Survivors' Input on Health Care-Connected Services for Intimate Partner Violence

Abstract

Background:

Intimate partner violence (IPV) is increasingly recognized as a social factor impacting health, and health care providers are encouraged to routinely screen and refer patients for needs related to IPV. Health care settings are often challenged, however, in their ability to connect patients with community-based IPV services. Some organizations have invested in on-site programs to facilitate identification and connection.

Methods:

The goal of this study was to understand IPV survivors' experiences with and perspectives on health care-connected IPV services. Semistructured in-depth interviews were conducted in-person by a trained and experienced interviewer and were audio-recorded and transcribed verbatim. Interview transcripts were analyzed using team-based qualitative thematic content analysis. Participants included 68 individuals who had experienced IPV, recruited through one of two settings: (1) a health care organization with embedded IPV services or (2) a community-based IPV service organization that partners with health care settings.

Results:

Interviews revealed benefits of having health care-connected IPV services, including that the health care setting can be critical for providing information about IPV programs and that survivors may need assistance with navigation of community services. Survivors further highlighted recommendations for trauma-sensitive care that includes providing clarification about the role and scope of IPV services, following-up with but not forcing intervention, and ensuring privacy, confidentiality, and trust in interactions.

Conclusions:

Findings support health care settings having in-house or close partnership with IPV advocates to adequately support patients' needs in connecting with and navigating community based IPV-related services.

Introduction

Intimate partner violence (IPV; including physical, psychological, financial, or sexual violence or abuse from intimate partners) affects a large segment of the population and has substantial impacts on health and well-being; women face particular risks of IPV exposure and adverse impacts.¹ Women who experience IPV visit health care providers more frequently than those who do not experience IPV, providing important opportunities to inquire about IPV experiences and offer information about IPV-related resources and services.^2,3 The literature clearly indicates that women want health care providers to directly inquire about IPV in a sensitive manner, provide validating and supportive responses, and offer options for IPV-related counseling interventions and services.^4
–6 The United States Preventive Services Task Force (USPSTF) recommends that “clinicians screen for IPV in women of reproductive age and provide or refer women who screen positive to ongoing support services.”⁷

Services for those experiencing IPV may include assessment of risk, safety planning, empowerment counseling—which may happen within or external to the health care setting—as well as community-based services for legal intervention, housing/shelter, and employment or other economic support. Yet, despite recommendations to couple routine screening with provision of or referral to services, health care settings are often not equipped with the knowledge, resources, and structural supports to systematically and effectively connect patients in need to these services.⁸ Key barriers to IPV referral practices include limited time and availability of on-site IPV resources, as well as lack of information about and resources for connecting patients to IPV services.^5,9,10 At best, health care providers may offer a “warm hand-off” to a social worker or behavioral health specialist or an IPV advocate. More typically, providers may offer a hotline number or pamphlet; at worst, they may fail to follow a disclosure of IPV (positive screen) with any resources, referrals, or services.^11
–13

Exceptions to these more common and limited practices around IPV screening and response include robust programs that offer either in-house IPV services within the health care setting or explicit relationships with external (and sometimes even colocated) community-based IPV programs. To assess IPV survivor experiences with and recommendations regarding health care-connected IPV services, we conducted interviews with IPV survivors recruited from two settings that offered these more robust programs. The findings from these interviews provide guidance to inform expansion of more effective, person-centered services to other settings. The lessons learned from this study may, further, offer insights for the implementation of health care-connected referrals and interventions for other social factors beyond IPV.

Methods

This study drew from qualitative interview data with IPV survivors recruited from two settings. The first setting included two Veterans Affairs Medical Center (VAMC) sites, one on the East Coast and one on the West Coast of the United States, that have implemented routine screening for IPV and in-house IPV coordinators to assist patients with navigation of both VA and community IPV services and resources. The second setting was a community-based IPV services program located in the same East Coast city as the VAMC; the program provides colocated IPV advocates within hospital and primary care settings to provide on-site advocacy services and opportunity for ongoing counseling and advocacy services. The studies were reviewed and approved by the local institutional review boards.

