JOINING FORCES

Joining Families

Volume 14, Issue 2 • Summer 2014

R E A L W O R L D R E S E A R C H F O R F A M I LY A D V O C A C Y P R O G R A M S

F E AT U R E D I N T E R V I E W

Universal Screening Versus Case Finding in
Intimate Partner Violence (IPV)An Interview with Harriet L. MacMillan, MD
Harriet L. MacMillan

Harriet L. MacMillan, MD, is a Professor in
the Departments of Psychiatry and Behavioural
Neurosciences, and Pediatrics at McMaster
University in Hamilton, Ontario, Canada. She isa member of the Offord Centre for Child Studies
and holds the Chedoke Health Chair in Child
Psychiatry. Dr. MacMillan was the founding
Director of the Child Advocacy and Assessment
Program at McMaster Children’s Hospital, amultidisciplinary program committed to reducing the burden of suffering associated with family violence. Dr. MacMillan’s research focuses on
the epidemiology of family violence, including
prevention of child maltreatment and intimate partner violence. She has led randomized

In This Issue

This edition of Joining Forces Joining Families (JFJF) is on screening for
intimate partner violence (IPV) against women, a topic that has been controversial. Our interview is with Harriet L. MacMillan, MD, in which she explores
some of the important issues for research, practice and policy on universal
IPV screening compared to inquiry through clinical case finding. We also
provide a summary of her work on these topics as well as our regular article,
Building Bridges to Research, where we discuss screening in more detail.
Websites of Interest provides links to the US Preventive Services Task Forceas well as other sites related to IPV. As always, we appreciate the work of ourreadership, and wish you a productive and healthy summer.
Contents
Featured Interview: Harriet L. MacMillan, MD................................................1
Research, Practice, and Policy.......................................................................3
Building Bridges to Research: What is Screening?........................................5
Websites of Interest.......................................................................................8

controlled trials investigating the effectiveness ofsuch approaches as universal screening in reducing intimate partner violence and nurse home
visitation in preventing the recurrence of physicalabuse and neglect among children.

Dr. McCarroll: How did intimate partner
violence and child maltreatment become
driving interests for you?
Dr. MacMillan: I was very influenced by myfather, who was a pediatrician. I grew up hearing about the abuse and neglect that children
experience. When I was in my pediatric residency I was struck by the fact that, if there wassuspicion that a child was abused or neglected,
there was a need to understand what happens
to them. That became a major question for me.
I also wanted to do child psychiatry. Being apediatrician would enrich my ability to meetthe needs of children and families as a childpsychiatrist. During my training as a psychiatrist, I also began my master’s degree in clinicalepidemiology and biostatistics because I saw
the need for training in methodology if I wasgoing to do intervention research.
Dr. McCarroll: How would you recommend
identifying women who have been abused?
Dr. MacMillan: The challenges are bothto understand and to communicate. Simply
asking a standard set of screening questions toeverybody has been studied in two randomized controlled trials (MacMillan, et al., 2009;
Klevens, et al, 2012). Neither study showed any
benefits for women.
Continued on page 2

Simply asking astandard set ofscreening questions
to everybody has
been studied in two
randomized controlled
trials. Neither study
showed any benefits
for women.

A screening test, to be effective, must havestrong psychometric properties, but there also
has to be an evidence-based intervention towhich people are referred. We have to lookat that overarching pathway to understandwhether identification plus intervention leads
to better outcomes. My concern is that people
have been so preoccupied with the concept ofidentification that screening has taken on alife of its own and people assume that it does
more good than harm. Recent studies haveshown that screening does not lead to better health outcomes for women (Wathen &MacMillan, 2012).
Our clinical response does not have tobe about screening. We do many things in
our exchanges with patients depending on
the nature of the diagnostic assessment. This
is what is known as case finding rather thanscreening, and that distinction is important.
We also need to appreciate that anything we
do in encounters with patients takes time andit means that something else may not be done.
Dr. McCarroll: What training do you suggest
for health care providers for identifying IPV?
Dr. MacMillan: Currently, people might
only get one or two sessions, and it tends tobe about the epidemiology of the problem.

