Domestic_violence

Canadian Task Force on Preventive Health Care

Recommendation Table

Prevention and treatment of violence against women: Systematic review & recommendations

Prepared by H.L. MacMillan, MD, MSc, FRCPC, and C.N. Wathen, MA, with the Canadian Task Force on Preventive Health Care

These recommendations were finalized by the Task Force in June 2001.

MANEUVER EFFECTIVENESS LEVEL OF EVIDENCE <REF> RECOMMENDATION

Screening

Women (pregnant or non-pregnant) Validated tools exist to detect violence but there is lack of a demonstrated link between screening and the reduction of violence outcomes Studies assessing psychometric properties of tools available, but no studies assessed screening to intervention outcomes.
The CTF concludes that there is insufficient evidence to recommend for or against routine screening for violence against pregnant or non-pregnant women (I Recommendation).*

*This is distinct from the need for clinicians to include questions about exposure to domestic violence as part of their diagnostic assessment of women. This information is important in caring for the patient, and may influence assessment and treatment of other health problems.

Men There is a lack of empirical studies. No studies available. The CTF concludes that there is insufficient evidence to recommend for or against primary care screening of men for domestic violence (I Recommendation).

Interventions for Pregnant & Non-Pregnant Women

Primary Care Counseling There is a lack of empirical studies. No studies available. The CTF concludes that there is insufficient evidence to recommend for or against counseling of abused women by the primary care clinicians, although decisions to do so may be made by the clinician and patient on other grounds (I Recommendation).

Referral to Shelters There is a lack of empirical studies. No studies available. The CTF concludes that there is insufficient evidence to recommend for or against referral to shelters, although decisions to do so may be made by the clinician and patient on other grounds (I Recommendation).

Referral to Post-Shelter Advocacy Counseling Among women who had spent at least 1 night in a shelter, an advocacy services program led to decreased rates of reabuse and improved quality of life during the next two years. Level I, fair <Sullivan & Bybee, 1999> The CTF concludes that there is fair evidence to refer women who have spent at least one night in a shelter to a structured program of advocacy services (B Recommendation)

Referral to Personal and Vocational Counseling There is a lack of empirical studies. No studies available. The CTF concludes that there is insufficient evidence to recommend for or against referral to personal or vocational counseling, although decisions to do so may be made by the clinician and patient on other grounds (I Recommendation).

Batterer/Couples Interventions
1 good study showed no difference between treatment and controls, but generalizability is low.

8 other studies and one review were of lesser quality and showed mixed results. Few of these studies had true controls - most compared different treatment strategies.

Level 1, good <Dunford, 2000>

Levels I <Harris, 1988, Edelson & Syers, 1991, Brannen & Rubin, 1996>, II-1 <Dutton, 1986, Chen et al., 1989, Palmer et al., 1992, Saunders, 1996>, II-2 <Dobash, 1996, Gondolf, 1999>, all poor

One fair systematic review <Davis & Taylor, 1999>
The CTF concludes that there is conflicting evidence regarding the effectiveness of batterer interventions (with or without partner participation) in reducing rates of further domestic violence (C Recommendation).

*See Appendix 1 for definitions of the levels of evidence, quality ratings and grades of recommendations.

Link to Published Recommendation Statement

Link to Related Commentary

Link to Full Technical Report (in pdf)

Link to Selected References list of this review

Link to JAMA abstract of this article

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MANEUVER	EFFECTIVENESS	LEVEL OF EVIDENCE <REF>	RECOMMENDATION
Screening
Women (pregnant or non-pregnant)	Validated tools exist to detect violence but there is lack of a demonstrated link between screening and the reduction of violence outcomes	Studies assessing psychometric properties of tools available, but no studies assessed screening to intervention outcomes.	The CTF concludes that there is insufficient evidence to recommend for or against routine screening for violence against pregnant or non-pregnant women (I Recommendation).* *This is distinct from the need for clinicians to include questions about exposure to domestic violence as part of their diagnostic assessment of women. This information is important in caring for the patient, and may influence assessment and treatment of other health problems.
Men	There is a lack of empirical studies.	No studies available.	The CTF concludes that there is insufficient evidence to recommend for or against primary care screening of men for domestic violence (I Recommendation).
**Interventions for Pregnant & Non-Pregnant Women**
Primary Care Counseling	There is a lack of empirical studies.	No studies available.	The CTF concludes that there is insufficient evidence to recommend for or against counseling of abused women by the primary care clinicians, although decisions to do so may be made by the clinician and patient on other grounds (I Recommendation).
Referral to Shelters	There is a lack of empirical studies.	No studies available.	The CTF concludes that there is insufficient evidence to recommend for or against referral to shelters, although decisions to do so may be made by the clinician and patient on other grounds (I Recommendation).
Referral to Post-Shelter Advocacy Counseling	Among women who had spent at least 1 night in a shelter, an advocacy services program led to decreased rates of reabuse and improved quality of life during the next two years.	Level I, fair <Sullivan & Bybee, 1999>	The CTF concludes that there is fair evidence to refer women who have spent at least one night in a shelter to a structured program of advocacy services (B Recommendation)
Referral to Personal and Vocational Counseling	There is a lack of empirical studies.	No studies available.	The CTF concludes that there is insufficient evidence to recommend for or against referral to personal or vocational counseling, although decisions to do so may be made by the clinician and patient on other grounds (I Recommendation).
Batterer/Couples Interventions	1 good study showed no difference between treatment and controls, but generalizability is low. 8 other studies and one review were of lesser quality and showed mixed results. Few of these studies had true controls - most compared different treatment strategies.	Level 1, good <Dunford, 2000> Levels I <Harris, 1988, Edelson & Syers, 1991, Brannen & Rubin, 1996>, II-1 <Dutton, 1986, Chen et al., 1989, Palmer et al., 1992, Saunders, 1996>, II-2 <Dobash, 1996, Gondolf, 1999>, all poor One fair systematic review <Davis & Taylor, 1999>	The CTF concludes that there is conflicting evidence regarding the effectiveness of batterer interventions (with or without partner participation) in reducing rates of further domestic violence (C Recommendation).