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Assessment Tool: HITS Scale

The HITS scale is a validated four-item screening tool for intimate partner violence (IPV). The acronym captures the four assessment domains: Hurt, Insult, Threaten, and Scream. Each item is rated 1–5 (Never to Frequently), producing a total score of 4–20. A score of ≥ 11 is the recommended cutpoint for a positive screen. This tool is used in primary care, emergency, obstetric, and mental health settings as part of a comprehensive health history that includes family violence and human trafficking assessment (D443.10.3). Always administer privately — never with a potential abuser present.

HITS Scale — Intimate Partner Violence Screen

A four-item validated screen for intimate partner violence (IPV) and domestic violence. Each item is scored 1–5 (Never to Frequently). Total scores range from 4–20; a score of ≥ 11 is the recommended cutpoint for a positive screen in most populations. The HITS acronym represents the four domains: Hurt, Insult, Threaten, Scream.

Score interpretation

4–10

Screen negative — no significant concern identified

≥ 11

Screen positive — further safety assessment and support required

This screen should be administered privately, with the patient alone. Safety planning and mandatory reporting obligations vary by jurisdiction — know your institutional and legal requirements before administering.

H — How often does your partner physically hurt you?
I — How often does your partner insult or talk down to you?
T — How often does your partner threaten you with harm?
S — How often does your partner scream or curse at you?

Safety and Disclosure Guidance

If a patient discloses abuse: respond with belief and validation, assess immediate safety, provide information about local resources (hotlines, shelters, legal advocacy), and document factually in the medical record. Never administer this screen with the partner present. Refer to your institutional policy for mandatory reporting requirements.