Woman Abuse Screening Tool (WAST)

Intimate partner violence (IPV) represents a significant public health concern affecting millions of individuals worldwide. Healthcare providers play a crucial role in identifying and supporting patients who may be experiencing abuse within their relationships. However, detecting IPV in clinical settings can be challenging due to various barriers, including patient reluctance to disclose, time constraints, and lack of standardized screening tools.

The Woman Abuse Screening Tool (WAST) was developed to address these challenges by providing healthcare professionals with a brief, validated instrument for identifying intimate partner violence during routine clinical encounters. Since its development in 1996, the WAST has become one of the most widely used screening tools for IPV in primary care and emergency settings.

Development and Validation of the WAST

The WAST was created by Dr. Judith Belle Brown and her colleagues at the Centre for Studies in Family Medicine at the University of Western Ontario. The tool was specifically designed for use in family practice settings, recognizing the need for a screening instrument that could be easily integrated into busy clinical workflows while maintaining sensitivity and specificity for detecting abuse.

The development process involved extensive research into the dynamics of intimate partner violence and consultation with experts in the field of domestic abuse. The resulting instrument was designed to be non-threatening, culturally sensitive, and appropriate for use across diverse patient populations.

Psychometric Properties

The WAST demonstrates strong psychometric properties that support its clinical utility. The tool has shown high internal consistency, with a Cronbach's alpha coefficient of 0.75, indicating that the items measure a coherent construct related to intimate partner violence. This reliability makes the WAST a dependable instrument for clinical screening purposes.

Validation studies have demonstrated the WAST's effectiveness across various populations and settings. The tool has been validated in multiple languages, including English, Spanish, Persian, and Chinese, making it applicable to diverse cultural contexts. This cross-cultural validation is particularly important given that IPV affects individuals from all backgrounds, and screening tools must be culturally appropriate to be effective.

The WAST Questionnaire Structure

The WAST consists of eight questions that assess various dimensions of intimate partner violence, including relationship tension, conflict resolution, emotional abuse, physical abuse, sexual abuse, and fear or intimidation. Each question is designed to be non-threatening and to facilitate disclosure in a supportive clinical environment.

Question 1: Relationship Tension

The first question asks, "In general, how would you describe your relationship?" This opening question serves multiple purposes. It provides a non-threatening entry point into discussions about relationship dynamics, allowing patients to express concerns about their relationship without immediately focusing on abuse. The question assesses overall relationship quality and tension levels, which can serve as an indicator of potential IPV.

Responses range from "No tension" (score of 1) to "A lot of tension" (score of 3). High scores on this question may indicate relationship distress that could be associated with abuse, though tension alone does not necessarily indicate IPV. However, when combined with other indicators, high relationship tension can be a significant warning sign.

Question 2: Conflict Resolution

The second question asks, "Do you and your partner work out arguments with:" This question assesses the couple's ability to resolve conflicts constructively. Responses range from "No difficulty" (score of 1) to "Great difficulty" (score of 3). Difficulty in conflict resolution can be associated with various relationship problems, including patterns of abuse where conflicts may escalate to violence or emotional harm.

Together, questions 1 and 2 form the WAST-Short, a two-question initial screening tool. If a patient responds with "A lot of tension" to question 1 or "Great difficulty" to question 2, this suggests the presence of relationship concerns that warrant further assessment with the complete WAST questionnaire.

Question 3: Emotional Abuse - Put Down

The third question asks, "Do arguments ever result in you feeling put down or bad about yourself?" This question specifically targets emotional abuse, which is often the most common form of intimate partner violence but may be less recognized than physical abuse. Emotional abuse can have profound psychological effects and is frequently a precursor to or co-occurs with physical violence.

This question helps identify patterns of psychological manipulation, belittling, or demeaning behavior that constitute emotional abuse. Responses range from "Never" (score of 1) to "Often" (score of 3). Positive responses to this question, particularly "Sometimes" or "Often," indicate the presence of emotional abuse that requires attention and support.

Question 4: Physical Abuse - Hitting, Kicking, Pushing

The fourth question asks, "Do arguments ever result in hitting, kicking, or pushing?" This question directly assesses physical violence within the relationship. Physical abuse represents a clear safety concern and requires immediate attention and intervention. The question uses specific behavioral descriptions (hitting, kicking, pushing) rather than abstract terms, which may facilitate more accurate reporting.

