Domestic Violence Intervention Treatment Workgroup Report — Commerce (November 2025)

Summary

The Domestic Violence Intervention Treatment Workgroup Report, a November 2025 report to the Legislature from the Office of Crime Victims Advocacy of the Washington State Department of Commerce, prepared under Chapter 376, Laws of 2024. It states that the Legislature appropriated $200,000 for fiscal year 2024 for Commerce to convene a workgroup to develop a roadmap for Medicaid and insurance billing for DVIT. The workgroup convened on September 25, 2024, and met monthly through April 2025. The report states that members, while supportive of DVIT in practice, are reluctant to recommend billing codes for Medicaid and commercial insurance. Its appendices include a map of state-certified DVIT providers.

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Full text

Domestic Violence Intervention
Treatment Workgroup Report

Report on Domestic Violence Intervention Treatment Workgroup per Sec.
126(137(a)) of Chapter 376, Laws of 2024

November 2025

Report to the Legislature
OFFICE OF CRIME VICTIMS
ADVOCACY Director Joe Nguyễn

v4
Acknowledgments
Washington State Department of Commerce
Trisha Smith, Managing Director,
Office of Crime Victims Advocacy

Kersten Bergstrom, Senior Project Manager,
Research and Development Services

Marissa Landeis, Senior Project Manager,
Research and Development Services

1011 Plum St. SE
P.O. Box 42525
Olympia, WA 98504-2525

www.commerce.wa.gov

For people with disabilities, this report is available on
request in other formats. Please call 360-725-4000 with
your request.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 2
Table of contents
Executive summary .............................................................................................................................................4

Introduction ........................................................................................................................................................6

Roadmap for DVIT integration with Medicaid and commercial insurance ..............................................................8

Barriers identified by the workgroup .................................................................................................................. 17

Additional solutions identified by the workgroup................................................................................................ 18

Conclusion ........................................................................................................................................................ 19

Workgroup members......................................................................................................................................... 20

Figure 1 - DVIT Education and Provider requirements ........................................................................................ 24

Appendix A: Medicaid Reimbursement Rates ..................................................................................................... 25

Appendix B: Terminology Defined...................................................................................................................... 26

Appendix C: Glossary of Acronyms and Abbreviations ....................................................................................... 30

Appendix D: 25 Core Competencies ................................................................................................................... 31

Appendix E: Sequence of Events for DVIT - Referral to Discharge ....................................................................... 32

Appendix F: The Need for DVIT.......................................................................................................................... 33

Appendix G: Map of State-Certified DVIT Providers ........................................................................................... 37

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 3
Executive summary
Domestic violence (DV) and intimate partner violence (IPV) pose serious public health and safety issues, requiring
an adaptive and comprehensive response. Domestic Violence Intervention Treatment (DVIT) refers to a program
that provides domestic violence assessments or intervention treatment to perpetrators of IPV. It is certified 1 by the
Washington State Department of Social and Health Services (DSHS) 2 and is recognized as a crucial element of
Washington's response to domestic violence. 3 The cost of DVIT has been of particular interest in making this
treatment accessible and affordable in the hopes of reducing IPV perpetration, recidivism, and rehabilitating a wide
range of offenders.

In June 2018, the Washington State Legislature released the report "Domestic Violence Perpetrator Treatment: A
Proposal for an Integrated System Response (ISR). 4 In this report, costs associated with DVIT were highlighted as
prohibitive and non-reimbursable by insurance. This lack of financial support could lead courts to order
perpetrators to participate in treatment options that are not state-certified or facilitated by Department of Health
(DOH)-credentialed counselors. A later report released by the Washington State Legislature in October 2020,
"Domestic Violence Intervention Treatment: Removing Obstacles to Implementation" 5 identified the creation of a
reliable funding scheme for court-ordered DVIT as a top concern. The 2020 report noted that the "insurance option"
potentially created a hurdle in funding DVIT because there were no billable codes 6 that were specific to treating
perpetrators of domestic violence. These reports also highlighted the need for recording data on court-ordered
therapy in IPV cases.

Medicaid and commercial insurers do not consider therapeutic treatment for IPV perpetrators a medical necessity
because IPV is not recognized as a treatable medical illness or mental disorder, viewing it instead as a criminal
behavioral issue. While abusive behavior may be connected to mental health issues, the violent act(s) are not
considered a diagnosable disease. Instead, it is addressed as a behavioral and legal problem. The treatment for
IPV is specifically designed to hold the offender accountable for their actions, to change violent or abusive
behavior, and therefore reduce recidivism. Because these treatments are legally mandated and specifically
designed to treat IPV, which is considered a criminal act, DVIT falls outside of current thresholds associated with
Medicaid and insurance billing. 7

The Legislature appropriated $200,000 for fiscal year 2024 for the Washington State Department of Commerce
(Commerce) to convene a workgroup (Workgroup members) to develop a roadmap for Medicaid and insurance
billing for DVIT, assess educational pathways for providers, and identify necessary statutory and funding changes.
The DVIT workgroup convened regularly to discuss and review these issues, examine barriers, and find potential
solutions. The workgroup also reviewed other concerns brought forward by members and from listening sessions.
The issues raised included the involvement of tribal court members, tribal DVIT Providers, and tribal DV Advocates,
as well as the expansion of DVIT provider networks and knowledge. Workgroup members, while supportive of DVIT
in practice, are reluctant to recommend billing codes for Medicaid and commercial insurance. This concern is
examined in detail throughout this report.

1 Any program that provides domestic violence treatment to perpetrators of domestic violence must be certified by the Department of Social

and Health Services (DSHS) and meet minimum standards for domestic violence treatment purposes. DSHS adopts rules for standards of
approval of domestic violence perpetrator programs per RCW 43.20A.735: Domestic violence perpetrator programs.
2 Washington Administrative Code (WAC) 388-60B outlines Domestic Violence intervention treatment program standards.
3 Domestic Violence Manual for Judges, Chapter 3 - The Legislative Response to Domestic Violence (Revised 2022).
4 Domestic Violence Perpetrator Treatment: A Proposal for an Integrated System Response (ISR). Report to the Washington State Legislature

(2018).
5 Domestic Violence Intervention Treatment: Removing Obstacles to Implementation. Report to the Washington State Legislature (2020).
6 ICD Code Lists - Centers for Medicare and Medicaid Services.
7 Court-Ordered Therapy.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 4
Roadmap for insurance and Medicaid billing
The Domestic Violence Intervention Treatment Workgroup convened for nine months to provide input in developing
the following roadmap and to identify the necessary steps toward its implementation. The workgroup determined
that each step in the roadmap was feasible, but would require significant public, private, interagency, and
intergovernmental coordination to achieve.

Some elements of the roadmap, including the modification or creation of new billing codes, are outside state
control because they require federal changes. Throughout this report, billing codes refer to the diagnostic codes
needed by service providers to assign the correct diagnosis necessary to determine treatment services. While the
details on each milestone on the roadmap are included in this report, at their highest level, they are summarized
below:

A) A Medicaid state plan amendment or 1115 waiver is necessary to allow Medicaid billing for domestic violence
intervention treatment.

B) Modification of existing billing codes, or creation of new billing codes to bill Medicaid and private insurance for
DVIT will be necessary since existing codes are insufficient.

C) A master's level behavioral health credential and licensure is required for providers to bill insurance or Medicaid
for domestic violence intervention treatment.

D) Educational pathways currently exist to become a domestic violence intervention treatment provider and are
detailed in Figure 1 - DVIT Education and Provider requirements

E) Statutory changes or funding when identifiable to implement the roadmap.

Workgroup conclusions
The DVIT workgroup met for a period of nine months and was comprised of 27 individuals representing a breadth
of professional experience in mental health care and DVIT. These individuals are dedicated to the provision of
treatment of intimate partner violence and domestic violence but were not all in alignment as to the methods for
how to provide such treatment. Some indicated that general complications with Medicaid and commercial
insurance billing would preclude their acceptance of insurance. Others indicated that the requirements associated
with these billing systems would require additional training or staff that they don't have. Collectively, the workgroup
was in alignment that they did not support moving forward with pursuing Medicaid and commercial insurance
billing as a method to pay for DVIT in Washington. Significant work remains to bring the greater practitioner and
provider communities on board with extending eligibility for DVIT in the Medicaid and commercial insurance
systems.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 5
Introduction
Legislative mandate
Sec. 126(137(a)) of Chapter 376, Laws of 2024 instructed the Department of Commerce's Office of Crime Victims Advocacy to
address domestic violence:

(a) $200,000 of the general fund—state appropriation for fiscal year 2025 is provided solely for the office to convene a
work group to create a roadmap that provides a detailed pathway describing the steps necessary for insurance billing for
domestic violence intervention treatment in Washington state.

(i) In developing the roadmap, the work group must:

(A) Determine if a Medicaid state plan amendment or 1115 waiver would be necessary to allow Medicaid billing for
domestic violence intervention treatment;

(B) Determine if existing billing codes would work for Medicaid and commercial insurance, or if new billing codes
would be necessary;

(C) Identify any healthcare certification or credentials needed for providers to be able to bill insurance for domestic
violence intervention treatment;

(D) Identify the educational pathways that exist to become a domestic violence intervention treatment provider;
and

(E) Identify any statutory changes or funding necessary to implement the roadmap.

(ii) The work group members must include representatives of:

(A) Organizations that provide domestic violence intervention treatment;

(B) Individual clinicians that provide domestic violence intervention treatment;

(D) Licensed marriage and family therapists;

(E) Domestic violence survivors;

(F) The domestic violence treatment program administered by the department of social and health services;

(G) Staff from the department of health with expertise in licensing and credentialing of health professionals;

(H) Staff from the health care authority who work on insurance billing for Medicaid, the public employees' benefits
board, and the school employees' benefits board;

(I) The office of the insurance commissioner;

(J) Medicaid managed care organizations; and

(K) Commercial insurance carriers.

(iii) The office of crime victims advocacy must provide staff support for the work group.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 6
(iv) The work group must submit a preliminary report including the roadmap to the appropriate committees of the
legislature by December 31, 2024.

A preliminary report was submitted to the Legislature.

Domestic violence background
Domestic violence was first recognized as a serious crime in Washington in 1970, 8 and the Administrative Office of
the Courts (AOC) offered its inaugural judicial training on domestic violence in 1984. The Domestic Violence
Manual for Court Judges was published more than 30 years ago. It provides a framework for sentencing domestic
violence perpetrators in the Washington court system. Several updates have been made to the Manual as the
understanding of these crimes has changed (updates in 1993, 1997, 2001, 2006, 2016).9

Domestic Violence (DV) includes, but is not limited to, 18 different crimes 10 committed by one family or household
member against another family or household member, or by one intimate partner against another intimate partner.
In Washington, an intimate partner includes a spouse, state-recognized partner, romantic partner, or past or present
date.10 Intimate partner violence (IPV) is a sub-category of DV involving physical, sexual, emotional, verbal,
psychological, and economic abuse, as well as coercive control. This distinction is key because DVIT applies
exclusively to IPV cases, rather than the broader category of DV crimes, which includes family and household
members.

