2023-2025
HRSA Strategy to Address
Intimate Partner Violence
STRENGTHEN
PROMOTE
ENHANCE
11
The publication was produced for the Health Resources and Services Administration (HRSA), Oce of Women’s
Health under contract number 75R60221F34006.
This publication lists non-federal resources in order to provide additional information to consumers. The views
and content in these resources have not been formally approved by HRSA. Listing these resources is not an
endorsement by HRSA.
2023-2025 HRSA Strategy to Address Intimate Partner Violence is not copyrighted. Readers are free to duplicate and
use all or part of the information contained in this publication.
Pursuant to 42 U.S.C. § 1320b-10, this publication may not be reproduced, reprinted, or redistributed for a fee
without specic written authorization from HRSA.
Suggested Citation: Health Resources and Services Administration, Oce of Women’s Health, 2023-2025 HRSA
Strategy to Address Intimate Partner Violence. Rockville, Maryland: 2023.
2023-2025 HRSA Strategy To Address Intimate Partner ViolenceIII
11
Table of Contents
i Acronyms
ii Note on Language
iii Foreword
iv Executive Summary
1 Introduction
1 IPV as a Public Health Issue
4 The Strategy
6 Aims, Objectives, and Activities
7 AIM 1: Enhance coordination between and among HRSA
projects to better focus IPV eorts
12 AIM 2: Strengthen infrastructure and
workforce capacity to support IPV prevention and
response services
22 AIM 3: Promote prevention of IPV through
evidence-based programs
28 Conclusion
29 Appendix A. Related National Initiatives
30 Appendix B. References
2023-2025 HRSA Strategy To Address Intimate Partner Violence
11
i
Acronyms
ACRONYM DEFINITION
BHW Bureau of Health Workforce
BPHC Bureau of Primary Healthcare
CDC Centers for Disease Control and Prevention
CRCC Civil Rights Coordination & Compliance
DV Domestic Violence
FORHP Federal Oce of Rural Health Policy
HAB HIV/AIDS Bureau
HRSA Health Resources & Services Administration
IEA Oce of Intergovernmental and External Aairs
IPV Intimate Partner Violence
LGBTQI+ Lesbian, Gay, Bisexual, Transgender, Queer, Intersex
MCHB Maternal and Child Health Bureau
NISVS National Intimate Partner and Sexual Violence Survey
NOFO Notice of Funding Opportunity
NTTAP National Training and Technical Assistance Partners
OCRDI Oce of Civil Rights, Diversity, and Inclusion
OFAM Oce of Federal Assistance Management
OPAE Oce of Planning, Analysis, and Evaluation
OSHI Oce of Special Health Initiatives
OWH Oce of Women’s Health
PTSD Post-Traumatic Stress Disorder
SANE Sexual Assault Nurse Examiner
SDOH Social Determinants of Health
SME Subject Matter Expert
T/TA Training and Technical Assistance
2023-2025 HRSA Strategy To Address Intimate Partner Violence
11
ii
Note on Language
Intimate partner violence (IPV) includes physically and emotionally abusive behaviors by a
current or former intimate partner, dating partner, or spouse. These behaviors may include
physical or sexual violence, sexual coercion, stalking, cyber abuse and cyberstalking, controlling
behaviors, and psychological aggression.
1-6
The Health Resources and Services Administration
(HRSA) recognizes that IPV is a form of gender-based violence, which consists of harmful acts
directed at an individual based on their gender.
7
IPV may intersect with various other forms
of and experiences with violence within relationships, families, households, or communities,
including domestic, interpersonal, and sexual violence and human tracking.
Domestic violence (DV) is a consistent eort of one intimate partner to maintain power and
control over another through emotional abuse, nancial control, intimidation, physical
assault, battery, sexual assault, or other abusive behavior.
i,8
While people often use “DV” and
“IPV” interchangeably, this 2023-2025 Framework primarily uses the term “IPV,” except when
referring to organizations that use the term “DV.”
Interpersonal violence describes “the intentional use of physical force or power against other
persons, and encompasses child abuse, community violence (e.g., among individuals who
are not related, but may know each other), family violence (e.g., violence within or between
family members), and domestic and intimate partner violence (e.g., violence between current
or former partners).”
9,10
Sexual violence, or sexual assault, is any nonconsensual sexual act
proscribed by federal, tribal, or state law, including when an individual lacks capacity to consent
(e.g., sexual harassment, rape, sexual exploitation, and unwanted sexual contact).
11,12
Human
tracking describes an individual performing labor or engaging in commercial sex by force,
fraud, or coercion and relates to IPV in the overlapping patterns of behavior employed by both
trackers and people who use violence against intimate partners.
13
The 2023-2025 Strategy recognizes the intersections between IPV and these other forms of
violence that impact individuals and communities served by HRSA-supported settings of care.
It underscores that preventing and addressing IPV requires recognizing and addressing these
other forms of violence that increase the risk for and impacts of IPV. The Strategy also focuses
on the experience of IPV from adolescence to adulthood. While child abuse and elder abuse
are important issues that also intersect with IPV, they are beyond the scope of this Framework.
This 2023-2025 Strategy uses “people who have experienced violence” and “people who
use violence” rather than “survivor” or “victim” and “perpetrator,” respectively. This language
acknowledges the dynamic nature of violence, in that people who experience violence may use
violence themselves and vice versa.
i
For more information on what constitutes abusive behavior, see https://ncadv.org/learn-more/what-is-domestic-violence/abu-
sive-partner-signs.
2023-2025 HRSA Strategy To Address Intimate Partner Violence
11
iii
Foreword
The Health Resources and Services Administration (HRSA) is dedicated to reducing disparities in
health care outcomes and providing health care to the nation’s highest need communities. We
serve people who are geographically isolated and those who have been historically underserved,
including people with low incomes, people with HIV, those who are pregnant, rural communities,
transplant patients, new parents and their infants and children, and other communities in need.
Intimate partner violence is a serious public health issue, and preventing and responding to it is
important across all of the communities that we serve.
HRSA implemented its original Strategy to Address Intimate Partner Violence between 2017 and
2020. As noted in the 2021 Summary Report, HRSA completed all 27 key activities of the 2017-
2020 Strategy, including:
• Launching Project Catalyst, which trained 1,200 health care providers and advocates;
• Incorporating benchmarks into the Home Visiting Collaborative Improvement and Innovation
Network 2.0; and
• Incorporating standard language on the impact of intimate partner violence in HRSA notices of
funding opportunities.
This updated 2023-2025 Strategy builds upon these prior successes and provides actionable
activities to realize three aims. Its development centered on the needs and priorities of people
and communities who have experienced or are at risk of experiencing intimate partner violence.
The three aims are to:
(1)
Enhance coordination between and among HRSA projects to better focus intimate partner
violence eorts;
(2) Strengthen infrastructure and workforce capacity to support intimate partner violence
prevention and response services; and
(3) Promote prevention of intimate partner violence through evidence-based programs.
I am grateful to HRSA’s sta for their continued leadership of this important work.
Working together, we can make a meaningful dierence and advance the work of preventing
intimate partner violence once and for all.
Carole Johnson
Administrator
Health Resources and Services Administration
2023-2025 HRSA Strategy To Address Intimate Partner Violence
11
iv
Executive Summary
The Health Resources and Services Administration (HRSA) serves those most in need,
including 30 million people at health centers in historically underserved communities, more
than 58 million pregnant women, infants, and children, 3.6 million infants—nearly every infant
in America—and more than 576,000 people with HIV.
14
The 2023-2025 Strategy is HRSA’s
plan for how it will address intimate partner violence (IPV) prevention and response within its
programs and assist HRSA-supported settings in preventing and responding to IPV.
IPV includes physically and emotionally abusive behaviors by a current or former intimate
partner, dating partner, or spouse, which intersects with multiple forms of abuse and
violence (see Note on Language). These behaviors extend beyond instances of physical
or sexual violence and include controlling behaviors, manipulation, coercion, stalking, and
psychological aggression. These behaviors can impact physical and behavioral health,
substance use, economic security, and quality of life.
1,2
IPV will aect nearly one in two people in their lifetimes, with slightly more trans/non-binary
individuals (54%)
15
experiencing IPV than cis-gendered women or men (46%
1
and 44%
1
,
respectively). The percentage of individuals who experience IPV also diers by race and
ethnicity, sexual orientation, gender identify, and age.