Any positive response to this question, particularly "Sometimes" or "Often," indicates physical violence that requires immediate safety assessment and intervention. Healthcare providers must be prepared to respond appropriately to positive screens for physical abuse, including safety planning, documentation, and connection to support services.

Question 5: Fear and Intimidation

The fifth question asks, "Do you ever feel frightened by what your partner says or does?" Fear is a critical indicator of intimate partner violence and represents a significant safety concern. This question captures the emotional impact of abuse, including intimidation, threats, and behaviors that create fear, even if they do not involve physical violence.

Fear in a relationship is a strong predictor of escalating violence and is associated with increased risk of serious harm. A response of "Often" (score of 3) to this question is particularly concerning and requires immediate attention and safety assessment. Fear may also indicate the presence of coercive control, a pattern of behavior used to dominate and control a partner.

Question 6: Direct Physical Abuse Assessment

The sixth question asks, "Has your partner ever abused you physically?" This question provides a direct assessment of physical abuse, using the term "abused" to allow patients to self-identify experiences that they may recognize as abuse. This direct approach can be important for patients who may not recognize specific behaviors (like hitting or pushing) as abuse but do recognize the overall pattern.

This question complements question 4 by providing an alternative way to assess physical abuse. Some patients may be more comfortable responding to this direct question, while others may find the behavioral specificity of question 4 easier to answer. Together, these questions provide multiple opportunities to identify physical abuse.

Question 7: Direct Emotional Abuse Assessment

The seventh question asks, "Has your partner ever abused you emotionally?" Similar to question 6, this question provides a direct assessment of emotional abuse, allowing patients to identify experiences they recognize as emotionally abusive. Emotional abuse can include various behaviors such as constant criticism, isolation from friends and family, threats, manipulation, and other forms of psychological harm.

This question complements question 3 by providing both specific (feeling put down) and general (emotional abuse) assessments. Together, these questions help identify the full spectrum of emotional abuse, which may be present even in the absence of physical violence.

Question 8: Sexual Abuse Assessment

The eighth and final question asks, "Has your partner ever abused you sexually?" Sexual abuse within intimate relationships is a serious form of violence that may be underreported. This question provides an opportunity to identify sexual coercion, forced sexual activity, or other forms of sexual abuse that may occur within the context of an intimate relationship.

Sexual abuse is associated with significant physical and psychological consequences and requires specialized support and intervention. Any positive response to this question warrants immediate attention, safety assessment, and connection to appropriate support services, including those specializing in sexual violence.

WAST Scoring System

The WAST uses a simple scoring system that makes it easy to use in clinical settings. Each of the eight questions is scored on a 3-point Likert scale, with responses scored as follows:

• Score of 1: Responses indicating absence or minimal presence of the concern (e.g., "Never," "No tension," "No difficulty")
• Score of 2: Responses indicating moderate presence of the concern (e.g., "Sometimes," "Some tension," "Some difficulty")
• Score of 3: Responses indicating frequent or severe presence of the concern (e.g., "Often," "A lot of tension," "Great difficulty")

The total WAST score is calculated by summing the scores from all eight questions, resulting in a total score ranging from 8 to 24. Higher scores indicate greater frequency or severity of abuse indicators.

Cutoff Score and Interpretation

A cutoff score of 13 has been recommended to indicate the presence of intimate partner violence. Scores of 13 or higher suggest possible abuse and warrant further assessment, safety planning, and connection to support services. Scores below 13 indicate a negative screen, though this does not definitively rule out abuse, and clinical judgment should always be applied.

It is important to note that the cutoff score is a guideline, not an absolute threshold. Clinical judgment, patient presentation, and other contextual factors should always be considered when interpreting WAST scores. Some patients with scores below 13 may still be experiencing abuse, while others with scores above 13 may have other relationship concerns that do not constitute IPV.

WAST-Short: Initial Screening Tool

The WAST-Short consists of the first two questions of the full WAST questionnaire and serves as an initial screening tool for busy clinical settings. The WAST-Short can be used to quickly identify patients who may benefit from more comprehensive assessment with the full WAST or other appropriate screening tools.

If a patient responds with "A lot of tension" to question 1 or "Great difficulty" to question 2, the WAST-Short is considered positive, suggesting relationship concerns that warrant further assessment. The WAST-Short has demonstrated excellent screening properties, with a sensitivity of 91.7% and a specificity of 100% in validation studies.

