Whatcom County Healthcare Project Report:
Survivor and Provider Perspectives on Intimate Partner Violence (IPV) Disclosure
“I felt like my primary care provider was really listening, she didn’t interrupt and didn’t make me feel rushed”
The Opportunity
Insights from local survivors and providers point to a shared truth: disclosures about intimate partner violence are difficult, but possible when the right conditions are in place. Survivors are waiting for safety, and providers are seeking better tools and support. The recommendations below highlight opportunities to close the gap between intention and impact. We recognize that taking the first step can feel complex, and we want to be a partner in these solutions. If you or your team would like guidance, tools, or a place to begin, we encourage you to reach out.
Implement structural policies that ensure providers can speak to patients alone, even briefly, can provide a space for openness. It is also important to consider the privacy of records and ensure that only those who truly need access to sensitive information can view it.
Mandate training in trauma-informed communication to increase provider comfort and reduce harm during sensitive conversations.
Incorporate universal education for all patients around what abuse and coercion can look like. This could be done through verbal conversations, handouts, and visible materials like posters to help raise awareness, reduce stigma, and let survivors know that support is available at every point of care.
Create a standardized protocol for screening and response to provide clarity and consistency, helping both patients and providers know what to expect. These protocols should also guide providers to offer referrals to DVSAS and LVOC, giving patients the option for added support.
Build systems for follow-up care to acknowledge that disclosures are just the beginning of the healing process.
This may seem like a lot, but it really comes down to five strong starting points, each a tangible step toward more compassionate, consistent care. This project shows that the healthcare system has a critical role in addressing sexual and intimate partner violence. Survivors are asking for privacy, autonomy, and compassion. Providers are asking for training, tools, and clear procedures. Both want systems equipped to handle these sensitive, life-altering conversations. We now have the knowledge, and the responsibility, to build them. We hope this report serves as a foundation for the work ahead.
Project Purpose
This healthcare project is part of our ongoing effort to better understand how individuals impacted by intimate partner violence (IPV) and sexual violence interact with the healthcare system. Building on previous survivor-centered input projects, we conducted in-depth interviews with survivors and distributed an online survey to healthcare providers across a range of specialties. Our goal was to explore the barriers to disclosure from both perspectives to inform more compassionate, practical, and consistent responses within healthcare settings.
Before getting into the specific findings of this project, it’s important to highlight a truth that has remained strikingly clear across all our survivor input work. The most persistent barrier to disclosure is not physical or logistical, it’s emotional and compounded by societal stigma. The fear of being judged, discredited, or blamed creates a powerful silence, often more difficult to overcome than logistical or physical hurdles. These feelings were often deeply internalized and worsened by prior negative experiences with healthcare or other support systems. Despite this, survivors also repeatedly told us that every opportunity to disclose matters. Even if they don’t speak up the first time (or the fifth) they notice when someone creates space for them, and they carry that with them until they’re ready.
Hearing From Survivors
During the interviews, survivors were asked what helped them feel safe or supported in disclosing, what barriers they encountered, and what they wish providers and systems understood. Across interviews, their responses centered around the idea of “what is most helpful from…” with key themes emerging around the provider’s role, the surrounding healthcare system, and the immediate response upon disclosure. During data collection, five consistent themes were identified. They are defined below and sorted in actionable steps in our recommendations.
What’s most helpful from….
The Provider
Genuine human connection
Survivors shared that the most meaningful support from healthcare providers came through genuine human connection. They emphasized the power of active listening without interruption, judgment, or pressure. As one survivor shared, “That was the first time I felt heard and seen, no pressure.” Others described providers who followed up after reviewing their responses, took time to check in, and approached them with sensitivity. Validation was a recurring theme; survivors felt deeply impacted by providers who acknowledged their experiences without placing blame. “She was really validating,” one said, while another reflected, “She made sure things went okay for me.” Feeling respected, supported, and empowered, not rushed or directed, helped survivors feel safe to open up. As one participant put it, “It’s really important to feel like my voice matters. To feel like they’re actually listening and want to work on it together.” Survivors consistently emphasized that what made the difference was not a perfect response, but a compassionate one.