In the first setting (VAMCs), participants were recruited as part of a larger study of hospital-based IPV services; eligibility for that study included having both received VA health care services and having experienced IPV in the prior year; participants were recruited through flyers, provider referral, and direct mail/telephone follow-up from the research team (see¹⁴ for more details on study recruitment and enrollment). In the second setting, participants included current clients of the IPV program who were informed about the study by their advocates or counselors or through flyers posted at the program center; women who were interested initated contact with the study investigators to participate. All participants had experienced IPV; in the second setting, as participants were recruited from an IPV services program, all participants had received IPV-specific counseling, whereas this was not necessarily the case for participants recruited from the first setting.

In total, in-depth semistructured qualitative interviews were conducted with 68 individuals who had experienced IPV, including 50 women receiving health care at one of two VAMCs and 18 clients of the community-based IPV program. Interviews were conducted between 2016 and 2019 (setting 1: 2016–2018; setting 2: 2017–2019). Participant ages ranged from 22 to 64 in setting 1 and 23–59 in setting 2. In setting 1, 4% of participants identified as Asian, 38% as Black or African American, 40% as White, and 18% as another race or multiple races. In setting 2, 67% of participants identified as Black or African American, 17% as White, and 17% as another race or multiple races.

Interviews followed a semistructured guide developed by the research team for this study. Interview questions and prompts asked about participants' experiences with disclosing IPV experience to a health care provider, if/how they learned about community-based IPV services and processes of getting connected, provider responses to IPV disclosures that were helpful and not helpful, and suggestions about ways in which health care providers can best support individuals experiencing IPV with getting connected to services. Other than three interviews conducted via telephone (to minimize transportation barriers for the participant), interviews were conducted in-person at either the VAMC site, the community-based organization, or the researcher's university office (according to participant preference) by a member of the research team who was trained and experienced in qualitative interviewing and IPV dynamics. Interviews lasted approximately one hour each and were audio-recorded and transcribed verbatim by a professional transcription company.

Analysis followed a combination of deductive and inductive approaches to qualitative content analysis,¹⁵ using tools of line-by-line coding, templated notes, and memoing.¹⁶ First, the research team created a case summary matrix¹⁷ to capture information in the narratives relevant to particular preselected topic areas (e.g., disclosure of IPV in health care setting and receipt of community-based IPV services). Next, based on a review of the case summaries, the research team developed a codebook for topics and subtopics and conducted line-by-line coding of the transcripts to apply the codes—meeting to discuss and make decisions on new codes as they arose. For the analysis specific to this article, at least two members of the research team each read the segments of the transcripts coded for health care-connected IPV services, reviewed each other's coding, and used memos linked to specific passages to identify and develop themes that were refined through team discussion. Thematic analysis was also developed through the creation of a brief narrative for each study participant, highlighting central salient points illustrated by the interview as a whole, which allowed us to capture themes difficult to illustrate via decontextualized coded passages. The analytic team then met to discuss themes and identify exemplar quotes and narratives.

Results

Analysis of the in-depth interviews revealed key themes regarding health care connection to social services, in particular as related to the IPV experience. As described in more detail below (and summarized in Table 1), and supported by excerpts from the transcripts, participant narratives indicated that: the health care setting can be a critical source for information about IPV services, survivors may need and want assistance with navigating services, and, especially in the context of IPV, it is important that provision of support attends to individual empowerment, self-determination, trust, and privacy.

Table 1.

Themes—Informing Elements of Survivor-Centered Health Care-Connected Intimate Partner Violence Care