Clinical Utility of WAST-Short

The high sensitivity of the WAST-Short means that it effectively identifies most patients who may be experiencing abuse, minimizing false negatives. The perfect specificity means that positive WAST-Short screens are highly likely to indicate genuine concerns. These properties make the WAST-Short an excellent initial screening tool that can be quickly administered during routine clinical encounters.

When the WAST-Short is positive, healthcare providers should proceed with the full WAST questionnaire or other appropriate assessment tools. The WAST-Short should not be used as a standalone diagnostic tool but rather as a screening mechanism to identify patients who need more comprehensive evaluation.

Clinical Applications and Settings

The WAST has been validated for use in various clinical settings, though it was originally developed for family practice. Its brevity and ease of administration make it suitable for multiple healthcare contexts where time may be limited but screening for IPV is important.

Primary Care Settings

In primary care settings, the WAST can be integrated into routine health maintenance visits, annual examinations, or visits for various health concerns. The tool's non-threatening nature and focus on relationship health make it appropriate for use during routine encounters, potentially normalizing discussions about relationship safety and reducing stigma.

Primary care providers can use the WAST to identify patients who may be experiencing IPV and connect them with appropriate resources, including domestic violence advocacy services, counseling, legal assistance, and safety planning support. Early identification in primary care settings can prevent escalation of abuse and improve patient outcomes.

Emergency Department Settings

Emergency departments represent important settings for IPV screening, as patients may present with injuries or health concerns related to abuse. The WAST can be used in emergency settings to identify patients who may be experiencing IPV, though the chaotic nature of emergency care may require adaptations in administration.

In emergency settings, positive WAST screens should trigger immediate safety assessment and connection to appropriate resources. Emergency department staff should be trained in responding to positive screens, including documentation, safety planning, and coordination with domestic violence services.

Obstetric and Gynecologic Settings

Pregnancy represents a time of increased risk for IPV, and obstetric and gynecologic settings are important locations for IPV screening. The WAST can be used during prenatal visits, postpartum care, and routine gynecologic examinations to identify patients who may be experiencing abuse.

IPV during pregnancy has serious implications for both maternal and fetal health, making screening in these settings particularly important. Healthcare providers in obstetric and gynecologic settings should be prepared to respond to positive WAST screens with appropriate support and resources.

Administration Guidelines

Proper administration of the WAST is essential for obtaining accurate results and ensuring patient safety. Healthcare providers should follow specific guidelines when using the WAST to maximize its effectiveness and minimize potential harm.

Privacy and Confidentiality

The WAST should always be administered in a private setting where the patient feels safe and where conversations cannot be overheard. This is particularly important for patients who may be accompanied by their partners, as disclosure of abuse in the presence of an abuser can increase risk of harm.

Healthcare providers should ensure that partners, family members, or others are not present during WAST administration unless the patient specifically requests their presence. If a partner is present and the patient cannot be seen alone, providers should attempt to create opportunities for private screening, such as during physical examination or when asking the partner to step out briefly.

Approach and Communication

The WAST should be introduced as a routine part of healthcare, normalizing the screening process and reducing stigma. Healthcare providers can explain that they ask all patients about relationship health and safety as part of comprehensive care. This approach helps patients understand that screening is standard practice, not a response to suspicion of abuse.

When administering the WAST, healthcare providers should use a non-judgmental, supportive tone and allow patients sufficient time to respond. Patients should be informed that their responses are confidential, though providers should also explain any limitations to confidentiality, such as mandatory reporting requirements that may apply in their jurisdiction.

Timing and Context

The WAST can be administered at various points during a clinical encounter, depending on the setting and circumstances. Some providers prefer to administer it early in the visit, while others may wait until after establishing rapport or addressing the patient's primary concern. The optimal timing may vary based on the clinical context and patient presentation.

Providers should be sensitive to patient cues and may need to delay or reschedule screening if the patient appears distressed, if privacy cannot be ensured, or if other urgent concerns take priority. However, providers should also recognize that there may never be a "perfect" time for screening and that routine administration helps normalize the process.

Interpreting WAST Results

Interpretation of WAST results requires clinical judgment and consideration of multiple factors beyond the numerical score. While the cutoff score of 13 provides a guideline, healthcare providers must consider the full clinical picture when interpreting results.

