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Guideline 10

Guideline 10: Intimate Partner Violence Screening

Programs:
Babies First! (BF)
Nurse-Family Partnership (NFP) CaCoon
Family Connects Oregon (FCO)
Effective Date:1/2021
Revised Date: February 2026
Review Responsibility: FCH and OCCYSHN State Nurse Consultants, PHN Home Visitor Workgroup, FCO Medical Director

Purpose 

Intimate Partner Violence (IPV) impacts people across all age groups, educational levels, races, ethnicities, socioeconomic backgrounds, and cultures; the number of individuals affected can only be estimated because many instances of IPV are never reported. The Centers for Disease Control and Prevention (CDC) reports that nearly 3 in 10 women and 1 in 10 men in the U.S. have experienced rape, physical violence, and/or stalking by a partner; these numbers do not reflect people subjected to psychological abuse. Pregnancy and the postpartum period are particularly dangerous times for people impacted by IPV. Home visiting professionals are in unique positions to assess, educate, and support  families in learning about healthy relationships, connecting clients with resources, and creating IPV safety plans as needed.

All home visitors should review the Family and Child Health IPV Education webinars as a companion to this clinical guideline. All NFP nurse home visitors must also complete the IPV Module Training on the Learning Hub.

IPV assessments are required at certain times for each home visiting program. See table below for a summary. Refer to program manuals for more detailed information.

Process

 

I.      Establish a relationship

  1. Use trauma-informed communication and a client-centered approach to make sure clients know that you're a safe person for them to talk to.
  2. Ensure clients understand your role as a mandatory reporter. This includes abuse or neglect of children or adults with disabilities: if you suspect a child with whom you have had contact is being abused, or that a person has abused a child, you must report it. For full mandatory reporting information, go to: http:/www.oregon.gov/DHS/ABUSE/Pages/mandatory_report.aspx
  3. Complete the HOPE building blocks worksheet with your client as a way to build connection, understand what is going on in the client's life, and frame needs as “what would you like to see more of in your life?"
  4. NFP home visitors should follow the IPV Clinical Guideline (e.g., use of facilitators How's it Going Between Us and the Life History Calendar.

II.    Universal Education and Referral – IPV Assessment Part I

  1. Initiate a HOPE-informed assessment process by beginning with the importance of relationships and normalizing the conversation. Example: “One of the topics we talk about in our program is healthy relationships, because we know that relationships are one of the building blocks of health. We talk about what makes relationships healthy and ask some questions so we know how to help you have the healthiest pregnancy you can. Can we schedule a time in the next couple of visits to do this? [or, for Family Connects, can we talk about this now?]"
  2. Provide every client information about relationships and how they affect health. Emphasize that this topic is part of the program because it helps support parent-child relationships. Choose from Futures without Violence Safety Cards or use the Power and Control Wheels to discuss examples of healthy versus unhealthy relationship behaviors. Note that non-structured discussions that focus on parenting, safety or healthy relationships may be more likely to elicit disclosure of violence; however, validated questionnaires help normalize the process, reduce stigma, and ensure all clients are screened in a systematic way, not just those with obvious signs or who chose to disclose during discussions.
  3. Provide every client with community resources for IPV advocacy support and service as part of a full list of general resources with no specific attention called to the topic. This supports confidentiality and increases safety. Ensure one of the resources is for a certified advocate (It may be best to start with a domestic violence resource center in your area).