Theme	Description and elements	Exemplar quote
Information: the health care setting is a critical resource for information about IPV services.	Participants' narratives reflecting lack of knowledge of IPV services before gaining information through the health care setting highlighted the importance of the health care setting as a source for information about such services. Failure to offer information about IPV services is a missed opportunity to help survivors presenting to health care settings. Lack of information can delay or inhibit receipt of services. Information about the purpose of inquiry and responses to disclosure of IPV is also critical for informating patients' decision-making about disclosure and help seeking.	If it wasn't for my doctor—well, the kids' doctor—telling me about [the program], [I wouldn't have known about it]. I went to the emergency room a couple of times for domestic [violence] and I reported it. I was looking at my paperwork recently. It said “alleged partner abuse” [and] they didn't do nothing. They just treated me [for my injuries].
Support: survivors may need and want assistance with connecting with and navigating IPV services.	Information may not be sufficient for connection for all survivors—survivors may need and want assistance with connecting with and navigating service access. Knowledge of services is a critical first step; assistance with navigation may be a critical second step. The stress and trauma of IPV can exacerbate barriers to complex or frustrating system navigation.	You're going to give me this little card.…And it's like, what if my phone is dead? What if I don't have a charger? …Where do I go? Where am I going? What do I need to do? …have somebody say, “I'll make the call with you,” that would have been nice. …I would have felt a little more comfortable than having to do it by myself or with my kids around. …Hold my hand through a situation.
Trauma-informed care: attention to supporting individual empowerment, self-determination, trust, and privacy is key.	The IPV context heightens the need for attention to trauma-informed care, including elements of empowerment, self-determination, trust, and privacy. IPV is, by its nature, disempowering, coercive, and unsafe—mitigating those impacts through trauma-sensitive care is particularly critical in the context of IPV.	Sometimes when these things [IPV] are happening to us, we turn in. …The person that we love, our significant other, has already broken our trust. So now I come to you and you're saying that you're going to help me get out of this, you only get one shot. And if you prove to me that you're not trustworthy, I'm going to go back inside. …If you say you're going to do something and you don't do it, that's it. …So, say I'm even going to try to escape a situation or try to whatever and you're telling me that I can reach out to you and I do and you're not there—oh, come on. You're hurting this person even more.

IPV, intimate partner violence.

The health care setting is a critical source for information about IPV services

Participants indicated a lack of knowledge of IPV services—both about the existence of services and what they could offer—before their connection to services. This lack of information about IPV services negatively impacted help-seeking and response to screening questions, delaying (or preventing) access to services. The settings with robust IPV identification and support programs are important, in part, for providing support in cases that were missed in other settings or encounters.

Some participants reported instances in which they sought treatment for IPV-related injuries or disclosed IPV experiences, and no further discussion about or assistance was offered in the health care visit. For example, Jasmine experienced and reported ongoing abuse to her own healthcare providers but was not aware of the services available to her until she learned about them through her children's pediatrician. She noted that previous providers for her own care in the emergency department setting had failed to provide the referral information even when she presented for injuries related to IPV:

If it wasn't for my doctor—well, the kids' doctor—telling me about [the program], [I wouldn't have known about it]. I went to the emergency room a couple of times for domestic [violence] and I reported it. I was looking at my paperwork recently. It said “alleged partner abuse” [and] they didn't do nothing. They just treated me [for my injuries].

Not receiving information about services even after disclosure of IPV reflects a missed opportunity to connect a patient with help.

Participants stressed the importance of the health care setting in receiving information about IPV services, regardless of patient disclosure of IPV. Some participants explained that they initially chose not to talk about their IPV experiences with their health care providers because they did not think that the health care system would be able to offer any services that could be of help to them.

Olivia's story highlights participants' uncertainties in what services were available and what steps providers would take if she disclosed her IPV experiences and the health consequences of escalating violence with no intervention. When asked if she thought about discussing her experiences with her doctor, she said:

No, because I didn't think that anybody would be able to help me… I'm like, if I do come to somebody, like, what is anybody gonna be able to do?

When health care providers screened for IPV, without knowing what the response would be to a disclosure of IPV, Olivia assumed that the response would be to contact the police or, in the pediatric setting, child protective services:

When my daughter's doctors ask me [about IPV], I think that they're gonna do something, like if I tell them I'm going through this, they might do something like take her away from me. Now when my regular [adult] doctor asks me [about IPV], I just think, like, they're gonna call the cops on him or something like that… Every time I take my daughter to the doctor, they ask. And whenever they ask me I be like, oh, they probably want to get [child protective services] involved.

After having avoided sharing her IPV experience with health care providers at previous visits, Olivia experienced an escalation of violence from her ex-partner that led to assault for which she was hospitalized. During her stay, hospital staff, knowing that Olivia's injuries were due to IPV, connected Olivia with a local IPV service program. Before that referral, Olivia had not known that such services existed—and said that she would have reached out sooner, had she known:

It's something I just heard about [at the hospital]. I never knew programs for abused women… really existed.

[Interviewer: And do you think that's something that you would have sought out before, if you knew about that?]

Yeah. Mm-hmm. Sooner, yeah.