Positive Screen (Score ≥ 13)

A WAST score of 13 or higher indicates a positive screen for possible intimate partner violence. Positive screens should trigger several important responses from healthcare providers:

• Safety Assessment: Immediate assessment of patient safety is critical. Providers should ask about current safety concerns, presence of weapons, threats of harm, and other factors that may increase risk.
• Documentation: Accurate and thorough documentation of screening results, patient disclosures, and clinical assessments is essential for continuity of care and potential legal proceedings.
• Support and Resources: Patients with positive screens should be connected to appropriate support services, including domestic violence advocacy programs, counseling, legal assistance, and emergency resources if needed.
• Safety Planning: Development of a safety plan can help patients reduce risk and prepare for potential escalation of violence. Safety planning should be individualized and consider the patient's specific circumstances.

Negative Screen (Score < 13)

A WAST score below 13 indicates a negative screen, suggesting that the patient may not be experiencing intimate partner violence. However, negative screens should not be interpreted as definitively ruling out abuse. Several factors may contribute to false negative results:

• Patient fear or reluctance to disclose abuse
• Normalization of abuse that prevents recognition
• Cultural or social factors that influence disclosure
• Timing of screening relative to abuse patterns

Healthcare providers should maintain awareness of potential IPV even with negative screens and should continue to monitor for signs of abuse during future encounters. Clinical judgment and observation of patient presentation remain important even when screening results are negative.

Pattern Analysis

Beyond the total score, healthcare providers should consider patterns in responses that may provide additional clinical insights. For example, high scores on questions related to fear (question 5) may indicate particular safety concerns, even if the total score is below the cutoff. Similarly, positive responses to questions about physical or sexual abuse (questions 4, 6, or 8) require immediate attention regardless of the total score.

Providers should also consider the relationship between different types of abuse indicators. For example, emotional abuse often co-occurs with physical abuse, and the presence of multiple abuse types may indicate more severe or escalating violence.

Responding to Positive Screens

Healthcare providers must be prepared to respond appropriately when patients screen positive for intimate partner violence. Appropriate response requires training, knowledge of available resources, and understanding of best practices for supporting patients experiencing abuse.

Immediate Safety Assessment

When a patient screens positive, the first priority is assessing immediate safety. Healthcare providers should ask direct questions about current safety concerns, including:

• Are you safe to go home today?
• Has the violence been getting worse or more frequent?
• Are there weapons in the home?
• Has your partner threatened to harm you or others?
• Do you have a safe place to go if needed?

These questions help providers assess immediate risk and determine whether emergency intervention is needed. Patients at immediate risk may require connection to emergency services, domestic violence shelters, or other emergency resources.

Documentation Best Practices

Thorough and accurate documentation is essential when patients screen positive for IPV. Documentation should include:

• Screening results and scores
• Patient disclosures and statements (using direct quotes when possible)
• Clinical observations and physical findings
• Safety assessment findings
• Resources provided and referrals made
• Safety planning discussions
• Follow-up plans

Documentation should be objective, detailed, and written with awareness that it may be used in legal proceedings. Providers should document what the patient reported, not their own interpretations or assumptions. Photographs of injuries, when appropriate and with patient consent, can also be important documentation.

Connecting to Resources

Patients who screen positive for IPV should be connected to appropriate support services. These may include:

• Domestic Violence Advocacy Programs: These programs provide crisis intervention, safety planning, legal advocacy, and support services.
• Counseling and Mental Health Services: Trauma-informed counseling can help patients process their experiences and develop coping strategies.
• Legal Assistance: Legal aid services can help with protection orders, custody issues, and other legal concerns.
• Emergency Resources: Hotlines, shelters, and emergency services provide immediate support and safety.
• Medical Follow-up: Ongoing medical care to address physical and mental health consequences of abuse.

Healthcare providers should have current information about local resources and should provide this information in a way that is safe for the patient, recognizing that abusers may monitor communication and access to resources.

Safety Planning

Safety planning is a critical component of responding to intimate partner violence. Safety plans are individualized strategies that help patients reduce risk and prepare for potential escalation of violence. Healthcare providers can initiate safety planning discussions, though specialized domestic violence advocates are best equipped to develop comprehensive safety plans.