Domestic Violence Intervention Treatment
DVIT 11 is a Washington state-certified program specifically designed to address intimate partner violence, often
through court-ordered 12 therapeutic services. These evidence-based services are aimed at increasing the safety of
communities and victims while offering rehabilitative efforts for the perpetrator to stop abusive behavior and
reduce rates of recidivism. 13 DVIT standards include staff qualifications, treatment modalities, continuing
education requirements, and treatment parameters, which are set and maintained by the Department of Social and
Health Services (DSHS).17 DSHS ensures that certified programs provide perpetrator intervention in accordance
with the state laws and rules specifically designed for DVIT. 14 As recently as 2023, an 82% reduction in abusive
behaviors was self-reported at the completion of DVIT state-certified programs.15

Currently, Washington has 65 DVIT state-certified providers offering in-person and internet-based therapeutic
intervention treatment to perpetrators. See Appendix G: Map of State-Certified DVIT Providers for the locations of
DVIT providers in the state. 16 State-certified DVIT providers are required to understand core competencies
(Appendix D) by the end of their training. Providers assess the level of risk, needs, responsiveness, and lethality of
the perpetrator prior to treatment. Based on this behavioral assessment, court records, consultation with the victim

8 This shift occurred throughout the United States of America in response to the Women's Liberation Movement and Battered Women's

Movement. National Library of Medicine (2015). Domestic Violence in the 1970s, Confronting Violence Archives.
9 Ganley, Anne L. "Domestic Violence: The What, Why, and Who as Relevant to Criminal and Civil Court Domestic Violence Cases", Chapter 2,

Domestic Violence Manual for Judges (2015 Version).
10 RCW 10.99.020: Definitions.
11 Any program that provides domestic violence treatment to perpetrators of domestic violence must be certified by the Department of Social

and Health Services (DSHS) and meet minimum standards for domestic violence treatment purposes. DSHS adopts rules for standards of
approval of domestic violence perpetrator programs. RCW 43.20A.735: Domestic violence perpetrator programs. RCW 43.20A.735: Domestic
violence perpetrator programs.
12 DVIT is for anyone who needs to stop their abusive behavior. While often court-ordered, it is not required for DVIT.
13 Berlin, Lucy, Merchant, Laura, Roberts, Amie and Martin, David "CBT Guide for Intimate Partner Violence" (2020).
14 WAC 388-60b.
15 Washington State Department of Social and Health Services, Economic Services Administration, Community Services Division, Domestic

Violence Intervention Treatment (2023).
16 DSHS. DVIT Programs by County - 1 DVIT state certified provider is not on this map, they are in Idaho but certified and provide treatment in

WA state.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 7
(if chosen by the victim), and the severity/lethality of domestic violence charges, perpetrators are assigned to
different levels of treatment, 17 resulting in a tailored approach (Appendix E). Although DVIT is court-ordered
treatment, it should be noted that it is not offered within the Department of Corrections, which means that some of
our most violent and lethal offenders may never receive this crucial treatment.

DVIT programs span between six, nine and 12 months, with some rare instances extending beyond one year of
treatment, depending on the level of care required. Although the time associated with treatment, as determined by
the behavioral assessment, varies, all perpetrators are expected to understand and accept certain competencies.
These competencies include recognizing different types of abuse, identifying belief systems associated with
abusive patterns, understanding the impact of abuse on children, and taking accountability for actions personally,
legally, and financially. During and after treatment, DVIT participants are asked to provide feedback on services and
the effectiveness of treatment to DSHS.

DVIT providers offer regular updates to the court and/or probationary services as required throughout the
therapeutic process. During assessment, at a mid-point check-in, and at the conclusion of treatment, 18 DVIT
providers reach out to the victims of their clients. This outreach aims to ensure the victim’s safety, identify any
unauthorized contact by their client, and assess whether the victim requires additional services. Notably, half of the
training to become a state-certified DVIT provider focuses on DV victim services, due to the necessary outreach
during treatment. This specialized training is unique to state-certified DVIT providers and underscores the victim-
centered care within this perpetrator treatment program.17

Methods and workgroup formation
The Domestic Violence Intervention Treatment Workgroup (Workgroup members) convened on September 25,
2024, and maintained a regular monthly meeting schedule through April 2025. Per Sec. 126(137(a)) of Chapter 376,
Laws of 2024. 27 workgroup members were identified and recruited to provide expertise in developing the
roadmap and identifying barriers to its implementation.

Workgroup meetings were utilized to understand barriers and opportunities to billing insurance and Medicaid, as
well as educational needs for providers. Commerce also met individually with subject matter experts to better
understand gaps, opportunities, and barriers to offering DVIT throughout Washington. These subject matter experts
included the Commerce Office of Tribal Relations, the Administrative Office of the Courts (AOC), the Regence
Insurance Team, court personnel (judges, probationary services, court records management staff, and court
coordinators), the Department of Corrections, the Office of Firearm Safety and Violence Prevention, researchers
from the Domestic Violence Intervention Project, researchers specializing in DV and DVIT and the Health Alliance
for Violence Intervention (HAVI).

Roadmap for DVIT integration with Medicaid and commercial
insurance
The following sections describe the steps necessary to bill Medicaid and private insurance for DVIT and introduce
some of the existing barriers to their implementation as identified by the workgroup.

17 WAC Chapter 388-60B, Domestic Violence Intervention Treatment Program Standards.
18Appendix F: The Need for DVIT (It is difficult to accurately assess the need for DVIT without examining a wide range of data that is often

incomplete or out of date)

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 8
Develop partnerships
Research findings and workgroup feedback indicate that the road to incorporating DVIT into Medicaid and
commercial insurance billing is a long process. It would require the collaboration of various state and federal
agencies, non-profit organizations, institutional advocacy, and greater support from the general community. The
first step will be to develop the partnerships needed to carry out this effort and grow support among the broader
statewide community of DVIT stakeholders. Such partnerships could be developed through a more permanent
workgroup or advisory committee dedicated to the advancement of DVIT in the nation's healthcare system.

Making Substance Use Disorder (SUD) a treatable and billable condition to insurance took national movements and
nationwide efforts among government agencies, treatment professionals, courts, and advocates. The national
movement behind SUD took well over 40 years 19 and included several federal acts, 20 21 22 research, funding, 23 as
well as the drug court movement. Washington state was not the sole actor in the SUD movement, and the
monumental task of making DVIT billable under insurance and Medicaid will also require nationwide assistance.
The financial costs, time commitments, and legal changes necessary for a nationwide movement are difficult to
determine and would require funding beyond Washington state.

Medicaid billing
Medicaid and Waiver 1115 background
While intimate partner violence (IPV) spans cultural and socio-economic boundaries, between 80% and 90% of
defendants found guilty of these crimes are indigent and often unable to afford court-ordered treatment.24 Despite
DVIT being well supported by research findings, the lack of insurance or Medicaid coverage creates financial
barriers, discouraging judges from ordering these services in sentencing.

The Medicaid state plan is a federal government health insurance program administered by the state that pays for
medical services for people with limited income and resources. 25 The state plan serves as a written agreement
between Washington and the federal government outlining details of the Medicaid Program, including eligibility,
covered services, and how providers are reimbursed. 26 Within Washington, approximately 1.8 million people
currently utilize Medicaid as their primary insurance. Medicaid can be used for some court-ordered therapies, such
as substance use disorder (SUD/SUDP) treatment, court-ordered institutional holds, and/or involuntary treatment; 27
but it can't be used for DVIT. Covering DVIT would require changes in both federal and state systems to establish a
new diagnosis and ensure specific treatment eligibility.

Washington state's Section 1115 demonstration waiver, established between the state Health Care Authority (HCA)
and federal Centers for Medicare and Medicaid (CMS), is an innovative project that enables the state to test new
approaches for delivering healthcare services. The waiver aims to improve the overall healthcare system and

19 The first instance of this movement occurred in 1956 when alcoholism was recognized as a disease by the American Medical Association,

but in 1987 the AMA officially termed addiction as a disease. Bettinardi, Katy and Angres, Danial. Journal of Nursing Regulation,
Understanding the Disease of Addiction (2018).
20 Centers for Medicare and Medicaid, the Mental Health Parity and Addiction Equity Act.
21 Medicaid, Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT)

Act: Section 1003.
22 McGinty EE, Daumit GL. Integrating Mental Health and Addiction Treatment Into General Medical Care: The Role of Policy. Psychiatry Serv.

(2020).
23 Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health [Internet]. Chapter 6 Health Care Systems and

Substance Use Disorders. (2016).
24 Delostrinos, C., Bellmer, M. & McAllister, J. "The Price of Justice: Legal Financial Obligations in Washington State" (2022).
25 Washington State Department of Social and Health Services, ALTA-Medicaid.
26 Washington State Health Care Authority, What is the State Plan.
27 Washington State Health Care Authority, Involuntary Treatment Act (ITA).

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 9
expand Medicaid coverage. 28 On June 30, 2023, CMS 29 approved the continuation of Waiver 1115 for five more
years. Currently, DVIT is not covered under Waiver 1115 and would not be eligible for inclusion until the next review
in June 2028.

Medicaid and Waiver 1115 medical necessity
Currently, DVIT does not reach the threshold of medical necessity utilized by the federal Centers for Medicaid and
Medicare (CMS) or by the HCA. Medicaid and Waiver 1115 use a federally approved standard of medical necessity
treatment to determine which services will be covered. The term 'medical necessity' refers to a requested service
that is determined necessary to prevent, diagnose, correct, cure, alleviate, or prevent worsening of conditions in the
client. These conditions endanger life, cause suffering and pain, result in an illness or infirmity, threaten to cause or
aggravate a handicap, or cause physical deformity or malfunction. The requested service must be demonstrated,
and it must be shown that there is no other equally effective, more conservative, or substantially less costly course
of treatment available or suitable for the client requesting the service. 30 Intimate partner violence (IPV) is not
recognized as a diagnoseable medical condition. Because IPV is not recognized as a medical diagnosis, treatment
for it is not considered a medical necessity.

Amending the state plan or creating an addition to Waiver 1115 has similar barriers. Modifying the definition of
medical necessity would require changes to the mental health parity law in Washington state, along with federal
inclusion of DVIT under CMS. Mental health parity laws are designed to ensure equal coverage (and access) for
mental health conditions and substance use disorders, rather than treatments for criminal behavior. Designating
DVIT as a medical necessity would require strict state guidelines, as IPV includes a broad range of criminal
offenses. Changes to state mental health parity law could be extensive, covering various crimes and behaviors
associated with IPV.

