One Health Principles Applied to Human Domestic Violence
“Between animal and human medicine there are no dividing lines--nor should there be.” Rudolf Virchow, MD (the father of cellular pathology)
Provided to the One Health Initiative website October 23, 2012 by:
*Kevin M. Sherin, MD, MPH
The way people treat their pets or other animals frequently is an indication of how they treat people. Unfortunately, animal abuse is too often connected to domestic violence and even serial killers.
The shooters in the Columbine High School rampage including Jeffery Dahmer, Ted Bundy, David Berkowitz (“The Son of Sam”), Albert DeSalvo (“Boston Strangler”) all are accused of abusing animals before committing their other crimes. This is why many states are being urged to establish animal abuse registries where anyone convicted of felony animal abuse would be registered for case management.
During my residency training many years ago, my wife and I were confronted in the middle of the night by a neighbor who stated she was badly beaten. After more news on high profile domestic violence cases, I became determined to create a screening tool…. and the HITS tool was born in 1998. The HITS instrument http://www.orchd.com/violence/documents/HITS_eng.pdf is comprised of four questions and asks: “How often does your partner physically Hurt you, Insult you or talk down to you, Threaten you with harm, and Scream or curse at you?” The title “HITS” captures these four forms of domestic violence.
The HITS tool has been rigorously tested in a variety of settings, but was originally tested with 160 women in a family practice. The results showed scores from the HITS correlated very well with a substantially larger and well known instrument that measures one’s experience with interpersonal violence. The HITS was then further tested using a group of 99 women living in a domestic violence shelter. The results showed that the HITS correctly identified 96% of the women living at the shelter and 91% of women who were routine family medicine patients. The results were published in the August 1998 edition of the journal Family Medicine.
Over the years, the HITS has been researched with Spanish and Chinese speaking women, among others. It has also been translated into Arabic, Urdu, Dutch, and is used in parts of Africa. Overall, the HITS has been used in all six populated continents.
The American Medical Association (AMA), and the U.S. Centers for Disease Control and Prevention (CDC) both recognize the HITS tool as a validated, researched screening instrument. The domestic violence cases identified by HITS may also in turn identify pets that are at risk.
Communities should collaborate and push for animal registries which can help prevent animal and human violence and abuse. Available tools and resources need to be linked. One example of this is the free R3 App, (Recognize, Respond and Refer) http://www.harborhousefl.com/2012/01/r3-app-2/, the first mobile domestic violence screening tool in the U.S. that uses the HITS process.
The mobile application, collaboration between Harbor House of Central Florida, Florida Hospital, and the HITS tool is working to turn smart phones and i-pads in hospitals and physicians’ offices into powerful screening tools that help identify victims of domestic abuse and direct them to the help they need. This kind of multidisciplinary/interdisciplinary One Health (http://www.onehealthinitiative.com) collaboration and communication is important to expand screening tools like this into more medical, veterinary medical (veterinarians), and mental health settings.
Animal Legal Defense Fund (ALDF). ALDF was founded in 1979 with the unique mission of protecting the lives and advancing the interests of animals through the legal system. www.aldf.org.
Clinical Research and Methods (Fam Med 1998;30(7):508-12.)
HITS: A Short Domestic Violence Screening Tool for Use in a Family Practice Setting
Kevin M. Sherin, MD, MPH; James M. Sinacore, PhD; Xiao-Qiang Li, MD; Robert E. Zitter, PhD; Amer Shakil, MD
HITS was copyrighted in 2003 by Kevin Sherin MD, MPH; For permission to use HITS, Email firstname.lastname@example.org; *HITS is used in multiple languages 2006
*NOTE: Dr. Kevin M. Sherin is Director and Health Officer, Orange County Health Department, Orlando, Florida (USA). Dr. Sherin also serves on the One Health Initiative Autonomous Pro Bono team’s Honorary Advisory Board http://www.onehealthinitiative.com/advBoard.php.
One Health Initiative Autonomous pro bono Team: Laura H. Kahn, MD, MPH, MPP ▪ Bruce Kaplan, DVM ▪ Thomas P. Monath, MD ▪ Jack Woodall, PhD ▪ Lisa A. Conti, DVM, MPH