Key Elements of Safety Planning

Safety plans should address multiple aspects of patient safety and should be tailored to the patient's specific circumstances. Key elements may include:

• Emergency Contacts: Identification of safe people to contact in emergencies
• Safe Places: Identification of safe locations where the patient can go if needed
• Important Documents: Plans for accessing and securing important documents (identification, financial records, legal documents)
• Financial Resources: Strategies for accessing financial resources if leaving becomes necessary
• Children's Safety: Plans for keeping children safe, including school notification and custody considerations
• Technology Safety: Strategies for maintaining privacy and safety when using technology

Safety plans should be living documents that are reviewed and updated regularly as circumstances change. Patients should be encouraged to keep safety plan information in a secure location that is not accessible to their partner.

Cultural Considerations

Intimate partner violence affects individuals from all cultural backgrounds, and effective screening requires cultural sensitivity and awareness. The WAST has been validated in multiple cultural contexts, but healthcare providers must still consider cultural factors when administering and interpreting the tool.

Cultural Barriers to Disclosure

Various cultural factors may influence patients' willingness or ability to disclose abuse. These may include:

• Cultural norms that discourage disclosure of family problems
• Fear of bringing shame or dishonor to the family
• Concerns about immigration status or deportation
• Language barriers that make communication difficult
• Distrust of healthcare systems or authorities
• Religious or spiritual beliefs that influence responses to abuse

Healthcare providers should be aware of these potential barriers and should work to create culturally sensitive environments that facilitate disclosure. This may include working with interpreters, understanding cultural contexts, and building trust with patients from diverse backgrounds.

Cultural Adaptations

While the WAST has been validated in multiple languages and cultural contexts, healthcare providers may need to consider cultural adaptations in some settings. These adaptations should maintain the core content and intent of the questions while ensuring cultural appropriateness and relevance.

When working with patients from diverse cultural backgrounds, providers should seek guidance from cultural experts, community leaders, or domestic violence advocates who understand the specific cultural context. This can help ensure that screening is effective and that responses to positive screens are culturally appropriate.

Mandatory Reporting Considerations

Healthcare providers must be aware of mandatory reporting requirements that may apply when patients disclose intimate partner violence. These requirements vary by jurisdiction and may depend on factors such as the patient's age, the presence of children, and the severity of abuse.

Understanding Reporting Requirements

Mandatory reporting laws vary significantly across jurisdictions. Some areas require reporting of IPV in certain circumstances, while others do not have mandatory reporting for adult IPV victims. Healthcare providers should be familiar with the specific requirements in their jurisdiction.

When mandatory reporting applies, providers should inform patients about the reporting requirement before disclosure, if possible. This allows patients to make informed decisions about what they choose to share. However, providers must balance patient autonomy with legal obligations.

Balancing Patient Safety and Legal Obligations

Mandatory reporting can create complex ethical and practical challenges. While reporting may be legally required, it may also increase risk for some patients, particularly if the abuser learns of the report. Healthcare providers must carefully consider these factors and work to minimize potential harm while fulfilling legal obligations.

When reporting is required, providers should work with patients to develop safety plans and should coordinate with appropriate agencies to ensure patient safety. Providers should also be aware that mandatory reporting may affect patient trust and willingness to disclose abuse in the future.

Integration into Clinical Workflows

Effective IPV screening requires integration into routine clinical workflows. The WAST's brevity and ease of administration make it well-suited for integration into various clinical settings, but successful implementation requires planning and support.

Workflow Integration Strategies

Several strategies can facilitate integration of WAST screening into clinical workflows:

• Electronic Health Record Integration: Embedding the WAST into electronic health records can prompt screening at appropriate times and facilitate documentation.
• Standardized Protocols: Developing clear protocols for when and how to administer the WAST helps ensure consistent screening practices.
• Staff Training: Training all clinical staff in WAST administration and response to positive screens ensures that screening can occur across various clinical roles.
• Resource Availability: Ensuring that support resources and referrals are readily available facilitates appropriate response to positive screens.

Successful integration requires organizational commitment, adequate resources, and ongoing support for clinical staff. Healthcare organizations should invest in training, resources, and systems that support effective IPV screening and response.

