Enhancing Emergency Preparedness in Health Centers for Addressing IPV, HT, and Exploitation
Authored by Dana Trampas, Kimberly Chang, MD, MPH, and Anna Marjavi

PURPOSE:
This educational brief outlines strategies for enhancing emergency p reparedness in health centers
 (HCs), focusing on intimate p artner violence (IPV), human trafficking (HT), and exploitation(E). By implementing improved protocols and strengthening community collaborations, HCs can better serve populations during p ublic health emergencies and natural disasters.
THE ISSUE:
Health Centers (HCs) provide essential care to 32.5 million people annually, including those uninsured and impoverished. IPV is a prevalent issue with 1 in 2 women and 2 in 5 men report having experienced IPV in their lifetime. Survivors of IPV, HT, and E experience a range of adverse health issues. Emergencies increase the incidence as survivors face heightened isolation and reduced access to services, making it critical for HCs to strengthen their preparedness.
BACKGROUND:
Historical data show that crises exacerbate rates of IPV and HT/E. For instance, reports of abuse and
human trafficking surged during Hurricane Katrina and other public health emergencies.

MITIGATION (PRE-CRISIS)
Actions taken to prevent or reduce the causes and impacts of disasters. HCs can:

Formalize p artnerships with community -based domestic and sexual violence (D/SV) p rograms, and anti-trafficking programs.
Adopt the CUES Intervention and educate all staff on the dynamics of IPV and lessons learned from recent disasters or public health emergencies.
Coordinate with state and local health departments as part of their emergency management planning, preparedness, mitigation, and response efforts.
Develop p artnerships with legal services and establish connections with culturally specific programs (e.g., elder, youth, community centers, etc.).
Integrate healing-centered non-clinical factors of health assessments into routine care to better understand patient needs and risks.
Conduct an area-specific risk evaluation by analyzing the most likely future disasters in the local area, paired with a community needs assessment.
Consider impacts of IPV/HT/E on staff and implement workplace p olicies.

PREPAREDNESS  (PRE-CRISIS)
Planning, training, and educational initiatives. It’s not a question of whether a crisis will occur, but rather when it will occur:

Adapt p rotocols for identifying and responding to IPV, HT, and E during emergencies, ensuring all patients receive education about available resources.
Invest in comprehensive staff training, focusing on empathic listening, healing-centered care, and emergency preparedness.
Establish memoranda of understandings (MOUs) with community organizations specializing in IPV and HT to ensure seamless referrals during a crisis.
Ensure that emergency alert systems include in-language alerts and audio-only formats for people with limited English proficiency or limited literacy.
Evaluate compliance with Emergency Preparedness regulations to participate in the Medicare or Medicaid program.

RECOVERY  (POST-CRISIS)
Efforts to restore services occur alongside regular operations:

Provide universal education about legal, social, and safety resources through the evidence-based CUES intervention, collaborating with community partners.
Evaluate the response post-emergency to assess effectiveness and improve future preparedness plans. Debrief with staff and CBO partners to assess what worked well and needs improvement.
Gather feedback from patients/survivors about the HC's emergency response and community referrals.

RESPONSE (CRISIS)
Occurs immediately after a disaster, and involves implementing disaster response plans:

Utilize PRAPARE assessments to identify patient needs and guide response efforts.
Develop a communication p lan to keep p atients informed during an emergency, including details on IPV and exploitation resources.
Leverage EHR sy stems to identify patients with a history of IPV, HT/E, enabling health centers to proactively reach out to check on their well-being and provide timely support during a crisis.
Maintain p atient confidentiality during public health emergencies and disruptions.
Connect with community p artners to identify real-time needs, necessary pivots, and opportunities to strengthen outreach and response.

Health Centers May Effectively Address IPV, HT, and Exploitation by:

1.	Standardizing universal education on available resources.
2.	Enhancing data collection through comprehensive non-clinical factors of health assessments and UDS. 3. Strengthening partnerships with community organizations.
4. Training all staff in healing-centered approaches, universal education, and emergency preparedness.

About Health Partners on IPV + Exploitation

Health Partners on IPV + Exploitation offers health center staff education on how to build partnerships, develop policy, and integrate processes designed to promote prevention and increase the identification and referral to supportive services for individuals at risk for, experiencing, or surviving intimate partner violence, human trafficking and exploitation.

Email: heathpartners@futureswithoutviolence.org Website: https://healthpartnersipve.org/
Visit www.IPVHealthPartners.org, an online toolkit on how to build partnerships between community health centers and domestic violence programs to support survivor health.