Existing Medicaid billing codes
Billing DVIT to Medicaid requires either modifying existing codes or establishing new codes to ensure coverage.
The International Classification of Diseases (ICD) is a global 31 medical classification system used for billing and
standardizing descriptions of diseases, causes of death, treatments, and health statistics.32 ICD codes are federally
controlled within the United States by the Centers for Disease Control and Prevention (CDC) 33 and they provide a
diagnosis that allows treatments such as group therapy, individual therapy, and assessments to be covered. 34
Diagnostic codes, like ICD-10, identify a patient's medical condition, while treatment codes describe the specific
services or procedures provided to treat that condition. In essence, diagnostic codes explain "why" a service is
being performed, and treatment codes explain "what" is being done. Throughout this report, billing codes refer to
the diagnostic codes needed by service providers to assign the correct diagnosis necessary to determine
treatment services.

28 Washington State Health Care Authority, Medicaid Transformation Project (MTP).
29 Medicaid is a state-run program. Approval and extension of services, such as Waiver 1115 is offered through Medicaid but receive federal

approval from CMS.
30 Washington Advisory Code 182-500-0070.
31 The ICD is produced and maintained by the World Health Organization, changes to codes or changing the way codes are applied within the

United States is under CDC guidance
32 Center for Disease Control, ICD-10.
33 Centers for Disease Control, ICD-10 Coordination and Maintenance Committee.
34 Current CPT (Current Procedural Terminology) for group, individual, and assessment codes could be applied after a new diagnostic code is

created.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 10
Currently, IPV is not classified as a primary treatable condition in the ICD. Instead, it falls under V and Z codes,
which represent environmental and societal factors rather than a billable diagnosis. These codes cannot be used
as the primary basis for treatment 35 because of the current Medicaid billing practices set by HCA and CMS.36

Creating new Medicaid billing codes
A proposal must be submitted to the ICD-10 Committee within the National Centers for Disease Control and
Prevention (CDC) to establish a new federal ICD code or modify existing Z and V codes.37 The proposal must be
supported by clinical evidence from multi-phased studies and be accompanied by peer-reviewed supporting
research, 38 to establish a new diagnosis or designate a condition as treatable. 39 Proposals are submitted in June of
each year, with hearings taking place the following October. Public comments remain open on proposals for the
duration of that year. Approximately one year after hearings, decisions regarding new codes are either approved or
denied.40

After the approval of a new ICD code, the state legislature would have the option to amend the definition of medical
necessity or medically necessary to include DVIT. These changes would fall under what are known as health parity
laws. Once changes were adopted into statute, the Office of the Insurance Commissioner would ensure the new
code was integrated into insurance requirements while also adhering to current RCWs and WACs, which regulate
insurance practices in Washington.41 42 Following this process, collaboration with the AOC, HCA, DOH, and DSHS
would support providers in navigating billing while ensuring that judges and court coordinators understand how
Medicaid can be utilized when ordering DVIT.

Waiver 1115 - preventative services
Once new federal ICD codes have been created, Medicaid coverage for DVIT would need to be approved by
Washington. The Washington State Health Care Authority would need to classify it as a medical necessity, which
would require a new or amended state mental health parity law — unless it qualifies as a preventative service. If
designated as a Section 13C Preventative Service, 43 no amendment would be necessary. In making the federal
determination for a 13C Preventative Service, Washington's HCA would make this recommendation to the U.S.
Preventative Services Taskforce. 44 This Taskforce would approve or deny DVIT as a preventive service. Medicaid
pilot projects for prevention are often tested in this way. A pilot project is currently being conducted in North
Carolina, where expanded prevention measures to integrate intervention services for interpersonal violence,
including IPV, are being tested 45 During the 2028 Waiver 1115 application cycle, HCA could evaluate DVIT as a

35 Current CPT (Current Procedural Terminology) for group, individual, and assessment codes could be applied after a new diagnostic code is

created
36 Washington State HCA Mental Health Services Billing Guide (2021).
37 The World Health Organization (WHO) collaboratively develops the ICD. Changes, maintenance, application, and regulation of ICD 10 within

the United States occurs within the CDC.
38 The clinical trial must be deemed "safe" to reach Phase 1, preferably these trials are submitted in Phase 2-4 where they are evaluating the

success of treatment based on an average population in both size and variation - Burt, Tal, Roffel, Ad, Langer, Oliver, Anderson, Kristen,
DiMasi, Joseph. 2022. Strategic, feasibility, economic, and cultural aspects of phase 0 approaches
And ICD Proposal Process - ICD-10-CM Proposal Process | Classification of Diseases, Functioning, and Disability | CDC
39 Center for Disease Control and Prevention, ICD 10- CM Proposal Process.
40 Center for Disease Control and Prevention, ICD 10-CV Committee Meetings.
41 Office of the Insurance Commissioner, Laws and Rules. Laws & Rules | Office of the Insurance Commissioner
42 To ensure coverage, a change to rulemaking within the Office of the Insurance Commissioner may also be required
43 Medicaid State Plan - Attachment 3, General Provisions.
44 The U.S. Preventative Services Taskforce is an independent, volunteer group of national experts in prevention and evidence based medical

prevention services who recommend clinical preventative services. Home page | United States Preventive Services Taskforce
45 Blue Cross Foundation of Carolina, "North Carolina’s experience as the first state in nation to offer interpersonal violence services in

Medicaid" (2024).

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 11
preventative service for a potential pilot project in collaboration with DSHS, HCA, providers, Managed Care
Organizations (MCOs), and Behavioral Health - Administrative Service Organizations (BH-ASOs).

Commercial billing
Commercial insurance background
Close to 4 million residents in Washington are covered by private insurance. 46 Between employee-sponsored
insurance, Medicaid, and the individual marketplace, only 5-6% of Washingtonians are uninsured. 47 If insurance
were to cover DVIT treatment in Washington, many residents could bill insurance as a form of payment. In
Washington, the Office of the Insurance Commissioner (OIC) regulates commercial health insurance. Amendments
are made through rulemaking, which establishes, amends, or repeals insurance regulations to ensure industry
compliance and consumer protection.48

The OIC does not create new diagnostic billing codes for behavioral health conditions such as DVIT. Creating a new
nationally recognized diagnostic code for billing insurance would take place through either a new federally
regulated ICD code, as outlined in Creating new Medicaid billing codes, or in creating a new diagnosis within the
American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and then creating
a new federally regulated ICD code.

Medically necessary
In 2025, legislation was passed to consolidate several definitions of medically necessary into a singular
definition. 49 Chapter 227, Laws of 2025 expanded the definition of medically necessary but excluded criminal
behaviors like IPV and treatment for it, such as DVIT. The term medically necessary refers to a service or product
addressing the specific needs of the patient for the purpose of screening, preventing, diagnosing, managing, or
treating an illness, injury, condition, or its symptoms, including minimizing the progression of an illness, injury,
condition, or its symptoms, in a manner that is: in accordance with generally accepted standards of mental health
and substance use disorder care; clinically appropriate in terms of frequency, extent, site, and duration of service or
product; and not primarily for the economic benefit of the insurer or purchaser or for the convenience of the
patient.

To designate IPV-related court-ordered treatment as medically necessary, a new or amended state mental health
parity law is required, in a process similar to that described in the subsection Creating new Medicaid billing codes
to include DVIT. However, this change would not establish a new insurance code, which is regulated at the federal
level.

Commercial insurance billing code requirements for DVIT
Billing DVIT to commercial insurance requires either modifying existing codes or establishing new codes to ensure
coverage. Commercial insurers base their coverage of mental disorders on diagnoses and treatment covered by
the DSM, a reference book on mental health and brain-related conditions published by the American Psychiatric
Association 50 and the ICD. The current Diagnostic and Statistical Manual (DSM-5) makes several references to
domestic violence and intimate partner violence, but there is no specific disorder or diagnosis associated with

46 Washington Sources of Insurance Coverage.
47 Association of Healthcare Journalists. Washington Sources of Insurance Coverage.
48 Understanding the rulemaking process.
49 State of Washington, House Bill 1432.
50 Insurance Implication of the DSM 5.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 12
being a victim or perpetrator of domestic violence. 51 Although abuse of a spouse or intimate partner is listed within
the ICD and DSM, it is considered a secondary V code or tertiary Z code, which cannot be used in diagnosis. Z
codes indicate factors that can influence a patient's health status and contact with healthcare providers and/or
services. V codes are used to identify issues that focus on clinical attention or affect the primary diagnosis, course
of treatment, or prognosis of the patient’s condition but are not billable as the primary diagnosis or condition. 52

Creating new commercial insurance codes
To bill commercial insurance for DVIT, new federally regulated ICD codes must be created or existing Z and V
codes modified. Since IPV is not recognized as a treatable diagnosis in the DSM, collaboration with the American
Psychiatric Association (APA) is necessary to advocate for its inclusion.53 To incorporate DVIT treatments for IPV
perpetrators into the DSM, coordination with the APA is required. This step ensures that the proposal is peer-
reviewed and meets standards set by the APA. The APA evaluates proposals through a steering committee and
workgroup to ensure they are evidence-based and address key clarifications.54 Once treatment for IPV perpetrators
is included in the DSM, the federal process of receiving a new ICD code would be more feasible.

A proposal for a new diagnostic category to recognize DVIT as a treatable condition is typically submitted through
a district branch of the American Psychological Association. 55 This proposal, like that of an ICD proposal, may be
submitted by any individual, organization, or agency. Successful proposals for such large-scale changes would
require a broader national movement like that which occurred for SUDP.

Once the DSM has been updated and a new ICD code created federally, the Washington Legislature would need to
amend mental health parity law to include DVIT. Separately, creating a new ICD code as outlined in Creating new
Medicaid billing codes will also be necessary as a parallel step in this process. Following this process in
Washington state, collaboration with the Office of the Insurance Commissioner, AOC, HCA, DOH, and DSHS would
support providers in navigating billing while ensuring that judges and court coordinators understand how Medicaid
can be utilized when ordering DVIT.

Credentials required for Medicaid and insurance billing background
If a new billable code for DVIT is created, only providers with a master's degree and a Behavioral Health credential 56
would be eligible to bill insurance or Medicaid for services. While state-certified DVIT providers adhere to
established standards for education and continuing education, state certification alone does not allow for
insurance or Medicaid billing.

Within the broader category of programs designed to intervene or treat perpetrators of IPV, there are different
educational requirements for providers:

• Domestic Violence Moral Reconation Therapy (DV MRT) requires providers to complete a four-day (32-hour)
virtual training, with no additional certification. 57

51 Kulpinski, Amber, Bank, Stella, and Blasdell, Raleigh (2023). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and Domestic

Violence. In: Shackelford, T.K. (eds) Encyclopedia of Domestic Violence. Springer, Cham.
52 Diagnosing IPV as a treatable mental health condition has historically received pushback from victim services and advocates -Batterer’s

Intervention: What Every Victim Advocate Needs to Know
53 American Psychiatric Association, Revising the DSM.
54 American Psychiatric Association, Submit Proposals for Making Changes to DSM-5-TR. Psychiatry.org - Submit Proposals for Making

Changes to DSM-5-TR
55 American Psychaitic Association, Guide to Submitting Proposals for Changes to DSM-5.
56 Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Independent Clinical Social Worker

(LICSW/LASW)
57 Correctional Counseling, Training for Domestic Violence Treatment.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 13
• Strength at Home (SaH) certification involves a two-day intensive training, participation in at least 15 weekly
group or individual consultations, and facilitation of two treatment groups, but no further certification is
needed.58
• Internal Family Systems (IFS) requires a master level behavioral health credential and supervised training.
• The Seattle Municipal Court’s Domestic Violence Intervention Project (DVIP) 59 utilizes DVIT state-certified
providers.
• Washington State certified DVIT providers must have at least a bachelor’s degree and a counseling credential
from DOH, and to serve as a DVIT supervisor, they must have a master’s degree and 100 hours of clinical
practice in DVIT.

