The World Health Organization (WHO) defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, against another person or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.”1
Every family physician knows patients in their practice who have experienced violence. Based upon the epidemiology of violence, family physicians cannot predict the total burden of violence in their patient population, but they can draw some conclusions. Many patients have experienced one or more forms of violence and trauma. While risk varies among populations, there are no economic, racial, religious or other groups who are immune from violence, and age, gender and other variables can account for the different types of violence individuals can be most at risk of experiencing.
There is a growing body of evidence linking the many forms of violence to adverse health effects. Many patients who have been exposed to violence will have increased incidences of post-traumatic stress disorder (PTSD), depression, anxiety, substance abuse disorders, chronic pain syndromes or chronic health problems such as diabetes or heart disease.2 For other patients, however, the effects of violence may not be noticeable, and physicians may be unaware of their histories of violence and trauma. Family physicians should understand this link and work with patients to minimize the adverse health effects associated with violence.
The American Academy of Family Physicians (AAFP) policy on violence states that the Academy “recognizes violence as a major public health concern. Violence occurs in the context of a broad range of human relationships and complex interactions that encompass social, cultural and economic risk factors, including but not limited to the influence of the media, substance use, interpersonal violence (including sexual and intimate partner violence), fragmentation of family life, availability of weapons and the rise of gangs and youth violence. Exposure to violence and abuse has been associated with death and severe physical and mental health outcomes. Violence disproportionately affects vulnerable populations, such as women, children, lesbian, gay, bisexual, transgender, questioning and intersex individuals, and those living in poverty, among others.”
Family physicians are uniquely positioned to lead efforts in violence prevention, early identification, trauma-informed response and structural change. The AAFP urges action across the following domains:
Physician level
Practice level
Community level
Educational level
Advocacy level
As mentioned, the WHO classifies violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.”1 They present a typology of violence that can be useful in understanding contexts in which violence occurs and the interactions between different types of violence. This typology distinguishes four modes in which violence may be inflicted: physical, sexual, psychological and deprivation (or neglect).3 The WHO describes three broad subtypes of violence: self-directed (including suicide and self-abuse); interpersonal; and collective.
Violence can take many forms, each with varying prevalence depending on the region, population and time period. Common economic, social and cultural risk factors influence all forms of violence, with vulnerable populations at an increased risk. All violence is functional, intended to dominate, punish, control, harm or eliminate an individual, group or community. Violence manifests in various forms within the context of a broad range of human relationships. These forms include interpersonal violence, community violence, collective violence, sexual violence and gender-based violence (GBV).
Interpersonal violence includes violence between individuals within and outside the family in varying forms, such as intimate partner violence (IPV), child abuse and neglect, and elder mistreatment.
IPV involves harm by a current or former partner or spouse. IPV can include physical and sexual assault, emotional or psychological mistreatment, threats and intimidation, economic abuse, and violation of individual rights.4-6 IPV can be carried out by or against any individual regardless of sexual orientation or gender identity and does not require sexual intimacy.
Child abuse and neglect encompass all forms of violence perpetrated against individuals under 18 years and includes acts committed by parents or caregivers, peers, partners or strangers.7 Abuse involves intentional actions causing harm, such as physical, sexual, emotional or psychological abuse. Neglect involves failing to provide for the basic needs of another person. Child abuse and neglect can lead to lifelong consequences for adverse physical and emotional health outcomes, including a shortened lifespan and increased risk of medical and psychiatric illness.
Elder mistreatment is any abuse or neglect of individuals 60 years or older by a caregiver or another trusted individual or group.8 Mistreatment of older adults may take the form of physical, sexual, psychological or emotional abuse. Neglect, abandonment and financial exploitation are other significant forms of abuse and mistreatment. Elder mistreatment is associated with physical and mental health problems, including bodily injuries, depression, poor control of chronic diseases and functional disability.