HRSA developed its initial 2017-2020 Strategy to Address Intimate Partner Violence to inform
eorts to respond eectively to IPV in the health care and public health sectors. The 2023-
2025 Strategy builds on the earlier Strategy to continue eorts to identify partnerships,
address barriers, strengthen existing programs, and create new activities preventing and
responding to IPV.
HRSA serves the nation’s highest need communities, including people who are geographically
isolated and those who have been historically underserved, including people with low
incomes, people with HIV, those who are pregnant, rural communities, transplant patients,
new parents and their infants and children, and other communities in need. IPV often aects
many people in these communities and the health workforce that cares for them. Thus, HRSA
is well positioned to prevent and respond to IPV.
To develop the 2023-2025 Strategy, HRSA conducted a literature review and engaged with
external subject matter experts and key sta from HRSA’s Bureaus and Oces. This process
led to an evidence-informed roadmap to strengthen HRSA’s systems-level approach to
prevent and address IPV.
The Strategy consists of the following aims, each describing how HRSA Bureaus and Oces can
prevent and address IPV:
• Aim 1: Enhance coordination between and among HRSA projects to better focus IPV eorts
• Aim 2: Strengthen infrastructure and workforce capacity to support IPV prevention
and response services
• Aim 3: Promote prevention of IPV through evidence-based programs
11
1 The 2023-2025 HRSA Strategy To Address Intimate Partner Violence
Introduction
The Health Resources and Services Administration (HRSA) developed its initial 2017-2020
Strategy to Address Intimate Partner Violence to support agency-wide eorts to eectively
respond to intimate partner violence (IPV) in the health care and public health sectors.
The 2023-2025 Strategy builds on the success of the 2017-2020 Strategy and will guide
continued eorts to identify partnerships, address barriers to accessing and delivering
care, strengthen existing programs, and create new initiatives to prevent and respond to
IPV.
HRSA’s extensive portfolio of projects, programs, and partners that deliver public health
and health care programs and services (referred to throughout this document as “HRSA-
supported settings”) uniquely position the agency to address IPV. HRSA-supported settings
include safety net settings such as health centers, rural health clinics, school-based clinics,
and critical access hospitals.
IPV as a Public Health Issue
IPV is a major public health issue that aects millions of individuals and families in the United
States.
Who Experiences IPV?
IPV aects nearly half of women and 44% of men.
1
Nearly two-thirds (61%) of bisexual
women
16-18
and over half (54%) of trans/non-binary individuals
15,19
report experiences of IPV. A
majority of individuals rst experience IPV before age 25.
1
Various other communities are also disproportionately aected by IPV, including:
• People with disabilities
20,21
• People living in rural areas
22
• Young people ages 12 to 18
23,24
• Lesbian, Gay, Bisexual, Transgender, Queer,
and Intersex (LGBTQI+) communities
15-19,25
• People who are pregnant
26
o The risk of homicide is 35% greater for
pregnant and postpartum women
27
and
nearly half of pregnancy-related homicides
are associated with IPV.
28
• People with HIV
29-33
• Individuals who use substances
34
o 40-60% of IPV incidence include substance
use
34
• Racial and ethnically minoritized
communities
1
(see Exhibit 1)
2023-2025 HRSA Strategy To Address Intimate Partner Violence2
11
2
INTRODUCTION: IPV AS A PUBLIC HEALTH ISSUE
Exhibit 1: IPV Prevalence Among Adults, by Race, Ethnicity, and Gender*
Non-Hispanic multiracial women
Non-Hispanic multiracial men
American Indian and Alaska Native women
American Indian and Alaska Native men
Black women
Black men
White women
White men
Hispanic women
Hispanic men
Asian or Pacic Islander women
Asian or Pacic Islander men
63
%
57
%
51
%
53
%
57
%
48
%
44
%
42
%
40
%
27
%
24
%
51
%
Data source: Leemis, R. W., Friar, N., Khatiwada, S., Chen, M. S., Kresnow, M., Smith, S. G., Caslin, S., & Basile, K. C. (2022). The National
Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Intimate Partner Violence. National Center for Injury Prevention
and Control Centers for Disease Control and Prevention.
*The National Intimate Partner and Sexual Violence Survey does not break out prevalence by race and ethnicity and gender identity or
sexual orientation.
While research studies tend to consider and report on categories like age, race, sexual orientation, and gender identity separately, indi-
viduals can identify with and experience membership in multiple categories simultaneously. There is also less research available about
experiences of IPV among highly specic groups (e.g., rural bisexual women; non-binary white individuals living with disabilities).
Experiencing IPV has many negative health outcomes and risk behaviors, which can have
lasting eects on individuals and their families.
1
Research shows that the myriad impacts of
violence can persist throughout the lifespan
35,36
and aect an individual’s:
Physical health, e.g., reproductive, cardiovascular, gastrointestinal, nervous system
conditions, and traumatic brain injury.
37,38
Behavioral health, e.g., Post-Traumatic Stress Disorder (PTSD), depression, and
suicidal ideation,
39,40
use of alcohol and other substances as coping mechanisms,
substance use disorder,
41-45
and high-risk sexual behaviors.
46
Economic outcomes, e.g., diminished access to opportunities, absenteeism,
reduced workplace productivity, and lost earnings.
47,48
Quality of life, e.g., decreased sense of safety, school or work attendance, and
needing to access advocate services.
33
11
3 The 2023-2025 HRSA Strategy To Address Intimate Partner Violence
The consequences of IPV extend beyond the people who experience violence themselves;
IPV also aects children in the household, friends, extended family, and even employers.
ii, 49-53
Despite the prevalence of IPV across many populations, people experiencing violence may
not seek or receive care for various reasons, including individual, organizational, socio-cultural
and structural circumstances or barriers.
INTRODUCTION: IPV AS A PUBLIC HEALTH ISSUE
ii
The Substance Abuse and Mental Health Services Administration (SAMHSA) denes secondary trauma, also known as vicarious trauma, as “trauma-related
stress reactions and symptoms resulting from exposure to another individual’s traumatic experiences, rather than from exposure directly to a traumatic
event. Secondary trauma can occur among behavioral health service providers across all behavioral health settings and among all professionals who provide
services to those who have experienced trauma (e.g., health care providers, peer counselors, rst responders, clergy, intake workers).”
52
Individual
• Fear for personal and children’s safety due to disclosure implications, condentiality,
and privacy concerns
54-58
• Shame and embarrassment from stigma and fear of judgment
54-56,58
• Lack of awareness about available resources or if experiences are IPV
58
Organizational
• Service and medical provider bias and stigma
54-56,59
• Limited availability of or constraints with IPV services, such as lack of privacy
60
• The impact of public health emergencies on processes and capacity, which can
increase challenges in providing universal screening and IPV response and magnify
inequities
61
Socio-cultural
• Language barriers, which can limit communication with providers
58,62
• Cultural norms, which can contribute to stigma regarding IPV and seeking
services
58,62
• Immigration and refugee status, which can hinder ability or willingness to access
care or disclose experiences of violence
58,62-65
Structural
• Systemic inequities and structural discrimination that create unwelcoming or
unreceptive health care and service environments, which may lead to distrust
58,66
• Limitations in health care access or ability to seek care due to unequal resource
distribution for people with lower socioeconomic status (e.g., income, educational
attainment, poverty)
67
• Social and geographic isolation, which reduces time or resources available to seek
care
22,54,58
• Policies that limit access to services
58
11
4 The 2023-2025 HRSA Strategy To Address Intimate Partner Violence
INTRODUCTION: IPV AS A PUBLIC HEALTH ISSUE
The Strategy
The Strategy advances HRSA’s mission through the three aims and corresponding objectives
and activities. The Strategy also complements related national public health initiatives (see
Appendix A).
2023-2025 Strategy Aims
An equitable and community-driven approach drives the 2023-2025
Strategy
In alignment with HRSA’s commitment to achieving health equity, the Strategy centers the
needs and priorities of people who have experienced or are at risk of experiencing IPV.
Equity-focused eorts aim to break cycles of violence by addressing violence itself and the
social determinants of health (SDOH; i.e., the conditions and environments that impact health
and quality of life outcomes)
68
that can be root causes of violence. Programs, policies, and
services that improve living conditions and SDOH can be violence prevention strategies in and
of themselves.
Equitable approaches also acknowledge the diverse identities and contexts of individuals and
communities to inform the design and delivery of IPV prevention and response programming.