JOINING FORCES
Joining Families
Editor-in-Chief
James E. McCarroll, PhD
Email:
James.McCarroll.ctr@usuhs.edu
Joining Forces Joining Families
is a publication of the U. S.
Army Installation Management Command and theFamily Violence and Trauma
Project of the Center for the
Study of Traumatic Stress(CSTS), Bethesda, Maryland
20814-4799, tel. 301-2952470. CSTS is part of the
Department of Psychiatry of
Uniformed Services University of the Health Sciences,which is our nation’s federal
medical school.

2 • Joining Forces/Joining Families

Editorial Advisor
COL Anthony L. Cox, LCSW, DCSW,
MSC, USA
Family Advocacy Program Manager
Headquarters, Department of the Army
Editorial Consultant
David M. Benedek, MD, COL, MC, USA
Professor and Scientist
Center for the Study of Traumatic Stress
Uniformed Services University of the
Health Sciences
dbenedek@usuhs.edu

People need training in understanding how
exposure to child maltreatment and IPV influences health. There needs to be more training about the actual clinical response whensomeone hears about patient exposure. Healthcare providers also need to know the evidence
about what works and what does not. They alsoneed to have a level of comfort and competence
in discussing exposure to violence with theirpatients.
Dr. McCarroll: It might be easier to teach brief
screening than case finding. Is teaching casefinding more difficult and time consuming?
Dr. MacMillan: Teaching history-taking
and case finding is more than asking a standard
set of questions. This is a sensitive area andpeople need very clear input as to what to ask.
Scripts can be helpful in training people how toincorporate such questions within the context
of diagnostic assessment, but ideally, over time,
people need to have experience in incorporating such inquiry within the art of historytaking.
Dr. McCarroll: You have been involved inresearch and policy on family maltreatment
with the Canadian Task Force on Preventive
Health Care and the World Health Organization(WHO) as a member of their Guidelines
Development Group on Responding to Intimate
Partner Violence and Sexual Violence against
Women (WHO, 2013). Are you involved inother work with the WHO?
Dr. MacMillan: There is a Lancet series on
early child development underway. I was asked
by WHO to be part of that group given my areaof focus on violence because WHO sees that it
is important to consider children’s exposure toviolence within the context of early child development. How violence intersects with otherareas of health is being thought about more
often. The plan is for a four-part series to comeout sometime next year.
Dr. McCarroll: Speaking of world health, theU.S. has seen a huge influx of immigrants
over the past 10 years or so. What do you thinkthat means for the cultural issues with regard
to understanding violence? Do you think thatpeople in other countries understand violencedifferently than we do in the Western world or
is violence violence?
Dr. MacMillan: There are differences acrossthe countries and much of it has to do with theContinued on p. 6
Summer 2014

Research, Practice, and Policy on Identifying Women
Exposed to Intimate Partner Violence (IPV)
By James E. McCarroll, PhD, and Robert J. Ursano, MD

Knowledge of apatient’s exposure
to IPV within thecontext of a diagnostic
assessment (i.e.,case finding) has thepotential to improve
diagnostic accuracy
and determine
approaches totreatment.

Harriet L. MacMillan, MD, has a distinguished career studying and writing onpractices and policies for how best to identify
IPV against women, in addition to many othertopics in family violence.

Why Not Universal Screening?

