The I-ARTS Framework: Identify-Approach-Report-Refer-Treat-Support: An Evidence-Informed, Dental-Specific Practical...

Domestic abuse is a public health concern, and dental professionals may encounter oral, facial, and head and neck injuries associated with violence. However, barriers related to training, confidence, documentation, reporting, referral, and professional role boundaries may limit responses. This paper aimed to develop a dental-specific guide for responding to suspected or disclosed domestic abuse.

The guide was developed by synthesizing literature on domestic abuse, healthcare responses, dental practice, trauma-informed care, documentation, reporting, and referral with findings from a multidisciplinary qualitative study involving dental professionals, psychologists, physicians, and nurses, social workers, and legal professionals. Thematic findings and evidence were organized into an interconnected six-domain framework.

The I-ARTS (Identify-Approach-Report-Refer-Treat-Support) framework organizes responsibilities across the patient's care journey. Identify emphasizes recognition of clinical, behavioral, and contextual indicators. Approach focuses on privacy, trauma-informed communication, patient autonomy, and opportunities for disclosure. Report addresses confidentiality, documentation, legal duties, and jurisdiction-specific reporting requirements. Refer connects patients with medical, psychosocial, legal, and community resources. Treat addresses oral and maxillofacial consequences while minimizing trauma and promoting safety using trauma-informed language. Support emphasizes continuity, follow-up, autonomy, and multidisciplinary collaboration. The domains may overlap and do not necessarily follow a fixed sequence.

Dental professionals have a role in recognizing and responding to domestic abuse, but effective care extends beyond identification and dental treatment. The proposed I-ARTS framework provides an evidence-informed structure for integrating trauma-informed communication, documentation, referral, safety, and continuing support into dental practice. Implementation will require education, institutional protocols, accessible referral pathways, and adaptation to local legal and safeguarding requirements.