Intimate Partner Violence
This webpage, focused on Intimate Partner Violence (IPV), is geared towards health, behavioral health and integrated care leadership, providers, and patients/consumers. The information and resources listed here can be easily adapted to other groups and settings.
It is vital for all staff employed by health, behavioral health, and integrated care organizations to understand the nature and impact of trauma and how to use principles and practices that can promote recovery and healing: Trauma-Informed Approaches. In addition to information and resources on IPV, this page provides links to resources on Trauma and Trauma-Informed Approaches, as well as Suicide Prevention, that we encourage you to explore.
According to the Centers for Disease Control and Prevention (CDC), IPV is a serious, preventable public health problem. The CDC defines Intimate Partner Violence (also described as domestic violence [DV]) as "physical, sexual, or psychological harm by a current or former partner or spouse. This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy."
The CDC reports that IPV is highly prevalent and preventable. IPV affects millions of people in the U.S. each year. Data from the 2010-2012 National Intimate Partner and Sexual Violence Survey (NISVS) indicate that nearly one in four adult women (23 percent) and approximately one in nine men (11 percent) in the U.S. report having experienced severe physical violence (e.g., being kicked, beaten, choked, or burned on purpose; having a weapon used against them; etc.) from an intimate partner in their lifetime. Additionally, one in three women and one in six men have experienced contact sexual violence (this includes rape, being made to penetrate someone else, sexual coercion, and/or unwanted sexual contact) from an intimate partner. One in six women and one in 19 men in the U.S. report having been stalked by an intimate partner, and nearly half of all women (47 percent) and men (47 percent) have experienced psychological aggression, such as humiliating or controlling behaviors.
Having experienced other forms of trauma or violence, such as child sexual or physical abuse or exposure to parental or caregiver IPV, is an important risk factor for perpetrating and experiencing IPV. IPV is also linked to increased risk for suicide in both boys and girls who experience teen dating violence (TDV) and for women exposed to partner violence. These women are nearly five times more likely to attempt suicide as women not exposed to partner violence. IPV is also a precipitating factor for suicide among men. (Reference: NISVS)
Health consequences are significant and important for behavioral, health, and integrated care providers to be aware of. Approximately 41 percent of female IPV survivors and 14 percent of male IPV survivors experience some form of physical injury that may also result in death. Data from U.S. crime reports suggest about one in six murder victims and more than 40 percent of female homicide victims in the U.S. are killed by an intimate partner. (Reference: NISVS)
Other adverse health outcomes associated with IPV include a range of cardiovascular, gastrointestinal, reproductive, musculoskeletal, and nervous system conditions, many of which are chronic in nature. Survivors of IPV also experience depression and post-traumatic stress disorder (PTSD) and are at higher risk for engaging in health risk behaviors, such as smoking, binge drinking, and HIV risk behaviors. Recognizing IPV as a public health issue, the CDC provides resources (listed below) with the intent of preventing IPV and equipping providers with the necessary tools to address these issues when signs of trauma and abuse are present. (Reference: NISVS)
According to research focusing on female victims by Johns Hopkins University, one of the most widely recommended interventions for abused women is safety planning. Recognizing that all genders and sexual orientations experience IPV, safety planning can be an applicable strategy for all IPV victims. In planning for safety, victims must consider complex individual and community factors such as custody of children, social support, access to affordable safe housing, employment with a living wage, and feelings for partner, as well as the severity of the violence. Those who are planning to leave or have already left an abusive relationship may need different safety strategies from victims who remain in the relationship. Personalized and victim-centered (i.e., conducted collaboratively with the IPV victims) planning should:
• Inform the victim about safety planning
• Help the victim prioritize for safety (e.g. children, resources, confidentiality)
• Reduce the risk for lethal violence
All types of trauma, including IPV, can have serious effects on health (see listing above), behaviors, relationships, work, and other aspects of life. It is important for behavioral, health and integrated care providers to have a basic understanding of the nature and impact of trauma and how to promote healing, recovery and wellness. Trauma-Informed Care (TIC) recognizes the role trauma plays in the lives of patients/consumers and seeks to shift the clinical perspective from “what’s wrong with you” to “what happened to you.” TIC is about shifting the culture to one that recognizes and accepts symptoms and difficult behaviors as strategies developed to cope with childhood trauma, a major risk factor for IPV. A trauma-informed approach can be used in any human services setting.