Screening for IPV against women is controversial. The Canadian Task Force on Preventive Health Care (CTFPHC) found insufficientevidence to recommend for or against universal screening of women for IPV (Wathen &MacMillan, 2003; MacMillan & Wathen, 2003).
In 2013, the CTFPHC appraised the US Guideline on Screening for Intimate Partner Violenceand Abuse of Elderly and Vulnerable Adults
and recommended against its use in Canada.
In the opinion of the CTFPHC, the available
evidence does not justify routine IPV screening. One of Dr. MacMillan’s major points is that
before clinicians can routinely screen womenfor abuse, there must be evidence that such
screening does more good than harm. Two
key elements must be considered: (1) does thescreening identify the condition and (2) does
the subsequent intervention lead to a favorable
outcome such as the reduction of violence? Dr.
MacMillan’s response to the first question wasthat, “Yes”, there are good screening instruments for use in primary health care settings,
including emergency departments. For the second question, she believes that except for a few
promising programs, there is a lack of evidence
on interventions to which health care providers
can refer women, that will reduce violence or
impact other important outcomes. Nevertheless, she advised clinicians to maintain a highindex of suspicion when assessing patients.
Knowledge of a patient’s exposure to IPV
within the context of a diagnostic assessment(i.e., case finding) has the potential to improve
diagnostic accuracy and determine approaches
to treatment, for example, of co-morbid mental
health conditions.

Training for Inquiring about IPVAmong the controversies about IPV screening are how clinicians are trained and how theymight conduct screening. In a study in Ontario,

http://www.CSTSonline.org

Canada, variability was found in programs
regarding the amount and methods for IPV
training of health care professionals (Wathen,et al., 2009). Of 222 programs in dentistry,
medicine, nursing, and other health professions, 57% reported some form of IPV-specificeducation with undergraduate nursing (83%)
and allied health programs (82%) being thehighest. Fewer than half the medical (43%) anddentistry (41%) programs offered IPV content
in their curricula.
A survey of physicians and nurses in Ontario identified eight factors related to whether
routine inquiry was conducted: preparedness, self-confidence, professional supports,
the nature of the abuse inquiry, practitioner
consequences of asking, comfort following
disclosure, practitioner lack of control andpractice pressures (Gutmanis, Beynon, Tutty,
Wathen, & MacMillan, 2007). There are factorsthat facilitate and those that impede clinicians’
decisions to address IPV with female patients.
Professional experience with disclosures was
the key element influencing how clinicians addressed IPV.

Barriers to Screening for IPV

Physicians and nurses were asked (1)what they experienced as barriers to screening women for IPV and (2) what has helped
or would help make screening easier for them
(Beynon, Gutmanis, Tutty, Wathern & MacMillan, 2012). The majority of respondents werefemale nurses (81.1%). Both nurses (61.5%) andphysicians (58.0%) reported that they had notreceived formal IPV training and had received
few disclosures (less than 20) in the past year.
The top barriers were lack of time, behaviors attributed to women (e.g., returning to the abuser
and defending him), lack of training, language
and cultural practices (e.g., abuse as accepted intheir culture and fearing that the police would
not protect them), and partner presence. Bothnurses and physicians described the need fortraining. IPV inquiry is emotionally charged
and complex for both providers and patients.
Continued on page 4

Joining Forces/Joining Families • 3

Research, Practice andPolicy, from page 3

Partner violence isan exposure, nota symptom or a
specific condition.

Screening for IPV in Different Settings
with Different Populations

A randomized trial was conducted todetermine whether IPV screening reduces
violence or improves health outcomes for
women (MacMillan, et al., 2009). As a partof this trial, several screening methods werecompared to determine the optimal approach
amongst different methods. Female patientsin emergency departments, family practices
and women’s health clinics were comparedon three approaches: a face-to-face interview
with a health care provider (physician ornurse), a written self-completed questionnaire, and a computer-based self-completed
questionnaire (MacMillan, et al., 2006). For
the three methods, two screening instruments
were compared: the Woman Abuse Screening
Tool (WAST) (Brown, Lent, Schmidt & Gast,
2000) and the Partner Violence Screen (PVS)(Feldhaus, et al., 1997). The WAST has eightitems that address the relationship and physical, sexual, and emotional abuse. The PVS has
three items: one addresses physical abuse andthe other two address feelings of safety. The
12-month prevalence of IPV ranged from 4.1%
to 17.7% depending on the instrument used,screening method, health care setting andpopulations screened. Among the approaches
tested, women preferred self-completed questionnaires over face-to-face inquiry. Based on
the findings of this study, the measure andapproach selected for use in the IPV screening
randomized trial (MacMillan, et al., 2009) was
the self-completed written form of the WAST.
Screening in health care settings may overidentify IPV (high false positive rate) and careshould be taken in how abuse is identified. In
addition, screening alone may under-identify
characteristics of women, partners, and relationships that could indicate abuse and other
health concerns when conducted throughclinical case finding (Wathen, et al., 2008).