Olivia recommended that health care providers inform patients about IPV services, even in the absence of a disclosure, allowing the patients to: know about the services that are available, contact the services on their own rather than having to go through the health care system, and receive information in a safe environment where their abusive partners are less likely to know about their help seeking for IPV. Olivia explained:

I think that like even though a woman say that she's not going through anything, that they should hand out stuff like when you're meeting with them. …I feel like that you should still hand them something, just in case they don't want to say anything about what they're going through. Like, if you need to talk to somebody and you don't want to talk to me, here's a number you can call, um, it's private, and things like that. …You could list up, like, this program does group talks, private talks, one-on-one time, and things like that. And whatever they could help you with to protect you. I think it would interest people in actually like speaking up and calling and helping theirselves.

Again, Olivia said she thought she would have reached out for help sooner, if she had been offered the resources:

I probably would have called. Yeah. Just to have somebody to talk to and like see like if it was a resource, it's a good resource. …I probably would have called sooner to get help, like I need help to get away from him. …I know there's a lot of females out there that's probably going through so much and don't say anything to nobody when they ask, like me. I was one of them. …I think I would have called. I would have called.

Without knowing that there are services, beyond police and child protective services, Olivia was not aware that provider inquiry about IPV could actually lead to provision of helpful services:

I would think like if I told him yeah, like they're not gonna be able to help me anyways, like they just want to be in my business. They just want to know if I'm going through something.

Jasmine's and Olivia's narratives were representative of common experiences shared by other women we interviewed, confirming that the health care setting can be a critical resource for obtaining information about IPV services. The health care setting may be the first or only opportunity that IPV survivors have to learn about the existence and availability of social series and supports specifically focused on IPV.

Survivors may need and want assistance with connecting with and navigating services (information, alone, may not be sufficient)

In addition to health care providers facilitating survivor knowledge of IPV services, some participants emphasized the importance of assistance with navigating and accessing services. While Olivia spoke of wanting to know about resources that she could contact on her own, other participants discussed challenges with the burden of reaching out themselves. The findings indicated that survivors of IPV interested in or seeking services may appreciate and benefit from support in navigating and accessing those services that extend beyond a simple hotline number or referral.

Participants described the process of seeking services on their own as being overwhelming, especially in the context of dealing with the strains of IPV, and expressed a desire for additional support in these processes. Robin envisioned a system in which health care providers could both have information about services and facilitate the connections:

There's no reason why any doctor in any line of practice should not be able to have, you know, a database of services to be able to have their staff or even them personally contact on [a] patient[’s] behalf, of course with the correct permissions. Because it's not just laborious, it's mentally, emotionally, and physically taxing to have to be the one to constantly make those phone calls to try to, you know, play phone tag with people and things like that. And even to have, like, a doctor or doctor's staff be able to reach out on the behalf of the patient, that gives that patient leverage into these services.

When survivors have to attempt multiple pathways and encounter roadblocks and being turned away, frustration and discouragement can build that thwart future help seeking. Support in identifying and connecting with appropriate and available services may be able to circumvent some of these challenges. Louisa stated, “Unfortunately, you kind of need your hand held sometimes.” The language of “hand-holding” comes up in several narratives of women attempting to navigate through systems to receive support in the context of IPV.

Some participants noted that, although they appreciated accessing services, they likely would not have taken the initiative to reach out for such support. Sondra reflected on the benefit of having the IPV program reach out to her, facilitated by the hospital staff:

[Having the hospital connect me to the IPV program] was great… they went the extra mile; whereas, they didn't give me papers or information and tell me to call this place. They asked, can we give them your information and let them contact you? …If I had to contact them, I probably never would have did it… If [the hospital] would have just gave me a number and pamphlets… I would have took it and stuck in my bag… and then maybe, one day, with a busted head and a black eye, think about, “Man, I should have called this place.” Too late then, you know. But because they reached out to me first, I got involved in the program; whereas, I wouldn't even know. I know me, I wouldn't have called.