The relevant identities of each person who experiences or is at risk for experiencing IPV may
compound the eects of structural violence and trauma experienced in their daily lives. These
include the violence of racism, sexism, classism, ableism, and other forms of discrimination
based on religion, sexual orientation, and immigration status. The socioeconomic, geographic,
and cultural contexts in which individuals experience violence also inuence how they speak
about violence, access services, and respond to treatment.
Aim 1:
Enhance coordination
between and among HRSA
projects to better focus IPV
eorts
Aim 2:
Strengthen infrastructure
and workforce capacity to
support IPV prevention and
response services
Aim 3:
Promote prevention of
IPV through evidence-based
programs
11
2023-2025 HRSA Strategy To Address Intimate Partner Violence5
INTRODUCTION: STRATEGY
HRSA Bureaus and Oces should consider seeking input from the individuals and communities
they serve, wherever possible, when developing, funding, implementing, and evaluating
programs and services to prevent and respond to IPV. Engaging individuals with lived
experiences of violence ensures a stronger understanding of community priorities, assets, and
challenges. In addition, governmental entities, direct service providers, and other community-
based organizations striving to improve the living conditions of the communities HRSA serves
are critical partners in this work. Culturally responsive care and using a health equity lens also
reduces disparities experienced by populations disproportionately impacted by IPV.
69
Programs that incorporate this type of equitable and community-driven approach are more
nuanced, eective, and tailored for the communities they serve. This cross-cutting approach
underlies all three aims of the Strategy.
YEAR 1 YEAR 2 YEAR 3
(2024)
Implement activities
supporting objectives
(2023)
Increase awareness
of the 2023-2025
HRSA Strategy
(2025)
Monitor progress and
identify opportunities
for sustainability
HRSA will implement the activities described in the following pages in
three phases between 2023-2025:
2023-2025 HRSA Strategy To Address Intimate Partner Violence6
11
AIM 1
Enhance coordination between and
among HRSA projects to better focus
IPV eorts
AIM 2
Strengthen infrastructure and
workforce capacity to support IPV
prevention and response services
AIM 3
Promote prevention of IPV through
evidence-based programs
The 2023-2025 Strategy identies three aims
grounded in an equitable and community-driven
approach to preventing and responding to IPV
that the HRSA Bureaus and Oces will prioritize
through strategic objectives and key activities:
Aims, Objectives,
and Activities
2023-2025 HRSA Strategy To Address Intimate Partner Violence7
11
Objective 1.1:
Promote communication and collaboration across HRSA on eorts
to prevent and respond to IPV.
Objective 1.2:
Increase HRSA sta knowledge to support IPV prevention and
response within HRSA-supported settings.
Objective 1.3:
Leverage data to drive decision-making to improve IPV prevention
eorts and access to IPV-specic care.
Enhance coordination
between and among HRSA
projects to better focus IPV eorts
Ongoing coordination of eorts within HRSA is key to raising and maintaining awareness about
IPV and its eects on health and equipping HRSA Bureaus and Oces to assist
HRSA-supported settings to prevent and respond to IPV. An internal HRSA Implementation
Team will coordinate implementation of the Strategy and align activities across HRSA
Bureaus and Oces, including identifying trainings for HRSA sta, activities to increase
awareness of IPV, and subject matter experts (SMEs). The Implementation Team will also
disseminate and share approaches and promising practices across HRSA and in
coordination with other federal agencies.
AIM 1
2023-2025 HRSA Strategy To Address Intimate Partner Violence8
11
AIM 1: OBJECTIVE 1.1
Objective 1.1:
Promote communication and collaboration across HRSA
on eorts to prevent and respond to IPV.
ACTIVITY 1.1.1 | Establish a HRSA Implementation Team to coordinate
implementation of the Strategy, align activities across HRSA Bureaus
and Oces, and ensure HRSA is on track to meet the Strategy aims.
Key Collaborators: Oce of Women’s Health (OWH), Oce of Special Health
Initiatives (OSHI), Oce of Planning, Analysis, and Evaluation (OPAE)
Action Items:
• Leverage Implementation Team with representation from across HRSA
Bureaus and Oces to monitor progress toward Strategy objectives.
• Identify emerging opportunities for collaboration and coordination across HRSA.
• Increase buy-in across HRSA leadership and sta.
• Encourage HRSA activities that increase opportunities for information exchange
and collaboration on activities related to preventing and responding to IPV.
• As possible, consult with the U.S. Department of Health and Human Services
and other partners with relevant equities.
Results:
• Increased partnerships between HRSA Bureaus and Oces to prevent and
respond to IPV that leverage each partner’s existing resources and competencies.
• Increased opportunities for activities related to preventing and responding to
IPV in HRSA-supported settings.
ACTIVITY 1.1.2 | Maintain and disseminate a roster of internal (e.g.,
HRSA sta) and external (e.g., academics, researchers, community
advocates) SMEs who can support HRSA in implementing IPV programs
and capacity-building eorts.
Key Collaborators: Implementation Team
Action Item:
• Build a roster of internal and external IPV SMEs and create sustainable
processes for HRSA to update and access rosters.
Results:
• Increased integration of internal and external SME perspectives throughout
activities in HRSA and HRSA-supported settings.
• Increased accessing of rosters of internal and external SMEs.
2023-2025 HRSA Strategy To Address Intimate Partner Violence9
11
ACTIVITY 1.2.1 | Expand capacity among HRSA sta to facilitate
implementation of IPV prevention and response programs within HRSA-
supported settings. Building on the success of the 2017-2020 Strategy, the
Implementation Team will contribute to HRSA sta training on how to support
HRSA-supported settings and the communities they serve in preventing and
responding to IPV and associated SDOH.
Key Collaborators: Implementation Team
Action Item:
• Leverage existing trainings that reect best practices in adult learning.
• Identify or develop trainings showcasing promising practices.
• As possible, incorporate practice-based learning opportunities and dynamic
approaches (e.g., roleplay) into trainings to identify and respond to IPV.
Results:
• Increased number of trainings oered to HRSA sta and leadership that build
knowledge around IPV and its impacts.
• Increased number of HRSA sta who have completed trainings about IPV.
• Increased capacity to identify opportunities to prevent and respond to IPV
across HRSA activities.
AIM 1: OBJECTIVE 1.2
Objective 1.2:
Increase HRSA sta knowledge to support IPV
prevention and response within HRSA-supported
settings.
2023-2025 HRSA Strategy To Address Intimate Partner Violence10
11
ACTIVITY 1.3.1 | Continue to build the evidence base for practices that
prevent and respond to IPV. Program evaluation and research can expand
upon existing and generate new evidence on programs and approaches
that demonstrate success and promote necessary continuous quality
improvement eorts.
Key Collaborators: HRSA-wide, Bureau of Primary Health Care (BPHC), Oce of
Intergovernmental and External Aairs (IEA), OPAE, Federal Oce of Rural Health
Policy (FORHP)
Action Items:
• Consolidate and disseminate existing evaluation resources to standardize
outcome evaluations across HRSA-supported settings.
• Use implementation science approaches to understand barriers and
facilitators to implementation.
• Integration of data and evidence to inform decisions related to IPV prevention
and response activities and ongoing quality improvement eorts.
Results:
• Integration of data and evidence to inform decisions related to IPV prevention
and response activities and ongoing quality improvement eorts.
ACTIVITY 1.3.2 | Strengthen HRSA’s data and analysis mechanism(s)
to drive decision-making to prevent and respond to IPV while ensuring
privacy. HRSA-supported settings and other entities can use data to inform IPV-
related programs, services, and policies.
Key Collaborators: HRSA-wide, BPHC, IEA, OPAE, FORHP
Action Items:
• Provide training and technical assistance (T/TA) to HRSA-supported settings on
strengthening IPV-related and SDOH data collection mechanisms and using
these data to inform IPV-related programs, services, and policies.
• Encourage ongoing data collection of IPV-related measures (e.g., consistently
collecting information on numbers of screenings conducted, patient education
conducted, referrals made).
• Support the development and reporting of IPV-related measures and SDOH.
AIM 1: OBJECTIVE 1.3
Objective 1.3:
Leverage data to drive decision-making to improve IPV
prevention eorts and access to IPV-specic care.
11
11 2023-2025 HRSA Strategy To Address Intimate Partner Violence
AIM 1: OBJECTIVE 1.3
Results:
• Increased number of T/TA engagements with HRSA-supported settings to
improve data collection.