The System
Privacy and autonomy
On a systemic level, survivors made it clear that privacy and autonomy are not optional, they’re essential. Many emphasized the need to be asked about IPV when alone, without a partner, child, or family member present. Several shared they wanted to speak up but held back due to concerns about who might hear or who might later access their information. As one survivor put it, “I was worried about people close to me finding out,” while another shared, “I need to know my name is safe.” The fear that someone in their community, or even within the healthcare system, might see or share their information was a powerful silencer. “You hear everyone has access to your things, and I’m trying to protect myself,” one noted.
Just as critical was the need for control over what happens next. Survivors spoke about the harm caused when they felt pressured to report or take specific actions before they were ready. “Being able to have a choice” and “deciding how I went about it” were described as empowering. One survivor recalled how impactful it was when someone simply said, “You don’t have to make any decisions today.” Survivors want space to process and choose their next steps without fear of judgment, breach of confidentiality, or forced action, because autonomy, just like privacy, is the foundation of safety.
Upon Disclosure
Belief
When survivors disclose, it is often one of the most vulnerable and frightening moments they face. Many emphasized how important it was to be met with compassion, acknowledgment, and emotional validation. Feeling heard, believed, and supported in that initial moment made a meaningful difference. For some, that validation alone was exactly what they needed, to know they weren’t alone, that someone saw them, and didn’t place blame. Others shared that, in addition to emotional support, having access to clear information and options helped reduce the fear of the unknown. It wasn’t that one was more important than the other, rather, both emotional validation and the availability of practical support were seen as powerful and, together, created a sense of safety and care.
Options
Survivors repeatedly emphasized that having access to resources, whether a referral to a therapist, a connection to an IPV support agency, or printed materials, was important not just for the practical assistance it could offer, but because it helped take away some of the unknown. Several mentioned how impactful it was when someone had asked them, “Would you like help connecting to DVSAS or other resources?” or offered options without assumptions or pressure. As one survivor explained, “The resources piece - a game plan, a template, like what do you do, that would have helped.” Others said that even if they didn’t want help at the time, simply knowing support was available gave them a sense of control and reassurance. The emotional weight of hearing affirming words like “you’re valued,” “you’re enough,” and “you’re not alone” was deeply powerful, especially when it came from someone who was also prepared to help, if and when they were ready.
Importantly, survivors also shared that support should never come with pressure to take a specific path. Phrases like “thank god you left” or “you’re so strong” sometimes felt minimizing or added to feelings of shame. What helped most was being asked, “What do you think you need right now?” or hearing, “I’m so sorry that happened to you.” These types of responses helped center the survivor’s needs and gave them agency in deciding what came next. Many noted how harmful it can be when disclosure is treated as a one-time event. Survivors encouraged providers to “throw everything at it,” to ask often, in different ways, and to create multiple safe, ongoing opportunities for someone to share. Support should not end after the first conversation.
Follow-Up
Survivors consistently described how helpful it was to not only feel emotionally supported, but to also have access to concrete information about what resources were available and what to expect next, especially within the first 24 to 48 hours. As one survivor put it, “She validated my emotions, which was great - but there was no follow-up.” Another said, “She was super nice, but I kind of had to figure out what to do next, once I knew it wasn’t okay.” For some, disclosing felt like “letting the beans out of the bag,” and when no one followed up, they were left feeling overwhelmed and unsure of where to turn. Survivors noted that even a simple follow-up message or check-in could make a meaningful difference. It showed that someone cared, that they weren’t being left to manage everything alone, and that there was a path forward if they wanted it. Ensuring follow-up can also mean connecting survivors with organizations like DVSAS or Lummi Victims of Crime (LVOC), so they know that someone will be supporting them and reaching out even if you are not able to do so yourself.
Ultimately, survivors want to be believed, but they also want to feel supported in whatever way makes sense for them. That might mean being offered a warm, empathetic conversation. It might mean being connected with resources. Often, it’s both. As one survivor put it, “Take it seriously. It’s not just like ‘that happened and it’s over.’ It can have such long-lasting effects.” Compassion is critical, but it’s the combination of validation, clarity, and access to options that help survivors feel safe, empowered, and not alone.
Practitioner Input
In addition to hearing from survivors, we also surveyed healthcare practitioners across a broad spectrum of care including birth and postpartum doulas, OB/GYNs, certified nursing assistants, urgent care providers, family medicine professionals, university health clinicians, and more.
