I read with vivid understanding Karen Roush's Viewpoint, "No One Asked What Happened" (April), regarding U.S. health professionals' indifference to screening for domestic violence. Her observation that "It's not enough to add a check box to the admission form" is important. Doing only that is a dishonor and disservice to the one in four women in this country who are victims of abuse. Health care facilities and educational institutions that aren't compliant with the Joint Commission's mandate for domestic violence education programs and policies should be fined and lose the accreditation they so covet.

I'm a staff nurse at a freestanding acute rehabilitation hospital. During our accreditation process several years ago, the staff told surveyors that we didn't universally screen patients for domestic violence. We now have a check box on the admission form, but we don't offer education, policies, or programs, despite my appeals, research, and pleas.

The U.S. Preventive Services Task Force study cited by Ms. Roush found insufficient evidence to recommend universal screening, but the outcome measure it used was "reduction in violence" as opposed to providing an opportunity for disclosure, which is the purpose of universal screening, according to many domestic violence advocacy groups, including the Family Violence Prevention Fund.1

The Agency for Healthcare Research and Quality has developed a quality assessment tool for evaluating hospital-based domestic violence programs. The tool is straightforward and provides a wealth of information and an opportunity to make a difference. For more information, see http://www.ahrq.gov/research/domesticviol.

Karen E. Myers, BSN, RN, CRRN

Lowell, MI

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