Tiffany spoke about additional challenges with having to reach out to unknown programs on her own and the desire for additional concrete support:

You're going to give me this little card.…And it's like, what if my phone is dead? What if I don't have a charger? …The lady told me that I just needed to get out [of my relationship] and I needed to go. And I was like, okay. I got that. Where do I go? Where am I going? What do I need to do? …She gave me a pep talk, but that was pretty much it, pep talk and a piece of paper. …But, yeah, have somebody say, “I'll make the call with you,” that would have been nice. That would have been cool. That's a nice little option. And I would have went with that. I would have felt a little more comfortable than having to do it by myself or with my kids around. …I was having so much of an emotional breakdown that emotionally and mentally I was screaming out for help, and that help I didn't get. …It still goes back to you just giving me a freaking piece of paper. I need something more tangible than that. …Hold my hand through a situation. …Because that's how frustrations happen. I'm calling out. I'm reaching out. I'm trying. I'm trying. I'm trying. And when you get no help, what are you supposed to do? It's like you're at the end of your road. It's like I'm screaming. …Even if, like I said, you sit down and someone makes the call with you—okay. That's supporting. That's like giving you that hug subliminally.

Individuals needing or wanting support in response to experience of IPV may be feeling overwhelmed and frustrated, as well as face challenges, including lack of information about services, lack of access to adequate transportation, communication (e.g., working telephone), and privacy (e.g., away from children and partners) to reach out to services. Having support in the outreach through the health care system may facilitate connections to services.

Attention to supporting individual empowerment, self-determination, trust, and privacy is key

Participants emphasized the importance of supporting and respecting an individual's right to self-determination around whether or not to engage with IPV-related services. Participants wanted to be offered information about and support in connecting with resources, but not feel pushed into accepting services they do not want. Renee explained:

Getting help shouldn't feel like it's forced upon a victim. They should want to do it themselves or they should want to seek it themselves. And once they do seek it, I don't feel like it should be a forced conversation. Like constant outreach calls—“Hey, I haven't heard from you.” While it could be okay and you may be worried about that person because of the situation, it can be overwhelming as well.

Renee did also note, however, that once an individual survivor does choose to connect with services or resources, a follow-up check in may be beneficial:

Once [the hospital] does connect a person to resources, I don't feel as though they should leave that person either… There should absolutely be follow-up. Not forced follow-up. Maybe a phone call or maybe an email or a text, whatever the person prefers, saying, “Hi, how are you? How are you doing? I was just calling to check on you.” And it's up to the victim if they want to respond or if they feel like, “Wow, this person really just checked up on me. That's cool. Let me call her back.”

Alejandra spoke about the importance of trust in the clinical relationship when addressing IPV, noting that IPV experience can erode trust, making individuals less likely to have confidence and emphasizing the importance of follow-through with promised actions:

Sometimes when these things [IPV] are happening to us, we turn in. There's a lack of trust. …The person that we love, our significant other, has already broken our trust. So now I come to you and you're saying that you're going to help me get out of this, you only get one shot. And if you prove to me that you're not trustworthy, I'm going to go back inside. …If you say you're going to do something and you don't do it, that's it. And people might think it's minor, but, no. They're really trying to find somebody to trust. …So, say I'm even going to try to escape a situation or try to whatever and you're telling me that I can reach out to you and I do and you're not there—oh, come on. You're hurting this person even more.

Individuals who expose vulnerability by disclosing IPV and reaching out for support may be discouraged from continuing to do so if their trust is broken.

Finally, participants noted the importance of privacy in communication and services related to IPV, both because of stigma that they may feel or perceive attached to victimization and/or to safety concerns if their abusers find out that they are sharing information about and seeking help for the abuse. Erica suggested that, in some cases, health care interactions specifically related to IPV should be masked as medical visits, for example, using the language of “doctor” rather than “social worker” or “counselor” and having appointments in examination rooms in medical clinics, especially in a situation in which an abuser may follow their partner to appointments or interrogate their partner about their interactions:

There has to be a way where [an IPV survivor] can still get the help that she needs even with [abusive partner] being on her hip. Because you know when she gets home or when she gets in the car, it's going to be 20 questions. “So, what's going on with you? So, what was that about?” Duh, duh, duh, duh, duh. And that's bad that you have to fake a potential health thing just to get somebody the help that they need. But I mean, if we don't do that, we're just leaving her there to suffer years and years and years of torment.

Another way that health care settings can be important for IPV-related care beyond connection to outside resources is also as a setting in which IPV-related services can be provided safely and confidentially under the guise of a health care visit.

