Tiered Intervention & Safety Response
A tiered response ensures that every positive screen receives a proportionate, survivor-centered response. Tiers should be defined in your protocol and communicated through training across care management and clinical staff.
- Tier 1 — Universal Education: All patients receive CUES education regardless of screen result. Document delivery and code using the CUES SNOMED code.
- Tier 2 — Disclosure Response: Member screens positive or discloses. Offer immediate support, care plan modification, safety planning resources, and warm referral to CBO consistent with the member consent. Document response, referral, and code as appropriate.
- Safety note: Engage in readiness for change approaches. If a member declines a referral, validate their self-determination and provide universal education. The goal is not solely focused on referral acceptance; rather it is on building a trusting foundation for if and when a member is ready to seek support.
- Tier 3 — High-Acuity Safety Response: Member indicates immediate danger. Activate safety planning protocol. Connect to 24/7 resources (National DV Hotline: 1-800-799-7233). Document and follow up within 24 to48 hours and code as appropriate.
Implementation Tip: After-Hours Coverage
Map your after-hours disclosure pathway before you launch. At minimum, every care manager and provider should have the National Domestic Violence Hotline number (1-800-799-7233) and know to refer members who disclose outside business hours.
Case Study: IPV SDOH Integration
CalOptima Health Plan integrated their IPV response within their larger social driver of health (SDOH) framework. This framework embraces the CUES model across all levels (from all members to specialty care) with mapped referral closure, follow up recommendations, and metrics.
Level 1 — All Members: Broad outreach and CUES delivery through newsletters and outreach scripts.
Level 2 — Provider Screening: IPV screening embedded in annual and new visits. Providers are responsible for referrals and documentation, including z-codes.
Level 3 — Care Management Screening: Deep assessment through the HRA and/or SDOH screener delivered by the ECM care manager. Follow ECM Closed loop protocol, and IPV is added to the care plan as appropriate.
PopHealth Learning Center, IPV Community of Practice, 2026
Special Population Pathways
IPV programming should include population-specific considerations for the following groups:
- Maternal and Perinatal: Embed CUES and a screening tool at prenatal intake and postpartum visits. Train OB/GYN, CNM, and doula providers. (See dedicated Birthing Pathway chapter.)
- Reproductive Health: Chlamydia screening visits and reproductive health encounters are natural touchpoints for the CUES intervention. Adapt care plans to take partner interference into consideration.
- Pediatric and Adolescent: Develop age-appropriate protocols for members ages 13–17. Screen caregivers at well-child visits. Children may be directly or indirectly impacted by exposure to IPV in the home. Note that teen dating violence is prevalent: 1 in 3 students experience some form of relationship abuse, and a majority do not report this to their parents or caregivers. Find additional information on teen dating violence here.
- Disability Populations: Members with disabilities may be at higher risk of being abused. Home health services, ECM, and respite services can be mechanisms to provide resources, education, and screening for members with increased vulnerability.
- Behavioral Health: Co-screen for IPV at behavioral health intake. Train BH care managers on CUES, and adapt care plans to take into account the nuances of IPV (such as partner coercion). Build referral pathways from BH to IPV CBOs. (Opportunity to embed in the ECM provider network.)
- Housing and Unhoused: Members experiencing homelessness have elevated IPV risk. Coordinate IPV screening with housing navigation protocols. Ensure CBOs serving unhoused members are in your network. (Opportunity to embed in the ECM provider network.)