Published research indicates that nearly one-third of women reported that they were presently experiencing some form of intimate partner violence (IPV) when they were asked about these occurrences during an ED visit. When questioned about their past, nearly 50% of women reported being victims of IPV. In addition, other research has demonstrated that 56% of victimized female patients presenting to the ED also report perpetration behaviors. Studies that have focused on detecting perpetrators of IPV in the ED suggest that screening is effective, but few of these individuals are actually identified in medical settings despite frequently being in attendance.
Testing a Shorter Screening Tool for IPV
The gold standard for detecting perpetrators of IPV in the ED has historically been the 25-question Physical Abuse of Partner Scale (PAPS). Although the PAPS is an effective, validated questionnaire, the length of time needed to administer it is not practical for a short visit in the ED. In the February 2012 Journal of Emergency Medicine, my colleagues and I had a study published in which we developed a shorter IPV screening alternative to the PAPS. We developed the PErpetration RaPid Scale (PERPS) by validating a shortened version of the PAPS consisting of three questions:
1. Have you ever forced your partner to have sex or hurt your partner during sex?
2. Have you ever pushed or shoved or poked your partner violently?
3. Have you ever hit or punched your partner’s arms, body, head, or face?
Unlike the PAPS, which uses a Likert scale for its 25 questions, PERPS has the potential to be administered more quickly because it uses only “yes/no” questions. To validate PERPS, we asked 214 patients presenting to a busy ED to complete both PERPS and PAPS screens. A positive PERPS result occurred when any of the three questions was answered with a “yes.” We found that the PERPS positively predicted IPV perpetration with high accuracy when compared with the PAPS. PERPS had a sensitivity of 66%, specificity of 93%, negative predictive value of 87%, positive predictive value of 78%, and an accuracy of 85%. Importantly, PERPS took less than 1 minute for ED patients to complete, and clinicians weren’t required to perform calculations to evaluate responses.
Applications to Practice
Some patients will not answer questions on PERPS or PAPS screens honestly because they fear the potential consequences. Emergency physicians should understand that the goal of IPV interventions in the ED should be to educate patients on the problems associated with IPV and refer them for assistance. Our study showed that the ED appeared to be an ideal place for PERPS screening. It can hopefully be used at an early stage of IPV when the cycle of violence can be broken.
When it’s determined that patients are a perpetrator of IPV, it’s important to discuss the ramifications of this violence and offer education about programs that can help. IPV education can also be provided with videos played on televisions in the ED waiting area. Computer-based educational programs can be developed to enable patients to complete PERPS screenings on a touchscreen computer. Considering the chaos of busy EDs and the fact that providers are often time constrained, a self-administered computer option of PERPS screens might prove to be ideal for IPV perpetration screening.
Readings & Resources (click to view)
Ernst A, Weiss S, Morgan-Edwards S, et al. Derivation and validation of a short emergency department screening tool for perpetrators of intimate partner violence: the PErpetrator RaPid Scale (PERPS). J Emerg Med. 2012;42:206-217.
Ernst A, Weiss S, Hall J, et al. Adult intimate partner violence perpetrators are significantly more likely to have witnessed intimate partner violence as a child than non-perpetrators. Am J Emerg Med. 2009;27:641-650.
Steadman H, Silver E, Monahan J, et al. A classification tree approach to the development of actuarial violence risk assessment tools. Law Hum Behav. 2009;24:83-100.
Ernst A, Weiss S, Hobley K, et al. Brief emergency department intervention about perpetration of intimate partner violence: victims improved knowledge attitudes and practice more than non-victims. Acad Emerg Med. 2009;16:S172-S173.
Rhodes K, Houry D, Cerulli C, et al. Intimate partner violence and comorbid mental health conditions among urban males patients. Ann Fam Med. 2009;7:47-55.
Houry D, Cunningham R, Hamkin A, et al. Violence prevention in the emergency department: future research priorities. Acad Emerg Med. 2009;16:1089-1095.
Houry D, Rhodes K, Kemball R, et al. Differences in female and male victims and perpetrators of partner violence with respect to WEB scores. J Interpers Violence. 2008;23:1041-1055.