Providers have a unique opportunity to improve the health of women affected by domestic violence and substance use. Millions of women experience domestic violence, which is most prevalent among women of reproductive age. Alcohol use and other substance use disorders are often underdiagnosed in women, regardless of age, race, ethnicity and socioeconomic status.

ACOG and the U.S. Department of Health and Human Services recommend all women coming into prenatal care or accessing healthcare should be screened for a substance use disorder and domestic violence.

Screening Tools

Routine screening is the first step for a provider to know if a person needs an assessment or intervention for substance use disorder or domestic violence.

Substance Use Disorder Screening Tools and Methods

These tools and methods can help you identify a substance use disorder and make referrals:

  • SBIRT - SAMHSA and the Centers for Disease Control and Prevention recommend Screening, Brief Intervention, and Referral to Treatment. SBIRT provides early intervention and referral to treatment for people with substance use disorders and those at risk of developing these disorders.
  • NIDA Quick Screen - This screening tool is appropriate for patients age 18 or older and may be delivered as an interview, or read aloud while having the patient fill out responses on a written questionnaire. The person administering the screening should review the sample script to introduce the screening process. The script offers helpful language for introducing what can be a sensitive topic for patients.
  • 4P's Plus and Integrated 5P's (PDF) - 4P's Plus is a validated screening instrument used to quickly determine a pregnant woman's risk for use of tobacco, alcohol or illegal drugs. The 5P's tool asks about parents, partners past and present, and alcohol and drug use past and present in a non-threatening manner.
  • TWEAK (PDF) - This screening tool uses five simple questions to see if a pregnant woman is at risk for alcohol use. 
  • T-ACE - This screening tool is a four-item instrument appropriate for detecting heavy alcohol use in pregnant woman.

Opioid-specific tools and resources can help you with treating pregnant or parenting women with opioid use disorder:

Domestic Violence Screening Tools

Providers can use several tools for routine domestic violence screening.

The CUES approach —validated as patient-centered and trauma-informed — helps providers discuss domestic violence with individuals. The CUES three-step intervention process:

  • Step 1. Confidentiality: See the person alone and disclose any limits of confidentiality before discussing or screening for domestic violence.
  • Step 2. Universal Education: Utilize safety cards or a formal screening instrument to talk about healthy and unhealthy relationships and the effects of violence.
  • Step 3. Support, Health Promotion and Documentation: Develop a patient-centered care plan to encourage harm reduction and make a warm referral. A warm referral is a referral where there is direct three-way communication between the person giving the referral, the person the referral is being made to, and the patient who is being referred to services. Document the disclosure.

The Relationship Assessment Tool (PDF) goes beyond physical violence and assesses emotional abuse by measuring a woman's perceptions of her vulnerability to physical danger and loss of power and control in her relationship. This tool may provide for earlier prevention and intervention.

When a Person Screens Positive

If a person screens positive, determine appropriate treatment or refer them to a Substance Use Program center or Family Violence Program center using the information below.

Substance Use Program

HHS has a network of providers who help people through mental health and substance use disorder services.

To find substance use treatment services in your area, or for immediate and confidential help 24/7, contact the outreach, screening, assessment and referral (OSAR) center in your HHS service region. OSARs may be the first point of contact for accessing substance use disorder services statewide and can also refer for appropriate mental health services. Regardless of ability to pay, Texas residents seeking substance use disorder services and information may qualify for services based on need.

Following the initial call, available services and treatment plans will vary from person to person, but could include:

  • Screening
  • Assessment
  • Motivational interviewing
  • Community and treatment referrals
  • Detoxification services
  • Residential treatment
  • Outpatient treatment
  • Case management
  • Life skills training

Search for the nearest substance use treatment program. However, for a person to access services, they will need to first contact their local OSAR.

Treatment programs with a waiting list prioritize admissions for certain populations in the following order:

  • Pregnant women with substance use disorders who inject drugs
  • Pregnant women with substance use disorders
  • Men and women with substance use disorders who inject drugs
  • Men and women with substance use disorders who have been referred by the Texas Department of Family and Protective Services

Family Violence Program

The Family Violence Program promotes self-sufficiency, safety, and long-term independence of adult victims of family violence, child victims of family violence and victims of teen dating violence. The program provides emergency shelter and support services to victims and their children. Click here for the HHS Family Violence Shelter and Non-Residential Shelter Directory.

Shelters can provide 24-hour emergency shelter.

Both shelters and non-residential centers can provide the following:

  • 24/7 crisis hotline answered by trained volunteers and employees
  • Crisis intervention
  • Emergency transportation
  • Assistance in obtaining medical care
  • Information and referrals to other community services
  • Safety planning
  • Legal advocacy, including identifying legal needs and rights and helping to pursue legal options
  • Peer support and counseling
  • Employment information and training

Resources for Health Care Professionals

If You Need Help

Domestic Violence

If you or someone you know has experienced domestic violence, call the National Domestic Violence Hotline at 800-799-7233 (800-799-SAFE) or TTY at 800-787-3224. For more information, visit the Family Violence Program page.

Find a Family Violence Program Center*

*Note: Locations reflect only HHSC funded programs and, for safety purposes, are approximate. If you do not find a shelter or non-residential center near your location, please contact the shelter or non-residential center nearest to you or call the National Domestic Violence Hotline, 800-799-7233 (800-799-SAFE) or TTY at 800-787-3224

Substance Use

If you or someone you know needs help with substance use, call 2-1-1 or 877-541-7905. For more information, visit Outreach, Screening, Assessment and Referral Centers (OSARs) page.

Find a Substance Use Program Center in Texas

Domestic Violence

Call the National Domestic Violence Hotline at 800-799-7233 (800-799-SAFE) or
TTY at 800-787-3224

Find an HHSC Family Violence Program Center*

Search

Safety Alert

Computer use is easily monitored and information is difficult to completely delete off the computer. If you are afraid that your email, internet or computer use might be monitored, please use a computer that cannot be monitored. You may also call the National Domestic Violence Hotline at 800-799-7233
(800-799-SAFE) or
TTY at 800-787-3224.

Substance Use

Call 2-1-1 or 877-541-7905

Find a Substance Use Program Center in Texas

Search