Domestic Violence, Sexual Violence, Intimate Partner Violence

Domestic violence amongst family members can take many forms. It may include emotional abuse, economic abuse, sexual abuse, threats, using the threat of removing children, isolation, and other behaviors used to maintain fear, intimidation, and power. Acts of domestic violence are categorized into psychological battering, physical battering, or sexual abuse (Office on Violence Against Women [OVW], 2025).

While the term “domestic violence” is still widely used, more recently, physical, psychological, or sexual violence in a relationship has been referred to as intimate partner violence(OVW, 2025).

Intimate partner violence (IPV) is a public health problem that can happen to all genders, all races, in all regions of the country, and all socioeconomic levels. It’s also a health crisis that any healthcare professional will encounter, in one form or another, in every clinical environment.

Per the Centers for Disease Control and Prevention (CDC) (2024), IPV is abuse or aggression that occurs in a current or previous dating relationship (Centers for Disease Control and Prevention [CDC], 2024a). This can be a current or even former spouse or partner. It may be a single episode or pattern of behaviors where the partner uses physical force or violence to gain and maintain power and control over the other partner. IPV can affect people in heterosexual and same-sex relationships. It also impacts people of all ages, races, and identities (Bacchus et al., 2024).

In their detailed report, Intimate Partner Violence: Uniform Definitions, the CDC states that IPV includes the following behaviors (CDC, 2024a):

1. Physical violence: The deliberate use of physical force against another person resulting in physical harm, injury, disability, or death. Includes hitting, slapping, kicking, biting, strangling, or using a weapon. The bruises and fractures may heal, but the fear and hypervigilance that linger long after the physical injuries fade can last for years.
2. Sexual violence: Forced or coerced sexual activity without the victim’s consent. This may include being unable to consent, due to fear, or situations in which the victim is intoxicated or unconscious. Reproductive coercion also falls under this category, such as sabotage of birth control methods, pregnancy decisions, or abortions.
3. Stalking: Unwanted, repeated attention, or contact that causes the victim to feel scared or feel their safety is compromised. With technology in our lives these days, it can include GPS location tracking, excessive texting, or other social media snooping and monitoring.
4. Psychological aggression: Communication, verbal or nonverbal, that can intimidate, manipulate, isolate, or control another person. Includes verbal threats, gaslighting, constant criticism, or withholding money, medications, or transportation.

IPV is an escalating process. It often begins with threats, name-calling, and damage to objects or pets. It may start to escalate into restraining, pushing, slapping, pinching, or biting, and then it may evolve into life-threatening behaviors like punching, kicking, choking, breaking bones, and using weapons (CDC, 2024a).

Coercive control is the use of fear, intimidation, and isolation to mentally and psychologically dominate another person, often resulting in the loss of liberty and a sense of self (Lohmann et al., 2024).

Coercive control can look like behaviors such as watching, checking, and controlling finances, whom someone can be friends with or talk to, where and when they can drive or have access to a car, or threatening to harm someone’s pet. Coercive control can occur with or without physical acts of violence (Lohmann et al., 2024).

Healthcare professionals can be a key point of intervention for coercive control survivors, many of whom can be seen in clinics or hospitals and appear high-functioning due to their clothing and verbal compliance, but in reality, are being held hostage through psychological means.

Missed cases may also be due to healthcare professionals simply not screening and many nurses are not prepared to provide care to a woman who is a victim of violence from her partner. There are many reasons nurses, physicians, and other allied health professionals may not screen for intimate partner violence (CDC, 2024b):

• Lack of time
• Lack of resources
• Lack of training
• Cultural barriers
• Language barriers
• Emotional discomfort
• Behavior of the victim, e.g., uncooperative, unwilling to accept help

Mental health professionals see victims of domestic violence for suicide attempts, anxiety, and depression. Practitioners who specialize in chronic pain, such as headaches or stomach disorders, also treat abuse victims. Pediatricians who see abused children may also see abused women because child abuse and spousal abuse frequently co-exist (CDC, 2024b).

Pregnancy can be a risk factor for abuse. It is estimated that nearly half (45%) of homicides to women who were either pregnant or within one year of having been pregnant have been associated with IPV (CDC, 2024b). In fact, the homicide rate is said to be about 16% higher among those who were expecting or within one year of pregnancy (CDC, 2024b).

When one experiences violence either before, during, or after pregnancy can have long-term effects on the overall health and general well-being of both the woman and the baby (CDC, 2024b). Violence during pregnancy increases the incidence of morbidity and mortality. Specifically, victims of violence are more likely to deliver a pre-term or low-birth-weight infant. It can also affect breastfeeding. These victimized women are more prone to miscarriage, depression, alcohol, and drug abuse, and forgoing prenatal care.

Healthcare professionals can help by screening for domestic violence, documenting abuse in the medical record, safeguarding evidence, providing medical advice, referrals, safety planning, and showing empathy and compassion. Victims of IPV may not discuss the violence unless they are asked directly. However, many victims of IPV will talk about the abuse if they are asked in a direct, caring, and non-judgmental manner.

Abuse victims need referrals to legal and social services. They may need help finding temporary shelter, advice on how to keep safe should they return home, and affirmation that the abuse is not their fault. We will discuss the components and important things to remember for an IPV safety plan that we can help victims create later in this course.

Screening questions should always be asked in a private room, away from the abuser, and preceded by assurances of strict confidentiality. The spouse or partner should be separated from the patient if they demand to accompany the patient into the examining room (Cline et al., 2020).

It is not the role of the healthcare professional to invoke or foster criminal justice intervention. Calling the police is not always in the best interest of a victim of domestic abuse. Some victims of domestic violence have learned to distrust the police or believe that law enforcement intervention will further endanger them. Immigrant victims may fear that calling the police will lead to deportation. Others are unwilling to use law enforcement intervention until a safety plan is in place.

Each victim should be informed of their legal options and encouraged to make their own choices (Cline et al., 2020). The requirements for reporting incidents of domestic violence/intimate partner violence - what must be reported, how it must be reported and to whom, and who is responsible for the reporting – vary from state to state. It is essential that you become familiar with the rules within your own state.

For an excellent breakdown of state by state statutes that address mandatory reporting requirements, state protocols, screening, required training, public health resources and responses, and insurance discrimination, visit this following resource, the Compendium of State and U.S. Territory Statutes and Policies on Domestic Violence and Health Care, as prepared by the U.S. Department of Health and Human Services (HHS). This most recent version was compiled in 2019 and availablehere.

Risk factors for violence against their spouse or significant other include (WHO, 2024):

• Family history of violence
• Alcohol and drug use
• Emotional dependency, insecurity, and low self-esteem
• Lack of impulse control
• Antisocial, aggressive, and borderline personality disorders
• Poverty
• Marital discord or conflict

Research from both developed and undeveloped countries has consistently identified the following triggers for domestic violence:

• Not obeying
• Suspicion of infidelity
• Going somewhere without permission
• Arguing
• Not caring sufficiently for the children or home
• Questioning
• Refusing sex
• Not having food ready on time

Abusers come from all social classes, races, cultures, religions, backgrounds, and countries. The following behaviors may be warning signs (National Domestic Violence Hotline, n.d.):

• Extreme jealousy
• Blames others for their faults and circumstances for their problems
• Unpredictable behavior
• Verbally abusive
• Insulting, demeaning, and shaming
• Preventing or discouraging time spent with others
• Controlling finances
• Unable to control their anger
• Always asking for a second chance, saying they'll change and won't do it again
• Their family resolves problems with violence
• It plays on your guilt
• Their way is the only way
• Behavior often worsens when using alcohol or drugs
• Cruelty to animals

Assessment tools have been developed that can help identify someone who has the potential for domestic violence/intimate partner violence. The Spousal Abuse Risk Assessment (SARA) is a validated tool that looks for the presence of 20 behaviors such as a history of assault or sexual violence, personality disorder, history of the use of weapons, and emotional denial or minimization of violence (Allard et al., 2024). We will dive a bit deeper into other available assessment tools later on in this course.

