Universal Education & Support
Evidence indicates that screening alone is insufficient. Effective IPV programming requires universal education, validated screening tools, tiered response workflows, and meaningful referral pathways, all of which should be implemented with fidelity to trauma-informed, healing-centered principles.
The CUES Framework
CUES (Confidentiality, Universal Education, Empowerment, and Support) is the evidence-based framework for IPV education and response.1 It is designed to be delivered universally — to all patients, not just those who screen positive — and is grounded in survivor-centered, trauma-informed principles.
Confidentiality
Establish the limits of confidentiality before the conversation begins. Explain what will and will not be shared, and with whom.
Universal Education + Empowerment
Offer education universally to all patients — not just those who appear at risk. Normalize the conversation and empower patients with information.
Support
Respond to disclosures with safety planning, warm referrals, and ongoing support. Do not pressure — follow the survivor’s lead.
Why CUES Matters
Most clinical domains begin with a validated screening instrument—the PHQ-9 for depression, the AUDIT-C for alcohol use—on the premise that a positive screen leads directly to disclosure and treatment. IPV does not always follow that logic: Disclosure can carry real safety risk, many survivors are not ready or not safe to name what is happening, and a screen-first approach places the burden of self-identification on the person with the least power in the room. The USPSTF Grade B recommendation pairs screening for IPV with the provision of, or referral to, ongoing support services; CUES operationalizes that pairing by establishing the limits of confidentiality first and leading with universal education, so every member receives the same information about healthy relationships and available support, whether or not they disclose. Because that message is universal rather than triggered by a positive screen, it travels well beyond the exam room; care management calls, CHW services, outreach scripts, member newsletters, and safety cards all become CUES touchpoints, which matters as multiple points of entry for care is critical.
The research is promising: Universal education models have demonstrated a threefold increase in disclosure amongst youth who have experienced relationship abuse.2 The approach is especially consequential in perinatal care, where the Birthing Care Pathway sets defined screening touchpoints (see Section 8) and where education offered at every contact destigmatizes the topic, builds safety, and empowers the survivor to make their own choice.
Visit IPV Health(opens in new tab) for a comprehensive CUES overview and training modules.
Survivor Voice – Approaching the conversation
“Even if the provider is unsure of how to approach the conversation, universally saying ‘We have all of these resources that we like to give to our patients. Are you okay taking them?’ [is important].
So that way you don’t make the person feel like you’re singling them out, because that can also feel very isolating. When you say this, you’re giving them the power back, you’re giving them the resources, and you’re not putting the pressure on them to make a decision in that moment to talk about something that they may not be ready to talk about. And they leave that conversation with materials to understand what they’re going through.”
Implementation Tip: Outreach Scripting & Member-Facing Educational Materials
CUES can be delivered broadly through written communications and outreach calls, in addition to patient-facing settings (e.g., waiting rooms, provider delivery during encounters). Standardized materials to support outreach activities and member-facing educational materials strengthen large-scale reach to members. Start with the tested materials developed by fellow managed care plans and partners:
- Sample Outreach Script(opens in new tab) (Developed by Blue Shield of California in partnership with Futures without Violence)
- Sample Newsletter copy(opens in new tab) (Developed by Kern Family Health Plan)
- General Health Safety Card(opens in new tab) (Developed by Futures Without Violence)
Case Study: IPV Points of Care through Community Resource Centers & Hubs
Managed Care Plans that operate or partner with community resource centers or community hubs can maximize universal member outreach through embedding materials and training center staff on IPV. Two MCPs piloted this approach, yielding promising results.
Blue Shield Promise: In a joint initiative with L.A. Care, Blue Shield Promise invested in IPV education and training across 14 Los Angeles-based community resource centers (CRCs). These community-based member hubs provide access to preventive health services, social supports, food pantries, community classes, and connections to local resources. The MCP tested implementation of CUES across these centers by training frontline and managerial staff, facilitating monthly meetings with case studies and examples of IPV-related interactions with members, and providing multilingual print resources with IPV education and safety-planning (including FUTURES CUES Cards). During the testing period, staff reported an increase in member-prompted inquiries related to IPV topics such as healthy relationships. CRC staff also voiced improved confidence in their skills to respond to IPV disclosures.
Molina Health Plan: The emerging results from Blue Shield’s pilot sparked interest from Molina, which applied a similar model to their One-Stop Help Centers. They identified a natural starting point: their monthly community baby shower activities. This opened a new entry of IPV care to their perinatal members by implementing a CUES messaging strategy to their existing outreach structure. Molina is in the early implementation stage and will be monitoring the learnings and outcomes.
PopHealth Learning Center, IPV Community of Practice, 2026
Birthing Care Pathway
Birthing Pathway Policy Requirement: Policies must explicitly address IPV screening and response in perinatal settings, including prenatal visits, postpartum care, and care management touchpoints for pregnant and recently postpartum members. Provider contract amendments for OB/GYN and maternal health providers should include CUES training requirements.
- Futures Without Violence developed CUES (Confidentiality, Universal Education + Empowerment, Support) as an evidence-based, trauma-informed intervention for addressing intimate partner violence in health care settings. See Futures Without Violence, ipvhealth.org(opens in new tab). ↩︎
- Miller E, Tancredi DJ, Decker MR, et al. A family planning clinic-based intervention to address reproductive coercion: a cluster randomized controlled trial. Contraception.2016;94(1):58 67. doi:10.1016/j.contraception.2016.02.009 ↩︎