Discussion

IPV services exist—but people in need might not know about them or how to access them; the health care setting can be critical in making this connection. Literature has reported on IPV screening practices, including patient and survivor preferences with findings largely consistent with the present study.^4,5,9,18,19 The findings from this study, based on analysis of interviews with 68 individuals who had experienced IPV and opportunities for health care-connected IPV intervention, extend this prior work by focusing on the connection to services, following disclosure or positive screen. In particular, this study focuses on connecting patients to community-based IPV-related social services and highlights three key elements of survivor-centered health care-facilitated IPV care (Table 1): (1) having information about community-based IPV services available and accessible in the health care setting, (2) offering assistance with navigating connection to IPV-related services, and (3) attending to considerations of power, empowerment, self-determination, trust, and privacy in health care encounters related to IPV (supported by approaches of trauma-informed care).

Implications for practice

The findings about the centrality of the health care setting being a source of information about IPV services support prior research and current recommendations to offer universal education about IPV, regardless of screening response or disclosure.^4,20 In addition, patient-facing materials in areas such as waiting rooms, examination rooms, and bathrooms can further spread information about services that can reach people in health care settings and offer another channel for help that patients can access on their own terms. Multimodal methods for disseminating information about IPV-related services are consistent with the current findings regarding women's desire for autonomy and self-determination in disclosure and help seeking.

Even when patients do learn about available services, actually navigating through and making the connection to services can be a challenge, especially in a context complicated by IPV that necessitates privacy and adds emotional strain. Providing a warm-handoff has been found to improve efficacy of referrals and increase uptake of services for behavioral and mental health interventions (e.g., for opioid use, smoking cessation, and depression) from emergency department and primary care settings^21,22 and is recommended for IPV connections.²⁰

The findings regarding the importance of trust, privacy, and self-determination further reinforce the principles of empowerment and trauma-informed approaches embraced and encouraged in IPV programs and best practices for IPV screening and response.^19,23
–25 Trauma-informed care approaches, as described by the Substance Abuse and Mental Health Services Administration (SAMHSA), emphasizing safety, trustworthiness, collaboration, empowerment, and choice, are particularly important in the IPV context.²⁶

Limitations

The qualitative nature of the study allows for survivor perspectives and voices in contributing to our understanding of best practices for health care connection to IPV services. The themes identified, however, reflect the views of only those individuals willing and able to participate in the study and may not transfer to all settings and populations. Despite this being a relatively diverse and large sample for a qualitative study, it is important to take care to note that findings likely do not cover the scope of experiences or perspectives. We note, in particular, that both study settings were situated in fairly densely populated urban environments, where a range of services are likely to be available even if unknown and unaccessed; the experiences of women in rural settings were not explored. Although all participants had experienced IPV and were recruited from settings with health care-connected IPV services, participants recruited from the VAMCs were not necessarily engaged with IPV-related services and those recruited from the community-based IPV program had not necessarily been connected to the program through a health care interaction.

Conclusions

Overall, the study strongly supports health care settings having in-house, or close partnerships with, IPV advocates who have the knowledge, resources, and skills to assist patients seeking safety and healing from IPV exposure. The health care setting may be critical for informing those experiencing IPV about available services and facilitating connection. In the absence of such programs within health care settings, social workers and other behavioral health specialists may be well-poised to develop knowledge about local programs, assist with navigation of services, and provide trauma-informed support that individuals experiencing IPV may need and want.

Footnotes

Acknowledgments

The authors acknowledge the contributions to this study of Anneliese Sorrentino, Elizabeth Pride, Alicia Chatterjee, Meagan Cusack, Summer Newell, and the staff and clients of the Lutheran Settlement House Bilingual Domestic Violence Program. Views expressed do not necessarily reflect those of the U.S. Government or the Department of Veterans Affairs.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This work was funded, in part, by a grant from the U.S. Department of Veterans Affairs, Health Services Research and Development (IIR 15-142, PI: M.E.D.). S.N.O. is supported by a training grant from the National Institute on Drug Abuse (1T32DA041898-01A1; Co-PIs: Drainoni and Stein).

References

Black

, Basile

, Breiding

, et al. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2011.

Dichter

, Sorrentino

, Haywood

, et al. Women's healthcare utilization following routine screening for past-year intimate partner violence in the Veterans Health Administration. J Gen Intern Med, 2018; 33:936–941.