• Increased number of sta in HRSA-supported settings who are involved in
tracking program implementation and outcome metrics in decision-making.
Activity in Action: Using Data Across HRSA Bureaus and Oces
The Maternal and Child Health Bureau (MCHB)-funded Maternal, Infant, and Early Childhood
Home Visiting programs report on two performance IPV indicators (percent of primary
caregivers screened for IPV with a validated tool within six months of enrollment, and percent
who get referral information to enroll in home visiting with a positive IPV screen from a
validated tool).
70
HRSA provides programs with additional information about IPV screening
and referral measures and tools in Maternal, Infant, and Early Childhood Home Visiting
performance measure FAQs.
BPHC’s Uniform Data System includes data on the number of visits for patients who have
experienced IPV and human tracking, determined through the following IPV screening
measures: 20e Human tracking (T74.5- through T74.6-, T76.5- through T76.6-, Z04.81,
z04.82, Z62.813, Z91.42) and 20f Intimate partner violence (T74.11, T74.21, T74.31, Z69.11).
71
11
12 2023-2025 HRSA Strategy To Address Intimate Partner Violence
Strengthen infrastructure
and workforce capacity to
support IPV prevention and
response services
HRSA can bolster the capacity of HRSA-supported setting workforce and infrastructure (e.g.,
technology, communication and collaboration systems, data collection systems, grant-writing,
management) to eectively implement IPV programs by providing program design guidance,
building and strengthening intersectional partnerships, and encouraging training. Training is
essential to support trauma-informed and culturally responsive care, eliminate bias in care
delivery, and enhance practical skills and knowledge.
AIM 2
Trauma-informed approach:
All people at all levels of the organization or system “realize the widespread impact of trauma
and understands potential paths for recovery; recognize the signs and symptoms of trauma;
respond by fully integrating knowledge about trauma into policies, procedures, and practices,
and actively resist re-traumatization.”
72
It also aligns with the following ve principles: Safety,
trustworthiness & transparency, peer support, collaboration & mutuality, and empowerment,
voice, & control.
72
Culturally responsive care:
Integration and transformation of knowledge about individuals and groups of people into
specic standards, policies, practices, and attitudes used in appropriate cultural settings to
increase the quality of services; thereby producing better outcomes.
73
2023-2025 HRSA Strategy To Address Intimate Partner Violence13
11
AIM 2: Strengthen infrastructure and workforce capacity to support IPV prevention
and response services
Objective 2.1:
Increase health care and public health workforce capacity to
support IPV prevention and response and understanding of factors
that can contribute to violence.
Objective 2.2:
Encourage HRSA-supported settings to incorporate IPV prevention
and response activities into existing and new programs to expand
implementation capacity.
Objective 2.3:
Promote development and strengthening of local partnerships and
referral networks within HRSA-supported settings to prevent and
respond to IPV.
Objective 2.4:
Improve access to IPV-specic care and interventions.
11
14 2023-2025 HRSA Strategy To Address Intimate Partner Violence
ACTIVITY 2.1.1 | Encourage incorporation of IPV education and training
into HRSA-supported settings’ existing programs, tools, frameworks,
and capacity-building initiatives (e.g., T/TA programs and learning
collaboratives).
Key Collaborators: HRSA-wide
Action Items:
• Identify ongoing and upcoming capacity-building initiatives and programs.
• Determine opportunities to include IPV prevention and response education
into new and existing learning activities.
Results:
• Increased integration of IPV prevention and response-related content into new
and existing HRSA training programs or stand-alone T/TA programs.
Objective 2.1:
Increase health care and public health workforce capacity to
support IPV prevention and response and understanding of
factors that can contribute to violence.
AIM 2: OBJECTIVE 2.1
Activity in Action: Promoting IPV Education and Training Across HRSA-supported
Settings
MCHB has several activities incorporating IPV education and training into HRSA-supported
setting initiatives, including the Home Visiting Collaborative Improvement and Innovation
Network 2.0. Through this learning collaborative, participants and local home visiting service
agencies use continuous quality improvement methods to improve screening of women for
IPV. These eorts increase home visitor sta knowledge and condence to support those
experiencing IPV through referrals to domestic violence (DV) advocacy services based on their
self-identied needs.
11
15 2023-2025 HRSA Strategy To Address Intimate Partner Violence
ACTIVITY 2.1.2 | Increase HRSA sta knowledge and capacity to
provide T/TA to HRSA-supported settings on how to adapt and tailor IPV
strategies to t their local contexts and needs.
Key Collaborators: HRSA-wide
Action Items:
• Identify IPV-related training needs of dierent HRSA-supported settings.
• Connect HRSA-supported settings to relevant IPV-related T/TA.
Results:
• Increased number of T/TA engagements between HRSA and HRSA-supported
setting sta to increase knowledge and capacity to implement IPV prevention
and response activities in their settings of care.
AIM 2: OBJECTIVE 2.1
Activity in Action: National Training and Technical Assistance Partners (NTTAPs)
BPHC funds 22 NTTAPs, each providing free T/TA and subject matter expertise to existing and
potential health center grantees and look-alikes. All T/TA activities proposed by NTTAPs align
with the seven domains in the Health Center Excellence Framework and help health centers
improve their performance. HRSA-supported health centers can contact the NTTAPs directly or
connect with their project ocers for more information.
• Health Partners on IPV + Exploitation NTTAP provides HRSA-supported health centers
with T/TA to increase trauma-informed service delivery, support partnerships and policy
development, and improve health center workows by increasing identication and
referral of people who are experiencing or have experienced IPV and/or human tracking.
11
16 2023-2025 HRSA Strategy To Address Intimate Partner Violence
ACTIVITY 2.1.3 | Provide T/TA to HRSA-supported settings on federal
civil rights laws and their application to IPV prevention and response
programs.
Key Collaborators: Oce of Civil Rights, Diversity, and Inclusion (OCRDI),
Implementation Team
Action Items:
• Identify the civil rights-related training needs of HRSA-supported settings.
• Create a resource that integrates civil rights, nondiscrimination, and IPV-
related information.
• Provide training and T/TA to HRSA-supported settings about potential
implications of federal civil rights laws on delivering services related to IPV.
Results:
• Increased number of trainings for sta in HRSA-supported settings on the
implication of federal civil rights laws on delivering services related to IPV.
• Increased number of sta in HRSA-supported settings who receive training on
federal civil rights laws and their potential impact on providing services related
to IPV.
AIM 2: OBJECTIVE 2.1
Activity in Action: OCRDI’s Civil Rights Coordination & Compliance (CRCC) Section
OCRDI’s CRCC Section takes a preventive and education-based approach to assisting HRSA-
funded recipients to comply with their federal civil rights obligations. OCRDI CRCC’s services
include the provision of T/TA and development of plain language informational resources on
emerging and nuanced civil rights issues and inequities as they relate to access to health.
2023-2025 HRSA Strategy To Address Intimate Partner Violence17
11
ACTIVITY 2.2.1 | Ensure HRSA Notices of Funding Opportunities
(NOFOs) encourage consideration of IPV and intersecting risk factors, as
possible.
Key Collaborators: Oce of Federal Assistance Management (OFAM),
Implementation Team, HRSA-wide
Action Items:
• Update NOFO template language to include information on IPV and
intersecting risk factors where appropriate.
Results:
• Increased number of funding opportunities that include IPV prevention and
response activities as allowable costs.
Objective 2.2:
Encourage HRSA-supported settings to incorporate IPV
prevention and response activities into existing and new
programs to expand implementation capacity.
AIM 2: OBJECTIVE 2.2
11
2023-2025 HRSA Strategy To Address Intimate Partner Violence18
ACTIVITY 2.3.1 | Encourage HRSA-supported settings to partner with
other health and human service providers to collaborate on programs
and initiatives preventing and responding to IPV. Interprofessional
collaborations address multiple co-occurring care concerns for individuals
experiencing or at risk of experiencing IPV and increase collaborations that
can facilitate primary prevention activities (e.g., education in school and
community settings).
Key Collaborators: OFAM, OWH, IEA, Implementation Team
Action Items:
• Include opportunities for partnerships that address IPV and other SDOH within
NOFOs, where appropriate.
• Develop, curate, and disseminate template memoranda of understanding,
data use agreements, and other T/TA materials that HRSA-supported settings
can use to facilitate formal partnerships.
• Encourage HRSA-supported settings’ use of templates.
Results:
• Increased number of memoranda of understanding, data use agreements,
and other templates available to promote and facilitate partnerships.