Community violence includes violence between individuals not in a family or intimate relationship and includes homicide, gang and youth violence. Community violence can lead to adverse health outcomes for whole communities.9
Collective violence encompasses social, political and economic violence composed of many individual acts of interpersonal violence organized within a larger social and cultural context. Collective violence includes war, terrorism, genocide, armed conflict, human trafficking, sexual exploitation and slavery.10
Sexual violence includes rape, assault, coercion and sex trafficking.11,12 Sexual violence is forced or manipulated sexual activity without the consent of the survivor. Any individual can experience sexual violence, but social inequalities increase the risk for certain populations. Reasons for a lack of consent can include fear, age, illness, disability, impairment or influence of alcohol and/or substances. The survivor often knows their perpetrator, and there is an overlap between IPV and sexual violence.
Gender-based violence (GBV) includes harm directed at individuals based on actual or perceived sex, gender, sexual orientation, gender identity or expression. Violence against individuals can be physical, emotional, psychological or financial.13,14 While GBV can be experienced by any gender or sexual orientation, women and girls are disproportionately affected.
Evidence shows the link between the many forms of violence and adverse health effects.15 Family physicians should understand this link and work with patients to minimize the negative health effects associated with violence. Engaging in opportunities to identify patients at risk of victimization or perpetration is vital. Family physicians are uniquely positioned to help prevent or influence outcomes associated with violence against patients.
Although no single theory can describe all causes of violence and abuse, the Centers for Disease Control and Prevention recommends a social-ecological model as a framework for prevention and intervention. Seeking to understand factors that shape and create risk for the development of violence and abuse is not intended to excuse or mitigate personal responsibility for criminal or immoral behaviors. However, for primary prevention, it is critical to understand the individual and social factors for perpetration of violence and abuse. Macrosocial factors are likely associated with the development of violent behaviors.
Power and control are often described as the underpinnings of violence and abuse.16 The patriarchal social structure can produce a social environment that supports male domination of women from the feminist perspective. Poverty, lack of economic opportunity, racism, and discrimination also support power differentials in society and are key drivers for the development of stress.17 Stress appears to be related to biologic pathways potentiating increased risk for developing maladaptive behaviors (e.g., substance misuse). Stress may also serve as a trigger for violent outbursts.18 Alcohol and substance misuse are strongly associated with violence, though debate exists in the literature regarding the causal relationship between the two.19,20 Family physicians should stay informed about new research and future developments in violence prevention. In particular, they should look for findings that can be implemented in the primary care setting.
Every family physician has patients who have experienced violence, e.g., survivors of child abuse, sexual assault or IPV; war veterans; refugees from high-conflict regions of the world; individuals who have been the target of a hate crime). Many patients who have been exposed to violence will have increased incidences of PTSD, depression, anxiety, substance abuse disorders, chronic pain syndromes or chronic health problems such as diabetes or heart disease.2,3 However, the effects of violence may not always be apparent, and the physician may not be fully aware of histories of violence and trauma. A key point to consider is that many patients have been exposed to one or multiple forms of violence.
AAFP policy states, “family physicians should follow all appropriate screening recommendations for patients at increased risk for intimate partner violence. To support their patients who are survivors of violence or are at risk, family physicians need to be aware of the various manifestations of violence, risk factors related to violence, availability of resources and services for survivors of violence and their families. The AAFP also encourages members to become involved in efforts to reduce violence through advocacy and education, as well as partnerships with law enforcement and community-based organizations. Family physicians should follow recommendations to screen patients for intimate partner violence in order to support their patients who are survivors of violence or are at risk.”
Domestic violence and IPV
Globally, one out of every three women has faced either physical or sexual violence at least once since the age of 15 years, usually by an intimate partner.1 Data from the National Intimate Partner and Sexual Violence Survey show that approximately 41% of women and 26% of men in the United States have experienced some form of contact sexual violence, physical violence or stalking by a partner.21 Additionally, more than 61 million women and 53 million men in the United States have endured psychological aggression from an intimate partner. For many, these experiences began before 18 years, with an estimated 16 million women and 11 million men reporting their first exposure to IPV occurred during childhood or adolescence.