• Responsibility for dependent children.
• Not employed outside of the home.
• The victim does not solely own any property. 
• Lack of access to cash or bank accounts.
• Fear of being charged with desertion; therefore, losing children or joint assets.
• Fear of a decline in living standards for herself and her children.

• Clergy and other religious counselors are often trained to see only the goal of saving the marriage at all costs.
• Police officers have been known to treat domestic violence as a dispute instead of a crime.
• Police may try to dissuade women from filing charges.
• Prosecutors are reluctant to prosecute cases and judges are lenient with the sentencing.
• There is little to prevent a released abuser from returning and repeating the assault, even with a restraining order.
• There are simply not enough shelters to keep victims safe.

• The belief is that divorce is not a feasible option.
• The belief is that a single-parent family is unacceptable and that even a father who can be violent is better than no father at all.
• Many women are taught to believe that they are responsible for making their marriage work.
• The isolation of a victim contributes to a sense that there is nowhere to turn.
• Rationalization of their abusers’ behavior by blaming stress, problems at work, unemployment, alcohol, or other factors.
• Many women feel that their identity and worth are contingent upon getting and keeping a husband.
• During the non-violent phases, the abuser may fulfill the woman's dream of romantic love. She believes that he is good overall.

Although women make up at least 85% of the victims of domestic violence, most often at the hand of male abusers, males are often victims (CDC, 2024c; Kippert, 2021). In fact, according to the CDC (2024), approximately 1 in 10 men in the United States have experienced sexual or physical violence and/or stalking by an intimate partner (CDC, 2024c). It is estimated that about 56% of men who were victims of physical violence, sexual violence, and/or stalking by an intimate partner first experienced this violence before their 25th birthday (CDC, 2024c). Male survivors of abuse often experience a stigma to be the “man” who should have the ability to fight back against an abusive partner, especially when that significant other is a female, which is the case 97% of the time (CDC, 2024c; Kippert, 2021).

In the case that the abuser is another male, they are often uncomfortable revealing the abuse because it would mean disclosing a same-sex relationship that they have more than likely not shared with others yet. Research has shown that 26% of gay men and 37% of bisexual men, compared to 29% of heterosexual men, have experienced physical violence, rape, and/or stalking by an intimate partner at some point in their lives (Kippert, 2021). Males also typically experience discrimination from police and domestic violence shelters (Kippert, 2021).

Partner violence within the Lesbian/Gay/Bisexual/Transgender/Queer+ (LGBTQ+) community occurs quite often. Unfortunately, there is much less research available for this community in comparison to those in gender-conforming, heterosexual relationships (Access Community Health Network, 2023). The most recent statistics from the Centers for Disease Control and Prevention (CDC) state that roughly 44% of lesbian women and 61% of bisexual women are raped, the victim of physical violence, and/or stalked by their partner (Access Community Health Network, 2023). The members of the LGBTQ+ community at the highest risk for intimate partner violence are African Americans, transgender persons, and bisexual people (Access Community Health Network, 2023).

The far majority of LGBTQ+ victims of domestic violence do not report their abuse (Gram et al., 2024; Access Community Health Network, 2023; Peterson, 2022). Members of this community have their own unique reasons for not seeking help. First is the risk of potential discrimination from law enforcement. As mentioned in the last section, the abuser could threaten their partner if they have not “come out” to their family and friends to disclose a same-sex relationship (Peterson, 2022). This threat can be potentially even more dangerous for any transgender, nonbinary, or those who are gender-nonconforming who have not publicly disclosed their gender identity (Peterson, 2022; Access Community Health Network, 2023). If someone from the LGBTQ+ community attempts to get help and their experiences are minimized, this also adds to the trauma of their experience (Peterson, 2022). In addition, homophobia and transphobia can still make a major impact in the legal proceedings of many states (Access Community Health Network, 2023). Additional research must be done in sincere partnership with the LGBTQ+ community to better capture them in the statistics as well as to provide evidence to inform action that needs to take place (Gram et al., 2024).

Evidence suggests that domestic violence increases the risk of child morbidity and mortality and is strongly associated with a high incidence of child neglect and maltreatment (Jofre-Bonet et al., 2024). Millions of children witness IPV at home. The effect of this exposure has been compared to direct physical abuse of the child. These children suffer from a wide range of emotional, physical, and psychological problems, including (Office on Women’s Health [OASH], 2025):

• Attention-deficit/hyperactivity disorder (ADHD)
• Anxiety
• Behavioral problems (aggression)
• Regressive behaviors (bedwetting, thumb-sucking)
• Depression
• Eating disorders
• Poor academic performance
• Low self-esteem
• Need for psychotropic medications
• Nightmares and/or difficulty falling or staying asleep
• Stuttering
• Physical health complaints (headaches and stomachaches)
• Self-harming behaviors
• Engaging in risky behaviors (using drugs/alcohol, unprotected sex)
• Bullying others/starting fights at school
• Long-term medical conditions (diabetes, heart disease, obesity)

Multicultural communities face distinct nuances with IPV:

• Rural survivors often lack shelters in a geographically reasonable distance. Many local survivors know the same police officers or healthcare workers for years, compounding fear of consequences of coming forward.
• Faith-based traditions can have significant influences on choices to stay or leave a relationship. Healthcare professionals should honor religious perspectives while also reinforcing autonomy and safety.
• LGBTQ+ community members experience dual stigmas and potential lack of affirming services.
• Immigrant and refugee families have elevated fears of deportation and cultural mistrust of authorities, so they may need culturally and linguistically specific advocacy.
• In some areas, the common reasons survivors returned to abusers have been lack of affordable housing and transportation. Recognizing these community and economic factors help healthcare professionals avoid judgmental biases and solutions that may not be feasible for patients.

Taken together, IPV epidemiology reveals the obvious: healthcare settings are a critical point of intervention. Survivors of IPV are rarely in clinics and hospitals to report themselves as “victims of domestic violence.” They arrive with headaches, anxiety, nonspecific abdominal pain, or chronic fatigue. Healthcare professionals must learn to see the red flags in these somatic complaints and uncover the stories of trauma hiding behind them.

Identification of IPV begins with definitions but is fully realized through application in patient care. Healthcare professionals armed with information, observation, and empathy will be equipped to identify IPV and support survivors to safety.

IPV is one of the most under-reported crimes in the country, with only a small number of survivors reporting reaching out to a healthcare professional for help. Increasing use of internet-connected devices, shared email accounts, and surveillance applications like Life 360 can make safety planning complex. Across the country, there are trends and data gaps that exacerbate a continued and growing problem among all populations. Here is an example of these trends and noticed data gaps:

• COVID-19: COVID-related lockdowns increased IPV cases nationwide (Piquero et al., 2021).
• Substance use: Opioid and methamphetamine use frequently co-occur with IPV and can both complicate disclosure and service linkage (Armstrong, 2023).
• Costs to the United States: There are many costs of IPV to society. The estimated lifetime economic cost of medical care, criminal justice, and lost productivity from work that is associated with IPV is $3.6 trillion (CDC, 2026).