• Increased number of opportunities to introduce IPV-responsive partnerships
and referral networks into HRSA funding proposals.
Objective 2.3:
Promote development and strengthening of local
partnerships and referral networks within HRSA-supported
settings to prevent and respond to IPV.
AIM 2: OBJECTIVE 2.3
Activity in Action: Academic-Practice Partnerships
Bureau of Health Workforce (BHW) Advanced Nursing Education - Sexual Assault Nurse
Examiner (SANE) grantees develop academic-practice partnerships as part of their funding
requirements, including collaboration with HRSA-supported health centers and critical
shortage facilities. These partnerships promote collaboration and the recruitment of diverse
participants and trainees and provide opportunities to integrate trauma-informed, evidence-
based sexual assault and DV services.
2023-2025 HRSA Strategy To Address Intimate Partner Violence19
11
ACTIVITY 2.4.1 | Enhance T/TA and guidance specic to telehealth
services for IPV to reduce barriers to accessing care.
Key Collaborators: Oce for the Advancement of Telehealth, Implementation
Team
Action Items:
• Identify and disseminate promising practices to increase options for virtual
connections between patients and sta in communities.
• Update and disseminate guidance around telehealth policies, procedures, and
best practices for implementation.
Results:
• Increase IPV resources available for patients and providers, including
resources on Telehealth.HHS.gov.
ACTIVITY 2.4.2 | Support adoption of new ways of providing services in
the community—and expand existing ones—to meet people “where they
are.” HRSA-supported settings can increase access to care by diversifying care
locations (e.g., mobile vans, providing IPV services in other social service settings
such as Family Justice Centers).
Key Collaborators: Implementation Team
Action Items:
• Identify and disseminate innovative strategies for HRSA-supported settings to
consider using to connect with patients.
• Identify and disseminate promising practices, policies, procedures, and best
practices for implementing innovative care delivery practices.
Results:
• Expanded care delivery options within HRSA-supported settings will reduce
barriers to accessing care.
Objective 2.4:
Improve access to IPV-specic care and interventions.
AIM 2: OBJECTIVE 2.4
2023-2025 HRSA Strategy To Address Intimate Partner Violence20
11
ACTIVITY 2.4.3 | Promote the development and use of interdisciplinary,
coordinated care teams to provide appropriate, specialized IPV care.
Coordinated care, one-stop-shop models, and approaches that facilitate rapid
connection to specialty care decrease barriers to linking to care and remaining
retained in that care.
Key Collaborators: Implementation Team
Action Items:
• Encourage the inclusion of diverse sta (e.g., providers, advocates, community
health workers, promotores de salud, health navigators, doulas, midwives,
peers, and extension workers) and an array of expertise across disciplines
(e.g., primary care, behavioral health, ancillary supports) in care delivery at
HRSA-supported settings.
• Encourage integration and co-location of social and medical services to
support wraparound, holistic care for individuals experiencing IPV.
• Encourage coordination among care teams, including secure information
exchange and providing warm referrals to ensure safe and eective care.
74
Results:
• Sustain focus on integration and coordinated care across HRSA NOFOs.
• Increased number of T/TA engagements that encourage integration and
coordinated care.
ACTIVITY 2.4.4 | Create a HRSA-wide inventory and support
implementation of IPV screening processes to identify and address
factors contributing to IPV (including SDOH) and specically screen for
IPV.
75,76
Disclosure-driven practices such as screening can be most supportive
of people experiencing IPV when they are culturally responsive, acknowledge
barriers to disclosing experiences of IPV, and are conducted by trusted
providers in private, one-to-one settings.
Key Collaborators: Implementation Team
Action Items:
• Identify evidence-informed screening tools (such as those compiled by the
Agency for Healthcare Research and Quality),
77
complementary protocols,
referral networks, training, processes, and other resources most appropriate
for HRSA-supported settings and the populations they serve.
• Disseminate screening resources to HRSA-supported settings to inform their
work with their grantees, awardees, recipients, and subrecipients.
AIM 2: OBJECTIVE 2.4
2023-2025 HRSA Strategy To Address Intimate Partner Violence21
11
Action Items Continued:
• Provide T/TA to HRSA-supported settings on how and when to use the
screening tools and how to respond if an individual’s screening indicates an
experience of IPV.
Results:
• Increased number of T/TA engagements to support implementation of
screenings.
• Increased number of HRSA-supported settings oering universal IPV
screening.
AIM 2: OBJECTIVE 2.4
11
22 2023-2025 HRSA Strategy To Address Intimate Partner Violence
Promote prevention of
IPV through evidence-based
programs
HRSA’s vision for preventing and responding to IPV includes prevention activities
78
across
diverse settings, with evidence-based programs to address the complexities and challenges of
serving individuals who are at risk for experiencing IPV.
AIM 3
iii
Sharps, P. W., Njie-Carr, V. P. S., & Alexander, K. (2021). The syndemic interaction of intimate partner violence,
sexually transmitted infections, and HIV infection among African American women: Best practices and
strategies. Journal of Aggression, Maltreatment & Trauma, 30(6), 811-827.
iv
Sullivan, K. A., Messer, L. C., & Quinlivan, E. B. (2015). Substance abuse, violence, and HIV/AIDS (SAVA) syndemic
eects on viral suppression among HIV positive women of color. AIDS Patient Care and STDs, 29, S42-S48.
v
Illangasekare, S., Burke, J., Chander, G., & Gielen, A. (2013). The syndemic eects of intimate partner violence,
HIV/AIDS, and substance abuse on depression among low-income urban women. Journal of Urban Health, 90(5),
934-947.
Three kinds of public health prevention strategies, primary,
secondary, and tertiary, can address risk for IPV and its co-occurrence
with other epidemics like HIV/AIDS, substance use disorder, and
mental illness.
iii,iv,v
Primary
Prevention:
Preventing IPV
before it happens
Secondary
Prevention:
Immediately
responding when
IPV occurs
Tertiary
Prevention:
Responding to
IPV’s lasting
impacts over time
2023-2025 HRSA Strategy To Address Intimate Partner Violence23
11
Objective 3.1:
Support implementation of upstream primary prevention
approaches that promote healthy relationships.
Objective 3.2:
Encourage establishment of safe and supportive settings
promoting secondary and tertiary prevention approaches to IPV
and its impacts.
AIM 3: Promote prevention of IPV through evidence-based programs
11
23 2023-2025 HRSA Strategy To Address Intimate Partner Violence
Objective 3.1:
Support implementation of upstream primary prevention
approaches that promote healthy relationships.
ACTIVITY 3.1.1 | Curate an inventory of IPV primary prevention strategies
and approaches (e.g., school-based initiatives and bystander intervention),
resources, and programs appropriate to HRSA-supported settings to
facilitate rapid uptake and implementation within HRSA-supported settings
(modeled after the Centers for Disease Control and Prevention (CDC)
Technical Package on Primary Prevention).
Key Collaborators: Implementation Team
Action Items:
• Identify and disseminate evidence-informed primary prevention programs
and approaches most appropriate for HRSA-supported settings and the
populations they serve, including populations that have traditionally been
underserved or experienced discrimination.
• Connect HRSA-supported settings with T/TA providers and SMEs for
implementation support as necessary.
• Encourage HRSA-supported settings to establish partnerships with schools,
school-based health centers, afterschool and youth programs, and community-
based settings to implement primary prevention activities.
Results:
• Increased number of T/TA engagements to support implementation of
prevention programs.
• Increased use of evidence-informed, culturally, and linguistically appropriate
trauma-informed IPV training resources (e.g., curricula, toolkits, experts) within
HRSA-supported settings.
AIM 3: OBJECTIVE 3.1
Activity in Action: Support of Primary Prevention Across HRSA Bureaus and Oces
The HIV/AIDS Bureau (HAB) and BPHC provided funding support to Futures Without Violence and
IPV Health Partners to develop the IPV Toolkit. The toolkit is available on the AIDS Education and
Training Centers National Coordinating Resource Center and on the BPHC-funded Health Center
Resource Clearinghouse. As part of its National HIV Curriculum, the HAB-funded AIDS Education
and Training Centers integrate curriculum on gender-based violence.
HAB maintains an inventory of evidence-based programs and a best-practices compilation
repository on TargetHIV.org.
