-  HHS Family of Agencies      -  HHS Agencies & Offices 
  -  Regional Offices 
  -  Advisory Committees, Task Forces & Initiatives 
  -  Organizational Chart 
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-  Budget & Performance      -  FY 2025 Budget in Brief 
  -  FY 2025 Annual Performance Plan and Report 
  -  FY 2024 Contingency Staffing Plan 
  -  FY 2024 Budget in Brief 
  -  FY 2024 Annual Performance Plan and Report 
  -  FY 2023 Contingency Staffing Plan 
  -  FY 2023 Budget in Brief 
  -  FY 2023 Annual Performance Plan and Report 
  -  FY 2022 Contingency Staffing Plan 
  -  FY 2022 Budget in Brief 
  -  FY 2022 Annual Performance Plan and Report 
  -  FY 2021 Contingency Staffing Plan 
  -  FY 2021 Budget in Brief 
  -  FY 2021 Annual Performance Plan and Report 
  -  FY 2020 Contingency Staffing Plan 
  -  FY 2020 Budget in Brief 
  -  FY 2020 Annual Performance Report 
  -  FY 2019 Contingency Staffing Plan 
  -  FY 2019 Annual Performance Report 
-  Strategic Plan FY 2022 - 2026      -  Message from the Secretary 
  -  Introduction: About HHS 
  -  Overview: Strategic Plan FY 2022 - 2026 
  -  Strategic Goal 1: Protect and Strengthen Equitable Access to High Quality and Affordable Healthcare 
  -  Strategic Goal 2: Safeguard and Improve National and Global Health Conditions and Outcomes 
  -  Strategic Goal 3: Strengthen Social Well-Being, Equity, and Economic Resilience 
  -  Strategic Goal 4: Restore Trust and Accelerate Advancements in Science and Research for All 
  -  Strategic Goal 5: Advance Strategic Management to Build Trust, Transparency, and Accountability 
  -  Appendix: Plan Updates 
-  News 
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# FY 2022 Annual Performance Plan and Report - Goal 3 Objective 2

Fiscal Year 2022Released June, 2021

**Topics on this page:**Goal 3. Objective 2 | Objective 3.2 Table of Related Performance Measures

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## Goal 3. Objective 2: Safeguard the public against preventable injuries and violence or their results

Injuries and violence affect all Americans regardless of an individual's age, race, or economic status.  Preventable injuries and violence—such as falls, homicide stemming from domestic violence, and gang violence—kill more Americans ages 1 to 44 than any other cause, including cancer, HIV, or the flu.22  Hospitalizations, emergency room visits, and lost productivity caused by injuries and violence cost Americans billions of dollars annually.

Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being.  The Department supports multiple trauma-informed care initiatives to integrate a trauma-informed approach into health, behavioral health, and related systems to reduce the harmful effects of trauma and violence on individuals, families, and communities.

In the previous administration, the Office of the Secretary led this objective.  The following divisions are responsible for implementing programs under this strategic objective: ACF, ACL, CDC, IHS, OASH, and SAMHSA.  HHS has determined that performance toward this objective is progressing.  The narrative below provides a brief summary of progress made and achievements or challenges, as well as plans to improve or maintain performance.

## Objective 3.2 Table of Related Performance Measures

Maintain the percentage of domestic violence program clients who have a safety plan (Lead Agency - ACF; Measure ID - 14D)

Family Violence Prevention and Services Act grantee data for fiscal years 2017 through 2019 show that more than 90 percent of domestic violence program clients reported improved knowledge of safety planning as a result of grantee efforts.  These data correlate with other indices of longer-term client safety and well-being.23 Since many program participants receive short-term crisis assistance and would not expect to report significant change, consistently achieving a higher than 90 percent benchmark is unrealistic.  In FY 2021 and 2022, ACF will continue to implement its improved data quality checks to ensure data accuracy as well as work with the grantees to identify ways to promote domestic violence safety.

Decrease the percentage of children with substantiated or indicated reports of maltreatment that have a repeated substantiated or indicated report of maltreatment within six months (Lead Agency - ACF; Measure ID - 7B)24

In FY 2018, the rate of repeat child maltreatment decreased to 6.7 percent, which met the target for that year.  In FY 2019, the rate continued to decrease to 6.6 percent, which was an improvement, but fell just short of the target of 6.5 percent.  In FY 2021 and FY 2022, ACF will continue to identify and implement ways to support states in their efforts to care for children and families who are experiencing a crisis, while ensuring the safety of children.  The renewed emphasis on prevention efforts may also lead to improved performance in this area.