Among these programs, only IFS and state-certified DVIT providers with a master's degree and a behavioral health
credential60 could be able to bill insurance and Medicaid, if a new billable code for DVIT is created.

Novel credential for DVIT providers
A new credential 61 is not required to bill insurance but could serve as a regulatory pathway for providers. It could
reduce the number of providers and, therefore, reduce IPV treatment options in Washington. The cost of creating
and maintaining a new credential is both costly and time-consuming. Creating a new credential is costly due to
administrative work, licensing, and certification regulations. Fees associated with these costs are often passed on
to credential holders, which could be high given the limited number of providers.62 Several providers could also be
excluded based on the educational requirements of a new credential. If a new credential is created, housing it
within DSHS would be beneficial because they currently maintain state certification standards for DVIT providers
and programs.63

Current educational pathways to become a DVIT provider
Educational requirements for state-certified DVIT providers consist of three certification pathways: trainee, staff,
and supervisor (Figure 1 - DVIT Education and Provider requirements). DSHS assists new providers in selecting the
most suitable route, securing required supervision, and accessing cost-effective educational opportunities based
on their location in Washington.

Representatives of domestic violence survivor services on the workgroup emphasized the value of DVIT providers
having training on survivor perspectives and needs and having skills for working effectively with survivors, in
addition to the skills they learn for working with DVIT participants. Half of the educational requirement for state-
certified DVIT providers focuses on victim issues, needs, and perspectives. Throughout a perpetrator's DVIT
treatment, providers actively engage with victims to amplify their voices and ensure they receive the support they
need. This approach places victims and survivors at the core of DVIT, prioritizing their well-being and emphasizing
an end to the abusive behavior of the perpetrator.

58 Strength at Home Trainings.
59 Domestic Violence Intervention Project - DVIP
60 LMFT, LMHC, LMSW
61 A new credential was explored to determine if it provides more regulation on those providing DVIT and would make billing insurance easier
62 65 state-certified DVIT providers, numbers of those certified in other research projects is unknown
63 Washington State Department of Social and Health Services, Domestic Violence Intervention Treatment.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 14
Roadmap: Statutory changes and funding required
While statutory changes are identifiable, funding estimates are indeterminate
This research identifies the steps necessary to incorporate DVIT as a covered treatment under Medicaid and
commercial insurance through a complex set of procedures, many of which are outside of state control. Of these,
updating national insurance billing codes presents the greatest challenge. Updating the billing codes is essentially
a national undertaking that is largely centered on a complex, multistate, and multiorganizational process over a
time period that cannot accurately be estimated. There is precedent for Washington -- the SUD billing code update
process that took place more than 40 years -- but even for that process, an accurate assessment of actual costs as
incurred by the state of Washington is unavailable. Due to the unknown and possibly lengthy national process for
creating new billing codes, cost estimates for subsequent steps within the control of the state of Washington, such
as insurance rulemaking and updating Medicaid waiver 1115, are not possible since those steps would presumably
occur many years from now.

For this reason, this report is unable to provide reasonable funding or cost estimates for steps in the roadmap due
to their interdependency with a national partnership-led process likely outside of state control. The magnitude and
sequential nature of some of these steps, such as developing new national billing codes, make the development of
reasonable cost estimates impossible.

Developing partnerships: Build a coalition and broader support
The methodology for developing this report identified a broad range of public and private stakeholders representing
many, but not all, of the interests that will require consultation in advance of establishing DVIT as allowable under
Medicaid and commercial insurance billing. Through the course of the meetings of the DVIT workgroup and
feedback received from numerous other state subject matter experts, there was an overwhelming sense of
hesitance to pursue DVIT billing under Medicaid and commercial insurance billing. For any successful effort to
incorporate such a path in Washington state, these stakeholders and other related interests will need to be
incorporated into the statewide effort to build support.

As explained in this report, the process will be nationwide and will require broad collaboration among other states
and national entities to come to fruition. For Washington state to play an influential role in this process, a more
unified voice among stakeholders will help ensure that the outcomes of the process best serve the needs of
Washington residents. Much like SUD, a national movement to respond to an epidemic of intimate partner violence
is needed, and Washington cannot do it alone.

To build support for this effort within the state and to participate in a broader national effort with a more unified
voice, Washington state could form a permanent task force or advisory committee. The individuals involved would
work through and resolve outstanding concerns prior to moving these concepts forward at the national level as
required to meet the standards for updating billing codes. Such an advisory committee would serve two purposes:
to be a collaborative place to build statewide support, and to serve as the point of coordination among the other
national stakeholders that would be working towards the same broader objectives.

Medicaid and commercial billing
As detailed in the roadmap, the process to undertake an update to the national ICD billing codes is federally
regulated and would involve many partners outside the state of Washington. If Washington state wishes to play a
lead role in this endeavor, a lead agency could be designated to coordinate state participation in the lengthy and
complex national process. The process to update or develop these new billing codes is a prerequisite for
subsequent steps in the roadmap.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 15
Medicaid and Section 1115 waiver
Once new federal ICD codes have been created, Washington state would need to approve Medicaid coverage for
DVIT. The Washington State Health Care Authority would need to classify it as a medical necessity, which would
require a new or amended state mental health parity law. More specifically, amending the definition of "Medically
necessary" in RCW 48.43 to include Domestic Violence Intervention Treatment explicitly. 64

Credentialing
The state may direct an agency to create a new credential for DVIT providers. At the time of writing this report, a
new credential is not warranted or needed for insurance or Medicaid billing purposes prior to changes at a federal
level.

Insurance rulemaking
Once new federal ICD codes have been created, changes will be required in the Office of the Insurance
Commissioner (OIC) through rulemaking. The rulemaking process takes one to two years, during which the OIC will
ensure that any RCWs and WACs are updated to reflect any necessary changes required to ensure coverage. This
rulemaking process takes place through a petition 65 and requires input from stakeholders, a public hearing, and a
period of open comment.

64 Chapter 227, Laws of 2025.
65 Petition for Adoption, Amendment, or Repeal of a State Administrative Rule.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 16
Barriers identified by the workgroup
Overarching barriers
The DVIT workgroup brought together a set of diverse interests and professional experiences in public health as it
relates to DVIT. Members were supportive of the use of DVIT and of efforts to increase its use and availability
throughout the state. Through the course of this research and workgroup meetings, however, workgroup members
consistently and overwhelmingly were less supportive of pursuing Medicaid and commercial insurance billing as a
method to increase the use of DVIT. Some of the concerns are outlined below, detailing complications in
reimbursement rates, plan participation, and the lack of authorized providers. Workgroup members overwhelmingly
were in favor of supporting DVIT as an option for violence intervention, but not through the Medicaid or commercial
insurance systems as currently established.

Provider perspective
DVIT providers and participants in the listening sessions shared concerns about incorporating court-ordered DVIT
into the Medicaid and commercial insurance systems.

Mental health providers face challenges with low Medicaid reimbursement rates, making it difficult for patients to
access timely and sustainable mental health care. 66 67 Providers often cap the number of Medicaid patients to
remain financially viable. Due to low reimbursement rates, prior authorization requirements, claim denials, delayed
payouts, audits, and administrative burdens, approximately 34% of psychologists in Washington do not accept any
form of insurance. 68 69 70 Mental health providers on the workgroup confirmed these concerns and indicated they
would not be likely to accept any form of insurance for DVIT services.

Currently, Washington has 65 state-certified DVIT providers with only three serving the highest-risk offenders. This
shortage is driven by the overall lack of mental health professionals, high occupational burnout, 71 limited funding
and overwhelming demand. 72 Most state-certified DVIT providers function on a private pay model, where
participants pay out of pocket. Many providers offer a sliding-scale fee, but some participants still cannot afford
these services. 73 If the state wishes to promote the increased use of DVIT through the Medicaid and commercial
insurance billing systems, a commensurate effort will be needed to address the lack of qualified mental health
professionals in Washington.

State-certified DVIT providers are most often sole proprietors and unable to afford the administrative costs
associated with insurance and Medicaid billing. Many areas of the state lack state-certified DVIT providers, and
since most IPV offenders are indigent and would rely on Medicaid if a new code were approved, this would create a
potential financial strain and administrative burden for providers, which may lead them to limit or cap services or
potentially end their practice. State-certified providers on the workgroup confirmed these concerns, with some
indicating they would never accept insurance for their services due to these and other related complications.

66 WA mental health providers say insurance reimbursement isn't enough.
67 Washington State Medical Association.
68 American Psychological Association, "Insurance challenges limit psychologists’ capacity to address ongoing mental health needs" (2025).
69 Busch Susan, Ndumele Chima, Foster Christine, Kyanko Kelley. Patient characteristics and treatment patterns among psychiatrists who do

not accept private insurance. (2019).
70 Henry, Tanya. Fixing prior auth: Nearly 40 prior authorizations a week is way too many. American Medical Association (2025).
71 Bahner, Angela and Berkel, LaVerne, "Exploring burnout in batterer intervention programs" (2007).
72 ADHD Advisor, State with the biggest mental health care desserts (2024).
73 This out-of-pocket expense may lead to courts not ordering DVIT treatment

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 17
Listening sessions with providers revealed a significant challenge in accessing survivor-centered education, which
constitutes half of the required training for state certification in DVIT. This gap has been identified as a barrier to
obtaining DVIT state-certified certification.

Court data and need for DVIT
Washington courts do not have a system to track IPV or separate it from domestic violence, 74 making it difficult to
assess the need for DVIT. The lack of standardization could stem from IPV not being classified as a formal charge.
Instead, related offenses—such as assault, harassment, or property damage are not linked to IPV unless explicitly
documented. The absence of specific notations for court-ordered IPV treatments complicates efforts to track
assessments and mandated interventions like DVIT, DV MRT, or other research practices.

Additional solutions identified by the workgroup
Better tracking of IPV and court-ordered treatment
Because court-ordered IPV treatment lacks a standardized recording system, it is difficult to determine the need for
mandated treatment. Without proper tracking, assessing treatment needs, analyzing effectiveness, and
understanding recidivism rates where DVIT is ordered is difficult. The absence of data also prevents tracking
outcomes for offenders sentenced in courts that do not mandate treatment.

