Intimate Partner Violence Implementation Toolkit

IPV Screening & Response

Universal education and support should be paired with direct inquiry or screening. After conducting universal education, you can select and standardize a validated screening tool across your provider network. The Gravity project lifts up:1

  • HARK (Humiliation, Afraid, Rape, Kick): 4-item tool, validated for use in primary care and prenatal settings. Recommended for perinatal populations. (Recommended)2
  • HITS (Hurt, Insult, Threaten, Scream): 4-item tool, validated across multiple populations including male and LGBTQ+ patients.3
  • HRA integration: Embed IPV screening questions into existing Health-Related Social Needs or Health Risk Assessment tools to reduce documentation burden.
    • Tip: Add explicit IPV screening questions in the Enhanced Care Management Comprehensive Assessment tool to broadly screen for IPV within ECM provider networks. Add in the CUES framework for best-practice facilitation amongst care managers.
  • HRSN screening tools: Several Health-Related Social Needs screening tools embed IPV screening questions. The Accountable Health Communities Screening Tool includes four safety questions applicable to IPV. This tool meets criteria for the SNS-E HEDIS measure requirements. A comprehensive overview of HRSN tools that screen for IPV can be found at the UCSF SIREN Network.4

Birthing Care Pathway

Perinatal Screening Standard: IPV screening should occur at the first prenatal visit and again at the postpartum visit. Screening at both touchpoints is aligned with the USPSTF Grade B recommendation and DHCS Birthing Care Pathway requirements. OB/GYN practices in your network should use HARK as the primary tool and document results with the appropriate ICD-10 Z codes.

  1. The Gravity Project (HL7 Da Vinci). Intimate Partner Violence. Standardized social risk data elements, including HARK and HITS value sets, are published in the Value Set Authority Center (VSAC). https://confluence.hl7.org/spaces/GRAV/pages/104562807/Intimate+Partner+Violence ↩︎
  2. Sohal H, Eldridge S, Feder G. The sensitivity and specificity of four questions (HARK) to identify intimate partner violence: a diagnostic accuracy study in general practice. BMC Fam Pract. 2007;8:49. DOI: 10.1186/1471-2296-8-49. ↩︎
  3. Feltner C, Wallace I, Berkman N, et al. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;320(16):1688–1701. ↩︎
  4. 23 Cartier Y, Fichtenberg C, Gottlieb L. Screening Tools Comparison Table. Social Interventions Research & Evaluation Network (SIREN), University of California, San Francisco. https://sirenetwork.ucsf.edu/tools-resources/resources/screening-tools-comparison-tables ↩︎
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