IPV is a very complex issue that requires behavioral and health care providers to be educated and informed about best practice approaches to care. Additionally, using a trauma-informed approach to care can create a safe, accepting, and respectful space. This type of safety is needed to reveal experiences associated with intimate partner violence or suicidality and can provide prevention opportunities and promote healing and recovery from the underlying trauma. It is not always necessary for a person to disclose past painful experiences. Through education about the impact of adverse childhood experiences and IPV, along with safety planning, within a trauma-informed culture, providers can promote positive health and behavioral health outcomes. It is important to note that exploring IPV and other traumatic experiences requires sensitivity, skills, and training.
Resources follow to help you in identifying, preventing, and addressing intimate partner violence and suicide. For more information and resources on trauma, trauma-informed approaches and suicide prevention, please find links to these pages below. These resources are arranged by their relevant audiences.
Resources for Clinicians/Staff
Resources for Organizations
Resources for Patients/Consumers and Families
- Resources for Policymakers and Leadership
Intimate Partner Violence
Recognizing, Preventing, and Addressing IPV
Recognizing IPV as a widespread public health issue, the CDC published a technical package titled Preventing Intimate Partner Violence Across the Lifespan. The package presents prevention strategies including fostering healthy relationships, creating protective environments, providing economic supports for families, and supporting survivors.
The online eLearning module, Domestic Violence: Understanding the Basics, describes the dynamics and common tactics that characterize domestic violence and provides an overview of the scope and impact on individuals and society. This module was created by VAWnet.org: An Online Resource Library on Gender-Based Violence, funded by the Family Violence Prevention and Services Act (FVPSA) Program and in part by the CDC.
Developed by the National Center on Domestic Violence, Trauma & Mental Health (NCDVTMH) in partnership with the National Resource Center on Domestic Violence (NRCDV), this three-part special collection, Trauma-Informed Domestic Violence Services provides an overview of the framework, philosophy, and research supporting trauma-informed approaches to working with survivors and their children; offers practical tools and resources on building capacity to implement trauma-informed programs; and describes resources for building collaboration to ensure that survivors and their children have access to domestic violence and trauma-informed mental health and substance abuse services.
Health centers and domestic and sexual violence advocacy organizations can partner to support survivor health and prevent violence. Through cross-trainings and warm referrals, providers and advocates can provide comprehensive coordinated care for survivors and their families.
The NCDVTMH conducted interviews with 45 programs or initiatives engaged in innovative trauma-informed work with survivors of violence and their children. Key themes that emerged from these interviews are summarized within the report, Promising Practices and Model Programs: Trauma-Informed Approaches to Working with Survivors of Domestic and Sexual Violence and Other Trauma.
The Office of Planning, Research and Evaluation (OPRE) at the Administration for Children and Families published a summary of research on the prevalence and experiences of IPV titled Prevalence and Experiences: Intimate Partner Violence Prevalence and Experiences Among Healthy Relationship Program Target Populations.
A Comprehensive Approach for Community-Based Programs to Address Intimate Partner Violence and Perinatal Depression is a Health Resources and Service Administration (HRSA) toolkit that recognizes the complex interplays of these issues and offers resources to appropriately identify risks and implement interventions.
The Substance Abuse and Mental Health Services Administration's (SAMHSA) overview of Trauma and Violence presents a compelling call to effectively address trauma in behavioral healthcare, describing the widespread impacts and costs of traumatic events, especially intimate partner violence. In a more detailed breakout of the Types of Trauma and Violence, the resource illuminates the complexities of intimate partner violence and its effects on those who experience it.
