Health centers (HCs) and Domestic Violence (DV)/Sexual Assault (SA)advocacy programs are natural partners given their shared mission to improve the health, wellness, and safety of their clients. Use this toolkit to build a comprehensive and sustainable response to DV/SA and Human Trafficking (HT) in partnership with DV/SA advocacy programs (social service organizations) to:
Improve
Improve how your health center identifies and responds to DV/SA and promotes prevention.
Develop
Develop proactive partnerships with local DV/SA advocacy programs to address the health needs of patients and connect them to health centers for care.
"When health center leadership commits to the system-wide integration of care, including developing formal partnerships with community based social service organizations to address intimate partner violence, we find they are better positioned to improve health outcomes for the patients they serve.”*
- Judith Steinberg, MD, MPH, Chief Medical Officer, Bureau of Primary Health Care, Health Resources and Services Administration
“Domestic violence programs and health centers, working in partnership, create communities where victims of domestic violence who ask for help receive a compassionate and helpful response.”
-Marylouise Kelley, Ph.D., Director,
Division of Family Violence Prevention and Services, Administration for Children and Families
*All quotes throughout this toolkit have been used with permission.
The terms intimate partner violence (IPV), domestic violence (DV) and domestic violence and sexual assault (DV/SA) will be used interchangeably throughout this toolkit.
Follow these essential steps to address IPV in your health center:
Intimate partner violence and human trafficking are public health epidemics in the U.S.
The U.S. Centers for Disease Control and Prevention defines IPV as physical violence, sexual violence, stalking and psychological aggression (including coercive acts) by a current or former intimate partner.
The Trafficking Victims Protection Act of 2000 defines human trafficking as exploitation of a person through the use of force, fraud, or coercion to obtain a labor or sex act. For minors, sex trafficking is defined as any commercial sex act with a minor under age 18.
DV/SA is a key social determinant of health and impacts your patients: almost 1 in 2 women and more than 2 in 5 men reported experiencing some form of IPV at some point in their lifetime. 1,2
LGBTQ communities experience violence at similar or higher rates to that of heterosexual women. 3,4,5,6,7,8
Human trafficking is also widespread: 88% of sex trafficking survivors had some contact with health care while being exploited.9
Health consequences can be severe. The long term impact of DV/SA includes physical injuries, chronic health and mental health issues, and high risk health behaviors.10
See this infographic on the health impact of violence.
The long-term health impact of human trafficking can include back pain, stomach pain, dizziness, chest/heart pain, and respiratory problems.11, 12
DV/SA is costly and interferes with quality of care. Read more about DV/SA health costs and utilization.
The U.S. Preventive Services Task Force recommends screening and brief counseling for IPV, currently a required women’s preventive service covered benefit.
Evidence-based interventions exist and preventive service codes can be used to bill for brief intervention and counseling.
Why health centers?
Given their enormous reach and overarching goals to promote health and safety, HCs are uniquely positioned to be leaders in violence prevention across the U.S. One in 11 people nationwide rely on a HRSA-funded health center for their health care needs. Locate a health center near you. Many HCs have already partnered with DV/SA organizations to implement health interventions with promising results to achieve better health outcomes for patients. Between 2014-2016, 10 HCs and 10 DV/SA programs across the country participated in the Improving Health Outcomes Through Violence Prevention Pilot Project to identify promising ways to promote the health and safety of patients. Under this pilot, health centers and partnering DV/SA programs tested all steps to address and respond to DV/SA. To learn more about how DV/SA programs and health centers have partnered, click here.
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This website was developed in 2017 with funding from the U.S. Department of Health and Human Services (HHS), Administration for Children and Families (ACF), Family and Youth Services Bureau (FYSB), and Family Violence Prevention and Services Program (FVPSA), Grant #90EV0414. Funding was also provided, in part, from the Health Resources and Services Administration (HRSA). As of 2023, updates to this website are made possible by HRSA’s Bureau of Primary Health Care (BPHC) with funding totaling $682,548 from the U.S. Department of Health and Human Services (HHS), with no contributions from non-governmental sources. The content is the authors' responsibility and does not necessarily reflect the views of HRSA, HHS, or the U.S. Government. For more details, visit www.HRSA.gov.