Hospital & Healthcare Coordination Pathways
A guide for hospitals and clinical teams integrating DV support pathways into emergency rooms, outpatient clinics, and community health programs.
Healthcare Coordination for Domestic Violence Response
Purpose and Scope
This page outlines operational models for coordination between healthcare systems and domestic violence (DV) organizations, including standardized screening workflows, referral pathways, cross-training mechanisms with shelters, and alignment with provincial/state health ministries.
The content is intended for hospitals, clinics, community health centers, DV agencies, shelters, coalitions, and health authorities developing or refining interagency agreements and protocols.
Core Components of Healthcare–DV Coordination
Healthcare coordination structures typically include the following components:
- Defined DV screening workflows embedded in clinical processes
- Standardized referral pathways to DV and related services
- Cross-training agreements between healthcare entities and shelters
- Formalized engagement with provincial/state health ministries or departments of health
- Data-sharing and reporting parameters that respect privacy and regulatory frameworks
- Governance mechanisms, such as steering committees or workgroups, that include health and DV partners
DV Screening Workflows in Healthcare Settings
DV screening workflows should be designed as repeatable operational processes that fit within existing clinical routines, documentation systems, and quality improvement structures.
Screening Framework and Levels
Organizations can define tiered screening levels to structure practice:
- Universal Screening: Offered to all patients in designated departments (e.g., emergency, primary care, obstetrics, mental health), with clear inclusion/exclusion criteria.
- Targeted Screening: Conducted when specific clinical or social indicators are present (e.g., unexplained injuries, frequent visits, reported relationship conflict).
- Clinical Inquiry: Professional judgment-based inquiry aligned with specialty practice (e.g., behavioral health, pediatrics, geriatrics).
Workflow Design Elements
Operational workflow design typically addresses:
- Trigger Points: When screening is initiated (intake, triage, annual wellness visit, prenatal visit, mental health assessment).
- Responsible Roles: Which staff conduct screening (nurses, physicians, social workers, behavioral health staff, community health workers).
- Screening Instruments: Standardized question sets or tools endorsed by the organization’s clinical leadership.
- Documentation: Where and how screening results are documented (EHR fields, templates, flags) and how access is controlled.
- Immediate Response: Operational steps when concerns are identified (offer information, engage onsite social work, initiate referral workflows).
Standard Operating Procedure (SOP) Components
A DV screening SOP in healthcare settings generally includes:
- Purpose, scope, and definitions (e.g., DV, intimate partner violence, family violence)
- Staff roles and responsibilities (clinical, administrative, security, social work)
- Approved screening questions and decision pathways
- Process for warm handoffs to internal resources (social work, behavioral health, patient navigators)
- Linkages to external DV agencies, shelters, and legal aid partners
- Quality monitoring (audit cycles, compliance checks, feedback loops)
Referral Pathways from Healthcare to DV Services
Referral pathways operationalize the connection between healthcare settings and DV service providers, including shelters, advocacy organizations, and legal aid partners.
Types of Referral Pathways
Common models include:
- Warm Referral: Real-time connection facilitated by a healthcare staff member (e.g., calling a DV agency while the patient is present, introducing the advocate by phone or onsite).
- Embedded or Co-Located Advocate: DV agency staff working onsite in healthcare settings with defined coverage schedules and referral criteria.
- Structured External Referral: Use of standardized referral forms or electronic referrals routed to partner agencies.
- Navigation Pathways: Internal patient navigators or social workers who coordinate multiple referrals (DV services, housing, legal, mental health).
Key Elements of a Referral Protocol
Referral protocols can standardize expectations across health and DV partners:
- Eligibility and Prioritization: Agreed parameters for who is best served by which DV partners (e.g., geographic coverage, language, special populations).
- Referral Mechanism: Phone, secure email, electronic referral platform, or shared intake portal, with clear instructions for staff.
- Timing Expectations: Response time targets (e.g., same-day callback during business hours, defined after-hours procedures).
- Information Fields: Minimum necessary information to initiate a referral, consistent with privacy requirements and patient consent policies.
- Feedback Loop: Mechanisms for DV partners to confirm receipt and disposition of referrals where appropriate and permitted.
Memoranda of Understanding (MOUs) for Referrals
MOUs between healthcare organizations and DV agencies can articulate:
- Purpose and scope of the partnership
- Referral criteria and processes, including priority cases and service limitations
- Communication expectations, contact points, and escalation channels
- Data-sharing parameters, including aggregate reporting options
- Training and cross-training commitments
- Review cycles and governance structures (e.g., joint steering committee)
Cross-Training with Shelters and DV Agencies
Cross-training supports consistent understanding of roles, capabilities, and constraints across healthcare and DV systems, yielding clearer coordination and reduced duplication.