IPV Screening and Assessment Tools
Developed by Futures Without Violence National Health Resource Center on Domestic Violence, in partnership with FVPSA, HRSA, and Office on Women's Health, the online toolkit, IPVHealthPartners.org offers a comprehensive and sustainable response to intimate partner violence that can be built or adapted in health centers/primary care safety net providers across the U.S. in partnership with local domestic violence, sexual assault and social service organizations to improve the health, wellness, and safety of their clients.
The Family and Youth Services Bureau has launched an Intimate Partner Violence Screening and Counseling Toolkit and Counseling Toolkit to support healthcare providers and domestic violence advocates in ensuring the health and safety of the populations that they support.
The HHS Office of Women’s Health (OWH) published the factsheet on Health Care Providers and Screening and Counseling for Interpersonal and Domestic Violence to answer commonly asked questions that arise when providers introduce screening for intimate partner violence into their practice.
The Agency for Healthcare Research and Quality (AHRQ) has compiled a tool, Intimate Partner Violence Screening: Fact Sheet and Resources, to guide providers in their screening and appropriate response to intimate partner violence.
Safety Planning, a computerized safety decision aid, was developed and tested by Johns Hopkins University researchers with Spanish or English-speaking abused women in shelters or domestic violence (DV) support groups. The decision aid provides feedback about risk for lethal violence, options for safety, assistance with setting priorities for safety, and a safety plan personalized to the user.
Women and girls are disproportionately impacted by intimate partner violence and certain forms of child maltreatment and sexual violence. For additional information and resources on Intimate Partner Violence from the HHS Office on Women’s Health.
Racial and Ethnic Minority Populations
A national technical assistance guide, Life in the Margins: Expanding Intimate Partner Violence Services for Women of Color by Using Data as Evidence, compiled by the Women of Color Network, notes higher rates of IPV among women of color and identifies certain causes of underreporting, challenges accessing support, and best and promising practice recommendations from the field.
Casa de Esperanza, and its project, the National Latin@ Network for Healthy Families and Communities, is a leader in the domestic violence movement and a national resource center for organizations working with Latino/a populations in the U.S.
The Asian Pacific Institute on Gender-Based Violence is a national resource center on gender-based violence against Asians, Native Hawaiians, and Pacific Islanders. The organization analyzes critical issues, provides technical assistance and training, conducts research, and informs public policy.
Ujima, Inc.: The National Center on Violence Against Women in the Black Community is a national resource center that addresses domestic, sexual and community violence through education and outreach, training and technical assistance, resource development, research, and public policy efforts to mobilize the black community and its allies to strengthen families, individuals, and communities at large.
Violence against women and girls is a significant problem in American Indian and Alaska Native (AI/AN) communities. Though national annual and lifetime rates for physical assaults are higher for AI/AN women compared to other women, like other women, they are more likely to be hurt by people close to them than by strangers. Find extensive resources from the Indian Health Service, the National Indigenous Women's Resource Center, and StrongHearts Native Helpline.
The Indian Health Service (IHS) has funded the International Association of Forensic Nurses to deliver training related to the identification, collection, and preservation of medical forensic evidence obtained during the treatment of victims of sexual and domestic violence. These trainings allow medical professionals to acquire and maintain the knowledge, skills, and competent clinical forensic practice to improve the response to domestic and sexual violence in hospitals, health clinics, and health stations within the Indian health system.
The National LGBTQ Institute on Intimate Partner Violence is a collaboration of the NW Network of Bisexual, Trans, Lesbian and Gay Survivors of Abuse and the National Coalition of Anti-Violence Programs. The National LGBTQ Institute on Intimate Partner Violence creates a bridge between mainstream domestic violence services and LGBTQ community programs, and empowers local communities to create sustainable strategies that work at the local level. Holding LGBTQ survivors at the center, the Institute increases the domestic violence field's capacity to provide domestic violence advocacy and prevention for diverse LGBTQ communities.