These practitioners care for people across the lifespan, from birth to end-of-life, and their responses made one thing clear: they care deeply about their patients’ safety and well-being, and many recognize that addressing intimate partner violence (IPV) is an essential part of that care. As one provider put it, “Yes, it’s highly needed and desired by patients.” Another echoed, “We need to ensure our families are kept safe.” Importantly, a full 92% of respondents said that IPV screening is both realistic and needed in their current practice. Yet, despite this commitment, only 19% felt that practitioners in their field adequately assess for IPV even though 67% reported to have received some form of IPV-related training. This highlights a concerning gap between intention, perceived knowledge, and implementation.
The Most Common Barriers: Time, Verbiage, Privacy
Practitioners were asked to identify barriers to screening for IPV in their setting. The most frequently cited obstacle was that the patient is often not alone during visits, reported by 77% of respondents. This lack of privacy is particularly challenging in settings like pediatrics, urgent care, and postpartum visits where a partner or family member may routinely be present.
Beyond that, 48.1% said they don’t know what to ask or how to phrase it, 40% said they don’t have enough time, and 37% admitted they sometimes simply forget, especially in fast-paced or high-pressure environments. Other barriers not visualized above include concern that they might offend the patient, discomfort, not sure what to do if a disclosure occurs, and lack of rapport. These responses underscore that the issue is not a lack of care or willingness, but a lack of practical, actionable tools that fit into real clinical workflows.
Recommendations
Based on the insights shared by both survivors and providers, it’s evident that the gaps in practice are not due to a lack of care, but a need for clearer structures, better tools, and consistent support. In the following section, we return to the recommendation chart introduced on the first page and outline how each recommendation responds directly to the themes identified in this project. For every recommendation, we highlight the specific gap it closes and summarize what survivors and providers told us about why this change matters.
Implement structural policies that ensure providers can speak to patients alone, even briefly, can provide a space for openness. It is also important to consider the privacy of records and ensure that only those who truly need access to sensitive information can view it.
Theme addressed: Privacy
Survivors: “I was always thinking this information is going to get back to him if I said anything.”
Providers: The most prevalent barrier reported by providers is getting the patient alone.
Mandate training in trauma-informed communication to increase provider comfort and reduce harm during sensitive conversations.
Theme addressed: Shame & Judgement, Provider Characteristics
Survivors: “I have had so many experiences where I don’t feel safe with this provider or don’t feel seen with this provider.”
Providers: “I think if people were more comfortable asking the questions in a standard fashion and then if they get positive responses, having some language around that.”
Incorporate universal education for all patients around what abuse and coercion can look like. This could be done through verbal conversations, handouts, and visible materials like posters to help raise awareness, reduce stigma, and let survivors know that support is available at every point of care.
Theme addressed: Shame & Judgement, Provider Characteristics
Survivors: “I think throw everything at it because it’s constant…I appreciate all the little ways people can get access to ‘oh this is not okay.’”
Providers: “We need to continue to build out how language about how IPV can also include coercive control and is not always physical.”
Create standardized protocol for screening and response to provide clarity and consistency, helping both patients and providers know what to expect. These protocols should also guide providers to offer referrals to DVSAS and LVOC, giving patients the option for added support.
Theme addressed: Privacy, Autonomy & Choice
Survivors: “I didn’t see options, no one even asked me anything, no one did. No one asked if I needed help, ever, ever, ever. It’s having options, I didn’t have options.”
Providers: Providers reported that they want a more streamlined screening protocol and a clear idea of where to connect survivors upon disclosure.
Build systems for follow-up care to acknowledge that disclosures are just the beginning of the healing process.
Theme addressed: Privacy, Autonomy & Choice
Survivors: “I didn’t know what to do or where to go…I did it all by myself and I felt a lot of shame for so long.”
Providers: Reported that screening for and supporting survivors through IPV disclosures is highly needed and desired by patients.
Each of these recommendations is supported by far more detail than can be captured in a brief summary or quote. Behind every theme lies extensive testimony, nuance, and practical insight from both survivors and providers. This is not only a list of policy and practice improvements, but a synthesis of the lived experiences and professional realities that make these changes both necessary and achievable. As a reminder, please reach out to us for support with identifying screening and response protocols, information on local referrals, universal education tools, training, and more.