Effectiveness of Screening for IPV

The Ontario randomized trial showedthat the women in the screened group did notexperience greater reduction in violence or
benefit in health outcomes, compared with thecontrol group (MacMillan, et al., 2009). There
was no evidence to indicate that IPV screening
improved outcomes for women. The lack ofeffectiveness of universal screening, as demonstrated in the Ontario trial, was replicatedin a subsequent US-based trial (Klevens, etal., 2012). These two trials suggest that clinical
4 • Joining Forces/Joining Families

case finding tailored to the individual woman’ssituation and presentation is indicated, rather
than universal screening.

Conclusions

In reviewing the research on screening for
IPV, Wathen and MacMillan (2012) concluded
that two randomized trials of universal IPV
screening showed no health or quality of life
benefits and there is little evidence of benefit ofservices to which women could be referred following a positive screen in a health care setting.
The following are their recommendations. Partner violence is an exposure, not a symptom ora specific condition. Therefore, abused women
will have different needs for services, including
ways to stay safe, and treatments for co-morbid
mental health issues like depression and posttraumatic stress disorder that take into accountexposures to IPV. Women are also likely topresent at different stages in their readiness toaddress partner violence. Advice for clinicians
includes the need for competency in case finding and diagnostic assessment in the context ofspecific physical and mental health concerns.
Among the key concerns for practitioners are
privacy, respect, co-occurrence of IPV withmental and physical health problems, and theroles of other practitioners and helping organizations for women exposed to IPV. Womenshould be assessed according to their presenting
history including symptoms and risks. Researchgoals are also important for evaluation of other
IPV primary prevention intervention programs
and community-based services.

References

Beynon C, Gutmanis I, Tutty L, Wathern CN &MacMillan HL. (2012). Why physicians andnurses ask (or don’t) about partner violence:a qualitative analysis. BMC Public Health; 12:473. http://www.biomedcentral. Com/14712458/12/473.
Brown JB, Lent B, Schmidt G & Sas G. (2000).
Application of the woman abuse screening tool
(WAST) and WAST-Short in the family practice setting. Journal of Family Practice; 49(10):896–903.
Feldhaus KM, Koziol-McLain J, Amsbury HL,
Norton IM, Lowenstein SR & Abbott JT.
(1997). Accuracy of 3 brief screening questions
for detecting partner violence in the Emergency Department. Journal of the American
Medical Association; 277: 1357–1361.

Continued on page 5
Summer 2014

BUILDING BRIDGES TO RESEARCH

What is Screening?
By James E. McCarroll, PhD, MPH

In general,
screening is
conducted to reducemorbidity andmortality throughearly identificationof a condition andearly treatment.

Among the conceptual and statistical issues
involved in screening are the purpose, population screened, setting, accuracy, and whether
treatments exist and are effective. The term
screening itself can be misused and misinterpreted. Screening for IPV highlights thiscomplexity.

What is screening?