 Resources from Health Partners on IPV + Exploitation	

Addressing IPV and Exploitation in Health Centers (CUES infographic). Health Partners on IPV + Exploitation. (2024). healthpartnersipve.org/resources/addressing-ipv-and-exploitation-in-health-centers-cues-infographic/
Building Partnerships for Health Providers. IPV Health Partners. (2024, May 20). ipvhealthpartners.org/partner/
Emergency Preparedness Resource Library. Health Partners on IPV + Exploitation. (2024). healthpartnersipve.org/resources/emergency -preparedness/
Futures Without Violence Cues Videos. Health Partners on IPV + Exploitation. (2024). healthpartnersipve.org/resources/futures-without-violence-cues-videos/
Health Information Technology Resource Library. Health Partners on IPV + Exploitation. (2024d). healthpartnersipve.org/resources/health-information-technology
Legal Partnership Resource Library. Health Partners on IPV + Exploitation. (2024). healthpartnersipve.org/resources/medical-legal/
Privacy principles for protecting survivors of IPV, E and HT in healthcare settings. Health Partners on IPV + Exploitation. (2024). healthpartnersipve.org/resources/privacyprinciples/
Sample Health Center Protocol. Health Partners on IPV + Exploitation. (2024). healthpartnersipve.org/resources/sample-health-center-protocol/
Sample memorandum of understanding. Health Partners on IPV + Exploitation. (2024). healthpartnersipve.org/resources/sample-memorandum-of-understanding/
Training and Webinar Resource Library. Health Partners on IPV + Exploitation. (2024). healthpartnersipve.org/resources/archived-webinar/

 References and Resources	
Anastario, M., Shehab, N., & Lawry, L. (2009). Increased gender-based violence among women internally displaced in Mississippi 2 years post–Hurricane Katrina. Disaster Medicine and Public Health Preparedness, 3(1), 18–26. doi.org/10.1097/dmp.0b013e3181979c32
Cannon, C. E., Ferreira, R., Buttell, F., & O’Connor, A. (2023). Intimate partner violence survivorship, posttraumatic stress disorder and disaster: Implications for future disasters. Violence Against Women, 30(12–13), 3251–3271. doi.org/10.1177/10778012231176205
Community Needs Assessment. Bureau of Primary Health Care. (2024). bphc.hrsa.gov/compliance/compliance- manual/chapter3
Emergency preparedness rule. CMS.gov. (2024). cms.gov/medicare/health-safety -standards/quality -safety - oversight-emergency -preparedness/emergency -preparedness-rule
Evans, M. L., Lindauer, M., & Farrell, M. E. (2020). A pandemic within a pandemic — intimate partner violence during covid-19. New England Journal of Medicine, 383(24), 2302–2304. doi.org/10.1056/nejmp2024046
Hoogesteyn, K., McCallum Desselle, L., Barrick, K., Pfeffer, R., & Vollinger, L. (2024). The intersection of human trafficking and natural disasters: A scoping review. Trauma, Violence, &amp; Abuse, 25(4), 2877–2890. doi.org/10.1177/15248380241227985
Model gender-based violence and harassment policy. Workplaces Respond. (2024). workplacesrespond.org/resources/model-gender-based-violence-and-harassment-policy
The National Intimate Partner and Sexual Violence Survey. CDC.gov. (2018). cdc.gov/nisvs/documentation/NISVSReportonIPV_2022.pdf
National Risk and Capability Assessment. FEMA.gov. (2024). fema.gov/emergency -managers/national- preparedness/goal/risk-capability -assessment#spr
Program Monitoring and Data Reporting Systems. Bureau of Primary Healthcare (HRSA). (2024). bphc.hrsa.gov/compliance/compliance-manual/chapter18
Protocol for Responding to & Assessing Patients’ Assets, Risks & Experiences (PRAPARE). PRAPARE. (2024). prapare.org/
Sustaining Essential Health Care Services Related to Intimate Partner Violence During Public Health Emergencies. Nationalacademies.org. (2024). nationalacademies.org/our-work/sustaining-essential-health-care-services- related-to-intimate-partner-violence-during-public-health-emergencies
Threat and hazard identification and risk assessment (THIRA) Comprehensive Preparedness Guide. Cybersecurity and Infrastructure Security Agency CISA. (2024). cisa.gov/resources-tools/resources/threat-and-hazard- identification-and-risk-assessment-thira-comprehensive
U.S. National Library of Medicine. (2024). Health effects of IPV on individuals experiencing IPV across the lifespan. Essential Health Care Services Addressing Intimate Partner Violence. ncbi.nlm.nih.gov/books/NBK605462/

This publication was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award to Health Partners on IPV and Exploitation (Futures Without Violence) totaling $679,175.00 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit www.HRSA.gov.

Revised June 2025	4