Humiliation, Afraid, Rape, Kick (HARK)
Detects domestic abuse (intimate partner violence) in women in primary care settings.
Advice
Interpret results in the context of overall clinical judgment.
Management
- Positive screen (any “yes" response):
- Validate the patient’s experience through empathetic and supportive communication.
- Tailor follow-up questions to the patient's responses to encourage further disclosure.
- Assess for immediate safety concerns and implement a safety plan if needed.
- Document findings thoroughly in the medical record, adhering to medico-legal requirements.
- Provide resources such as hotlines, shelters, and referrals to counseling, social work, and/or advocacy services (e.g., the National Domestic Violence Hotline).
- Schedule follow-up appointments for ongoing support.
- Negative screen:
- Maintain vigilance and consider re-screening at future visits, especially if concerns persist.
- Educate the patient on IPV resources as part of routine care, emphasizing their availability if needed.
Critical Actions
Be familiar with local mandatory reporting requirements, as these vary by jurisdiction. Exercise particular caution in cases involving children or vulnerable adults.