In general, screening is conducted to reducemorbidity and mortality through early identification of a condition and early treatment.
According to the public health model, thetwo criteria for its effectiveness of a screening
test are that (1) there must be an accurate test
for the condition, one that includes accepted
standards, and (2) evidence exists that screening can prevent adverse health outcomes (Cole,
2000). Additional requirements for screening
tests are (1) that it is reasonably quick, (2) it issafe and acceptable to the person screened andto the person performing it and (3) the properties of the screening test (sensitivity, specificity,
positive predictive value and others) are known
and acceptable (Jekel, Katz, & Elmore, 2001).

Properties of screening tests.

Sensitivity and specificity are two important measures of how well the test performs.
Sensitivity is the test’s ability to detect a
condition when it is present (screen positive);
specificity is the test’s ability to indicate thatthe person does not have the condition (screen
negative). These two measures have important
implications depending on how important it
is to identify the condition. Both false nega-tive and false positive results can have serious
implications for the person screened and for theprovider. For example, if the screen is for a very
serious disease, sensitivity should be extremely
high in order to avoid false negatives (i.e., those
who screen negative when they actually havethe condition). On the other hand, if specificity
is low producing false positives, people can beincorrectly identified leading to worry, misdirected treatment and other unintended consequences. Two additional statistical measuresof screening tests are the positive and negative
predictive values. Respectively, these indicate
the probability of having or not having thecondition. In addition to psychometric properties, clinical judgment and screening skill in
diagnostic assessment are required.

What is clinical case finding and how doesit differ from screening?
Clinical case finding involves including questions about IPV exposure as part ofhistory-taking based on the patient’s clinicalpresentation, as compared to screening, which
involves administering a standard set of questions to everyone, regardless of their presentation.

References

Cole TB. (2000). Is domestic violence screening
helpful? Journal of the American Medical Association, 284(5):551–553.
Jekel JF, Katz DL, & Elmore JG. (2001). Epidemiology, Biostatistics, and Preventive Medicine,
2d Edition. Philadelphia, PA: Saunders, pp.
261–273.

Research, Practice and Policy, from page 4
Gutmanis I, Beynon C, Tutty L, Wather CN & MacMillan HL.
(2007). Factors influencing identification of and response to
intimate partner violence: a survey of physicians and nurses.
BMC Public Health; 7(12): 1–11. doi:10.1186/1471-2458/7/12.
Klevens J, Kee R, Trick W, Garcia D, Angulo FR, Jones R, &Sadowski LS. (2012). Effect of screening for partner violence
on women’s quality of life. Journal of the American Medical
Association; 308(7): 681–689.

http://www.CSTSonline.org

MacMillan HL & Wathen CN. (2003). Violence against women:
integrating the evidence into clinical practice. Canadian Medical Association Journal; 169(6): 570–571.
MacMillan HL, Wathen CN, Jamieson E, Boyle M, McNutt L,
Worster A, … McMaster Violence Against Women ResearchGroup. (2006). Approaches to screening for intimate partner
violence in health care settings. Journal of the American Medical Association; 296: 530–536.
Continued on page 7

Joining Forces/Joining Families • 5Harriet L. MacMillan
Interview, from page 2

People need training
in understanding how
exposure to childmaltreatment and IPV
influences health.
There needs to be moretraining of health careproviders about theactual clinical responsewhen someone hears
about patient exposure.
They also need to know
the evidence about
what works and what
does not.

