Hidden No More: What Every Health Center Should Know for Domestic Violence Awareness Month

In a bustling Community Health Center, Nurse Maria meets a patient named Ana during a routine visit. At first glance, Ana appears unremarkable-no bruises or visible signs of distress, just quiet with tired eyes. However, as they talk, Maria notices subtle cues: a hesitation in Ana's voice, an undercurrent of anxiety in her answers. Recognizing these signs, Maria understands the importance of her role. She starts to administer CUES-using gentle conversation to share information about relationships that are healthy and ones that aren't, including where to get support in the community.

Ana's visit represents the hidden battles many face behind closed doors. While Maria does not expect Ana to disclose an abusive relationship, her role in offering support-without pressure or judgment-can make all the difference.

Every year, intimate partner violence (IPV) affects over 12 million people. Many, like Ana, walk into health centers not seeking to disclose their trauma, but the opportunity for compassionate support can be a crucial lifeline for those who are isolated, or may not understand that there are alternatives to their experiences of unhealthy relationship dynamics.

UDS Measures and IPV Reporting

To address the complexities of IPV, the Bureau of Primary Health Care (BPHC) introduced Uniform Data System (UDS) measures on IPV and exploitation in 2020. These measures track suspected or confirmed patient experiences with IPV and exploitation. Because not all patients feel comfortable disclosing abuse, and may be fearful, the CUES intervention is not reliant on disclosures.

This approach integrates medical care, behavioral health services, and collaboration with domestic violence programs, ensuring a holistic, survivor-centered experience. Health centers play a vital role in delivering care to 32.5 million people each year, many of whom are uninsured, have limited English proficiency, or live below the poverty line. Despite this critical service, IPV often goes underreported because of gaps in recognizing and documenting these cases.

Healing through Innovation

Health Information Technology (HIT) is transforming the support for survivors of IPV by streamlining care and enhancing access to resources. Epic OCHIN's Electronic Health Record (EHR) system includes a specialized SmartTool that provides scripts to guide health centers on how to respond if a patient discloses IPV and how to document referrals or adaptations to the care plan to better support the patient.

The CUES approach-Confidentiality, Universal Education, Empowerment, and Support-is integral to this process. By encouraging providers to discuss relationship health with every patient, CUES ensures patients know help is available without pressure to disclose their experiences. This method plants seeds of support that can flourish when the patient feels ready.

Following a successful pilot in 2022, OCHIN's SmartTool can enable health centers to effectively implement the CUES approach. This resource assists providers in documenting and coordinating care for patients affected by IPV, facilitating connections to essential medical and mental health services, advocacy, and safety planning-all while ensuring confidentiality within the medical record. OCHIN's documentation methods place CUES data within flow sheets instead of summary sheets, safeguarding sensitive information. This allows for seamless care coordination and helps health centers to track IPV-related assessments and services, ensuring comprehensive support that aligns with UDS measures.

Advancing a Safer Future

As we observe October's Domestic Violence Month, it's an opportunity to push the boundaries of our understanding and approach to IPV. The advancements in UDS measures and CUES represent only the beginning of what's possible. At Health Partners on IPV + Exploitation, we are committed to supporting health centers in refining their approach to IPV.

Your role in driving this change is vital. Only through collective effort can we ensure every story is heard and every survivor receives the support they need. The power to effect change is in our hands-let's use it to create a safer, more supportive world for survivors of IPV.

Visit Health Partners on IPV + Exploitation to take action now.

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