Rivara

, Anderson

, Fishman

, et al. Healthcare utilization and costs for women with a history of intimate partner violence. Am J Prev Med, 2007; 32:89–96.

Chang

, Decker

, Moracco

, Martin

, Petersen

, Frasier

. Asking about intimate partner violence: Advice from female survivors to health care providers. Patient Educ Couns, 2005; 59:141–147.

Dichter

, Wagner

, Goldberg

, Iverson

. Intimate partner violence detection and care in the Veterans Health Administration: Patient and provider perspectives. Womens Health Issues, 2015; 25:555–560.

Iverson

, Huang

, Wells

, Wright

, Gerber

, Wiltsey-Stirman

. Women veterans' preferences for intimate partner violence screening and response procedures within the Veterans Health Administration. Res Nurs Health, 2014; 37:302–311.

Curry

, Krist

, Owens

, et al. Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: US Preventive Services Task Force final recommendation statement. JAMA, 2018; 23:1678–1687.

O'Campo

, Kirst

, Tsamis

, Chambre

, Ahmad

. Implementing successful intimate partner violence screening programs in health care settings: Evidence generated from a realist-informed systematic review. Soc Sci Med, 2011; 72:855–866.

Iverson

, Wells

, Wiltsey-Stirman

, Vaughn

, Gerber

. VHA primary care providers' perspectives on screening female veterans for intimate partner violence: A preliminary assessment. J Fam Violence, 2013; 28:823–831.

10.

Sprague

, Madden

, Simunovic

, et al. Barriers to screening for intimate partner violence. Women Health, 2012; 52:587–605.

11.

Hamberger

, Rhodes

, Brown

. Screening and intervention for intimate partner violence in healthcare settings: Creating sustainable system-level programs. J Womens Health (Larchmt), 2015; 24:86–91.

12.

Morse

, Lafleur

, Fogarty

, Mittal

, Cerulli

. “They told me to leave”: How health care providers address intimate partner violence. J Am Board Fam Med, 2012; 25:333–342.

13.

Iverson

, Adjognon

, Grillo

, et al. Intimate partner violence screening programs in the Veterans Health Administration: Informing scale-up of successful practices. J Gen Intern Med, 2019; 34:2435–2442.

14.

Dichter

, Sorrentino

, Haywood

, et al. Women's participation in research on intimate partner violence: Findings on recruitment, retention, and participants' experiences. Women's Health Issues, 2019; 29:440–446.

15.

Hsieh

, Shannon

. Three approaches to qualitative content analysis. Qual Health Res, 2005; 15:1277–1288.

16.

Rivas

. Coding and analyzing qualitative data. Res Soc Cult, 2012; 3:367–392.

17.

Averill

. Matrix analysis as a complementary analytic strategy in qualitative inquiry. Qual Health Res, 2002; 12:855–866.

18.

Hathaway

, Willis

, Zimmer

. Listening to survivors' voices: Addressing partner abuse in the health care setting. Violence Against Women, 2002; 8:687–716.

19.

Dienemann

, Glass

, Hyman

. Survivor preferences for response to IPV disclosure. Clin Nurs Res, 2005; 14:215–233.

20.

Miller

, McCaw

. Intimate partner violence. N Engl J Med, 2019; 380:850–857.

21.

Horevitz

, Organista

, Arean

. Depression treatment uptake in integrated primary care: How a “warm handoff” and other factors affect decision making by Latinos. Psychiatr Serv, 2015; 66:824–830.

22.

Richter

, Faseru

, Shireman

, et al. Warm handoff versus fax referral for linking hospitalized smokers to quitlines. Am J Prev Med, 2016; 51:587–596.

23.

Wilson

, Fauci

, Goodman

. Bringing trauma-informed practice to domestic violence programs: A qualitative analysis of current approaches. Am J Orthopsychiatry, 2015; 85:586–599.

24.

Kulkarni

. Intersectional trauma-informed intimate partner violence (IPV) services: Narrowing the gap between IPV service delivery and survivor needs. J Fam Violence, 2019; 34:55–64.

25.

Wood

. Hoping, empowering, strengthening: Theories used in intimate partner violence advocacy. Affilia, 2015; 30:286–301.

26.

Substance Abuse and Mental Health Services Administration. SAMHSA's concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14–4884. Rockville, MD: 2014.