importance of gender. Issues of gender-based
violence and equity are extremely importantin understanding cross-country comparisons.
WHO refers to the ecological framework ofviolence: looking at risk and protective factors
at the individual, the family, the community
and then societal level. It is very hard to gethigh quality evidence about this, but there issome indication that in those countries where
women are not valued in the same way as men,those societies have higher rates of violence.
Dr. McCarroll: What do you do clinically witha patient who has been treated violently andshe is from another country?
Dr. MacMillan: One has to be respectfulof people’s countries of origin, but at the sametime make it clear that violence is not acceptable. It is important with patients from othercountries to listen to their experiences and tothen indicate to them that abusive experiences
are not something that anybody should have to
face. This is another example where sensitivity is so important. It is not about criticizing
a person’s upbringing or homeland or family
members; it is about helping to protect themand to focus on how the experience is not acceptable.
Dr. McCarroll: What do you find as thebest approach to preventing IPV and childmaltreatment?
Dr. MacMillan: For child maltreatment, thebest evidence, and I have to declare my conflictof interest here, is for the Nurse Family Partnership (NFP), a targeted program provided
to socially disadvantaged first time moms toprevent abuse and neglect. There are otherprograms that are promising like the Triple P(Positive Parenting Program), Howard Dubowitz’s SEEK, and Early Start, another home
visitation program developed in New Zealand.
Dr. McCarroll: Your preference seems to be
for a family-based program as opposed to anindividual clinical intervention.
Dr. MacMillan: It really depends on thefocus. It is not going to be just one type ofapproach; it will be multiple approaches thatwork. But, in developing a program, we needoutcome measures. Proxy measures are notenough. What are we doing at the family level,at the community and societal level to reduce
IPV and child abuse and neglect?

6 • Joining Forces/Joining Families

Dr. McCarroll: It sounds like you are sayingthat we need more thoughtful approaches
before we take off on something in an area
where we really do not know a lot about
what is going on. What are you currently
researching?
Dr. MacMillan: If we are going to be innovative in considering ways to reduce violence wealso need to think of approaches that ideallyreduce more than one type of violence. For
example, the terms IPV and domestic violence
are often used interchangeably. I prefer intimate
partner violence because it is more specific.
Some people use the term domestic violence toinclude child maltreatment as well. We need tounderstand how types of violence overlap.
With colleagues, such as David Olds fromthe University of Colorado, Jeff Coben from
West Virginia University, Susan Jack who is also
here at McMaster, and Nadine Wathen at Western University, we have developed a curriculumwith training on IPV embedded in the NFP to
reduce intimate partner violence. Results froman early study on home visitation by nurses
showed that when there are high rates of IPV in
the home the benefits in reducing child maltreatment wash out (Eckenrode, 2000). We arein the midst of a randomized controlled trial(RCT) comparing the existing NFP program
to the augmented program. Our sample now isalmost 500 women and we are following themthrough to the end of the NFP program, until
the child is 24 months of age. All the respondents have completed their six month postpartum interviews so we have about another 12months to go. We are not analyzing data now,
but we hear that the nurses are identifying IPV
and discussing it with clients much more often
than they did previously.
We published a summary of the preliminary work leading up to the trial including theconceptualization of the intervention itself (Jacket al., 2012). We are very happy with this work
because we feel that it underscores a process bywhich modifications to an intervention can beevaluated. Does that mean that I think that every time there is a modification to an intervention that an RCT is required? Absolutely not,but I think when one is making a major change
to an intervention, and in the case of the NFP,
we want to make sure that we are doing moregood than harm.
Dr. McCarroll: What are you hopeful about?
Dr. MacMillan: I am hopeful about anumber of things. I believe that violence isContinued on page 7
Summer 2014

Harriet L. MacMillan
Interview, from page 6

What are we doing at
the family level, at thecommunity and societal
level to reduce IPV
and child abuse andneglect?

now perceived as a public health problem andthat makes me hopeful. I also think that weare moving toward the use of evidence-based
approaches more often in evaluating effectiveness. If you think back even ten or twenty years
ago, we had very few randomized trials and
now we are seeing high quality research examining the effectiveness of interventions. But, I
think we have to continue building research capacity in this area. It is not an area that attracts
a lot of researchers and it takes time to bringpeople along. I am very optimistic now.
Dr. McCarroll: Thank you for your insights andfor your work.
Dr. MacMillan: You are welcome.