Firearms are a major risk factor for lethality in domestic violence situations. Federal law 18 U.S.C. § 922(g)(8) prohibits possession or purchase of firearms or ammunition by persons subject to qualifying protective orders. To qualify, the order must be issued after notice and a hearing, restrain the respondent from harassing, stalking, or threatening an intimate partner or child, and include specific findings that the person presents a credible threat.

In 2024, the U.S. Supreme Court in United States v. Rahimi upheld this prohibition as constitutional. The Court ruled that temporary firearm restrictions tied to protective orders are consistent with longstanding safety measures and do not violate the Second Amendment (HHS, 2025).

Even with strong statutes, barriers to enforcing protective orders remain, such as limited awareness among survivors about eligibility or renewal and backlogs in court scheduling. Respondents ignore the order and test boundaries, with survivors limited in further action due to fear of retaliation or job loss.

While healthcare professionals are not law enforcement officers, they do have a role in risk assessment and safety education. During a lethality assessment, include questions about firearms. Encourage safe-storage practices, provide referrals to law enforcement for voluntary surrender, and document these discussions objectively (Futures Without Violence, 2024). Use neutral phrasing, such as “Let’s talk about safety around firearms,” rather than “You should give up your gun.” This can reduce defensiveness while addressing risk.

Healthcare professionals cannot give legal advice, but they should:

• Explain options in clear, neutral language.
• Provide resources (hotlines, regional contacts, court-based victim advocates).
• Support autonomy (respect the person’s readiness to pursue an order).
• Document thoroughly (all information shared, any stated intent).

IPV is not just an issue between two adults, as we have discussed; it also involves the impact that these violent acts have on children, adolescents, and family systems (Andreescu & Redman, 2025). It is essential to know the effects of IPV not only on direct victims but also on the children around them.

As briefly alluded to earlier in this course, IPV has been found to have both short- and long-term effects on children. It has been shown to have an impact on the child’s developing brain as well as increase a child’s (Bogat, Levendosky, & Cochran, 2023):

• Anxiety
• Depression
• Aggression
• Impulsivity
• Conduct problems

It has also been shown to impact a child’s attention span, concentration, and is associated with increased academic difficulties (Bogat, Levendosky, & Cochran, 2023).

Children exposed to IPV at home are at a higher risk for various mental health issues, and they are more likely to experience health, behavioral, and academic problems. Healthcare professionals are in a place where they can make a difference for these families, and it is crucial that we are aware of the signs in our pediatric, school health, or emergency clinic settings. Children’s behaviors at home and school may be completely different, so it is also essential to know how to effectively assess and question these individuals.

Children may not be the direct victims of violence, but they are still victims of the situation, as they are also at risk of developing serious health issues in the future. They can be directly or indirectly exposed to violence, but the main impact of IPV on a child is through the level of anxiety and fear that a caregiver is showing at home (Bogat, Levendosky, & Cochran, 2023). This affects children’s health and well-being and also disrupts the homeostasis of the family system. One caregiver may become isolated and controlled in the family system, where the abusive partner holds all the money and financial assets, as well as using children to monitor and control the other parent’s actions, through the care of the children. Children can also become pawns in an abusive relationship when parents fight over custody and visitation rights (Bogat, Levendosky, & Cochran, 2023).

It is crucial to talk about not only IPV between adults but also the children and families affected. We need to know what to look for in these patients and their families, as well as be able to counsel the adults in the home on what effect this is having on their children, and ways to help both them and their children.

In June 2025, the United States Preventive Services Task Force (USPSTF) posted an updated recommendation statement on screening for IPV in women of reproductive age and screening for caregiver abuse in older or vulnerable adults (U.S. Preventative Services Task Force [USPSTF], 2025). The following are the specific USPSTF recommendations for 2025 (USPSTF, 2025):

• USPSTF recommends screening women of reproductive age (including pregnant or postpartum women) for IPV.
• They are not recommending screening every adult or older person, unless there are signs or suspicion of abuse.
• Under the Affordable Care Act, IPV screening is a preventive service that should be covered by many health insurance plans.
• USPSTF suggests using a brief validated questionnaire to assess for current or recent abuse (e.g. in the past year).
• If a patient screens positive for IPV or caregiver abuse, the clinician should provide or refer them to “multicomponent interventions with ongoing support” instead of just a one-time referral.
• Screening followed by referral to ongoing support services can reduce IPV exposure and improve physical or mental health outcomes among women of reproductive age.
• Connecting women survivors to services earlier can reduce repeat violence, injury, and downstream health consequences.
• Screening studies did not always show significant reductions in IPV outcomes versus no-screening arms, which suggests that screening alone is insufficient without a robust support system.
• There is insufficient current evidence to support routine screening in men. However, some men do experience IPV so use clinical judgment if other risk indicators are present.
• If concerns or behavioral indicators are present, screening and referral may be justified among populations of older and vulnerable adults.

The following table spells out different known key barriers to screening for IPV.

Some of the most commonly validated tools include short (3 to 8 items) questionnaires and have been used in prior research that informed practice. Validated means the questions have been tested for reliability and sensitivity to abuse (Melendez-Torres et al., 2023). 

A positive screening test is not a diagnosis of violence, but rather a bridge to a conversation with supportive referral resources. Some tips for embedding screening into a routine workflow include:

• Screen for IPV, but do not force it if it is clearly contraindicated. 
• Screen in a private place at every visit or certain key visits (e.g., annual physical, prenatal, mental health visit).
• Embed screening into standard assessments (e.g., add a yes/no screen to intake form, triage assessment, or EHR flow sheet).
• Never screen unless in a private setting (e.g., no one within earshot).
• If positive, do a warm handoff to advocacy or social work (in person or by phone).
• Document carefully, including exact verbatim responses, which tool used, and any referrals made.

All tools below are validated for use in outpatient, emergency, or inpatient settings, and can be administered verbally, on paper, or digitally (as long as privacy is ensured) (USPSTF, 2025):

1. HITS (Hurt, Insult, Threaten, Scream)
2. HARK (Humiliation, Afraid, Rape, Kick)
3. PVS (Partner Violence Screen)
4. WAST (Woman Abuse Screening Tool)
5. E-HITS (extended with questions on sexual violence)

Please review the following table to see the included elements and questions in each of these listed screening tools.

A positive answer is not the end of the work, it is the beginning of the supportive conversation. The healthcare professional should immediately:

• Ensure privacy and safety (away from partner).
• Validate the disclosure: “You don’t deserve to be hurt or controlled.”
• Provide resources such as brochures that your place of work has.
• Document objective information (tool used, score, education given).
• Offer referral or warm handoff to advocacy services.

Asking the questions is only half the battle: it’s the how, the follow-through, and the team response that makes a true difference. The best screening tool will not change culture if a clinic is perceived as hurried, unsafe, or punitive (Melendez-Torres et al., 2023). Many clinicians know what to ask but not how to ask. Inflection, posture, and privacy signal whether it’s a safe space to share abuse. A person’s tone and inflection can create or dissolve a rapport that takes months to build (Melendez-Torres et al., 2023).

Whether novice or experienced, the healthcare professional has an opportunity to change lives and create that safe space needed for therapeutic communication. Practice and engagement take only minutes and can be done quickly, with one or two peers to role-play. 

In absence of the time and space to practice language in this low-stakes setting, use the following scenarios as an opportunity to reflect on translating this important skill into practice. Note phrases that worked well or sounded awkward. Screening is not an interrogation; it is an invitation to safely discuss fears and feelings.

Take the opportunity with the table below to walk yourself through some possible screening scenarios.

