Screening for Interpersonal Violence: Potential Harm of Modifying Tools

摘要

HITS, the Hurt Insult Threat Scream tool, was developed to detect intimate partner violence (IPV) in primary care settings. The Center for Medicare and Medicaid Innovation (CMMI) modified the tool to screen more broadly for interpersonal violence—rather than restricting to IPV—and integrated it into a multidomain social risk screening tool in an ongoing national demonstration project. HITS includes four questions: one on physical abuse and three on verbal abuse. The physical abuse question asks: “How often does anyone, including family and friends, physically hurt you?” The three verbal abuse questions ask about being insulted, threatened, or screamed at, respectively. Questions are scored based on frequency of experiencing abuse (1 = “Never”; 5 = “Frequently”). Scores range from 4 to 20. A scoring system for the original tool was validated in adult female survivors of IPV, with a score ≥11 signaling a safety concern. In the current demonstration, CMMI recommends using the original HITS scoring cutoff, despite having broadened the scope of the questions. The objective of this study was to evaluate the use of the original scoring system for detecting rates of reported physical and verbal interpersonal violence.