Increase Intimate Partner (Domestic) Violence screening among American Indian and Alaska Native (AI/AN) females (Lead Agency – IHS; Measure ID – 81)

Domestic and intimate partner violence has a disproportionate impact on AI/AN communities.  AI/AN women experience intimate partner violence at higher rates than any other single race or ethnicity in the United States.  However, intimate partner violence is a preventable public health problem and screening for Intimate Partner (Domestic) Violence provides the ability to identify victims and those at risk for injury.  The Intimate Partner (Domestic) Violence screening measure supports improved processes for identification, referral, and treatment for female victims (age 14-46) of domestic violence.  In FY 2018, IHS began reporting the Intimate Partner (Domestic) Violence screening measure using the IHS Integrated Data Collection System Data Mart (IDCS DM).  FY 2020 represents the third year of IDCS DM reporting; IHS continues to monitor and adjust to reporting system changes and provide training for documentation in the electronic reporting system.

In FY 2019, IHS identified successful strategies among the IHS Areas and sites that met or exceeded the target screening rates for intimate partner violence.  Strategies that sites identified as a pathway to success include: frequent data review and communication of data to staff; staff training that targeted the use of specific screening tools; and inclusion of this important measure in facility quality improvement projects.  IHS uses this information to increase support and to cultivate knowledge about this measure across sites and to provide technical assistance and training to IHS health care providers and sites.  In FY 2020, IHS continued to encourage dissemination of these evidence-based strategies across all facilities.  IHS continues to provide training on the appropriate screening and injury assessments and documentation in the IHS electronic health record reporting system.  IHS provides outreach and assistance to tribal sites upon request including a virtual training made available in FY 2020 regarding a specific Intimate Partner Violence (IPV) lethality risk screening tool.  In addition, IHS recorded a two-hour live training webinar provided to Urban health organizations that discussed screening tools and appropriate interventions to offer patients experiencing intimate partner violence.  Due to COVID-19 response efforts, opportunities for facilities to participate and complete trainings were limited.

Although several IHS Areas met or exceeded the FY 2020 target, IHS did not meet the national target of 41.5 percent.  The IHS COVID-19 pandemic response and the transition from in person primary care to virtual care at several sites, may have impacted screening women for DV/IPV.  To avoid potential coronavirus exposure risk, there have been fewer in-person visits and many health care services for prevention and health maintenance were postponed by patients during the pandemic.  While patients with acute illness or the need for emergency care were still seen at IHS facilities, the COVID-19 pandemic response limited health care provider – patient interactions and reduced opportunities to screen the general population.  Due to the sensitivity of the DV/IPV screening, proper administration requires the health care provider to ensure the patient is comfortable responding without external influence.  Therefore, increased telehealth visits that occur within a patient's home would not necessarily meet the safety and security recommendations to be applied during the DV/IPV assessment.

While IHS anticipates similar challenges in FY 2021, increased administration of the DV/IPV screening will occur as in-person patient-provider interactions increase.  In addition, IHS is aligning this measure with the agency-wide policy on the care of patients experiencing Intimate partner violence which can be found within the Indian Health Manual, Part 3, Chapter 31.  Long-term efforts will include targeted approaches to increase participation and reporting of this measure including technical and training assistance for future grant awardees that address the DV/IPV objectives.  IHS will also promote webinars and on-demand trainings that support the agency-wide policy to increase participation among IHS, Tribal, and Urban facilities.  Starting in FY 2021, IHS is establishing methods to assist grant recipients in prioritizing the intimate partner violence screening within their community facilities, including data collection tools and resources.  These efforts will strengthen facility and service unit quality improvement programs and emphasize the importance of including this measure in such efforts to reduce and address intimate partner violence and improve health care delivery.

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22https://www.cdc.gov/injury/wisqars/overview/key_data.html

23 Bybee, D. I., and Sullivan, C. M.  (2002).  Strengths-based intervention resulted in positive change for battered women over time.  **American Journal of Community Psychology, 30**(1), 103-132.

24 The program updated the FY 2016 actual result for this performance measure based on a technical correction to calculate the data based on the national population, which is consistent with previous results.  The program updated the FY 2017 target due to this change.

25 Interim result.

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Content last reviewed September 27, 2022