IPV may manifest in a wide variety of somatic symptoms without recent injury. Healthcare professionals need to be able to connect the dots between physical and psychosocial causes without making assumptions through reflection questions they can pose to themselves during or after triage/assessment or later when more privacy is possible:

• What nonverbal clues were observed?
• Were they nervous, sorry, or withdrawn?
• Were they chronically late or distracted when partner present?
• In what ways might fear, control or trauma affect sleep, appetite, or pain?

A positive IPV screen is a window of opportunity, not a “check-the-box” point-of-care.
Facilities should have developed, practiced, and consistent protocols in place that promote safety, offer “warm referral” to advocacy and includes thorough documentation of the abuse (Melendez-Torres et al., 2023). Take a look at the following table to see a sample script for a “warm referral” or “warm handoff” approach.

Healthcare professionals serve many unique populations. Healthcare should always be patient-centered but also consider cultural differences without stereotyping. “Culturally responsive” ≠ assuming beliefs. Ask how their healthcare can make them feel the most comfortable.

Please take a look at the following table to review specifics of some cultural communities where additional considerations are necessary.

(U.S. Department of Health and Human Services Office of Minority Health [OMH], n.d.)

Trauma-informed screening is not just a way to ask questions—it is a way to document the encounter. Every word, phrase, and description captured in the record will be a legal and clinical artifact of that care. For patients who screen positive for IPV, this charting will potentially be seen by police or court officers, entered into the record in support of protective orders or judicial recommendations, or used by other clinicians to follow-up on what they learn.

TIC uses the six principles, one privacy script, one tool (HARK or E-HITS), one warm-handoff pathway, and one documentation template. It is helpful to choose the scripts and patterns that resonate in practice and use those four things every time.

To become an expert in TIC, it may be necessary to shape the system by standardizing 1:1 privacy, interpreter workflows, and tech-safety protocols. With collaboration from all members of the healthcare team, it is possible to create limited-visibility documentation options, and audit charts for quality. Most importantly, healthcare professionals are able to drive that change.

Trauma-informed, culturally responsive care increases disclosure, safety, and trust—and it’s fully compatible with healthcare ethics and the 2025 USPSTF screening guidance. Take a look at the following table for the “do’s” and “don’ts” of conversations incorporating TIC.

Utilize the following to communicate best in your documentation:

• Objectivity: Write facts and quotes, avoid opinion, interpretation, or speculation.
• Completeness: Include facts that were observed, heard, or did (assessment, education, resources, referrals).
• Privacy: Protect sensitive information that could harm the survivor if someone else accesses it (check shared portals).
• Consistency: Use standardized EHR fields if available for follow-up data tracking.
• Neutral Tone: Delete loaded words like claim, alleges, admits, or denies. Swap with neutral verbs like states or reports.  

Take a look at the following table to see some specific documentation examples utilizing the Good/Better/Best model.

Photographing injuries and collecting evidence in suspected or known IPV cases can be lifesaving, but it must be done safely, consistently, and respectfully. Images can preserve critical facts, not just trauma. They are documentation, not an investigation. The legal standard is not the photographer’s skill, it is trauma-informed, standardized process (Chandawarkar & Nadkarni, 2021).

Healthcare professionals should always follow their agency’s policy regarding photographs as part of documentation. If a facility does not have a photo policy, individual healthcare professionals should not independently be doing forensic photography. Simply document in writing and notify supervisor, social worker, or SANE/FNE (Kentucky Association of Sexual Assault Programs, n.d.). Obtain consent before each image. Obtain consent for storage and ongoing care purposes. Many states do not have a single state-wide mandate for healthcare professionals to take photos, but many hospital and health system policies are now consistent with nationally recognized forensic and trauma-informed practices:

• Obtain verbal or written consent prior to taking any photos.
• Photographs should only be taken using agency-owned, secure devices (not personal phones).
• Images should be stored only in secure evidence module or restricted-access section of the EHR.

Documentation should indicate that photos were obtained and stored, but should not describe graphic content of the image in the narrative chart note (Chandawarkar & Nadkarni, 2021). Example: “Photographs of left arm bruising and facial redness obtained with consent using hospital camera. Images stored in secure EHR media file per policy.”

Photographing injuries for evidentiary purposes can feel especially invasive, embarrassing, and/or re-traumatizing to someone who has experienced violence. Best practice trauma-informed care takes this into account while still ensuring evidentiary accuracy.

According to Chandawarkar & Nadkarni, (2021), it is important to explain before, during, and after:

• “This is to document your injuries more accurately. I want to make sure I understand what you are telling me.”
• “Do you have any questions about why we are taking these photos and where they will be stored?”
• “You have the right to say no to these photos or stop at any time. I am documenting them as part of your care, but you are not obligated to allow me to take them.”
• “Are you comfortable if I take this photo?”
• “Would you like to see the photo immediately after I take it?”

Only include staff who are necessary for the process. Minimize presence of others by using privacy curtains or closing the door. Do not include identifiable background features (e.g., other patients, staff, children) in photos. Expose only the specific areas needed to document. Cover other areas of body completely and always provide coverings. Allow the patient to stop, cover, or review each photo. This helps preserve autonomy and reduce re-traumatization. Remain neutral and professional. Facial expressions and reactions to the images may be interpreted as judgmental.

Involve a Sexual Assault Nurse Examiner (SANE) or a Forensic Nurse Examiner (FNE) for high-risk cases or when injuries are complex (Kentucky Association of Sexual Assault Programs, n.d.). These specially trained nurses are familiar with evidence collection and preparing for legal testimony.

If the organization you work for has forensic nurse colleagues, they should take photos, collect specimens, and maintain chain of custody. Providers should document an assessment of clinical findings, and the forensic nurse can document forensic details. Example: “Forensic nurse examiner notified; arrived at bedside 21:25. Photographs and evidence collection completed. Nursing care continued per plan.” If no forensic nurse is available, contact a regional domestic violence program or statewide SANE network for advice.

National case reports are increasingly identifying “digital abuse” as an element of IPV. Digital abuse includes threats via text, photographs, GPS tracking, or secret hidden cameras (Futures Without Violence, n.d.). Healthcare professionals are now more frequently seeing screenshots, devices, or threatening text messages offered as evidence. Do not photograph these items or store them on healthcare devices. Refer to law enforcement or advocate for guidance on digital evidence preservation. Document in the chart factually, without speculation or judgment: “Patient reports receiving threatening text messages from partner; showed me on phone. No photos taken; education provided about preserving messages for law enforcement.”

Photos should never be taken in lieu of compassionate, trauma-informed patient care (Chandawarkar & Nadkarni, 2021). Done ethically and professionally, however, photographs can become powerful advocacy tools. They help transform trauma into evidence that can accurately and truthfully speak for itself. It is best practice to use secure, agency-owned equipment and obtain consent and explain purpose before, during, and after. When necessary, ensure safety, privacy, and cultural sensitivity and take overview and close-up shots with scale and orientation with the thought of evidence-keeping in mind. Document who, when, where, what in the chart but never substitute photos for compassion.

Photographic evidence and good documentation are charting with a purpose, and a thorough note is the clinical record of a trauma-informed care encounter (Scafide et al., 2023). Clinical decisions are documented, including a healthcare professional’s objective observations and interventions in a patient-centered and trauma-informed manner. Healthcare professionals who document from a place of objectivity and compassion keep the patient encounter in mind long after the charting is complete, looking to build a continuity of care and community that aims to keep survivors safer in the long-term.

The CDC and World Health Organization (WHO) both use an ecological model to understand violence as a product of four interconnected layers (World Health Organization [WHO], n.d.). The more risk factors in each level, the more a person is at risk for victimization or perpetration.