People Living with HIV/AIDS
Creating a Culture of Acceptance: Abuse, HIV and Women in Shelter is an interactive eLearning module created by the NRCDV for crisis counselors, domestic violence victim advocates, and shelter managers to help HIV positive survivors residing in domestic violence shelters regain control of their health and their lives, including helping women recognize their own risk, providing guidance on positive action steps to increase their health and safety, and creating an environment of acceptance and support that de-stigmatizes HIV positive women.
Fewer than 10 percent of HIV providers routinely screen for IPV, yet incidence is highly disproportionate among populations at risk for HIV. There is a very high prevalence of trauma among people with HIV/AIDS, particularly women who experienced child sexual abuse and men who have sex with men. The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau provides extensive information, resources and tools related to HIV/AIDS including contact information on the Ryan White Technical Assistance Center – TARGET.
Children and Youth
The National Child Traumatic Stress Network (NCTSN) strives to improve access to care, treatment, and services for traumatized children and adolescents exposed to traumatic events. In partnership with Futures without Violence, NCTSN has developed +10 fact sheets on children and domestic violence for parents who may have left, or are still in, an abusive relationship.
The Office of Juvenile Justice and Delinquency Prevention, a component of the U.S. Department of Justice, supports states and local communities in implementing programs that address the needs of youth and their families. It provides specific information on the impact of trauma on children, especially those who are exposed to violence.
The Adult Children Exposed to Domestic Violence (ACE-DV) Leadership Forum is composed of advocates in the movement to end gender based violence and who identify as having experienced domestic violence in childhood. As a project of the NRCDV, the Leadership Forum was established to amplify the voices and experiences of ACE-DV to enhance their work to end domestic violence.
Promising Futures, a project of Futures Without Violence and a national capacity building center, is a useful resource for helping service providers, educators, and others transform or enhance their program’s ability to effectively meet the needs of victims, children and youth experiencing domestic violence. The online repository is an evolving resource of innovative tools, model practices and interventions, up-to-date research, and communities in action that highlight the work of the field to end domestic violence.
HRSA published a policy brief on Intimate Partner Violence in Rural America that concluded that, while women living in rural areas experience IPV rates that are often comparable to women in urban areas, "they are more likely to experience greater severity of violence, less likely to reach out for help as a result of the high degree of social interconnectedness in rural communities, and less likely to be screened for IPV by their health care providers."
The Journal of Women's Health has also conducted research that reveals a Rural Disparity in Domestic Violence Prevalence and Access to Resources and concludes that more resources targeting the prevention of IPV among women in rural areas are necessary.
Limited English Proficiency (LEP) Populations
Individuals with limited English proficiency (LEP) may encounter unique barriers that undermine access to care and services. An LEP individual is a person who does not speak English as a primary language and has limited ability to read, write, speak, or understand English. Language barriers are a major factor that contribute to under reporting and influence patterns of seeking care. Title VI of the Civil Rights Act (42 USC § 2000d) and HHS regulations mandate that recipients of Federal Financial Assistance from HHS take reasonable steps to provide meaningful access to LEP persons.
It is essential that survivors with LEP and providers communicate effectively through trained interpreters who are neutral, trained in a code of ethics, and can ensure accuracy and completeness of information. Community and advocacy organizations such as Casa de Esperanza, the Asian Pacific Institute on Gender-Based Violence, and The National Immigrant Women's Advocacy Project offer resources that that providers can utilize to better serve IPV survivors with LEP.
Education and Training
The HRSA Office of Women’s Health, Bureau of Primary Healthcare, and the Administration for Children and Families collaborated to conduct a pilot study with health centers and their social service partners to identify strategies to address IPV in the primary care setting. These efforts led to the creation of a virtual toolkit on integrating IPV education into health centers by Futures Without Violence, which serves as ACF’s designated National Health Resource Center on Domestic Violence. Futures Without Violence served as the technical assistance partner to the pilot. Through five essential steps, this virtual toolkit is designed to support healthcare settings to build partnerships with social service sites, adopt evidence-based interventions, promote patient education around IPV, and enhance practice policies, procedures, and capacities to improve long-term health and safety outcomes for women and their families.