11
24 2023-2025 HRSA Strategy To Address Intimate Partner Violence
ACTIVITY 3.1.2 | Promote the use of universal education within HRSA-
supported settings. HRSA-supported settings can implement universal
education to provide consistent information as standard practice to all patients,
including adolescents, about available supportive services, should they need
them, in addition to implementing screening when feasible and appropriate
during a patient-provider interaction.
Key Collaborators: Implementation Team
Action Items:
• Identify existing universal education materials and gaps in materials, to inform
T/TA.
• Disseminate universal education materials to HRSA colleagues to inform their
work with their grantees, awardees, recipients, and subrecipients.
• Provide information and T/TA to HRSA-supported care settings to increase
use of universal education.
Results:
• Increased number of HRSA-supported settings using universal education
tools and implementation strategies.
AIM 3: OBJECTIVE 3.1
Activity in Action: Universal Education in Select Health Centers
A cohort of HRSA-supported health centers utilized a protocol developed by BPHC’s IPV
NTTAP, Health Partners on IPV + Exploitation, to engage patients through universal education
approaches on Exploitation, Human Tracking, DV, and IPV. This initiative enabled HRSA-
supported health centers to provide trauma-informed, person-centered care; intervention
with clinical and case management services; and formalized ways to connect patients with
community-based services that provide resources for DV, employment assistance, housing,
food, civil legal aid, and other basic needs.
11
25 2023-2025 HRSA Strategy To Address Intimate Partner Violence
ACTIVITY 3.2.1 | Promote policies and procedures that encourage HRSA-
supported settings to provide trauma-informed, culturally responsive
services to people who have experienced violence. People experiencing
violence may also face stigma, challenges with SDOH, and other lived experiences
and obstacles that may aect their ability to seek care and services. Trauma-
informed care and related policies and procedures enable HRSA-supported
settings to respond eectively and sensitively to the trauma of experiencing
violence and challenges with intersecting needs. Training all sta to understand
and implement a trauma-informed approach ensures “no wrong door” to care.
Key Collaborators: Implementation Team
Action Items:
• Identify new and existing training opportunities on the integration of trauma-
informed care and culturally responsive practices into care delivery for all sta
in HRSA-supported settings.
• Identify and disseminate model trauma-informed and culturally responsive
policies and practices that HRSA-supported settings could adapt and adopt.
Results:
• Increased integration of trauma-informed, culturally responsive policies and
procedures within HRSA and HRSA-supported settings.
Activity in Action: Promote Trauma-informed Care Across HRSA Bureaus and Oces
Trauma-informed care will be the focus of one of three HAB Part D Communities of Practice set to
launch in scal year 2023. The Communities of Practice will increase delivery of programs that are
evidence-informed or have emerging levels of evidence that enhance patient outcomes; increase
the skill level of the HIV workforce providing care and treatment to women, infants, children, and
youth; and involve partner collaboration for dissemination of best practices.
One of BHW Advanced Nursing Education - SANE Program goals is cultivating an environment
conducive to SANE training and practice through partnerships and T/TA consultation. Grantees
work with local and national partners to reduce barriers to SANE training and practice and
incorporate these services into the standard health care workow. The goal of SANE training is to
enable examiners to eectively evaluate and address survivors’ health concerns, minimize trauma,
and promote healing during and after their exam, and detect, collect, preserve, and document
physical evidence related to the assault for potential use by the legal system.
Objective 3.2:
Encourage establishment of safe and supportive settings
promoting secondary and tertiary prevention approaches to
responding to IPV.
AIM 3: OBJECTIVE 3.2
2023-2025 HRSA Strategy To Address Intimate Partner Violence27
11
ACTIVITY 3.2.2 | Extend trauma-informed and culturally responsive
resources and approaches to sta in HRSA-supported settings. HRSA-
supported setting sta themselves may need access to supportive services
and human resource practices (e.g., clinical supervision, time o for behavioral
health care).
Key Collaborators: Implementation Team
Action Items:
• Support the implementation of policies and procedures for sta in HRSA-
supported settings to address their own violence exposure or risks and to
reduce the potential for secondary trauma.
79-84
Results:
• Increased access to workforce resources among sta at HRSA-supported
settings.
AIM 3: OBJECTIVE 3.2
2023-2025 HRSA Strategy To Address Intimate Partner Violence28
11
Conclusion
HRSA is uniquely positioned to address IPV’s lasting impacts on health care needs and access.
Building on the success of the 2017-2020 Strategy, the 2023-2025 Strategy focuses on the
activities HRSA can undertake to strengthen eorts to increase knowledge of IPV and its
impacts and support IPV prevention and response within HRSA-supported settings.
Through the Strategy’s three aims and their related objectives and activities, HRSA will identify
opportunities to respond to and address the intersections between violence, SDOH, structural
and systemic discrimination, and critical public health issues. The Strategy’s aims, objectives,
and activities outline how to coordinate implementation and align activities, process metrics,
and plan for sustainability that help prevent and respond to IPV across HRSA activities. An
agency-wide approach recognizes the diversity of HRSA’s activities and the varying needs of the
populations and communities served in HRSA-supported settings. Completing the Strategy’s
activities and meeting its objectives is part of HRSA’s ongoing commitment to taking actionable
steps to achieve health equity and improve public health, improve access to quality health
services, foster a health workforce and infrastructure able to address current and emerging
needs, and optimize and strengthen HRSA operations and program engagement.
2023-2025 HRSA Strategy To Address Intimate Partner Violence29
11
Appendix A:
Related National Initiatives
The 2023-2025 Strategy complements related national initiatives, including:
• The National Strategy on Gender Equity and Equality, which includes eliminating gender-
based violence.
• Healthy People 2030, which includes reducing IPV as a Health Behavior objective.
• The goals and activities of the Administration for Children and Families, including the Family
Violence Prevention & Services Resource Centers and the Missing and Murdered Native
Americans: A Public Health Framework for Action (2020); the National Health Resource
Center on Domestic Violence; the Stop Observe Ask Respond to Human Tracking
Health and Wellness Training; and the National Human Tracking Training and Technical
Assistance Center.
• The Indian Health Services’ existing portfolio of initiatives to address IPV.
• Centers for Disease Control and Prevention seminal surveillance work via the National
Intimate Partner and Sexual Violence Survey (NISVS) and the 2017 Preventing Intimate
Partner Violence Across the Lifespan technical package for states and communities.
• The White House Blueprint for Addressing the Maternal Health Crisis, which includes goals
for addressing violence against pregnant and postpartum individuals.
• The Department of Health and Human Services Roadmap for Behavioral Health
Integration, which aims to provide care for individuals who have experienced IPV.
• The White House Task Force to Address Online Harassment and Abuse, which will address
the disproportionate eect on women, girls, people of color, and lesbian, gay, bisexual,
transgender, queer, and intersex individuals.
2023-2025 HRSA Strategy To Address Intimate Partner Violence30
11
Appendix B:
References
1
Leemis, R. W., Friar, N., Khatiwada, S., Chen, M. S., Kresnow, M., Smith, S. G., Caslin, S., & Basile, K. C. (2022).
The National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Intimate Partner Violence.
National Center for Injury Prevention and Control Centers for Disease Control and Prevention.
2
World Health Organization. (2021). Violence against women. https://www.who.int/news-room/fact-sheets/
detail/violence-against-women
3
Brown, C., Sanci, L., & Hegarty, K. (2021). Technology-facilitated abuse in relationships: Victimisation patterns
and impact in young people. Computers in Human Behavior, 124.
4
Taylor, S., & Xia, Y. (2018). Cyber partner abuse: A systematic review. Violence and Victims, 33(6), 983-1011.
5
Fissel, E. R., Graham, A., Butler, L. C., & FIsher, B. S. (2021). A new frontier: The development and validation of
the intimate partner cyber abuse instrument. Social Science Computer Review, 40(4).
6
Fernet, M., Lapierre, A., Hébert, M., & Cousineau, M. (2019). A systematic review of literature on cyber
intimate partner victimization in adolescent girls and women. Computers in Human Behavior, 100, 11-25.
7
The UN Refugee Agency. Gender-based violence. https://www.unhcr.org/en-us/gender-based-violence.html
8
National Coalition Against Domestic Violence. What is domestic violence? https://ncadv.org/learn-more
9
Mercy, J. A., Hillis, S. D., Butchart, A., Bellis, M. A., Ward, C. L., Fang, X., & Rosenberg, M. L. (2017). Interpersonal
Violence: Global Impact and Paths to Prevention. In C. N. Mock, R. Nuge, O. Kubusingye, & K. R. Smith (Eds.),
Injury Prevention and Environmental Health. 3rd edition (Vol. 7).