Overcoming Implementation Barriers

Various barriers may impede effective implementation of IPV screening, including time constraints, discomfort with the topic, lack of training, and concerns about how to respond to positive screens. Healthcare organizations can address these barriers through:

• Providing comprehensive training on IPV screening and response
• Allocating adequate time for screening and response
• Creating supportive environments where staff feel comfortable addressing IPV
• Ensuring access to resources and support services
• Providing ongoing supervision and consultation

Addressing these barriers requires organizational commitment and investment in staff training and support systems.

Special Populations and Considerations

While the WAST was developed for use with women experiencing abuse, intimate partner violence affects diverse populations, and screening approaches may need to be adapted for different groups.

Pregnant Patients

Pregnancy represents a time of increased risk for IPV, and screening during pregnancy is particularly important. The WAST can be used during prenatal visits, but providers should be aware that pregnancy may create additional barriers to disclosure, including concerns about child custody and increased dependence on the partner.

Providers should be prepared to address the unique safety concerns of pregnant patients, including risks to both maternal and fetal health. Safety planning for pregnant patients may need to consider delivery plans, postpartum safety, and child custody concerns.

Elderly Patients

Elderly patients may experience IPV in the context of long-term relationships or may be vulnerable to abuse from caregivers. Screening approaches for elderly patients may need to consider cognitive function, physical limitations, and unique safety concerns related to aging.

The WAST can be adapted for use with elderly patients, but providers should be aware of potential barriers to disclosure, including dependence on the abuser for care, fear of institutionalization, and generational attitudes about relationship problems.

Patients with Disabilities

Patients with disabilities may face unique risks and barriers related to IPV. Dependence on caregivers, communication barriers, and social isolation may increase vulnerability to abuse while also creating barriers to disclosure and help-seeking.

Screening approaches for patients with disabilities may need to be adapted to accommodate communication needs, cognitive function, and physical limitations. Providers should work with patients and their support systems to ensure that screening is accessible and that responses to positive screens are appropriate.

Limitations and Considerations

While the WAST is a valuable screening tool, healthcare providers should be aware of its limitations and should use clinical judgment in conjunction with screening results.

Screening Tool Limitations

The WAST is a screening tool, not a diagnostic instrument. It is designed to identify patients who may be experiencing IPV and who would benefit from further assessment and support. A positive screen does not definitively diagnose IPV, and a negative screen does not definitively rule it out.

Clinical judgment, patient presentation, and other contextual factors should always be considered alongside WAST results. Providers should maintain awareness of potential IPV even when screening results are negative, particularly if clinical signs suggest possible abuse.

False Negatives and Positives

Like all screening tools, the WAST may produce false negative and false positive results. False negatives may occur when patients are unable or unwilling to disclose abuse, when abuse patterns do not align with the questions asked, or when patients do not recognize their experiences as abuse.

False positives may occur when patients have relationship problems that do not constitute IPV or when other factors influence responses. Clinical judgment and further assessment can help distinguish between true positives and false positives.

Ongoing Assessment

IPV screening should be an ongoing process, not a one-time event. Relationship dynamics can change over time, and patients who screen negative initially may later experience abuse. Healthcare providers should maintain awareness of IPV risk factors and should consider repeat screening when appropriate.

Providers should also recognize that leaving an abusive relationship is a process that may take time, and patients may need ongoing support and screening as they navigate this process. Continued engagement and support are essential for patients experiencing IPV.

Training and Education

Effective use of the WAST requires appropriate training and education for healthcare providers. Training should cover not only how to administer the tool but also how to respond appropriately to positive screens and how to support patients experiencing abuse.

Essential Training Components

Comprehensive training for WAST use should include:

• Understanding of intimate partner violence dynamics and patterns
• Administration of the WAST questionnaire
• Interpretation of WAST results
• Safety assessment and risk evaluation
• Documentation best practices
• Connecting patients to resources and support services
• Safety planning basics
• Cultural sensitivity and considerations
• Mandatory reporting requirements
• Self-care and provider support

Training should be ongoing and should provide opportunities for skill development, case discussion, and consultation. Healthcare organizations should invest in comprehensive training programs that support effective IPV screening and response.

Continuing Education

IPV screening and response is an evolving field, and healthcare providers should engage in continuing education to stay current with best practices, research findings, and available resources. This may include attending conferences, participating in case discussions, and accessing online resources and training materials.

Healthcare organizations should support continuing education and should create opportunities for providers to share experiences, learn from each other, and develop skills in IPV screening and response.