Example: In an Appalachian community that has high substance misuse, lacks reliable transportation, and has only one hospital, we may see more IPV risk because of a lack of protective community or societal factors. This type of environment might normalize or enable individual- or relationship-level risk, like alcohol misuse or financial control.

As seen, each level can promote safety or harm. Healthcare professionals are in a position to see all four every day, whether at the bedside, in clinics, and/or out in community settings.

Healthcare professionals practice with cultural norms that impact risk and resilience. Practicing cultural humility is admitting that “risk” and “protection” will always look different across communities. It is being aware of how cultural norms can influence one’s thinking and perspective. Remember: what’s non-negotiable is partnership. Meeting people where they are with their belief systems, while prioritizing safety.

Identifying risk factors is only part of the equation; we must intervene when we see patterns of high-risk indicators. Under U.S. v. Rahimi (U.S. Supreme Court, 2024) and 18 U.S.C. § 922(g)(8), individuals under applicable protective orders are prohibited from possessing firearms.

In the presence of firearm danger, healthcare professionals can document that safe-storage or surrender information was offered as part of the safety plan. A lethality assessment tool (ex. Danger Assessment (DA) or Maryland Lethality Assessment Program (LAP)) can help determine next steps. Firearm questions are included as part of lethality screening and include note of safe storage counseling in progress notes (Futures Without Violence, 2024). Initiate a warm referral to advocacy or law enforcement if immediate danger is present. Integration of a brief safety plan prior to discharge, and clear, factual documentation is essential.

High-Risk indicators can include:

• Recent separation from partner
• Escalation in frequency/severity of violence
• Threats with or access to firearms
• Strangulation or attempted strangulation
• Forced sex
• Threats of suicide or homicide
• Partner monitoring or controlling daily activities, money, or medications
• Pregnancy or new infant in the home

Protective factors function like safety nets, helping to buffer recovery, autonomy, and stability. Each protective factor should be reinforced with the individual. Protective factors can be clearly documented in the plan of care and communicate work in progress for things like “Connected with advocate,” “Housing application submitted,” or “Counseling referral completed.” This not only supports follow-through of care but also provides measurable outcomes.

Important protective factors can include:

• Access to stable housing or emergency shelter
• Economic independence (employment, education, childcare support)
• Supportive friends, family or peers
• Connection to advocacy, counseling, and peer support groups
• Access to trauma-informed healthcare
• Legal protection (restraining orders/protective orders)
• Community connection (faith, school, civic engagement)

Protective factors help transform a moment of crisis into an opportunity for recovery when we recognize and build upon them. Small prevention efforts add up, and all support statewide resiliency. The nursing community has already influenced laws, curricula, and crisis response programs through collective voices. Risk factors illuminate why violence occurs; protective factors illuminate how healing occurs. Nurses are poised at the intersection of both.

Risk becomes practice when a public health nurse partners with a local high school to deliver a “Healthy Relationships 101” session. Protection becomes practice when an ED charge nurse creates a quick-reference card for IPV screening questions and referral resources. Nurse leadership becomes practice when a nurse leader participates in statewide coalition meetings to strengthen regional response coordination.

Nurses have three central prevention roles (Palmieri & Valentine, 2021):

1. Clinical Prevention: Routine screening, early identification, trauma-informed response.
2. Educational Prevention: Teaching patients and communities about healthy relationships, stress management, and consent.
3. Advocacy Prevention: Engaging in system-level change–policy development, community partnerships, and institutional training.

Laws, advocacy network, and healthcare professionals can form a web of safety that has the potential to catch people before they fall through (Kentucky Justice and Public Safety Cabinet, n.d.). Risk factors do not determine destiny, even if they increase vulnerability. Protective factors can be built, one connection at a time, through available resources and strengths counterbalancing the encountered risks. Nurses are in a unique position to recognize both risk and protective factors and to intervene early.

Disclosure (sometimes referred to as ‘confession’) is the last step in a survivor’s journey to accessing services, after they have taken stock of their options, reconciled their fears, and made a plan to stay safe. Disclosure is powerful; it’s also dangerous. Not every survivor will take this step.

Denial can be a form of protection. Someone who is in a domestic violence or dating violence situation may be thinking about many things: the danger of further violence, housing and job concerns, community shame, immigration status, the concern that they will not be believed. Do not take it personally if a patient (or child) says “No.”

The role of the healthcare professional is not a detective, and a confession is not needed to provide patient-centered care for an individual. Although IPV may be suspicioned based on objective findings, affect, or behavior, the healthcare professional does not have the obligation to determine if abuse is happening when the person says, “no violence” or “no problems at home.” Stay neutral and compassionate, without attempting to “convince” the person—they are weighing risks internally. Keep the person safe, document, and consistently offer services and education (Palmieri & Valentine, 2021). Future tense language (“if that ever happens”) works better than questions (“are you sure he didn’t mean to?”) when offering resources without intruding. Trauma-informed documentation reflects this, allowing the chart to “speak” even if the person says “No.” Consider some examples of therapeutic communication:

• “Sometimes things like this happen in unsafe situations. If that’s ever the case for you, I want you to know there’s help out there, 24/7.”
• “I know you don’t want to talk about that. I’m going to slip a brochure in your papers just in case you need it.”
• “You should feel safe at home. If that’s not the case, you can always come back here.”
• “You don’t have to decide today but know there’s support if you need it.”

Asking why someone would not disclose or reveal their situation is like asking “why did you survive?” Trauma responses are complex and diverse. The reasons for denial or minimization are varied but some of the most common include:

• Fear of increased violence: The person may worry that violence will be worse if their partner knows.
• Fear of shame or loss of community: Especially in smaller or faith-based communities.
• Cultural beliefs: Some cultures place more value on family unity, autonomy, or privacy than outside intervention.
• Fear of financial loss: Loss of partner can mean loss of financial support, childcare, transportation, and/or housing.
• Fear of immigration repercussions or custody loss: Fear of deportation (especially if undocumented) or custody loss.
• Fear of personal safety or further system involvement: They may have previously been disbelieved, blamed, or further endangered after reaching out to systems or services.

Always document facts that support clinical judgment, even if the person does not disclose abuse. The key to language is to stay neutral and descriptive rather than assumptive or judgmental.

Words matter more when a person is denying. Words like “claims,” “refuses,” and “alleged” can seem accusatory or disbelieving. Instead, use factual, objective language. Healthcare professionals should avoid language that could imply assumption or bias.

A safety plan for IPV is a personalized set of actions and reminders that a victim can use to protect themselves, and their children if they have them, from harm and remove themselves from an unsafe situation (Toof, 2024). Healthcare professionals in all healthcare settings are aptly positioned to assist victims in creating a safety plan (Childress et al., 2024).

Keep the following in mind while working on a safety plan with a IPV victim (Childress et al., 2024; Toof, 2024):

• Each plan will be a bit different depending on the individual’s specific life situations.
• Victims are unable to display their safety plan openly at home. Therefore, the patient must be able to remember the components of their plan, place it in a safe place that the partner will not find it, or leave it with a trusted person who is aware of their situation.
• Make sure to remember that cultural considerations are addressed as needed within the safety plan.
• Be careful if utilizing telehealth services when talking to these patients. Abusive partners could have installed spyware on the computer that they are using. It might be helpful to establish code words or signals to abruptly stop discussing the abuse or if the victim needs the healthcare professional to contact the authorities.