Cross-Training Objectives
Typical objectives include:
- Familiarity with shelter admission processes and service scope
- Shared understanding of healthcare processes (triage, discharge, outpatient follow-up)
- Clarification of information-sharing boundaries and consent practices
- Alignment on expectations for advocacy within healthcare environments
- Development of joint problem-solving approaches for complex cases
Training Structures and Formats
Multi-agency partners may consider the following structures:
- Foundational Sessions: Introductory training for new staff that covers partner roles, services, and referral processes.
- Role-Specific Modules: Tailored sessions for clinicians, social workers, front-desk staff, security staff, and shelter advocates.
- Scenario-Based Workshops: Joint tabletop exercises to test workflows, including hospital-to-shelter referrals, coordination with child-serving systems, and discharge planning.
- Shadowing and Observation: Time-limited observation opportunities (where appropriate and compliant with privacy policies) to understand day-to-day operations.
- Annual Refresher Training: Scheduled updates on protocol changes, new services, or policy shifts.
Training Governance and Documentation
To maintain consistency and accountability, partners can:
- Assign cross-training leads in both healthcare and DV organizations
- Maintain a shared training calendar and attendance tracking
- Document curricula, learning outcomes, and evaluation methods
- Set intervals for reviewing and updating training materials
- Integrate cross-training expectations into MOUs and partnership agreements
Coordination with Provincial/State Health Ministries
Engagement with provincial or state health ministries (or departments of health) supports alignment with jurisdictional priorities, funding mechanisms, and reporting requirements.
Roles of Health Ministries in DV-Health Coordination
Health ministries may provide:
- Strategic frameworks and policy directives on DV and health
- Funding programs for DV-health integration projects or pilots
- Guidance on data standards, indicators, and reporting expectations
- Support for province-/state-wide training and capacity-building initiatives
- Linkages to other government departments (justice, social services, housing)
Engagement Mechanisms
Healthcare and DV organizations can interface with health ministries through:
- Formal Advisory Committees: DV-health advisory groups convened or endorsed by the ministry.
- Regional Planning Tables: Health region or local health integration meetings that include DV representation.
- Project-Based Partnerships: Ministry-funded initiatives with defined deliverables and timelines.
- Data and Evaluation Collaborations: Joint work on indicators, dashboards, and evaluation frameworks.
Alignment with Regional and National Frameworks
To maintain consistency, coordination efforts often reference broader frameworks, such as:
- Provincial/state health strategies that include DV or interpersonal violence
- Quality and safety standards for hospitals and community health centers
- Public health surveillance and prevention strategies
- Cross-ministerial action plans addressing violence and health determinants
Governance and Partnership Management
Governance structures support sustainable healthcare–DV coordination and help partners manage risk, role clarity, and continuous improvement.
Governance Models
Common models include:
- Joint Steering Committee: Representatives from healthcare organizations, shelters, DV agencies, and, where feasible, regional health authorities.
- Operational Workgroups: Staff-level groups that focus on implementation of screening, referral pathways, and training.
- Regional Coalitions: Multi-sector coalitions that integrate healthcare priorities into broader DV coordination.
Key Governance Functions
Core functions can include:
- Review and endorsement of protocols, SOPs, and MOUs
- Monitoring implementation progress and resolving operational challenges
- Reviewing aggregate data and evaluation findings
- Identifying funding and sustainability opportunities
- Coordinating with provincial/state health ministry initiatives
Data, Reporting, and Quality Improvement
Data use in DV-health coordination focuses on system performance and service linkage, while respecting privacy and applicable regulations.
Example Indicators for Coordination
Partners may track:
- Proportion of eligible visits where DV screening is documented
- Number and type of referrals from healthcare to DV services
- Average time between referral and first contact by a DV service provider
- Staff participation in cross-training sessions
- Service coverage across geographic or demographic groups
Quality Improvement Cycles
Continuous improvement can be supported through:
- Routine data reviews in steering committees or workgroups
- Root cause analysis for recurring coordination challenges
- Protocol refinement based on feedback from both healthcare and DV staff
- Testing small changes in workflows (e.g., Plan-Do-Study-Act cycles)
Funding and Sustainability Considerations
Multi-agency coordination often relies on blended or braided funding arrangements.
- Health system budgets for staffing (social workers, navigators, clinicians)
- DV agency funding for advocates, shelter operations, and outreach
- Provincial/state grants for integrated health and DV initiatives
- Philanthropic support for pilot projects, evaluation, and innovation
Partners can address sustainability in MOUs and governance forums, including shared planning for grant cycles, staffing models, and infrastructure investments.