A standardized coding system for IPV cases would allow courts within Washington to better track court-ordered
DVIT treatments, completion rates of these court orders, understand the treatment's impact on recidivism, and aid
in determining the need for DVIT. This data would enable a cost-benefit analysis, and additionally improve
understanding about the efficacy of treatment, support ICD/DSM updates, and potentially strengthen the case for
DVIT insurance coverage. The Administrative Office of the Courts could develop this system 75 in collaboration with
judges' associations.

Expand DVIT provider care networks
Providers identified the lack of survivor-centered education as a barrier to DVIT certification. To address this and
increase the number of DVIT providers, they recommended the development of an online training database to
provide information about courses on DV survivor services and DVIT education, benefiting both providers and DV
victim advocates. 76 Stakeholders recommended that the Washington State Coalition Against Domestic Violence
(WSCADV) and DSHS develop and maintain the database, with dedicated funding provided by the legislature.

Listening sessions revealed a significant gap in awareness among behavioral and physical health professionals
regarding DVIT, revealing that many were not aware of the existence of state-certified providers, referral processes,
and available DVIT treatment plans. To address this, the workgroup recommends incorporating a DVIT-focused
training course into the Health Equity Continuing Education 77 series provided by the Department of Health (DOH).
This mandatory training, required every four years, would educate a wide range of healthcare professionals on how
to access and refer patients to DVIT providers. DOH and DSHS could develop and maintain this course, with
dedicated funding provided by the legislature.

74 Conflating IPV and DV in court records was found to be an issue in previous reports to the Legislature - Domestic Violence Perpetrator

Treatment: A Proposal for an Integrated System Response (ISR), (pages 25-33). June 2018.
75 This system has previously been suggested in the 2018 report but was deemed too costly at the time- Domestic Violence Perpetrator

Treatment: A Proposal for an Integrated System Response (ISR), (pages 25-33). June 2018.
76 Zegree, Joan "Batterer's Intervention: What Every Victim Advocate Needs to Know" (2008). WSCADV.
77 Department of Health, Health Equity Continuing Education.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 18
Expand DVIT treatment by establishing fee-for-service contracts with DVIT
programs
Funding fee-for-service programs would allow DVIT providers to offer evidence-based treatment for low-income
individuals at free or reduced cost. Since the overwhelming majority of offenders ordered to DVIT treatment are
indigent, this funding would directly benefit many people who could not otherwise afford DVIT services.

In a 2024 decision package submitted to OFM, DSHS estimated that $4.8 million in the 2025-27 biennium would
allow for contracts with 55 state-certified DVIT programs. If funded, the program would have provided DVIT
services for at least 639 individuals in its first year, ramping up over time to serve at least 2,462 individuals in
FY29.78 The funding was ultimately not included in the 2025-27 enacted budget.

Funding DVIT services for low-income participants will reduce violence, prevent homicides, and increase safety for
victims and children. Funding treatment for low-income individuals supports public safety goals and improves
equity for low-income individuals and families.

Conclusion
Ensuring sustainable access to DVIT is essential to breaking the cycle of intimate partner violence in Washington.
DVIT has demonstrated effectiveness in addressing intimate partner violence while prioritizing survivor and public
safety. Given its unique nature, it requires a dedicated diagnostic code to bill insurance plans and Medicaid.

While insurance and Medicaid could help expand access, significant financial and regulatory obstacles remain.
Creating or modifying diagnostic codes for insurance and Medicaid involves complex federal policy changes and
revisions to state mental health parity laws. These changes would require a significant investment of time and
resources by state agencies, providers, advocates, and other stakeholders.

Ensuring access to DVIT for both providers and clients may require alternative solutions. Strengthening provider
networks and expanding education opportunities could help grow Washington’s DVIT system, making treatment
more accessible and affordable. Improved court record-keeping would allow for a more accurate assessment of
DVIT needs, leading to effective treatment strategies that enhance public health and safety.

Expanding provider networks and streamlining access to DVIT are critical for long-term success. A deeper
understanding of the demand, achieved through better court data, will support efforts to break cycles of violence
and better protect communities throughout Washington.

78 Dept of Social and Health Services - Program 060 Economic Services Administration - 2025-27 Regular Budget Session
Policy Level U9 DV Intervention Treatment

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 19
Workgroup members
Mark Adams, MA, LMHC

• Representing: Organizations that provide domestic violence intervention treatment/Individual clinicians that
provide domestic violence intervention treatment
• Title and organization: Supervising Therapist, ACT&T Central

Rosemary Crawford, MA, LMHC

Stacy Crutcher- McFadden, MSW, CC, DV Certified Level 1-4

• Representing: Individual clinicians that provide domestic violence intervention treatment/Social Worker
• Title and organization: Supervisor, Owner, Counseling and Wellness PC

Dr. Alisha Guthery, PhD, LMHC, CATP

Dr. Nancy Murphy, LMHC, Dmin

Valerie Waterland, MS LMFT ARM

• Representing: Individual clinicians that provide domestic violence intervention treatment/Licensed Marriage
and Family Therapist
• Title and organization: DVIT Supervisor/Trainer, Waterland Counseling LLC

Ashley Albert

• Representing: Domestic violence survivor organizations
• Title and organization: Representative of Washington State Coalition Against Domestic Violence, Founder
and Certified Peer Counselor for Intuned Consulting, LLC

Ward Urion

• Representing: Domestic violence survivor organizations
• Title and organization: Senior Prevention Strategist, Washington State Coalition Against Domestic Violence

Mette Earlywine

• Representing: The domestic violence treatment program administered by the Washington State Department
of Social and Health Services
• Title and organization: Domestic Violence Program Administrator, Washington State Department of Social
and Health Services, Community Services Division

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 20
Amie Roberts, LMHC

• Representing: The domestic violence treatment program administered by the Washington State Department
of Social and Health Services
• Title and organization: Domestic Violence Intervention Treatment Program Supervisor, Washington State
Department of Social and Health Services

Eve E. Austin, RDN, CD

• Representing: Staff from the Washington State Department of Health with expertise in licensing and
credentialing of health professionals
• Title and organization: Office of Health Professions Executive Director -Behavioral Health, Washington State
Department of Health

Chelsey Anderson

• Representing: Staff from the Washington State Health Care Authority who work on insurance billing for
Medicaid, the Public Employees Benefits Board, and the School Employees Benefits Board
• Title and organization: Uniform Medical Plan, Account Manager - Employee and Retiree Benefits Division,
Washington State Health Care Authority

Tina Anderson, MSW, SUDP, Curyung Tribal Member

• Representing: Staff from the Washington State Health Care Authority who work on insurance billing for
Medicaid, the Public Employees Benefits Board, and the School Employees Benefits Board
• Title and organization: North Sound Regional Tribal Liaison - Island, San Juan, Skagit, Snohomish, Whatcom
Counties - Office of Tribal Affairs, Washington State Health Care Authority

Amy Dura, MA, LMHC, MHP, CMHA, SUDP

• Representing: Staff from the Washington State Health Care Authority who work on insurance billing for
Medicaid, the Public Employees Benefits Board, and the School Employees Benefits Board
• Title and organization: Substance Use and Overdose Response Supervisor, Washington State Health Care
Authority

Lauren Johnston

• Representing: Staff from the Washington State Health Care Authority who work on insurance billing for
Medicaid, the Public Employees Benefits Board, and the School Employees Benefits Board
• Title and organization: Uniform Medical Plan, Senior Account Manager, Washington State Health Care
Authority

Delika Steele

• Representing: The Office of the Insurance Commissioner
• Title and organization: Health Policy Analyst, Washington State Office of Insurance Commissioner

Donna Arcieri, HIA, MHP

• Representing: Medicaid managed care organizations/ Commercial Insurance Carrier
• Title and organization: Vice President, Business Process Outsourcing Operations, Community Health Plan of
Washington

Ali Desautel

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 21
• Representing: Medicaid managed care organizations/ Commercial Insurance Carrier
• Title and organization: Tribal Liaison, WA Health Plan - United Healthcare Community and State

Erin Gilliland, LMHC, CCM, SUDP-T

• Representing: Medicaid managed care organizations/ Commercial Insurance Carrier
• Title and organization: Behavioral Health Operations Manager, Community Health Plan of Washington

Lindsey Greene, MSW

• Representing: Medicaid managed care organizations/ Commercial Insurance Carrier
• Title and organization: Medicaid Program Manager, Coordinated Care of Washington

Libby Hein

• Representing: Medicaid managed care organizations/ Commercial Insurance Carrier
• Title and organization: Director of Behavioral Health, Molina

Robert E. Howard

• Representing: Medicaid managed care organizations/ Commercial Insurance Carrier
• Title and organization: Tribal Liaison - Medicaid/Medicare State of Washington, Wellpoint Washington Inc.

Camille Walton

• Representing: Medicaid managed care organizations/ Commercial Insurance Carrier
• Title and organization: Medicaid Program Manager, Coordinated Care of Washington

Brittany St. Clair, NCMA, CHW

• Representing: Medicaid managed care organizations/ Commercial Insurance Carrier
• Title and organization: Social Determinants of Health Liaison, WA Health Plan - United Healthcare
Community and State

Alla Hassan

• Representing: Washington State Department of Commerce's Office of Crime Victims Advocacy
• Assistant Managing Director, Office of Crime Victim's Advocacy

Jodine Honeysett

• Representing: Washington State Department of Commerce's Office of Crime Victims Advocacy
• Title and organization: Violence Against Women Section Manager, Office of Crime Victim's Advocacy

Sarah Thompson

• Representing: Other
• Title and organization: Therapeutic Court Coordinator, Spokane Municipal Court

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 22
Table 1: DVIP vs. DV MRT vs. Anger Management 79

DVIP MRT-DV Anger Management

State certification required? Yes No No

Risk/Needs Assessment Required? Yes No No

Input required from victims? Yes No No

RCW 43.20A.735
Associated laws/regulations None None
WAC 388-60B

Special training required to
Yes Yes No
conduct?

Continuing education required? Yes No No

Counseling
Credentials required to facilitate? No No
credential from DOH

Behavior change required to
Yes No No
complete?

Addresses underlying trauma? Yes No No

79 This table comes directly from Dr. Tara Richards' research and preliminary results in the Domestic Violence Intervention Project through

Seattle Municipal Courts.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 23
Figure 1 - DVIT Education and Provider requirements80

Trainee level requirements Staff level requirements Supervisor level requirements

Be currently Licensed or registered as a Have a minimum of fifty hours of Have at least one hundred hours of
counselor under Chapter 18.19 RCW experience working with victims of experience working with victims of
domestic violence domestic violence.

AND

Be in good standing with DSHS Have a minimum of two years of
experience in facilitating domestic
Have a minimum of fifty hours of violence intervention treatment groups
supervised, direct treatment services to at a certified program. At least two
domestic violence participants in a hundred and fifty hours of direct
Have a bachelor’s degree from an certified domestic violence treatment treatment contact with participant in a
accredited university in counseling, program. certified domestic violence intervention
psychology, social work, or a similar treatment program.
services related field.

