Family violence and trauma - screening tools for domestic violence

Overview

Structured, validated screening tools for domestic/family violence support systematic, non-judgemental identification in routine clinical practice - direct, private, and sensitively conducted enquiry (away from a potentially controlling partner/family member) substantially improves disclosure rates compared with indirect or absent screening
Relevant across general medical practice given the significant, often under-recognised prevalence of family violence and its substantial associated physical and psychological health impact, extending well beyond the immediate presenting complaint

Family violence frequently remains undisclosed without direct, specific enquiry, given fear, shame, safety concerns, or the abuser's presence during the consultation - structured screening tools provide a systematic, evidence-based framework for asking in a way shown to improve genuine disclosure rates, while a private setting (ensuring the patient is not accompanied by a potentially controlling partner during the screening conversation) is essential to enabling safe, honest disclosure

Screening should occur in a private setting, with the patient alone (using an appropriate reason to separate them from an accompanying partner/family member if needed), given the safety implications of screening in the presence of a potential perpetrator
A trauma-informed, non-judgemental approach to the screening conversation itself supports more accurate and complete disclosure

Immediate safety assessment for any patient disclosing current family violence, including assessment of escalation risk and immediate safety needs (safe accommodation options, whether it is safe for them to return home)
Referral to specialised family violence support services (advocacy, legal support, crisis accommodation) for ongoing support beyond the immediate medical consultation, given the specialised, ongoing nature of effective family violence support
Documentation practices should carefully consider patient safety (e.g. risk of a disclosure being inadvertently accessible to a perpetrator through shared health records) alongside standard clinical documentation needs

Private setting requirement for safe disclosure (a critical, non-negotiable screening precondition), immediate safety/risk assessment on disclosure, specialised family violence service referral pathways, documentation safety considerations given shared record access risk
Family violence screening must occur in a private setting with the patient alone, since screening in the presence of a potentially controlling partner or family member is not just less effective at eliciting disclosure but can create genuine safety risk for the patient - ensuring privacy is a non-negotiable precondition for safe, effective screening, not simply a preference for improving disclosure rates

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