Website References
World Health Organization Guidelines
Development Group on Responding to Intimate
Partner Violence and Sexual assault (2013)
http://apps.who.int/iris/bitstream/10665/85240/1/9789241548595_eng.pdf
Nurse Family Partnership
http://www.nursefamilypartnership.org/
Triple P
http://www.triplep.net/glo-en/home/
SEEK
http://umm.edu/programs/childrens/services/child-protection/seek-project

References

Eckenrode J et al., (2000). Preventing child abuse
and neglect with a program of nurse home
visitation. Journal of the American Medical
Association; 284(11):1385–1391.
Jack SM, Ford-Gilboe M, Wathen CN, Davidov
DM, McNaughton DB, Coben JH, Olds DK& MacMillan HL.(2012). Development of anurse home visitation intervention for intimate partner violence. BMC Health Services
Research; 12:50. http://www.biomedcentral.
com/1472-6963/12/50.
Klevens J, Kee R, Trick W, Garcia D, Angulo
FR, Jones R, & Sadowski LS, 2012. Effect ofscreening for partner violence on women’squality of life: a randomized controlled trial.
Journal of the American Medical Association;308(7):681–689.
MacMillan HL, Wathen CN, Jamieson E, Boyle
MH, Shannon HS, Ford-Gilboe M, …
McMaster Violence Against Women ResearchGroup. (2009). Screening for intimate partner
violence in health care settings: a randomized
trial. Journal of the American Medical Association; 302 (5):493–501.
Wathen CN & MacMillan HL. (2012). Healthcare’s response to women exposed to partner
violence. Journal of the American Medical
Association; 308(7): 712–713.

Early Start
http://homvee.acf.hhs.gov/document.
aspx?rid=3&sid=38

Research, Practice andPolicy, from page 5

MacMillan HL, Wathen CN, Jamieson E, Boyle
MH, Shannon HS, Ford-Gilboe M, …
McMaster Violence Against Women ResearchGroup. (2009). Screening for intimate partner
violence in health care settings: a randomized
trial. Journal of the American Medical Association; 302 (5): 493–501.
Wathen CN, & Jamieson E, MacMillan HL & theMcMaster Violence Against Women ResearchGroup, 2008). Who is identified by screening
for intimate partner violence? Women’s Health
Issues; 18: 423–432.

Wathen CN, & MacMillan HL. (2012). Healthcare’s response to women exposed to partner
violence. Journal of the American Medical
Association; 308(7): 712–713.
Wathen CN, Tanaka M, Catallo C, Lebner AC,
Friedman MK, Hanson MD, MacMillan HL.
(2009). Are clinicians being prepared to care
for abused women: A survey of health professionals education in Ontario, Canada. BMC
Medical Education; 9I34 doi10.1186/14726920-9-34.

Wathen CN, MacMillan HL with the CanadianTask Force of Preventive Health Care. (2003).
Prevention of violence against women: Recommendation statement from the Canadian Task Force on Preventive Health Care.
Canadian Medical Association Journal; 169(6):582–584.
http://www.CSTSonline.org

Joining Forces/Joining Families • 7

Websites of Interest
The US Preventive Services Task Force makes recommendations about preventive services in primary medical care
http://www.uspreventiveservicestaskforce.org/.
The Centers for Disease Control and Prevention (CDC) has
a number of publications on IPV as well as other healthrelated conditions such as injury and diseases.
Resources for IPV Victims and Providers:
http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/resources.html
Risk and Protective Factors in IPV:
http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/riskprotectivefactors.html
Futures Without Violence is a US-based non-profit organization focused on ending domestic and sexual violence. It
is involved in community based programs, developing educational material, and public policy work. There are many
subjects covered by this website including the effects of IPV
on health and about screening for IPV
http://www.futureswithoutviolence.org/.
The WHO published guidelines on responding to IPV andsexual violence against women. This publication has clinicaland policy guidelines and a discussion of the issues involved
in developing the guidelines. It also provides examples ofclinical conditions associated with intimate partner violence, care for survivors, and training of providers.
http://www.who.int/reproductivehealth/publications/violence/9789241548595/en/.

8 • Joining Forces/Joining Families

Summer 2014