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Program Profile

The Abuse Assessment (The Abuse Screen)

Evidence Rating: Promising - One study Promising - One study

Program Description

Program Goals
The Abuse Assessment (The Abuse Screen) protocol aims to detect abuse in pregnant women and refer them to a counselor, and also to increase documentation of abuse in medical records.

Program Components
The Abuse Screen is a multiple-item questionnaire that asks about past and current emotional, sexual, and physical abuse, both prior to and during pregnancy. The questions assess the severity and frequency of injury and abuse. The form is included in all medical charts prepared for new prenatal care patients at their first visit to a clinic or emergency room.

Key Personnel
The form is completed during the initial intake interview and usually is conducted by the clinic or a triage nurse. But it also could be conducted by other nurses, physicians, nutritionists, counselors, or clerical staff. Any referrals of abuse are given to an onsite counselor for further assessment and follow-up.

Evaluation Outcomes

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Study 1
Abuse Screening
Wiist and McFarlane (1999) found that before implementation of The Abuse Assessment (The Abuse Screen) protocol no specific form to detect abuse was used in maternity medical records. After implementation, however, 88 percent of maternity medical records contained The Abuse Screen. After 12 months, the number of medical records that had the form decreased, nonsignificantly, to 85 percent. Of the forms included, 96 percent were completed and all were completed during the initial visit.

Abuse Detection and Reporting
Before the protocol was implemented, there were three instances of abuse reported in medical records at the intervention clinics and one in the control clinic. Once implemented, intervention clinics had a significantly higher rate of abuse reporting than the comparison (7 percent versus 0 percent). The number of women identified as abused at the intervention clinics was proportionately higher than that of the comparison location (7.22 percent versus 0.83 percent). According to an odds ratio, women were 6.78 times as likely to be identified as abused after implementing the protocol (confidence interval=2.34, 19.56).

Referrals for Abuse
Before implementation, there were no documented referrals in the medical records at any of the clinics for women identified as abused. At 3 months postimplementation, referrals were included in 67 percent of records. At 12 months, referrals were included in 53 percent of records.
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Evaluation Methodology

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Study 1
Using a quasi-experimental design, Wiist and McFarlane (1999) evaluated an implementation of The Abuse Assessment (The Abuse Screen) protocol in two public health department clinics in a large southwestern U.S. city. A third clinic of the same health department that did not implement the Abuse Screen served as the comparison group. During their initial prenatal visit, women in the intervention clinics were given the form to complete in a private room without the male partner or other individuals present. The form was available in English and Spanish, and there was a bilingual counselor onsite in case of abuse referral.

The researchers conducted an audit of randomly selected first-visit maternity patient charts at each of the three clinics at two time periods: 15 months before implementation of The Abuse Screen (n=540) and 15 months afterward (n=540). To evaluate short- and long-term effects, the latter period was then divided into a 3-month period and a 12-month period. Researchers audited records of women who were past their due date, to include abuse screening at any prenatal visit.

Using a data collection form, researchers collected information on demographics, number of prenatal visit, whether The Abuse Screen form was included in the records, whether The Abuse Screen form was completed, whether the women had been abused, documentation of referrals for abuse, and who made the referral (a nurse, a physician, or a health care provider). Statistical significance between groups before and after protocol implementation was tested using a Fisher two-tailed exact test. The Bonferroni technique was used to control the overall error rate at 0.05 for each set of Fisher exact tests.
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There is no cost information available for this program.
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Implementation Information

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The Abuse Assessment Screen (The Abuse Screen) form is available in English and Spanish.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Wiist, William H., and Judith McFarlane. 1999. “The Effectiveness of an Abuse Assessment Protocol in Public Health Prenatal Clinics.” American Journal of Public Health 89(8):1217–21.
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Additional References

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These sources were used in the development of the program profile:

McFarlane, Judith, Barbara Parker, Karen Soeken, and Linda Bullock. 1992. “Assessing for Abuse During Pregnancy: Severity and Frequency of Injuries and Associated Entry Into Prenatal Care.” Journal of the American Medical Association 267(23):3176–78.

McFarlane, Judith and William H. Wiist. 1996. “Documentation of Abuse to Pregnant Women: A Medical Chart Audit in Public Health Clinics.” Journal of Women’s Health 5(2):137–142.

Parker, Barbara, and Judith McFarlane. 1991. “Identifying and Helping Battered Pregnant Women.” American Journal of Maternal Child Nursing 16:161–64.
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Related Practices

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Following are practices that are related to this program:

Interventions for Domestic Violence Offenders: Cognitive Behavioral Therapy
The interventions aim to reduce partner violence by identifying and changing the thought processes leading to violent acts, and teaching offenders new skills to control and change their behavior using Cognitive Behavioral Therapy applied in a domestic violence setting. The practice is rated No Effects for recidivism outcomes with respect to violent offenses and No Effects for reducing victimization.

Evidence Ratings for Outcomes:
No Effects - More than one Meta-Analysis Crime & Delinquency - Violent offenses
No Effects - One Meta-Analysis Victimization - Domestic/intimate partner/family violence

Interventions for Domestic Violence Offenders: Duluth Model
This practice employs a feminist psychoeducational approach with group facilitated exercises to change abusive and threatening behavior in domestically violent men. The practice is rated Effective for reducing recidivism with respect to violent offenses and Promising in reducing victimization. The results found fewer partner reports of violence in the intervention group relative to the comparison groups.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Crime & Delinquency - Violent offenses
Promising - One Meta-Analysis Victimization - Domestic/intimate partner/family violence
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Program Snapshot

Age: 18 - 36

Gender: Female

Race/Ethnicity: Hispanic

Geography: Urban

Setting (Delivery): Inpatient/Outpatient, Other Community Setting

Program Type: Victim Programs, Violence Prevention

Targeted Population: Females, Victims of Crime

Current Program Status: Active

William H. Wiist, DHSc, MPH
Professor, Dept. of Health Science
Northern Arizona University, Interdisciplinary Health Policy Institute
P.O. Box 15015
Flagstaff AZ 86011-5015
Phone: 928-523-5852