This list can give you an idea of what can be included in an IPV safety plan (Ignite Healthwise, 2025; Childress et al., 2024; Toof, 2024):

• Identify a safe place to go inside the home during altercations (a place that locks, away from weapons)
• Identify 3-4 safe places to go outside of the home (such as a neighbor’s house, fire station)
• Have a “go-bag” packed with clothing, written phone numbers, cash, prescription medications, IDs, and other important documents.
• Memorize phone numbers and addresses for supportive family members and crisis centers
• Plan an escape route to get out of the home and practice it
• Make a habit of backing in the car into the driveway and always have some gas
• Turn off location on cell phones and all apps that have a location finder
• Keep an old cell phone charged and/or consider buying a prepaid cell phone and hiding it for use in emergencies
• Teach children and/or safe family members a code word to be used so they can know to call 911
• Prepare children to know how to call 911, how to share their address, and have them memorize emergency contacts if possible
• Open a savings account in a new bank in your name only
• Confide in a close neighbor to be aware of the situation to ask them to call 911 if they hear or see anything that worries them
• Make plans for pets in the home (consider a shelter that allows you to keep your pets with you)
• Check to see if your workplace allows for family/domestic violence leave to help employees experiencing IPV
• After leaving a dangerous situation, consider changing your phone number, get a P.O. box for important mail, try to change your normal routines (different route, different bus, different shopping places), talk to a lawyer or police about getting a protection order, and alert your workplace and your children’s school(s) about any protection order

As we have discussed, there are many long and short-term effects of IPV and many of them not only affect the victim or children, but can also affect the caregivers and healthcare professionals themselves.

As the secondary victims to the story of IPV, healthcare professionals can be at risk of secondary trauma and burnout due to the stress of working with those affected by IPV. Secondary trauma, also known as secondary traumatic stress or vicarious trauma, can affect providers who are caring for others who have been traumatized, and is a normal reaction to hearing about other’s trauma and pain (Melinte & Turliuc, 2023). Secondary trauma can have the same effects as Post-Traumatic Stress Disorder (PTSD) in caregivers, such as emotional exhaustion, depersonalization, and reduced personal accomplishment at work. Signs of secondary trauma in healthcare professionals can include (Melinte & Turliuc, 2023):

• Flashbacks
• Difficulty concentrating
• Problems sleeping
• Anxiety
• Irritability
• Feeling isolated or withdrawn
• Lack of empathy

On the other hand, burnout is the result of chronic workplace stress that has not been successfully managed and can also affect the professional’s physical and mental health, as well as their job performance. There are three main areas of burnout in healthcare professionals, originally established as the Maslach Burnout Inventory (MBI), which includes (The Calm Team, 2025):

1. Emotional exhaustion (chronic fatigue and inability to cope with workplace stress)
2. Depersonalization (negative or callous feelings towards others in the workplace)
3. Reduced personal success (feelings of incompetence and lack of productivity in the workplace)

Like any patient education, providing information to patients on how to identify and cope with secondary trauma is key to recovery. It is equally important to provide this education for all staff members, as it is crucial to the long-term success and efficiency of clinical work. Melinte & Turliuc describe some tools and techniques that can be used to prevent secondary trauma and burnout in healthcare professionals (2023):

• As soon as these symptoms are identified in a coworker, it is essential to use brief grounding techniques such as breathing exercises, a short walk, or even using mindful moments, if these resources are available.
• For those experiencing secondary trauma, it is essential to practice self-compassion. This can include journaling and self-care.
• Peer support can be a powerful tool, as talking together about the difficult cases can validate staff feelings and reflect community emotions within those experiences.
• Setting professional boundaries is also an essential strategy to prevent secondary trauma and burnout.
• It is also important to stay connected to a professional purpose and be able to identify and celebrate small accomplishments. This can be something as small as a patient making it to their follow-up visit, connecting their child with a counselor, or even just leaving a bad situation.
• Administrators can help prevent secondary trauma and burnout in their staff by incorporating trauma-informed principles into workplace culture, such as predictable schedules, transparent communication, and staff recognition.

Secondary trauma and burnout are a risk in the medical field, but that does not mean we have to accept it as the norm. By following the strategies and techniques listed above, we can ensure the long-term health and happiness of ourselves and our colleagues in the field.

National Domestic Violence Hotline

The National Domestic Violence Hotline is staffed 24 hours a day by trained counselors who can provide crisis assistance and information about shelters, legal advocacy, health care centers, and counseling.

• 1-800-799-SAFE (7233)
• 1-800-787-3224 (TDD)
• Text “START” to 88788

Rape, Abuse & Incest National Network

The Rape, Abuse & Incest National Network (RAINN) is the nation's largest anti-sexual assault organization. Among its programs, RAINN created and operates the National Sexual Assault Hotline at 1-800-656-HOPE and the National Sexual Assault Online Hotline at rainn.org. This partnership features the nationwide collection of over 1,100 local rape crisis centers provides victims of sexual assault with free, confidential services, 24 hours per day, 7 days per week. These hotlines have helped over 5 million people since RAINN's founding in 1994.

• 1-800-656-HOPE (4673)

National Runaway Safeline

• 1-800-RUNAWAY (800-786-2929)

National Sexual Assault Hotline

• 1-800-656-HOPE (4673)

Abused Deaf Women’s Advocacy Services (ADWAS)

• 1-855-812-1001
• Instant messenger: DeafHotline

National Teen Dating Abuse Helpline

• 1-866-331-9474
• 1-866-331-8453 (TTY)

National Center for Victims of Crime

• 1-855-VICTIM (1-855-484-2846) (call or text)

StrongHearts Native Helpline

• 1-844-7NATIVE (762-8483)

National Human Trafficking Hotline

• 1-888-373-7888
• 711 (TTY)
• Text: 233733

Alabama:

Alabama Coalition Against Domestic Violence

• P.O. Box 4762
• Montgomery, AL 36101
• Phone: 1-800-650-6522 (in state)
• Email: info@acadv.org
• Crisis help lines are open 24 hours

Alaska:

Alaska Network on Domestic Violence and Sexual Assault

• 130 Seward Street, Room 214
• Juneau, AK 99801
• Phone: 907-586-3650
• Email: andvsa@andvsa.org 

Arizona:

Arizona Coalition Against Domestic Violence

• P.O. Box 9096
• Phoenix, AZ 85012
• Phone: 602-279-2900
• Email: info@acesdv.org

Arkansas:

• Arkansas Coalition Against Domestic Violence
• 1401 West Capitol Ave, Suite 170
• Little Rock AR 72201
• Phone: 501-907-5612
• Email: info@domesticpeace.com 

California:

California Partnership to End Domestic Violence

• P.O. Box 19005
• Long Beach, CA 90807
• Phone: 916-444-7163
• Email: info@cpedv.org 

Coalition to End Family Violence

• 1000 Town Center Drive, Suite 500
• Oxnard, CA 93036
• Phone: 1-805-983-6014

Colorado:

Alternative Horizons

• P.O. Box 503
• Durango, CO 81302
• Phone: 970-247-9619 (24-hour hotline)
• Email: info@alternativehorizons.org 

Colorado Coalition Against Domestic Violence

• 1120 Lincoln Street, Suite 900
• Denver, CO 80203
• Phone: 303-831-9632
• Email: info@violencefreeco.org

Washington, D.C.:

D.C. Coalition Against Domestic Violence

• 1101 14th Street NW, Suite 300
• Washington, DC 20005
• Phone: 202-299-1181
• Email: info@dccadv.org

My Sister's Place

• P.O. Box 21463
• Washington, DC 20009
• Phone: 202-540-1064
• Email: shelterinfo@mysistersplacedc.org 

Delaware:

Delaware Coalition Against Domestic Violence

• 100 W. 10th Street, Suite 703
• Wilmington, DE 19801
• Phone: 302-658-2958
• Email: dcadv@dcadv.org