STAFF LEVEL QUALIFICATION
COMPLETED SUPERVISOR LEVEL
Have a minimum of thirty hours of QUALIFICATION COMPLETED
Note: Each direct treatment staff must
domestic violence training from an
complete a minimum of twenty hours of Note: A supervisor must have a master’s
established domestic violence victim or
cornuting education each year after the degree from an accredited university in
survivor services program
program is certified, or each year the counseling, psychology, social work or
staff person is added to the staff list. similar field.
AND

Have a minimum of thirty hours of
training on the provision of domestic
violence intervention assessment and
services, provided by an established and
certified domestic violence intervention
treatment services program or other
organization

TRAINEE LEVEL QUALIFICATION
COMPLETED

80 This information comes directly from WAC 388-60B-0210, WAC 388-60B-0230, WAC 388-60B-0240, WAC 388-60B-0250, WAC 388-60B-

0270.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 24
Appendix A: Medicaid Reimbursement Rates
Current average rates for state certified DVIT 81
Assessment (Criminal Court): $326.39

Assessment (family-court referral): $838.33

Group Therapy (per session): $46.39

Individual Therapy (per session): $90.58

Maximum Allowable Fee for Medicaid Reimbursement 82
Assessment (behavioral identification): $19.17

Assessment (behavioral identification supporting assessment): $60.00

Group Therapy (per session) The average group size is 8, so rates for 6+ applied: $9.06

Individual Therapy: $12.65

81 Data provided by DSHS of 2024 average rates for state certified providers
82 Washington State HCA Treatment Fee Schedule (2024).

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 25
Appendix B: Terminology Defined
Behavioral Assessment: Contains demographic information and a detailed description of the participant's history
of violence in familial relationships, as the perpetrator and victim (including sexual assault). Also included are
active or expired protective orders, parenting assessments (including complete supervision orders), and history of
parole or probation. The evaluation of the participant's views on current and past violent incidents include but are
not limited to their thoughts and feelings towards their victim(s), any information collected from these incidents
such as victim advocate statements, 911 calls, and any information the victim would like applied to their
assessment is also taken and documented.83 The treatment plan and level for each participant consider acute and
critical factors for lethality in recidivism.

Behavioral Health Administrative Services Organizations (BH-ASOs): These organizations can provide services to
help clients access mental health or substance use disorder (SUD) treatments. BH-ASOs are funded through state
and federal block grant funding. 84

Centers for Medicare and Medicaid Services (CMS): Agency within the U.S. Department of Health and Human
Services that administers health programs, including Medicare, Medicaid, Children’s Health Insurance Programs,
and the Health Insurance Marketplace.

Claim Denial: When an insurance claim made by an insured person(s) is denied by their insurance (including
Medicare, or Medicaid). There are several reasons why an insurance claim may be denied. 85

Diagnostic and Statistical Manual for Mental Health Disorders (DSM): A handbook used by healthcare
professionals in the United States as a guide to diagnose mental disorders. The DSM contains symptoms,
descriptions, and other criteria for diagnosing mental disorders.86

Domestic Violence (DV): Involves physical harm, bodily injury, assault, or the infliction of fear of physical harm,
bodily injury, or assault by an intimate partner, family member, or household member. 87 Also included are
nonconsensual sexual conduct, nonconsensual sexual penetration, coercive control, unlawful harassment, or
stalking by an intimate partner, family member, or household member.88

Domestic Violence Intervention Program: A DSHS certified program providing domestic violence assessments or
intervention treatment to perpetrators of intimate partner violence.88

Domestic Violence Intervention Project (DVIP): This multidisciplinary treatment program within Seattle Municipal
Courts provides treatment to level 1-3 offenders. It involves collaboration between DVIT counselors, probation
officers, court personnel, community partners, researchers, and informal advisory members. The program also
examines the effectiveness of Domestic Violence Intervention Treatment. 89

Domestic Violence Intervention Treatment (DVIT): A Washington state-certified court-ordered therapeutic program
designed to address intimate partner violence. These services focus on increasing safety for the community and
victim(s) while increasing rehabilitative efforts for the perpetrator to reduce rates of recidivism. The Department of

83 WAC 388-60B-0400:
84 Washington State Health Care Authority. Behavioral Health - Administrative Service Organizations Fact Sheet.
85 Washington State Office of the Insurance Commissioner.
86 Kulpinski, Amber, Bank, Stella, and Blasdell, Raleigh (2023). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and Domestic

Violence. In: Shackelford, T.K. (eds) Encyclopedia of Domestic Violence. Springer, Cham.
87 Chapter 7.105, RCW 7.105.010: Definitions. (Effective until July 1, 2025).
88 WAC 388-60B-0015.
89 Seattle Municipal Court, Domestic Violence Intervention Project.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 26
Social and Health Services (DSHS) sets and maintains treatment standards, including staff qualifications,
treatment modalities, continuing education requirements, and focus of treatment.88

DVIT Continuing Education: This is a requirement for training for DVIT providers and service programs with DSHS
certification to be completed annually. The training must include ten or more hours on DVIT, nine or more hours on
DV Victim Services, and one or more hours on suicide prevention. Providers who facilitate Level 4 are required to
complete an additional four or more hours of continuing education bi-annually. This supervisor specific training
must cover criminogenic factors, risk issues, psychopathy, and related topics. 90

Domestic Violence Moral Reconation Therapy (DV MRT): This is a workbook-based domestic violence treatment
used as a primary treatment method by many programs for perpetrators. The workbook, “Bridging Peace to
Relationships,” is divided into 24 modules to be completed within six months in open-ended group settings.
Correctional Counseling, Inc. provides training to become a DV MRT Facilitator, which requires a four-day, 32-hour
training. 91

Health Equity Continuing Education: The Department of Health (DOH) has implemented Chapter 276, laws 2021.
The law requires that health care professionals be credentialed under Title 18 RCW, and subject to continuing
education requirements, complete health equity continuing education training. This training must be taken at least
once every four years. The department, in consultation with health profession boards and commissions, was
required to adopt model rules but can adopt rules that exceed the minimum standards.92

International Classification of Diseases (ICD) Codes: A standardized system used to classify and code diagnoses,
symptoms, medical conditions, morbidity data, and procedures in healthcare. 93

Intimate Partner: The spouse, state-recognized partner, romantic partner, or date of another person presently or in
the past. Also included is any person who has one or more children in common with another person, regardless of
whether they have been married, in a domestic partnership with each other, or lived together at any time.88 All
therapeutic processes discussed within this document are solely utilized for intimate partner violence.

Intimate Partner Violence: Is abusive behavior that is used by one intimate partner against the other and can
include, but is not limited to, a categorization of domestic violence offenses as defined in RCW 10.99.020.
Examples of offenses include physical, sexual, emotional, verbal, psychological, and economic abuse. It can also
include coercive control, which is the infliction or threat of harm against an intimate partner and is directed at
achieving compliance from or control over that intimate partner. Also included is the improper use of children to
control the victim.

Level of Care: Is the treatment plan a participant is recommended, required, or currently receiving as determined by
a certified program through a behavioral assessment, standardized testing, and the "risk, needs, and responsivity"
form.88 The level of care can range from one to four and corresponds to a set time-period of treatment, with level
four being treated by supervisors only. This treatment plan can be updated at any time based on the participant's
needs, other criminal or civil charges, contact with the victim, and/or other pertinent information obtained by the
provider.

Level 1: Minimum 6 months of treatment (26 weekly group or individual sessions)
Level 2: Minimum 9 months of treatment (39 weekly group or individual sessions)

90 WAC 388-60B-0270.
91 Correctional Counseling, Inc., Domestic Violence - Moral Reconation Therapy - MRT.
92 Department of Health, Health Equity Continuing Education.
93 National Center for Health Statistics, Classification of Diseases, Functioning, and Disability.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 27
Level 3: Minimum 12 months of treatment (52 weekly group or individual sessions)
Level 4: Minimum 18 months of treatment (78+ weekly group or individual sessions)
Level 4 can only be treated by Supervisors who receive additional training and continuing education.

Managed Care Organizations (MCO): A health plan that uses managed care to provide healthcare while controlling
costs. MCOs in Washington State are Amerigroup, Coordinated Care, Community Health Plan of Washington,
Molina, Wellpoint, and United Healthcare. 94

Medicaid Pilot Project: Tests new approaches to improve care and services for Medicaid beneficiaries. 95

Medical Necessity: A requested service that is determined necessary to prevent, diagnose, correct, cure, alleviate,
or prevent worsening of conditions in the client. These conditions endanger life, cause suffering and pain, result in
an illness or infirmity, threaten to cause or aggravate a handicap, or cause physical deformity or malfunction. The
requested service must be demonstrated or proven that there is no other equally effective, more conservative, or
substantially less costly course of treatment available or suitable for the client requesting the service. 96

Medically Necessary: A service or product addressing the specific needs of the patient, for the purpose of
screening, preventing, diagnosing, managing, or treating an illness, injury, condition, or its symptoms, including
minimizing the progression of an illness, injury, condition, or its symptoms, in a manner that is: in accordance with
generally accepted standards of mental health and substance use disorder care; clinically appropriate in terms of
frequency, extent, site, and duration of service or product; and not primarily for the economic benefit of the insurer
or purchaser or for the convenience of the patient. 97

Prior Authorization: When a health plan requires healthcare providers get approval prior to providing healthcare
services or prescribing prescription medication.98

Preventative Services: Refers to the section in the Medicaid State Plan that outlines the requirements for providing
Community Health Worker services as a type of preventative care, which must be recommended by a licensed
practitioner. 99

Promising practices: Programs and strategies with scientific research or data showing positive outcomes in
delaying a negative outcome but aren't yet generalizable to a broader population.88

Sex Offender Therapy Provider (SOTP): a certified affiliate sex offender treatment provider who is licensed as a
psychologist, marriage and family therapist (including associate), social worker, mental health counselor (including
associate), independent clinical social worker associate, advanced social worker associate, or psychiatrist as
defined in RCW 71.05.020.

Stipulated Order of Continuance: A pretrial diversion agreement where the defendant agrees to certain conditions.
If those conditions are met, the case is dismissed at the end of the agreement period. 100

94 Healthier Washington Collaboration Portal, MCO Collaborative Workgroups.
95 Washington State Medicaid Transformation Project 2.0 Demonstration, Section 1115 Quarterly Report.
96 Washington Advisory Code 182-500-0070.
97 Engrossed Second Substitute House Bill 1432.
98 National Association of Insurance Commissioners, What Is Prior Authorization?
99 Medicaid State Plan - Attachment 3, General Provisions.
100 "Criminal Case Dispositions", Chapter 7, Domestic Violence Manual for Judges (2015 Version, Updated 2016).

