What works?
Educate all patients about the connection between IPV and HT and their health and engage them in strategies to promote wellness and safety. The following are evidence-based steps that a multi- disciplinary care team can take to educate all patients on IPV and HT, while also promoting prevention. You can find additional information around the evidence behind the CUES intervention. This approach was also adapted during the COVID-19 Public Health Emergency for telehealth.
Evidence-Based Intervention: “CUES”
C: Confidentiality
Know your state or territory’s reporting requirements and share any limits of confidentiality with your patients.
Ensure that you can bring up relationships, violence, or stress safely by seeing patients alone for at least part of the in person or virtual visit.
Make sure you have access to professional interpreters and do not rely on family or friends to interpret.
Always see the patient alone for part of every visit so that you can bring up relationship abuse safely.
UE: Universal Education + Empowerment
Give each patient two safety cards to start the conversation about
relationships and how they affect health.
Open the card and encourage them to take a look. Make sure
patients know that you’re a safe person for them to talk to.
S: Support
Though disclosure of violence is not the goal, it will happen --
know how to support someone who discloses.
Make a warm referral to your local domestic/sexual violence
partner agency or national hotlines (on the back of all safety
cards).
Offer health promotion strategies and a care plan that takes
surviving abuse into consideration.
FamilyCare Health Center has seen a large increase in IPV disclosures since we’ve implemented universal education with the safety card. Our DV/SA advocacy partner, Branches, was quite full in the month after we held the training on IPV.
— Kat Cadle Adams, PsyD Psychologist, FamilyCare Health Center (Scott Depot, WV)
The terms intimate partner violence (IPV), domestic violence (DV) and domestic violence and sexual assault (DV/SA) will be used interchangeably throughout this toolkit.
Use Universal Education
It is important to use universal education in clinical settings, the strategy used to talk to all adult female-identifying and LGBTQ patients, and adolescent patients about the health consequences of IPV and HT. Even when asked directly by skilled providers, women may not disclose abuse for reasons including distrust and concern for subsequent violence.15,16 Combining universal education on IPV and HT(regardless of a disclosure on any screening tool) with brief trauma-informed harm reduction strategies and warm referrals is beneficial to patients. Following these steps help to increase safety, reduce violence, and improve clinical and social outcomes.
Use the safety card intervention
Universal education is aided by the use of safety cards. The evidence-based safety card tool was developed to help clinicians and DV/SA advocates open conversations about IPV and HT and healthy relationships with their clients. Because survivors may choose not to disclose abuse for a variety of reasons, universal education ensures that patients receive information regardless of disclosure, promoting primary prevention. With the support of FUTURES’ safety cards and other patient education materials, survivors of IPV and HT do not have to disclose abuse in order to receive help.
Tools to Promote Universal Education
Foonotes
15. Bair-Merritt MH, et al. Primary care-based interventions for intimate partner violence:. Am J Prev Med 2014;46(2):188-94. McCloskey LA, et al. Assessing intimate partner violence in health care settings leads to women’s receipt of interventions and improved health. Public Health Rep 2006;121(4):435-44.
16. Miller E, et al. A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion. Contraception 2011;83(3):274-80. Rhodes KV, et al, Interventions for intimate partner violence against women: clinical applications. JAMA 2003;289(5):601
Next Step
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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.