Maintaining relationship safety while promoting relationship health: Family service referrals among veterans screened for intimate partner violence

Intimate partner violence (IPV) poses a tremendous public health burden across large health care systems. While the predominant response to IPV focuses on individual screening and referral, relationship and family services provide an opportunity to prevent low-risk verbal aggression from escalating and to address some forms of bidirectional physical IPV. This study examines mental health and screening variables associated with IPV experience and subsequent referral to family services using a large national data set of N = 256,894 patients screened for IPV in the first year of the Veterans Health Administration's adoption of a national IPV screen. Of those screened, 7.4% reported any IPV, 1.4% reported severe IPV, and only 0.1% received a referral for couple and family services within the next 90 days. Mental health conditions associated with greater likelihood of IPV (e.g., personality disorders, posttraumatic stress disorder, substance use disorders, and depression) were in turn associated with greater likelihood of referral. Despite the overlap between IPV and mental health conditions that benefit from couple-based interventions, referrals remained infrequent. Referrals were often placed by a different clinic than the service assessing the IPV. Risk behaviors for severe violence (e.g., choking) and suicide ideation were also associated with increased couple and family service referrals, underscoring the need for integrated assessment and risk management. These findings highlight important opportunities for health care systems to enhance the alignment of IPV screening and appropriate treatment recommendations by strengthening screening-to-referral pathways for family services and integrating systematic safety assessments.