Program Profile: The Abuse Assessment (The Abuse Screen)

This is an abuse assessment tool for medical staff to aid in the detection and referral of abuse in pregnant women. The program is rated Promising. With regard to increased detection of abuse, seven percent of the intervention group women were identified as abused and 53 percent received referrals, while zero percent of the comparison group women were identified as abused and zero percent received referrals, at the 12-month follow up. These differences were statistically significant.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals

The Abuse Assessment (also known as the The Abuse Screen) protocol is designed to detect abuse in pregnant women. If abuse is detected, the women are referred to a counselor. The protocol also seeks to increase documentation of abuse in medical records.

Program Components

The Abuse Screen is a multiple-item questionnaire administered to all prenatal patients at their first visit to a clinic or emergency room during the routine prenatal intake interview conducted by a nurse. The questionnaire 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. For example, the woman is asked “Since you’ve been pregnant, have you been hit, slapped, kicked, or otherwise physically hurt by someone?”

The woman is then asked to identify the person who perpetrated the crime (e.g., husband, boyfriend, stranger, other, or multiple), how many times the abuse occurred, and to rank the severity of the abuse on a scale from 1 to 6. Lower ratings (1–2) include threats of abuse or slapping and punching without lasting injury. Middle ratings (3–4) include punching and kicking that results in bruises, cuts, severe contusions, or broken bones. Severe ratings (5–6) include head or internal injuries, permanent injuries, use of weapon, or wound from weapon.

Key Personnel

A clinic or triage nurse typically administers the form during the initial prenatal intake interview. However, other nurses, physicians, nutritionists, counselors, or clerical staff may also conduct the screening. Women whose screenings indicate abuse are referred to an onsite counselor for further assessment and follow up.

Study

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). Ninety-six of the women were Latina, 97 percent had annual family incomes of less than $20,000, 60 percent were between the ages of 20 to 29, and 24 percent were younger than 20 years old. At the time of their first visit to the clinic, 42 percent were in their first trimester (<14 weeks) of pregnancy, and 42 percent were 14 to 28 weeks pregnant. Sixty-one percent of the women made five or more prenatal visits to the clinic. A larger proportion of the women at the intervention clinics (46 percent) had annual family incomes of $10,000 or more, compared with the women at the comparison clinic (31 percent). This difference was statistically significant.

To evaluate short- and long-term effects, the follow-up 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.

The Abuse Assessment Screen (The Abuse Screen) form is available in English and Spanish.

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

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.