5
    no, not
    at all    		 only slightly,
    doubtful    		 possibly, probably,
    somewhat    		 yes, quite
    likely    		 definitely

    ii) By care receiver or other (comments)___________________

    1 2 3 4 5
    no, not
    at all    		 only slightly,
    doubtful    		 possibly, probably,
    somewhat    		 yes, quite
    likely    		 definitely

  4. If any answer for #3 except "no, not at all," indicate what kind(s) of abuse(s) is (are) suspected.

    i) physical____   ii) psychosocial____   iii) financial____   iv) neglect____ (includes passive and active)

  5. If abuse is suspected, about how soon do you estimate that intervention is needed?

    1 2 3 4 5
    immediately within 24 hours 24-72 hours 1 week 2 or more weeks

Scoring information was not provided.

Hwalek-Senstock Elder Abuse Screening Test (HSEAST)60

Violation of Personal Rights or Direct Abuse

  1. Does someone else make decisions about your life—like how you should live or where you should live?
  2. Does someone in your family make you stay in bed or tell you you're sick when you know you're not?
  3. Has anyone forced you to do things you didn't want to do?
  4. Has anyone taken things that belong to you without your OK?
  5. Has anyone close to you tried to hurt or harm you recently?

Characteristics of Vulnerability

  1. Do you have anyone who spends time with you, taking you shopping or to the doctor?
  2. Are you sad or lonely often?
  3. Can you take your own medication and get around by yourself?

Potentially Abusive Situations

  1. Are you helping to support someone?
  2. Do you feel uncomfortable with anyone in your family?
  3. Do you feel that nobody wants you around?
  4. Does anyone in your family drink a lot?
  5. Do you trust most of the people in your family?
  6. Does anyone tell you that you give them too much trouble?
  7. Do you have enough privacy at home?

"A response of "no" to items 6, 8, 13, and 15 and a response of "yes" to all other score in the abused direction."

The Caregiver Abuse Screen (Reis-Nahmiash CASE)61

Please answer the following questions as a helper or caregiver with yes or no:

  1. Do you sometimes have trouble making ( ___ ) control his/her temper or aggression?
  2. Do you often feel you are being forced to act out of character or do things you feel bad about?
  3. Do you find it difficult to manage ( ___'s) behavior?
  4. Do you sometimes feel that you are forced to be rough with ( ___ )?
  5. Do you sometimes feel you can't do what is really necessary or what should be done for ( ___ )?
  6. Do you often feel you have to reject or ignore ( ___ )?
  7. Do you often feel so tired and exhausted that you cannot meet ( ___'s ) needs?
  8. Do you often feel you have to yell at ( ___ )?

Scoring information was not provided.

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