Florida:

Harbor House of Central Florida

• P.O. Box 680748
• Orlando, FL 32868
• Email: webcontactus@harborhousefl.com 
• FL Domestic Violence Hotline: 1-800-500-1119

Georgia:

Women’s Resource Center to End Domestic Violence

• P.O. Box 171
• Decatur, GA 30031
• Phone: 404-370-7670
• Email: info@mysite.com 

Hawaii:

Hawaii State Coalition Against Domestic Violence

• P.O. Box 214
• Honolulu, HI 96810
• Phone: 808-832-9316
• Email: info@hscadv.org 

Iowa:

Iowa Coalition Against Domestic Violence

• P.O. Box 41700
• Des Moines, IA 50311
• Phone: 515-244-8028
• Email: admin@icadv.org

Idaho:

Idaho Coalition Against Sexual and Domestic Violence

• 1402 W Grove St
• Boise, ID 83702
• Phone: 208-384-0419
• Email: info@engagingvoices.org

Illinois :

Illinois Coalition Against Domestic Violence

• 806 South College Street
• Springfield, Illinois 62704
• Phone: 217-789-2830
• Email: ilcadv@springnet1.com

Between Friends

• P. O. Box 608548
• Chicago, IL 60660
• Phone: 773-274-5232
• Email: info@afriendsplace.org

Life Span

• 701 Lee Street #700
• Des Plaines, IL 60016
• 24-Hour Crisis Line: 847-824-4454
• Phone: 847-824-0382
• Email: life-span@life-span.org

Indiana:

Indiana Coalition Against Domestic Violence

• 1915 W 18th Street, Suite B
• Indianapolis, IN 46202
• Phone: 317-917-3685
• Crisis Line: 1-800-332-7385

Kansas:

Kansas Coalition Against Sexual and Domestic Violence

• 634 SW Harrison
• Topeka, KS 66603
• TOLL-FREE: 888-END-ABUSE (Kansas state-wide hotline)
• Phone: 785-232-9784
• Email: coalition@kcsdv.org 

YWCA Northeast Kansas

• 225 SW 12th Street
• Topeka, KS 66612
• Phone: 785-233-1750
• Email: info@ywcaneks.org 

Kentucky:

ZeroV

• 111 Darby Shire Circle
• Frankfort, KY 40601
• Phone: 502-209-5382
• Email: info@zerov.org 

Louisiana:

Louisiana Coalition Against Domestic Violence

• P.O. Box 77308
• Baton Rouge, LA 70879-7308
• Phone: 225-752-1296
• HOTLINE: 1-888-411-1333

Maine:

Maine Coalition to End Domestic Violence

• P.O. Box 5188
• Augusta, ME 04332
• Phone: 207-941-1194
• HOTLINE: 866-834-HELP
• Email: info@mcedv.org

Maryland:

• Maryland Network Against Domestic Violence
• 1997 Annapolis Exchange Parkway, Suite 300
• Annapolis, MD 21401
• Phone: 301-352-4574
• Email: info@mnadv.org

Massachusetts:

Jane Doe Inc./Massachusetts Coalition Against Sexual Assault and Domestic Violence

• P.O. Box 960849
• Boston, MA 02196
• Phone: 617-248-0922
• Email: info@janedoe.org

Michigan:

Bay County Women's Center

• 3411 E. Midland Rd.
• Bay City, MI 48706
• Phone: 989-686-2251
• Michigan 24-Hour Crisis Line: 800-834-2098

Minnesota:

Violence Free Minnesota

• 60 East Plato Blvd., Suite 230
• St. Paul, MN 55107
• Phone: 866-223-1111
• Email: mcbw@pclink.com

Missouri:

Missouri Coalition Against Domestic Violence

• 217 Oscar Dr., Suite A
• Jefferson City, MO 65101
• Phone: 573-634-4161

Community Women Against Hardship

• 3963 W. Belle Pl
• St. Louis, MO 63108
• Office: 314-289-7523

Mississippi:

Mississippi State Coalition Against Domestic Violence

• P.O. Box 4703
• Jackson, MS 39296-4703
• HOTLINE: 800-898-3234
• After Hours HOTLINE: 1-800-799-7233
• Phone: 601-981-9196
• Email: support@mcadv.org 

Montana:

Montana Coalition Against Domestic and Sexual Violence

• P.O. Box 818
• Helena, MT 59624
• Phone: 406-443-7794

Nebraska:

Nebraska Coalition to End Sexual and Domestic Violence

• 245 S. 84th Street, Suite 200
• Lincoln, NE 68510
• Phone: 402-476-6256

Nevada:

Nevada Coalition to End Domestic Violence and Sexual Violence

• 250 South Rock Blvd., Suite 116
• Reno, NV 89502
• Phone: 775-828-1115

Safe House

• 921 American Pacific Dr., Suite 300
• Henderson, NV 89014
• Phone: 702-451-4203
• HOTLINE: 702-564-3227 

New Hampshire:

New Hampshire Coalition Against Domestic and Sexual Violence

• P.O. Box 353
• Concord, NH 03302-0353
• TOLL-FREE For Domestic Violence: 866-644-3574
• TOLL-FREE For Sexual Assault: 1-800-277-5570
• Phone: 603-224-8893

New Jersey:

New Jersey Coalition to End Domestic Violence

• 1 N Johnston Ave
• Hamilton, NJ 08609-1806
• Phone: 609-584-8107
• HOTLINE: 1-800-572-7233
• Email: info@njcbw.org

Strengthen Our Sisters

• P.O. Box 1089
• Hewitt, NJ 07421
• HOTLINE: 973-831-0898
• Office: 973-728-0059
• Email: info@strengthenoursisters.org 

New Mexico:

New Mexico State Coalition Against Domestic Violence

• 3167 San Mateo NE
• Albuquerque, NM 87110
• Legal Helpline: 800-209-DVLH
• Phone: 505-246-9240
• Email: info@nmcadv.org

New York:

New York State Coalition Against Domestic Violence

• 119 Washington Avenue
• Albany, New York 12210
• Phone: 518-482-5465
• English: 1-800-942-6906
• Spanish: 1-800-942-6908
• Email us at nyscadv@nyscadv.org

North Carolina:

North Carolina Coalition Against Domestic Violence

• 3710 University Drive, Suite 300
• Durham, NC 27707
• Phone: 919-956-9124
• HOTLINE: 1-888-232-9124

North Dakota:

North Dakota Council on Abused Women's Services

• State Networking Office
• 418 East Rosser Avenue, Suite 320
• Bismarck, ND 58501
• Phone: 701-255-6240

Ohio:

Ohio Domestic Violence Network

• 174 E Long Street, Suite 200
• Columbus, Ohio 43215
• Phone: 614-781-9651
• HOTLINE: 1-800-934-9840
• Email: info@odvn.org

Oklahoma:

Oklahoma Coalition Against Domestic Violence and Sexual Assault

• 174 E Long Street, Suite 200
• Oklahoma City, OK 73118
• Telephone: 405-524-0700
• Email: info@ocadvsa.org

Oregon:

Oregon Coalition Against Domestic Violence and Sexual Assault

• 9320 SW Barbur Blvd., Suite 250
• Portland, OR 97219
• Telephone: 503-230-1951
• Statewide Crisis Number: 1-888-235-5333
• Email: Info@ocadsv.org 

Pennsylvania:

Pennsylvania Coalition Against Domestic Violence/National Resource Center on Domestic Violence

• 3501 N Front Street, Suite 200
• Harrisburg, PA 17110
• Phone: 717-545-6400

Women's Center of Montgomery County

Main Administrative Office:

• 101 Washington Lane, Ste. WC-1
• Jenkintown PA 19046
• Email: wcwebmail@womenscentermc.org 

Norristown Office: 

• Women's Advocacy Project
• 400 Courthouse Plaza, 18 W. Airy St.
• Norristown PA 19404
• Phone: 610-279-1548

Pottstown Office:

• Women's Advocacy Project
• 555 High Street, 2nd Floor
• Pottstown PA 19464
• Phone: 610-970-7363

Bryn Mawr Office: 

• Phone: 610-525-1427

Lansdale Office: 

• Phone: 215-853-8060

Laurel House

• P.O. Box 764
• Norristown, PA 19404
• Phone: 610-277-1860
• HOTLINE: 1-800-642-3150
• Email: info@laurel-house.org

Rhode Island:

Rhode Island Coalition Against Domestic Violence

• 641 Bald Hill Rd., Suite 1
• Warwick, RI 02886
• HOTLINE: 800-494-8100
• Phone: 401-467-9940
• Email: ricadv@ricadv.org

South Carolina:

South Carolina Coalition Against Domestic Violence & Sexual Assault

• P.O. Box 7776
• Columbia, SC 29202-7776
• Phone: 803-256-2900

South Dakota:

South Dakota Coalition Against Domestic Violence and Sexual Assault

• P.O. Box 141
• Pierre, SD 57501
• HOTLINE: 800-430-7233
• Phone: 605-945-0869

• P.O. Box 1402
• Sioux Falls, SD 57101
• Phone: 605-271-3171

Safe Harbor

• 2005 S. Merton Street
• Aberdeen, SD 57401
• Phone: 605-226-1212
• Email: safeharbor@safeharborsd.org 

Tennessee:

Tennessee Task Force Against Domestic Violence

• 2 International Plaza Dr., Suite 425
• Nashville, TN 37217
• Phone: 615-386-9406
• Email: webmistress@tcadsv.org

Texas:

Texas Council on Family Violence

• P.O. Box 163865
• Austin, TX 78716
• Phone: 512-794-1133

Families In Crisis, Inc.

• P.O. Box 25
• Killeen, Texas 76540
• Phone: 254-773-7765

Utah:

Utah Domestic Violence Coalition

• 124 S 400 E, Suite 430
• Salt Lake City, UT 84111
• Phone: 801-521-5548
• Email: admin@udvc.org 

Vermont :

Women Helping Battered Women

• P.O. BOX 1535
• Burlington, VT
• Phone: 802-658-3131
• HOTLINE: 802-658-1996
• Email: whbw@whbw.org 

Vermont Network Against Domestic Violence and Sexual Assault

• P.O. Box 405
• Montpelier, VT 05601
• Phone: 802-223-1302
• 24 Hour HOTLINE: 1-800-228-7395
• Email: info@vtnetwork.org

Virginia:

Virginia Sexual and Domestic Violence Action Alliance 

• P.O. Box 4342
• Richmond, VA 23220
• Phone: 804-377-0335
• Email: info@vsdvalliance.org

Washington:

Washington State Coalition Against Domestic Violence

WSCADV- Olympia Office

• 711 Capitol Way, Suite 207
• Olympia, WA 98501
• Phone: 360-586-1022

WSCADV- Seattle Office

• 1402 3rd Ave, Suite 406
• Seattle WA 98101
• 206-389-2515
• Email: wscadv@wscadv.org

West Virginia:

West Virginia Coalition Against Domestic Violence

• 400 Patterson Lane
• Charleston, WV 25311
• Phone: 304-965-3552

Wisconsin:

Manitowoc County Domestic Violence Center

• 300 E. Reed Ave.
• Manitowoc, WI 54220
• Phone: 1-920-684-5770
• HOTLINE: 877-275-6888
• Email: incourage@incouragewi.org 

Wisconsin Coalition Against Domestic Violence

• 1400 E. Washington Ave. Suite 227
• Madison, WI 53703
• Phone: 608-255-0539

Wyoming:

Wyoming Coalition Against Domestic Violence and Sexual Assault

• P.O. Box 236
• 710 Garfield Street, Suite 218
• Laramie, WY 82073
• Phone: 307-755-0992
• Email: info@wyomingdvsa.org

Futures Without Violence

Main Office:

• 100 Montgomery Street, The Presidio
• San Francisco, CA 94129
• Phone: 415-678-5500
• Email: info@futureswithoutviolence.org

Washington, DC Office

• 1101 Connecticut Ave NW
• Suite #1050
• Washington, D.C. 20036

Boston Office

• CIC c/o Futures Without Violence
• 50 Milk St., 16th floor,
• Boston, MA 02109-5009

National Coalition Against Domestic Violence

• P.O. Box 90249
• Austin, Texas 78709
• Phone: 737-225-3150

National Battered Women's Justice Project

• 540 Fairview Avenue N, Suite 208
• St. Paul, MN 55104
• Phone: 800-903-0111
• Email: technicalassistance@bwjp.org 

Safe Horizon

• 2 Lafayette Street, 3rd Floor
• New York, NY 10007
• Crime Victims HOTLINE: 1-800-621-4673
• Rape and Sexual Assault & Incest HOTLINE: 212-227-3000
• Email: website@safehorizon.org

Resource Center on Domestic Violence, Child Protection, and Custody

National Council of Juvenile and Family Court Judges (NCJFCJ)

• P.O. Box 8970
• Reno, NV 89507
• Phone: 775-507-4777
• Email: contactus@ncjfcj.org 

The National Defense Center for Criminalized Survivors

Previously known as the National Clearinghouse for the Defense of Battered Women, The National Defense Center for Criminalized Survivors is a national resource and advocacy center providing assistance to women defendants, their defense attorneys, and other members of their defense teams in an effort to ensure justice for battered women charged with crimes.

• 125 South 9th Street, Suite 302
• Philadelphia, PA 19107
• Phone: 215-351-0010

Faith Trust Institute

• 2400 N. 45th Street #10
• Seattle, WA 98103
• Phone: 206-634-1903, ext. 10
• Email: info@faithtrustinstitute.org

National Network to End Domestic Violence

• 1325 Massachusetts Ave NW
• Washington, DC 20005-4188
• Phone: 202-543-5566
• HOTLINE: 800-799-SAFE (7233)

National Center for Victims of Crime (NCVC)

• A thorough national resource committed to advancing victims’ rights and helping victims of crime rebuild their lives. It is devoted to serving individuals, families, and communities harmed by crime.
  • P.O. Box 2770
  • Hyattsville, MD 20784

National Domestic Violence and Housing Technical Assistance Consortium

• This organization provides training, resource development, and technical assistance at the critical intersection of domestic and sexual violence, housing, and homelessness.

Family Violence Prevention & Services Act Program

• This program is the primary federal funding project dedicated to supporting emergency shelters and related assistance for victims of domestic violence and their children, under the U.S. Department of Health and Human Services.

Office for Victims of Crime – Direct Services for Victims

• A list of direct services through the Department of Justice’s Office of Victims of Crime.
  • 999 N Capitol Street NE
  • Washington, DC 20531

Office on Violence Against Women (OVW)

• In conjunction with the U.S. Department of Justice, this office provides federal leadership in seeking justice for victims of domestic violence, dating violence, sexual assault, and stalking.
  • U.S. Department of Justice
  • 145 N Street NE
  • Washington, DC 20530
  • Phone: 202-307-6026

Victim Connect Resource Map

• A search tool with national and local resources that can be filtered by keywords, categories, services, and location.
  • Call/Text: 855-484-2846