10
American Psychological Association. (2017). Interpersonal violence. https://www.apa.org/advocacy/
interpersonal-violence
11
National Sexual Violence Resource Center. (2010). What is sexual violence? Fact sheet. https://www.nsvrc.org/
sites/default/les/2012-03/Publications_NSVRC_Factsheet_What-is-sexual-violence_1.pdf
12
Oce on Violence Against Women. Sexual assault. United States Department of Justice. https://www.justice.
gov/ovw/sexual-assault
13
Oce on Tracking in Persons. What is human tracking? U.S. Department of Health & Human Services.
https://www.acf.hhs.gov/otip/about/what-human-tracking
14
Health Resources & Services Administration. (2023). 2022 Agency Overview. HRSA. https://www.hrsa.gov/
about/agency-overview
15
James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Ana, M. (2016). The report of the 2015 U.S.
Transgender Survey. National Center for Transgender Equality.
16
Walters, M. L., Chen, J., & Breiding, M. J. (2013). The National Intimate Partner and Sexual Violence Survey (NISVS):
2010 Findings on Victimization by Sexual Orientation. National Center for Injury Prevention and Control and
Centers for Disease Control and Prevention.
17
Roberts, T., Gorne, S. G., & Hoyt, W. T. (2015). Between a gay and a straight place: Bisexual individuals’
experiences with monosexism. Journal of Bisexuality, 15(4).
2023-2025 HRSA Strategy To Address Intimate Partner Violence31
11
18
Friedman, R. M., Dodge, B., Schick, V., Herbnick, D., Hubach, R., Bowling, J., Goncalves, G., Krier, S., & Reece,
M. (2014). From bias to bisexual health disparities: Attitudes toward bisexual men and women in the United
States. LGBT Health, 1(4), 309-318.
19
National Coalition of Anti-Violence Programs. (2014). Lesbian, Gay, Bisexual, Transgender, Queer, and HIV-
Aected Hate Violence. https://avp.org/wp-content/uploads/2017/04/2013_ncavp_hvreport_nal.pdf
20
Hahn, J. W., McCormick, M. C., Silverman, J. G., Robinson, E. B., & Koenen, K. C. (2014). Examining the impact
of disability status on intimate partner violence victimization in a population sample. Journal of Interpersonal
Violence, 29(17).
21
Breiding, M. J., & Armour, B. S. (2016). The association between disability and intimate partner violence in the
United States. Annals of Epidemiology, 25(6), 455-457.
22
National Advisory Committee on Rural Health and Human Services. (2015). Intimate Partner Violence in Rural
America: Policy Brief.
23
Taylor, B. G., & Mumford, E. A. (2016). A National Descriptive Portrait of Adolescent Relationship Abuse:
Results from the National Survey on Teen Relationships and Intimate Violence. Journal of Interpersonal
Violence, 31(6), 963-988.
24
Halpern, C. T., Spriggs, A. L., Martin, S. L., & Kupper, L. L. (2009). Patterns of intimate partner violence
victimization from adolescence to young adulthood in a nationally representative sample. Journal of
Adolescent Health, 45(5), 508-516.
25
Brown, T. N. T., & Herman, J. L. (2015). Intimate Partner Violence and Sexual Abuse Among LGBT People: A Review
of Existing Research. The Williams Institute.
26
Alhusen, J. L., Ray, E., Sharps, P., & Bullock, L. (2015). Intimate partner violence during pregnancy: Maternal
and neonatal outcomes. Journal of Women’s Health, 24(1), 100-106.
27
Wallace, M. E. (2022). Trends in pregnacy-associated homicide, United States, 2020. American Journal of Public
Health, 112(9), 1133-1136.
28
Palladino, C. L., Singh, V., Campbell, J., Flynn, H., & Gold, K. J. (2011). Homicide and suicide during the perinatal
period: Findings from the National Violent Death Reporting System. Obstetrics & Gynecology, 118(5), 1056-
1053.
29
Centers for Disease Control and Prevention. (2014). Intersection of intimate partner violence and HIV in women.
30
Siemieniuk, R. A. C., Krentz, H. B., Miller, P., Woodman, K., Ko, K., & Gill, M. J. (2013). The clinical implications
of high rates of intimate partner violence against HIV-positive women. Journal of Acquired Immune Deciency
Syndromes, 64(1), 32-38.
31
Schafer, K. R., Brant, J., Gupta, S., Thorpe, J., Winstead-Derlega, C., Pinkerton, R., Laughon, K., Ingersoll, K., &
Dillingham, R. (2012). Intimate partner violence: A predictor of worse HIV outcomes and engagement in care.
AIDS Patient Care and STDs, 26(6), 356-365.
32
Machtinger, E. L., Wilson, T. C., Haberer, J. E., & Weiss, D. S. (2012). Psychological trauma and PTSD in HIV-
positive women: A meta-analysis. AIDS and Behavior, 16(8), 2091-2100.
33
Smith, S. G., Zhang, X., Basile, K. C., Merrick, M. T., Wang, J., Kresnow, M., & Chen, J. (2018). The National
Intimate Partner and Sexual Violence Survey (NISVS): 2015 Data Brief—Updated Release. National Center for Injury
Prevention and Control Centers for Disease Control and Prevention.
34
Addiction Resource Editorial Sta. (2021). Relationship Between Substance Abuse and Domestic Violence.
AddictionResource.net. https://www.addictionresource.net/substance-abuse-and-domestic-violence/
APENDIX B: REFERENCES
2023-2025 HRSA Strategy To Address Intimate Partner Violence32
11
35
Centers for Disease Control and Prevention. (2021). Fast facts: Preventing intimate partner violence. https://
www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html
36
Niolon, P. H., Kearns, M., Dills, J., Rambo, K., Irving, S., Armstead, T. L., & Gilbert, L. (2017). Preventing Intimate
Partner Violence Across the Lifespan: A Technical Package of Programs, Policies, and Practices. National Center for
Injury Prevention and Control Centers for Disease Control and Prevention.
37
Black, M. C. (2011). Intimate partner violence and adverse health consequences: Implications for clinicians.
American Journal of Lifestyle Medicine, 5(5), 428-439.
38
Liu, L. Y., Bush, W. S., Koyuturk, M., & Karakurt, G. (2020). Interplay between traumatic brain injury and
intimate partner violence: Data driven analysis utilizing electronic health records. BMC Women’s Health, 20.
39
Warshaw, C., Brashler, P., & Gil, J. (2009). Mental Health Consequences of Intimate Partner Violence. In C.
Mitchell & D. Anglin (Eds.), Intimate Partner Violence: A Health-Based Perspective (pp. 147-170). Oxford University
Press.
40
Alhusen, J. L., Frohman, N., & Purcell, G. (2015). Intimate partner violence and suicidal ideation in pregnant
women. Archives of Women’s Mental Health, 18(4), 573-578.
41
Caerky, B. M., Mendez, M., Anderson, J. R., & Stith, S. M. (2018). Substance use and intimate partner violence:
A meta-analytic review. Psychology of Violence, 8(1), 110-131.
42
Rivera, E. A., Phillips, H., Warshaw, C., Lyon, E., Bland, P. J., & Kaewken, O. (2015). An applied research paper on
the relationship between intimate partner violence and substance use. National Center on Domestic Violence
Trauma & Mental Health.
43
Devries, K. M., Child, J. C., Bacchus, L. J., Mak, J., Falder, G., Graham, K., Watts, C., & Heise, L. (2014). Intimate
partner violence victimization and alcohol consumption in women: A systematic review and meta-analysis.
Addiction, 109(3), 379-391.
44
Smith, P. H., Homish, G. G., Leonard, K. E., & Cornelius, J. R. (2012). Intimate partner violence and specic
substance use disorders: Findings from the National Epidemiologic Survey on Alcohol and Related
Conditions. Psychology of Addictive Behaviors, 26(2), 236-245.
45
Gutierres, S. E., & Van Puymbroeck, C. (2006). Childhood and adult violence in the lives of women who
misuse substances. Aggression and Violent Behavior, 11(5).
46
Breiding, M. J., Black, M. C., & Ryan, G. W. (2008). Chronic disease and health risk behaviors associated with
intimate partner violence—18 U.S. states/territories, 2005. Annals of Epidemiology, 18(7), 538-544.
