Informatics applications for the Universal Screening of Intimate Partner Violence and Human Trafficking
Mary Ann Contreras has been a nurse 38 years specializing in the field of trauma, emergency and critical care. Her practice comes from a compilation of experience in the state of Texas, Virginia and Florida. Currently, she is the Violence and Injury Prevention Manager at JPS Health Network, the Level One Trauma Center in Fort Worth Texas. In this position she studies trauma, behavior, environment and policy to develop, implement and evaluate prevention initiatives. She is active in regional and state trauma advisory councils, the Texas Injury Prevention Leadership Collaborative and other community collaborations. Mary Ann was named one of the DFW Great 100 nurses for 2019.
Heather Scroggins has been a registered nurses for 22 years all at JPS Health Network. She earned her MSN in Nursing Informatics from Texas Tech University Health Science Center and is board certificated in nursing informatics. Heather is an active member of the American Nursing Informatics Association (ANIA) where she serves on her local Dallas/Fort Worth ANIA Board as the Treasurer. Her current role in informatics includes operationalizing initiatives into the electronic health record (EHR) as an EMR Clinical Liaison. DFW Hospital council awarded her the 2019 Community Service Employee of the year for her efforts in human trafficking.
Statement of Purpose
In Texas, one in three women and one in seven men are impacted by intimate partner violence (IPV) (Texas Council on Family Violence, 2017). Texas ranks second in the nation National Human Trafficking Hotline utilization (Polaris, 2017). Over half of the victims trafficked receive healthcare while in captivity (Shandro et al., 2016). Historically, healthcare professionals have not been successful recognizing IPV or HT victims. The Joint Commission requires universal IPV screening in accredited hospitals although there is no such specific requirement for human trafficking (HT) screening (The Joint Commission Standard PC.01.02.09). The aim of this project is to increase IPV disclosure, identify HT victims and increase access to resources for victims of IPV and HT utilizing the Electronic Health Record (EHR).
Population and Setting
Patients presenting in the emergency room, urgent care, OB Triage, Trauma Critical Care Unit, Outpatient Clinic, Women’s Clinic in a large, urban, public, academic teaching, hospital in Fort Worth, Texas.
The hospitals Informatics Nursing Liaison and Nurse Residency Program conducted a review of literature to identify evidenced based practice screening (EBP) tools for IPV and the Hurt, Insulted Threatened, Screamed (HITS) instrument was selected based on good reliability from previous studies, use in both female and male populations and brevity. The HITS is a 4 question instrument with a 5 point Likert scale response with 1 being never and 5 being frequently. The tool generates a score from 5 to 20. Scores over 10 indicate being at risk for violence. Based on the pilot study the HITS tool was placed in the hospital EHR and providers and nurses were educated on how to use the tool. The HITS tool has greatly increased disclosure of IPV with the identification of violence against the patients. Violence and vulnerability is also indicative of potential HT. A search was conducted for an EBP HT tool and no tools were validated for inpatient populations. The Health and Human Services (HHS) HT screen was validated in a community setting so the team incorporated the HHS tool into an IPV/HT algorithm by combining IPV HITS scores over 10 and one HT red flags which trigger the HHS questions.
In the period from May 2018 and June 2019 JPS has been screening in six distinctly different areas of our Healthcare organization. In the pilot areas, 140,689 screens of men and women have been performed using the HITS and HT Red Flags. Of those screened, 479 were positive for intimate partner violence. Of those positive, 299 answered positively to questions regarding symptoms of Human Trafficking. During this time 272 referrals were offered to outside resources. Unfortunately 92 offerings of resources ended in refusal. In the first 7 months of the pilot, the local women’s shelter increased referrals from healthcare organizations 27% as a result of the change in screening. The local Family Justice Center had an increase of 100% during the same period.
Nurses reported increased awareness in recognition of potential HT victims and satisfaction of the ease of delivering the IPV screening. Staff was happy to see clear instructions of how to speak to patients as well as what local and national resources were available. Nurses continue to be frustrated with the low numbers of victims who wished to be “rescued” from their situation. Further education has begun comparing the planting of a seed of hope for a possible out instead of the expectation that each victim is ready to leave when offered.
Conclusions & Significance to the field
Utilizing an algorithm built within the EHR, the hospital is now able to use the data to look at prevalence of IPV and HT. Available data provides pinpoint compliance in screening and . Information collection was influential in proving the incidence of IPV and HT red flags exist and require next steps in providing resources from the community.
- Recognize healthcare organizations have a unique opportunity to screen and refer patients for IPV and HT
- Identify the steps required to create a screening workflow for IPV and HT
- Justify the value of collaboration with internal stakeholders
- Shandro J.R., Chisolmstraker, M., Duber, H.C., Findlay, S.L., Munoz, J., Schmitz, G., Stanzer, M., Stoklosa, H., Wiener, D.E., Wingkun, N. (2016). Human Trafficking: A guide to identification and approach for the emergency physician. Annals of Emergency Medicine. 68(4), 501-508e. DOI:
- Texas Council on Family Violence (2017). Learn the facts. Retrieved from https://tcfv.org/
- The Joint Commission (2017). Comprehensive Accreditation Manual for Hospitals, Standard PC.01.02.09. Retrieved from
- Polaris, (2017). National human trafficking hotline: Hotline statistics. Retrieved from https://humantraffickinghotline.org/states