Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the comparative effectiveness of assessment tools to predict and interventions to reduce lethality associated with intimate partner violence (IPV)?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

• Risk Assessment Instruments for predicting future abuse or lethality, e.g., Domestic Violence Screening Instrument, Kingston Screening Instrument for Domestic Violence, Spousal Assault Risk Assessment, Domestic Violence Method (DV-MOSAIC), Danger Assessment, etc.
• Different settings: community, justice system, outpatient and inpatient health care settings
• Interventions: counseling, education, legal action

Sources:

Campbell JC, Webster DW, Glass N. The Danger Assessement: Validation of a Lethality Risk Assessment Instrument for Intimate Partner Femicide. J Interpers Violence. 2009;24(4): 653-674.

Major Federal Research Project Studies Domestic Violence Assessment https://www.mosaicmethod.com/documents/DOJ_Study.pdf. Accessed 4/9/2012

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

All women and men

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Adolescent girls and boys Middle-aged women Elderly women Pregnant women Middle-aged Men Elderly men

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

• Preventing homicide, suicide, serious injury
• Maintaining healthy pregnancy
• Relieving mental health burden

Describe any health-related risks, side effects, or harms that you are concerned about.

• Increasing risk of violence (partner notification, potential for pregnancy loss)
• Miscategorization of risk (unreliability of assessment tool)
• Labeling and stigmatism

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Depression and other mental health disorders
• Functional limitations and disability
• Pregnancy, including preterm birth
• Substance abuse

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

This topic is important because of the high prevalence of intimate partner violence (IPV) and intimate partner homicide (IPH) in the United States, which has the highest rate of IPH of any industrialized country. In the United States approximately 1,200 women and 300 men are killed each year by their current or former intimate partner. Assessing lethality risk and implementing effective interventions to decrease lethality in intimate relationships is particularly important for women as IPV and IPH affect women in disproportionate numbers. Women constitute approximately 75 percent of all victims of IPH, and intimate partners commit approximately 30 percent of all homicides wherein women are the victims. It is also important to find effective screening instruments and interventions to address IPV and IPH because victims frequently experience other health-related issues such as depression, attempted suicide, anxiety, high-risk sexual behavior, drug and alcohol abuse, and overuse of health services.

Sources:

Fox, JA and Zawitz MA. Homicide Trends in the U.S. Bureau of Justice Statistics. 2006. Available: http://bjs.ojp.usdoj.gov/content/homicide/homtrnd.cfm. Accessed 4/11/2012.

Intimate Partner Violence Information Sheets. Injury Prevention: Indian Health Service, Portland Area. Available: http://www.ihs.gov/medicalprograms/portlandinjury/Worddocs/InjuryTopics/IntPartVio.pdf. Accessed 4/10/2012.

Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. World report on violence and health. World Health Organization. Geneva. 2002. Available: http://whqlibdoc.who.int/publications/2002/9241545615_eng.pdf. Accessed 4/10/2012.

Roberts, DW. Intimate Partner Homicide: Relationships to Alcohol and Firearms. Journal of Contemporary Criminal Justice. 2009;25(1): 67-88.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This question was prioritized by stakeholders engaged in the Topic Identification project conducted by the Oregon Evidence-based Practice Center on “Prevention in Women’s Health.”

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

What are the effective tools and interventions to address lethality risk when intimate partner violence is identified by a health care provider or organization?

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

This report would help identify the best tools and interventions to address lethality risk when a victim of intimate partner violence is identified. It would help victims and the organizations that care for them.

Describe the timeframe in which an answer to your question is needed.

Not aware of a specific timing issue

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Women, teens, low income population

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

This report would help identify the best tools and interventions to address lethality risk when a victim of intimate partner violence is identified. It would help victims and the organizations that care for them.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program