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 28
V Codes: identify issues that focus on clinical attention or affect the primary diagnosis, course of treatment, or
prognosis of the patient’s condition. V, W, X, and Y codes describe an environmental event causing injury but do not
describe the nature of the injury and can't be utilized for primary diagnosis. 101

Victim services program: A nonprofit program or organization that primarily provides information, assistance, and
advocacy for domestic violence victims through medical, legal, immigration, human services, and financial
assistance systems. The broad range of domestic violence services can include crisis intervention, individual and
group support, referrals, safety assessments, planning, securing shelter, emergency transportation, self-help
services, culturally specific services, legal advocacy, and economic advocacy. Not considered domestic violence
services programs are those associated with or under the direct supervision of a court, law enforcement, a
prosecution agency, or the child protective services section of the department as defined in RCW 26.44.020. 102

Waiver 1115: is a demonstration project that allows the state to test new ways to deliver Medicaid and is also
referred to as the Medicaid Transformation Project. 103

Z Codes: do not diagnose a condition but indicate factors that can influence a patient's health status and contact
with healthcare providers and/or services. Z codes are considered a social determinant of health or environmental
factors, not the cause of the disease, injury, or justification for treatment, and therefore cannot be utilized for
primary diagnosis. 104 105

101 ICD-9-CV Official Guidelines for Coding and Reporting (2011).
102 Revised Code Washington 26.44.020: Definitions, (Effective until July 1, 2025).
103 Medicaid Transformation Project (MTP) Waiver 1115.
104 Centers for Medicare and Medicaid Services, Office of Minority, Utilization of Z Codes for Social Determinants of Health among Medicare

Fee-for-Service Beneficiaries (2019).
105 ICD-10-CV Official Guidelines for Coding and Reporting (2019).

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 29
Appendix C: Glossary of Acronyms and Abbreviations
APA - American Psychological Association

BH-ASOs – Behavioral Health Administrative Services Organizations

C&E – Continuing Education

CMS – Center for Medicare and Medicaid

DOC– Department of Corrections

DOH- Department of Health

DSHS – Department of Social and Health Services

DSM – Diagnostic and Statistical Manual for Mental Health Disorders

DV – Domestic Violence

DVIT – Domestic Violence Intervention Treatment

DVIP – Domestic Violence Intervention Project

DV MRT – Domestic Violence Moral Reconation Therapy

HCA – Health Care Authority

ICD – International Classification of Diseases

IPV – Intimate Partner Violence

MCO – Managed Care Organization

MER – Medicaid Enrollment Ratio

NVDRS - National Violence Death Reporting System

SaH – Strength at Home

SOTP – Sex Offender Treatment Providers

SUDP – Substance Use Disorder Professional

USPSTF – United States Preventative Services Taskforce

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 30
Appendix D: 25 Core Competencies
The following core competencies are required for State-certified Domestic Violence Intervention Treatment
Providers by the Washington State Department of Social and Health Services. After completing training,17 providers
should:

• Be able to explain different types of intimate partner violence, including common types of coercive and
controlling behaviors
• Know the differences between DVIT and anger management treatments
• Be familiar with what victims hope DVIT can provide
• Understand your own biases and how to incorporate cultural competency into your DVIT program
• Be familiar with WAC 388-60B, where to find information you’re likely to need, and what office to call for
assistance
• Be able to explain why the legal status of a participant does not influence an assessment or treatment plan –
see the participant, not their charge or lack thereof
• Be practiced and have skills for increasing victim safety, making contact with victims during the DVIT
process, and protecting the confidential information victims may share
• Have an understanding of participant confidentiality requirements and when confidentiality must be broken
• Be familiar with what the latest research on DVIT tells us about the most effective treatment approaches
• Be able to identify, and have contact information for, your nearest coordinated community response group (or
similar type of DV task force)
• Have a list of DVIT counselors who you can call for confidential case consultations and support
• Be familiar with your personal challenges as a counselor, and have a practice of self-care
• Be able to describe some common attributes and possible differences between participants in DVIT
• Be able to explain the RNR model and how it is adopted in the assessment, treatment plan and delivery of
DVIT
• Know your treatment scope, determined by education, DOH credential, experience and training
• Be able to name various types of trauma-informed treatment models, explain the difference between trauma
and complex trauma, and how DVIT is trauma-informed
• Have an understanding of what makes forensic counseling unique and how to prevent and manage collusion
with participants
• Have experience facilitating a small group, and be knowledgeable about group treatment strategies and how
to use them
• Be practiced in conducting a DVIT behavioral assessment and at least two types of risk and lethality tests for
domain seven
• Be practiced in filling out an RNR form and creating a treatment plan
• Be able to explain the premise of cognitive behavioral therapy and be familiar with three CBT treatment
models
• Have an understanding of the University of Washington Harborview curriculum and how to use the manual
• Have an understanding of how to document the cognitive and behavioral changes participants are required to
make in DVIT
• Know the core competencies and completion criteria participants must meet in order to successfully
complete DVIT
• Have experience writing a discharge summary and know how to assist participants with filling out the
confidential feedback form when they are discharged from DVIT

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 31
Appendix E: Sequence of Events for DVIT - Referral to Discharge

Referral and Behavioral Placement Treatment DVIT Ancillary Cognitive and Discharge and
Screening Assessment and Levels 0-4 planning Treatment Behavioral Data Outcomes
Victim Contact Changes

1) DVIT programs screen referrals to their program from courts, DCYF, probation departments, DOC and other
sources. A DVIT program has the authority to accept or reject any referral for assessment or enrollment into its
program (WAC 388-60B-0300 (1)).

2) The DVIT program conducts a behavioral assessment (WAC 388-60B-0400), which must include collateral
information (WAC 388-60B-0400 (3)(a)), testing (WAC 388-60B-0400 (14)) and contacting the victim when they
are able (WAC 388-60B-0325 (3)(a)). The assessment includes a diagnostic evaluation when it is completed by
mental health professional practicing within their scope of practice (WAC 388-60B-0400 (10)(a)).

3) Once a behavioral assessment is complete, a Risk, Needs and Responsivity form is filled out for the client (WAC
388-60B-0400 (2)(a)) to determine which level of DVIT to recommend for placement (WAC 388-60B0410).

4) Before a client begins treatment, a treatment plan must be completed and be individualized for the client with
measurable goals and objectives. The treatment plan must identify critical or acute factors and co-occurring
treatments recommended or required for the client (WAC 388-60B-0405).

5) DVIT is facilitated in group or individual sessions (WAC 388-60B-0320 (2)). There are 15 areas of treatment
focus the DVIT program must address in treatment (WAC 388-60B-0415). Clients must achieve cognitive and
behavioral changes as well as core competencies in order to complete treatment successfully (WAC 388-60B-
0430).

6) Once a client is discharged from DVIT, the program must complete a discharge summary which includes a
summary of cognitive and behavioral changes the client demonstrated in treatment, the goals and objectives
the participant met, the program’s assessment of the client’s current risk factors, any recommendations for
treatment after discharge and the client’s eligibility to return to DVIT if necessary (WAC 388-60B-0435 (4)). A
Data Outcomes Form is given to the client to fill out anonymously and return to DSHS to track demographic
information and some program effectiveness (WAC 388-60B-0125 (2)(f)). The anonymous data is analyzed by
DSHS, compiled and then shared with DVIT programs.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 32
Appendix F: The Need for DVIT
Prevalence of Intimate Partner Violence
Assessing the actual need for Domestic Violence Intervention Treatment (DVIT) is challenging, in part because
intimate partner violence (IPV) is often underreported. Victims may fear retaliation, 106 face stigma and victim
blaming, 107 or struggle with economic dependency and financial constraints, 108 all of which deter reporting.
Additional factors—including concerns about privacy, socio-economic status, cultural influences, mandatory arrest
policies, inadequate legal consequences, and distrust in reporting systems—further contribute to underreporting. 109

Marginalized populations, in particular, experience higher barriers to reporting, making it even more difficult to
estimate the true need for DVIT and identify victims of IPV. 110 Research and workgroup findings highlight these
challenges, showing that underreporting skews available data. Additionally, the lack of standardized reporting
within Washington Courts makes it even harder to accurately assess the demand for DVIT and ensure appropriate
intervention.

The Washington State Department of Health (DOH) reports that 1 in 8 Washington adults report having been injured
by an intimate partner. 111 The National Coalition Against Domestic Violence reports that approximately 41.4% of
women and 31.7% of men in Washington have experienced domestic violence at the hands of an intimate partner.
According to the Washington Association of Sheriffs and Police Chiefs, 64,554 domestic violence offenses were
reported in 2023, 112 making up 13.7% of all violent crimes reported within Washington. The most recent data
provided by the National Domestic Violence Hotline shows that 7,624 contacts reporting DV incidents were made
to the hotline from Washington in 2023. 113 When we consider that these numbers are under-reported, the lack of
tracking of those who need DVIT treatment and survivor services becomes more dire.

A research gap identified was the absence of updated data on Intimate Partner Violence (IPV), including its lethality
and the demographic groups most affected by IPV in the aftermath of COVID-19. The data presented here
represents the most up to date research currently available.

Fatalities of Intimate Partner Violence
A recently published cross-sectional study114 of the National Violence Death Reporting System (NVDRS) found that
of the 7,352 intentional violent deaths reported in Washington between 2015-2022, 12.9% had known DV
histories.114 Of the group with known DV histories, 44% had prior contacts with social services or the legal system,
with civil protection orders and calls to 9-1-1 being the most common. Circumstances of DV were most common
among females who died by homicide, 204 of 312 females who died by homicide (65.4%) died in connection to DV
compared with 156 of 880 males who died by homicide (17.7%). Among suicides, proportions with DV

106 Sefton Women's and Children's Aid, Why is domestic abuse often not reported?
107 Connection for Abused Women and Children, Stigma and Domestic Violence (2023).
108 Gurum, Balbier and Marchbank, Jennifer "Chapter 8: Why Survivors Don't Report" (2020).
109 YWCA Spokane "Barriers to Reporting" (2024).
110 Heron, Rebecca, Maarten, Eisma. "Barriers and facilitators of disclosing domestic violence to the healthcare service: A systematic review

of qualitative research" (2021).
111 Washington State Health Assessment (2018).
112 Washington Association of Sheriffs and Police Chiefs, Crime in Washington Annual Report (2023).
113 This is voluntary reporting data requested from the national domestic violence hotline for the calendar year from contacts who reported

their location as WA state. These years were chosen to represent data post COVID 19.
114 Kafka Julie, Adhia, Avanti, Martin, David, Mustafa, Ayah, Rowhani-Rahbar, Ali, and Rivara, Frederick "Deaths Related to Domestic Violence

in Washington State" (2024).

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 33
circumstances were similar for males (468 of 4701 [10.0%]) and females (120 of 1459 [8.2%]). When children under
the age of 10 were killed in a homicide, DV was common most of the time, (47 of 51 [92.2%]).

