The letters from Drs. Nelson and Johnston, Dr. Nicolaidis, and Ms. Soler and Dr. Campbell raise several issues that warrant clarification about the scope of the USPSTF and the meaning of a grade I recommendation.

First, a grade I recommendation from the Task Force is not a recommendation against screening; it simply means that there is currently no good evidence showing that screening improves health outcomes. As with all Task force recommendations, this recommendation is based on a systematic review of the scientific evidence and does not reflect the experience of any individual clinician. A grade I recommendation likewise does not, and is not intended to, replace clinical experience or judgment.

Second, this Task Force recommendation, like all Task Force recommendations, addresses screening in asymptomatic individuals, not case finding (in this instance, this means that the Task Force did not address the identification of those who present with signs or symptoms suggestive of family violence). This Task Force recommendation statement does, in fact, encourage all clinicians examining children and adults to be alert to physical and behavioral signs and symptoms associated with abuse or neglect (for example, trauma or somatic symptoms) and to manage and refer those identified as victims of abuse to appropriate resources.

Finally, the concern raised in these letters misinterprets the recommendation as directing clinicians to ignore family violence until the "evidence is in," which is far from the case. The only way for clinical and research communities to learn more about family violence is for clinicians to consider it in their daily practice and to ask their patients about their experiences. The recommendation highlights the pressing need for attention and resources to be directed toward finding definitive evidence about effective screening tools and management interventions to help primary care clinicians address this important public health issue.