implications for the social service and criminal justice systems, particularly in the areas of prevention and perpetrator prosecution. As noted in Chapter 1 and in the paper by Wolfe (this volume), however, a preoccupation with case identification can also have high costs; recent experience in child abuse indicates that a single-minded emphasis on case investigation (when accompanied by the threat of prosecution or other disruptive interventions) can undermine the goal of protection.

Several approaches are used to identify persons with important conditions or situations in the clinical setting, and general principles have been well developed (Rich and Sox, 2000; Neilsen and Lang, 1999). Figure 6-2 represents a framework for screening approaches, emphasizing that case screening and investigation are parts of a multistage process, although the nature and timing of each stage is varied. Validation of each step is an important aim of research. A LEAD standard would be the appropriate means of validating any proposed screening method prior to its widespread application. Typically, the process of clinical screening and case identification starts with designating appropriate settings and situations for carrying

FIGURE 6-2 A framework for clinical screening and case identification.