Non-fatal strangulation, often referred to as "the last warning shot" 115 was only recently identified as one of the
most lethal forms of IPV despite being a strong indicator of DV-related homicide by firearm. Washington State
defines non-fatal strangulation as compressing a person’s neck to obstruct blood flow or breathing or doing so
with the intent to cause such obstruction. 116 No hospital or emergency facility costs for examining a domestic
violence victim of nonfatal strangulation, when conducted to gather evidence for prosecution, shall be billed to the
victim. These costs are covered by the state under RCW 7.68.803. 117 In 2022, the Crime Victim's Compensation
Program received 77 claims related to non-fatal strangulation in cases of IPV. 118 Homicides in the United States by
violent partners with a firearm have increased by 36% between 2014 and 2023. 119 It is estimated that gun violence
costs Washington an average of $5.3 billion every year and perpetrators of IPV use firearms more often than other
weapons combined. 120 In Washington State, American Indian, and Alaska Native women are our highest-risk
population for gun violence and IPV, and are 2.8 times more likely to die at the hands of an intimate partner. 121 IPV-
related homicides and crimes are costly to our communities and an economic burden felt throughout the state. The
message is clear: intimate partner violence is devastating our communities, is costly to Washington, and that
ending these cycles of violence is a life and death situation.

Domestic Violence Intervention Treatment and Courts
Although IPV has been recognized as an issue within Washington courts for over 30 years, DVIT as a form of
treatment, often court ordered, is far more recent. 122 Washington Administrative Code (WAC) 388.60B, which
outlines the criteria for state-certified providers, programs, and staff, was comprehensively updated in 2018, with
more minor updates in 2019 and 2025. WAC 388.60B outlines procedures for DVIT services in meeting court
orders, assessing lethality and risk, competencies required for clients/perpetrators, level of care, and an advisory
committee containing court personnel. As recently as 2023, an 82% reduction in abusive behaviors 123 was self-
reported by participants at the completion of DVIT state-certified programs. Although DVIT is successful, it is not
the most court-ordered treatment, due in part to cost.

Charges and cases related to IPV are heard in County, Municipal, and Superior courts, spanning both criminal and
civil litigation. The most common outcome for individuals convicted of domestic violence offenses is being placed
on supervised probation for two years. 124 The court may also order court-ordered therapies such as DVIT, parenting
classes, alcohol or drug classes, and/or sexual deviancy treatment depending upon the charges. Nearly 2.4 million
domestic violence cases were filed in Washington State's criminal courts between 2001-2012 with 78% of those
being misdemeanor offenses.125 DV convictions are the greatest predictor of future criminal acts and violent

115 Alliance for Hope International, Strangulation 101: The Last Warning Shot.
116 RCW 9A.04.110.
117 RCW 7.68.803 Nonfatal strangulation - Payment of costs for medical examination. Prior to 2022, treatment for non-fatal strangulation

was not explicitly compensated for crime victims.
118 Senate Bill Report SB 5070.
119 Everytown Research analysis of FBI Supplemental Homicide Report (SHR) data from 2014–2023 (2024). America's Uniquely Lethal

Intimate Partner Violence Problem.
120 Women's Commission, Washington State, Biennial Report 2021 - 2022.
121 Washington State Coalition Against Domestic Violence, Washington State Domestic Violence Fatalities Involving Native People in

Washington State (2012).
122 DSHS has established and monitored DVIT standards since 1991 (Engrossed Substitute Senate House Bill 1884, Section 7 (Pg 14)) - but it

is unclear how long courts have ordered treatment in Washington.
123 SELF-reported BY PARTICIPANTS at the completion of state-certified DVIT programs
124 Seattle Municipal Court, What Happens in Cases.
125 Washington State Institute for Public Policy, Recidivism Trends of Domestic Violence Offenders in Washington State (2013).

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 34
crimes;126 however, these cases are notoriously difficult to prosecute, under-reported, and often result in pleas or
stipulated order of continuance (SOC).

Data provided by the Administrative Office of the Courts (AOC) shows that from 2023-2025, 1,937 Defendants in
IPV cases were pled and proved guilty, 127 while 2,656 were either dismissed, awaiting sentencing, or unknown at
the time of this report. Prior to 2023, there was little to no information available on ordered therapeutic treatment in
IPV cases. Previous reports to the Legislature have highlighted the challenges in assessing the need for DVIT
because IPV and DV are not distinctly categorized or flagged within the Washington Court System. 128 This lack of
separation may create the false impression of fewer IPV cases when, in reality, they simply go unmarked in official
reporting.

During the data-gathering process, the Administrative Office of the Courts (AOC) confirmed that IPV and DV are not
separately categorized. These crimes are not flagged or marked as IPV or DV in sentencing. This absence of
distinct data makes it difficult to assess the need for treatment, analyze recidivism rates, or determine the specific
type of treatment a defendant has been ordered to complete. Additionally, it complicates efforts to evaluate the
demand for insurance or Medicaid coverage and assess the cost-benefit implications of modifying insurance and
Medicaid billing practices.

Promising Practices and Research
Promising Practices, as described in WAC 388-60B are programs or strategies that have illustrated a reduction in
domestic violence perpetration, but the research and/or data are not yet generalizable to the broader state
population. Meaning that these practices are typically offered or monitored by outside researchers to determine the
most efficient, cost-effective, and evidence-based approaches are used within Washington State. A promising
practice being utilized within Washington is the Domestic Violence Intervention Project (DVIP) Table 2: DVIP vs. DV
MRT vs. Anger Management. Unlike DVIP, a promising practice, Strength at Home (SaH) and Internal Family
Systems (IFS) are research projects that have been granted exceptions to the requirements to comply with
standards under WAC 388-60B specifically for research purposes only. Unless otherwise stated, there is also no
state regulatory agency overseeing current research detailed within this section. 129

The Domestic Violence Intervention Project (DVIP) differs from Internal Family Systems (IFS) and Strength at
Home (SaH) because it follows the regulations put forward in WAC 388-60B, to meet state-certified requirements
of DVIT treatment. This research project is being conducted by University of Nebraska Omaha and the Urban
Institute, operating within the Seattle Municipal Courts. 130 DVIP is unique in its approach, as it integrates court
personnel into the assessment process and establishes a 'treatment team' led by a state-certified DVIT provider. 131
This occurs before the standardized treatment required under state-certified DVIT programs (Appendix E:
Sequence of Events for DVIT - Referral to Discharge). The multidisciplinary approach incorporates probationary
services, state-certified DVIT counselors, advocates for the victim, a DVIP coordinator, and community advisors.
Preliminary data from Seattle Municipal Court indicates that individuals who completed the DVIP program exhibit
significantly lower recidivism rates compared to those who began the program but did not finish. Among DVIP

126 Washington Association of Prosecuting Attorneys and the King County Prosecuting Attorney’s Domestic Violence Unit, Prosecutors’

Domestic Violence Handbook (2017).
127 Administrative Office of the Courts pulled all data in which DV Assessment or Treatment was ordered. Because no standardization for

this order exists, this data may not represent those who were ordered but instead gaps in recording.
128 Domestic Violence Perpetrator Treatment: A Proposal for an Integrated System Response (ISR), pg 25-33. Report to the Washington State

Legislature (2018).
129 Domestic Violence Intervention Program (DVIP) is overseen by Seattle Municipal Courts
130 Richard, Tara, Wright, Emily, and Nystrom, Alyssa, "A Formative Evaluation and Evaluability Assessment of the Seattle Domestic Violence

Intervention Project" (2025).
131 Domestic Violence Intervention Project - Seattle Municipal Courts.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 35
completers, only 15% committed a new crime (4% non-DV; 9% DV-related offenses), whereas non-completers had a
recidivism rate of 52% (20% non-DV; 28% DV-related offenses).

Strength at Home (SaH) has been granted an exception to WAC 388-60B during a clinical trial. The randomized
control trial is currently being conducted by the University of Boston and funded under Sec. 126 (137(b)) of Chapter
376, Laws of 2024. SaH focuses on treating trauma and explaining how IPV is learned behavior. SaH ranges in
duration from 12-26 weeks and is carried out by those certified by the primary program developer and his staff.132
The SaH model focuses on developing offender accountability through group sessions, with the aim of
encouraging perpetrators to change their behaviors and reduce violent or controlling behaviors. Results from
previous controlled trials with military/veteran populations show a decrease in IPV recidivism. Currently, SaH
accepts offenders at all levels. However, they do not conduct assessments, which may result in the levels of
offenders being unknown within their study. In June of 2025, the clinical trial in Washington state will conclude, and
the initial results will be provided by researchers to the Office of Crime Victims Advocacy.

Internal Family Systems (IFS) is another research project in its pilot phase being conducted by researchers at
Harvard University in Washington state and funded under Sec. 126(137(b)) of Chapter 376, Laws of 2024. This
program has current state-certified DVIT providers observe group therapy sessions and become trained in these
services. IFS focuses on the self and helps “people heal by accessing and healing their protective and wounded
inner parts.” 133 While IFS has demonstrated positive results in other settings, this is the first time it will be used to
treat IPV perpetration. Similar to SaH, IFS does not include a DVIT assessment of risk, needs, and responsivity and
therefore takes all levels of offenders. In June of 2025, the pilot study in Washington state will conclude, and the
initial results will be available.

Domestic Violence Moral Reconation Therapy 134 (DV MRT), once a research project in Washington, this form of
therapy is now the most widely used form of court-ordered intervention for IPV offenders in Washington. This
program is usually carried out by an individual working in Probationary Services. The program is six months in
duration, does not have an assessment, and is work-book based. The average cost is $135 for the entire 6-month
long program and workbook. Although initial results were promising, "research showed that DV-MRT became less
effective in the second year", though the treatment group still showed better outcomes than the comparison group
receiving no therapy. The study authors recommended further long-term evaluations. 135 However, these
evaluations were never completed, leaving a gap in understanding the long-term effects of this treatment.

132 Strength At Home.
133 Internal Family Systems Institute.
134 "The term "moral" refers to moral reasoning based on Kohlberg's levels of cognitive reasoning. The word "reconation" comes from the

psychological terms "conative" and "conation," both of which refer to the process of making conscious decisions. MRT is a cognitive-
behavioral treatment system that leads to enhanced moral reasoning, better decision making, and more appropriate behavior."
135 Washington Courts: Press Release Detail. Gender and Justice Commission Research Finds Domestic Violence MRT Treatment is

Effective, Low Cost (2022).

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 36
Appendix G: Map of State-Certified DVIT Providers
This map was created using the list of state-certified DVIT providers maintained by DSHS. 136 While state providers
are limited in geographical location in Washington, DVIT can be offered virtually and is therefore accessible
throughout the state.

State-Certified DVITProviders in Washington State
Whatcom

Skagit

Snohomish

Chelan

Kitsap Spokane

King
Mason

Grays Harbor
Pierce
Thurston

Pacific
Yakima

Cowlitz Benton

136 DVIT Programs by County.

DOMESTIC VIOLENCE INTERVENTION TREATMENT WORKGROUP REPORT 37

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