The Danger Assessment-5 (DA-5) (TABLE 333) is a useful 5-item tool for quickly assessing the risk for severe IPV.33 Patients respond to whether:
- the frequency or severity of violence has increased in the past year
- the partner has ever used, or threatened to use, a weapon
- the patient believes the partner is capable of killing her (him)
- the partner has ever tried to choke or strangle her (him)
- the partner is violently and constantly jealous.
Sensitivity and specificity analyses with a high-risk female sample suggested that 3 affirmative responses indicate a high risk for severe IPV and a need for adequate safety planning.
Brief motivational enhancement intervention. There are 3 components to this intervention.
- Assess interest in making changes or seeking help. IPV is paradoxical: Many factors complicate the decision to leave or stay, and patients across the spectrum of victimization might have some motivation to stay with their partner. It is important to assess the patient’s motivation to make changes in their relationship.4,34
- Provide feedback on screening. Sharing the results of screening with patients makes the assessment and referral process collaborative and transparent; collaborative engagement helps patients feel in control and invested in the follow-through.35 In the spirit of this endeavor, physicians are encouraged to refrain from providing raw or total scores from the measures; instead, share the interpretation of those scores, based on the participant’s responses to the screening items, in a matter-of-fact manner. At this point, elicit the patient’s response to this information, listen empathically, and answer questions before proceeding.
Consistent with screening for other serious health problems, we recommend that all patients be provided with information about abuse in romantic relationships. The National Center for Injury Prevention and Control Division of Violence Prevention has published a useful, easy-to-understand fact sheet (www.cdc.gov/violenceprevention/pdf/ipv-factsheet.pdf) that provides an overview of IPV-related behavior, how it influences health outcomes, who is at risk for IPV, and sources for support.
Continue to: Our IPASSPRT interview script...