III.   Screening – IPV Assessment Part II

1. General considerations:

    • Screen clients for IPV through a private, confidential conversation, never with partner, friends or family or any child older than 18 months.
    • Use a professional interpreter if needed, never a family member.
    • Consider factors, including participant's comfort level, preferences, and “red flag signs" before screening on a virtual visit (e.g., partner always present, physical injuries, change in demeanor). See additional guidance on addressing IPV on virtual home visits here: https://nhvrc.org/wp-content/uploads/NHVRC-Brief-040121-FINAL.pdf
    • If it is not possible to screen for IPV safely and confidentially, do not screen client. Defer screening until a follow-up visit. Ensure reason for screening deferral is noted in chart. Do ensure that IPV Assessment Part I (Universal Education and Referral) is completed, regardless of whether a screening was completed or not.
 2. Initiate a HOPE-informed screening process:
    • During the screening create a safe space, review the power of positive experiences: “Your relationships have an impact on your health, so that's why it's an important topic. Like all topics, if there are questions that are uncomfortable or you don't want to answer for any reason, you don't have to answer or go into detail about these. The goal is to get a sense of where you are today with your relationships and how I can best support what you want. One of the things we know is that even when we have hard relationships, there are things we can do to support your wellbeing, so thank you for taking the time to walk through the tool with me."
    • Use a validated tool to screen for IPV. NFP programs should use the Clinical IPV Assessment form. FCO programs can use any validated tool. BF/CaCoon programs should choose one of the following tools:
    • Best practice is to give the screening tool to the client for them to fill it out on their own. However, use best judgment and modify based on reading level or need for translation.

IV.  Safety Planning – IPV Intervention

  1. Regardless of the client's disclosure of IPV, the home visitor should be supportive and provide information and resources (as noted in section II.b.)
  2. NFP nurse home visitors should follow the Changent IPV Clinical Guideline to determine appropriate facilitators and next steps based on screening result and the client's stage of change.
  3. Continue providing a HOPE-informed screening process (this script assumes a positive screen):
    After the screener, review positive experiences you've already seen, celebrate the work the parent already does: “Thank you so much for going through this screen with me; I know this is hard to talk about. First, let me say that I've noticed some strengths in you that I know will help you and your baby when they are born. For example, you mentioned that you've been [e.g., exercising, focusing on drinking more water], and it seems small and can be tough, but it makes a big difference. How you keep yourself healthy really does make a big difference for the health of your baby. Relationships are complicated, and it can be so tough to make changes, especially when it feels overwhelming; but even small changes can make a big difference for you and your baby. These questions indicate that you have a partner that is not always supportive. Would you be interested in brainstorming ways to build more positive and safe experiences during your pregnancy? [do not say statements like, “you need to …."].
  4. When IPV is disclosed, thank them for trusting you, believe them, validate their feelings, do not make judgmental comments about the abuser. Speak with the client about their immediate and future safety; ask them what would be helpful and support them based on their stage of change. They may not be ready or want to leave. See more information on safety plans here: https://www.thehotline.org/what-is-a safety-plan/

    The plan should cover:

    • Safety during a violent incident
    • Safety when preparing to leave
    • Safety in client's own home
    • Safety with a protection order

  5. If they decide to reach out to an advocacy group or shelter, describe what will happen.
  6. Ensure client knows if you must disclose something as a mandatory reporter. If it feels safe, you may let the person know when you will make the report.
  7. Ensure mutual understanding of the plan for checking in again on this topic.
  8. Ensure client has access to a certified Advocate, who is not obligated to divulge any information about abuse (OAR 40.264). Advocates can connect clients to safety planning and support groups, protection orders and legal advocacy, temporary assistance for DV survivors (through DHS), and shelters and housing programs.

 References:

  1. How to Screen for Intimate Partner Violence: Tools from ACOG.
    https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2012/02/intimate-partner-violence#:~:text=Screen%20for%20IPV%20in%20a,one%20associated%20with%20the%20patient.
  2. Addressing Intimate Partner Violence in Virtual Home Visits
    https://nhvrc.org/wp-content/uploads/NHVRC-Brief-040121-FINAL.pdf
  3. IPV and Home Visiting
    https://homvee.acf.hhs.gov/sites/default/files/2020-08/Home_Visiting_IPV_Research_Brief_1.pdf
  4. IPV Webinar Series. Part I and Part II and Part III