47
Reeves, C., & O’Leary-Kelly, A. M. (2007). The eects and costs of intimate partner violence for work
organizations. Journal of Interpersonal Violence, 22(3), 327-344.
48
National Center for Injury Prevention and Control. (2003). Costs of Intimate Partner Violence Against Women in
the United States. Centers for Disease Control and Prevention.
49
Gregory, A. C., Williamson, E., & Feder, G. (2016). The impact on informal supporters of domestic violence
survivors: A systematic literature review. Trauma, Violence, & Abuse, 18(5), 562-580.
50
Bender, A. E., McKinney, S. J., Schmidt-Sane, M. M., Cage, J., Holmes, M. R., Berg, K. A., Salley, J., Bodell, M.,
Miller, E. K., & Voith, L. A. (2022). Childhood exposure to intimate partner violence and eects on social-
emotional competence: A systematic review. Journal of Family Violence.
51
Lee, H., Russell, K. N., O’Donnell, K. A., Miller, E. K., Bender, A. E., Scaggs, A. L., Harris, L. I., Holmes, M. R., &
Berg, K. A. (2022). The eect of childhood intimate partner violence (IPV) exposure on bullying: A systematic
review. Journal of Family Violence.
APENDIX B: REFERENCES
2023-2025 HRSA Strategy To Address Intimate Partner Violence33
11
52
Kimber, M., Adham, S., Gill, S., McTavish, J., & MacMillan, H. L. (2018). The association between child exposure
to intimate partner violence (IPV) and perpetration of IPV in adulthood—A systematic review. Child Abuse &
Neglect, 76, 273-286.
53
Riger, S., Raja, S., & Camacho, J. (2002). The radiating impact of intimate partner violence. Journal of
Interpersonal Violence, 17(2), 184-205.
54
Heron, R. L., & Eisma, M. C. (2021). Barriers and facilitators of disclosing domestic violence to the healthcare
service: A systematic review of qualitative research. Health & Social Care in the Community, 29(3), 612-630.
55
Othman, S., Goddard, C., & Piterman, L. (2014). Victims’ barriers to discussing domestic violence in clinical
consultations: A qualitative enquiry. Journal of Interpersonal Violence, 29(8), 1497-1513.
56
Narula, A., Agarwal, G., & McCarthy, L. (2012). Intimate partner violence: Patients’ experiences and
perceptions in family practice. Family Practice, 29(5), 593-600.
57
Spangaro, J. M., Zwi, A. B., & Poulos, R. G. (2011). A qualitative study of women’s decisions to disclose and
their perceptions of the impact of routine screening for intimate partner violence. Psychology of Violence, 1(2),
150-162.
58
Robinson, S. R., Ravi, K., & Voth Schrag, R. J. (2020). A systematic review of barriers to formal help seeking for
adult survivors of IPV in the United States, 2005–2019. Trauma, Violence & Abuse, 22(5), 1279-1295.
59
Salmon, D., Baird, K. M., & White, P. (2015). Women’s views and experiences of antenatal enquiry for
domestic abuse during pregnancy. Health Expectations, 18(5), 867-878.
60
Hudspeth, N., Cameron, J., Baloch, S., Tarzia, L., & Hegarty, K. (2022). Health practitioners’ perceptions of
structural barriers to the identication of intimate partner abuse: A qualitative meta-synthesis. BMC Health
Services Research, 22.
61
Kochhar, R. (2020). Unemployment rate is higher than ocially recorded, more so for women and certain other
groups. Pew Reseach Center. https://www.pewresearch.org/fact-tank/2020/06/30/unemployment-rate-is-
higher-than-ocially-recorded-more-so-for-women-and-certain-other-groups/
62
Scheppers, E., van Dongen, E., Dekker, J., Geertzen, J., & Dekker, J. (2006). Potential barriers to the use of
health services among ethnic minorities: A review. Family Practice, 23(3), 325-348.
63
Choi, Y. J., Elkins, J., & Disney, L. (2016). A literature review of intimate partner violence among immigrant
populations: Engaging the faith community. Aggression and Violent Behavior, 29, 1-9.
64
West, C. M. (2015). African immigrant women and intimate partner violence: A systematic review. Journal of
Aggression, Maltreatment & Trauma, 25(1), 1-14.
65
Family Violence Prevention Fund. (2009). Intimate partner violence in immigrant and refugee communities:
Challenges, promising practices and recommendations. Robert Wood Johnson Foundation.
66
Lundell, I. W., Eulau, l., Bjarneby, F., & Westerbotn, M. (2018). Women’s experiences with healthcare
professionals after suering from gender-based violence: An interview study. Journal of Clinical Nursing, 27(5-
6), 949-957.
67 American Psychological Association. (2010). Violence & Socioeconomic Status. https://www.apa.org/pi/ses/
resources/publications/violence
68
Social Determinants of Health. U.S. Department of Health and Human Services, Oce of Disease Prevention
and Health Promotion.
69
Health Resources & Services Administration. (2020). Oce of Health Equity.
APENDIX B: REFERENCES
2023-2025 HRSA Strategy To Address Intimate Partner Violence34
11
70
HRSA Maternal & Child Health. Maternal, Infant, and Early Childhood Home Visiting Program Performance
Indicators and Outcomes Summary. https://mchb.hrsa.gov/sites/default/les/mchb/programs-impact/
performance-indicators-sys-outcomes-summary.pdf
71
Health Resources & Services Administration. Health Center Program Uniform Data System (UDS) Data. https://
data.hrsa.gov/tools/data-reporting
72
Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and
Guidance for a Trauma-Informed Approach. https://ncsacw.acf.hhs.gov/userles/les/SAMHSA_Trauma.pdf
73
Centers for Disease Control and Prevention. (2021). Cultural competence in health and human services. CDC
National Prevention Information Network. https://npin.cdc.gov/pages/cultural-competence#what
74
Agency for Healthcare Research and Quality. (2018). Care Coordination. https://www.ahrq.gov/ncepcr/care/
coordination.html#:~:text=Care%20coordination%20involves%20deliberately%20organizing,safer%20
and%20more%20eective%20care
75
Bair-Merritt, M. H., Lewis-O’Connor, A., Goel, S., Amato, P., Ismailji, T., Jelley, M., Lenahan, P., & Cronholm, P.
(2014). Primary care-based interventions for intimate partner violence: A systematic review. American Journal
of Preventive Medicine, 46(2), 188-194.
76
Morse, D. S., Lauer, R., Fogarty, C. T., Mittal, M., & Cerulli, C. (2012). “They told me to leave”: How health care
providers address intimate partner violence. Journal of the American Board of Family Medicine, 25(3), 333-342.
77
Agency for Healthcare Research and Quality. (2015). Intimate partner violence screening. https://www.ahrq.
gov/ncepcr/tools/healthier-pregnancy/fact-sheets/partner-violence.html
78
Washington State Department of Health, & Injury and Violence Prevention. (2017). Sexual Violence
Prevention Plan. https://doh.wa.gov/sites/default/les/legacy/Documents/Pubs/140-165-
SexualViolencePreventionPlan.pdf
79
ASPE Oce of the Assistant Secretary for Planning and Evaluation. (2020). Trauma-Informed Approaches:
Connecting Research, Policy, and Practice to Build Resilience in Children and Families. U.S. Department of Health
and Human Services. https://aspe.hhs.gov/reports/trauma-informed-approaches-building-resilience-
children-families
80
Kimberg, L., & Wheeler, M. (2019). Trauma and Trauma-Informed Care. In M. R. Gerber (Ed.), Trauma-Informed
Healthcare Approaches. Springer.
81
Hamberger, L. K., Barry, C., & Franco, Z. (2019). Implementing trauma-informed care in primary medical
settings: Evidence-based rationale and approaches. Journal of Aggression, Maltreatment & Trauma, 28(4).
82
Warshaw, C., Tinnon, E., & Cave, C. (2018). Tools for transformation: Becoming accessible, culturally responsive,
and trauma-informed organizations. National Center on Domestic Violence Trauma & Mental Health.
83
Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S., & Rajagopalan, C. (2015). Trauma informed care in medicine:
Current knowledge and future research directions. Family & Community Health, 38(3), 216-226.
84
Administration for Children & Families. Resource Guide to Trauma-Informed Human Services. https://www.
acf.hhs.gov/trauma-toolkit#:~:text=A%20trauma%2Dinformed%20approach%20involves,your%20
organization’s%20practices%20and%20services.
APENDIX B: REFERENCES