SAMHSA maintains a Training and Technical Assistance Center on Trauma to promote trauma-informed approaches to care and provide resources and continued support to organizations that are addressing these issues across various areas of focus. In addition, SAMHSA funds a number of Grants Related to Trauma and Violence.
Primary care provider organizations and domestic and sexual violence advocacy organizations can partner to support survivor health and prevent violence. Through cross-trainings and warm referrals, providers and advocates can provide comprehensive coordinated care for survivors and their families.
The Suicide Prevention Resource Center (SPRC), supported by SAMHSA, promotes a public health approach to suicide prevention, strongly linked to IPV. Their website contains important information and numerous resources, including the Framework for Suicide Prevention, a Best Practice Registry, and a section for providers.
The importance of understanding and addressing burnout, vicarious trauma, and compassion fatigue among behavioral health providers is essential to providing effective care for persons served in behavioral health and integrated care settings. The American Institute of Stress lists a myriad of symptoms of compassion fatigue, which it defines as, "The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events." The frequent listening to and/or direct observation of the suffering of others may elicit strong emotional, psychological and physical reactions that leads to emotional exhaustion, a cynical attitude towards one’s work, and a loss of empathic connections to others.
Developed by the National Sexual Violence Resource Center (NSVRC), this online guide, Self-Care and Trauma Work, includes the common signs of vicarious trauma and information on how to build workplace cultures that can combat stress.
A webinar from the NRCDV, Keeping Your Cup Full: Self-Care is Essential to Trauma Informed Advocacy, offers strategies for dealing with daily work-related stress, increases awareness of the issue of vicarious trauma, and provides ideas in order to gain organizational support to help sustain and support those working with survivors of trauma.
This webinar series from the National Center on Domestic Violence, Trauma, and Mental Health, Practical Strategies for Creating Trauma-Informed Services and Organizations, focuses on practical strategies and tools for creating accessible, culturally attuned, domestic violence and trauma-informed services and organizations. The resources offered include information on agency self-assessment tools, self-care and sustaining advocacy work, reflective supervision, and trauma-informed peer support, among other related topics.
Designed through a series of multi-year research studies conducted by Johns Hopkins University School of Nursing, myPlan is the first interactive safety decision aid. The tool is accessible via a mobile app and website, and designed to assist intimate partner violence (IPV) survivors in identifying and navigating their own safe path forward.
Funded through the Family and Youth Services Bureau, the National Center on Domestic Violence, Trauma, and Mental Health promotes dialogue about the complex intersections of domestic violence, trauma, and mental health and current strategies to enhance work in this area; builds capacity among local agencies, state domestic violence coalitions, and state mental health systems; and provides recommendations on policies, practices, and collaborative models that will positively impact the lives of survivors and their children, particularly in relation to trauma and mental health.
The CDC has developed a toolkit titled, Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies, and Practices. The toolkit includes educational resources that describe the prevalence of IPV, identify at-risk populations, and emphasize the importance of prevention.
The National Intimate Partner and Sexual Violence Survey is an ongoing survey published by the CDC that collects the most current and comprehensive national- and state-level data on intimate partner violence, sexual violence, and stalking victimization in the U.S. The aim of this study is to shed light on this important public health issue.
The CDC's collection, Measuring Intimate Partner Violence Victimization and Perpetration: A Compendium of Assessment Tools, provides researchers and prevention specialists with a set of assessment tools with demonstrated reliability and validity for measuring the self-reported incidence and prevalence of intimate partner violence victimization and perpetration. This compendium provides professionals who are addressing this problem with easy access to a set of tools with demonstrated reliability and validity for measuring the self-reported incidence and prevalence of IPV victimization and perpetration.
Understanding trauma, all types, its impact and prevalence is critical to working with individuals exposed to or perpetrating IPV. For more information and resources on these and other areas of trauma, including Post-Traumatic Disorder (PTSD), as well as Trauma-Informed Approaches, please visit the CIHS Trauma webpage.