Sexual violence
More than half of women and nearly a third of men have faced sexual violence involving physical contact at some point in their lives.12 The risk is especially pronounced among women and certain racial and ethnic groups, such as non-Hispanic American Indian or Alaska Native populations, who bear a disproportionate share of the burden.
Child and adolescent abuse and neglect
The WHO estimates that up to one billion children worldwide from 2-17 years had experienced some form of physical, sexual or emotional violence or neglect in the year of the study.22 In the United States, a nationally estimated 2,000 children died from abuse and neglect in 2023, with one in seven children experiencing abuse or neglect.23 That year, child protective services agencies received an estimated 4.4 million referrals for alleged maltreatment involving approximately 7.8 million children. While unintentional injury remains the leading cause of death for children and adolescents,24 homicide is a top-five cause of death for all youth age groups, with a reported child homicide rate of 1.28 per 100,000 children in 2023.25 That year, 36% of child homicides involved a firearm, increasing from 20% in 2014.
Elder mistreatment and abuse
Elder mistreatment and abuse can include physical, emotional or psychological abuse, financial exploitation, and neglect and abandonment of adults 60 years or older.8,26 Abuse is experienced by approximately 1 in 10 older adults, though it is estimated that only 1 in 24 cases are reported to authorities.8 Nearly half of all perpetrators of violence were family members, and 13% were medical, non-family caregivers. Social isolation and mental impairment contribute to vulnerability risks for abuse in older adults.
Community violence
Community violence can cause financial, physical and emotional strain and impact overall health outcomes for entire communities.9 Concerns about physical safety in their communities can prevent individuals from engaging in healthy behaviors, such as walking or using public spaces like parks. Risk of violence in communities impedes business growth, slows community progress and strains community resources, such as the justice and medical systems. Risk of violence can contribute toxic stress and lead to adverse childhood experiences (ACEs).
Community violence impacts entire families, schools and communities, with young Latino and Black communities being disproportionately affected. Homicide is the second leading cause of death for youth and young adults 10-24 years, and it is the third leading cause of death for adults 25-34 years. More than 700,000 young people are treated for injuries resulting from violence annually in the United States.
Collective violence
Human trafficking, forced labor and commercial sexual exploitation are international and domestic issues. There were an estimated 27.6 million victims worldwide of human trafficking in 2021—77% through forced labor and 23% through commercial sexual exploitation.27,28 In the United States in 2023, the U.S. Department of Transportation received reports of 9,619 potential human trafficking cases with 16,999 potential victims.28
Ongoing research on war-related trauma shows that a large majority of war veterans experience traumatic events and have higher risks of PTSD, depression, anxiety and IPV due to the collective violence they experienced in wars and armed conflicts. In 2024, approximately 15% of veterans who served in the Iraq and Afghanistan wars experienced PTSD.29
Exposure to violence and abuse has long been associated with adverse health outcomes across the lifespan and within vulnerable communities. The AAFP recognizes that providing care for patients with trauma histories is implicit in the role of family medicine practices and defines trauma-informed care (TIC) as a “whole-person approach to health care that acknowledges the impact of trauma on health and facilitates long-term engagement in care that is inherently patient-centered.”
Family physicians should understand the context in which violence occurs, accounting for the overlap and interplay among the many factors that can impact domestic, intimate, interpersonal, neighborhood, community, and social and political violence.
Violence (i.e., physical, emotional, or psychological) can have a significant and lasting impact on health, both immediate and long term. It is one of several critical social determinants of health (SDOH) affecting individual and community well-being.30 Studies controlling for tissue injury, maladaptive behaviors, lifestyle choices, and comorbid mental illness do not fully explain the associations between violence exposure and chronic disease, suggesting that the presence of other pathophysiological mechanisms related to violence may also impact health outcomes.31
Research indicates that the primary mechanisms by which exposure to violence causes adverse health outcomes, such as chronic disease, include stress-mediated dysregulation of homeostatic pathways regulating neuroendocrine systems and the hypothalamic-pituitary-adrenal (HPA) axis.2,32 Neurobiological mechanisms include alterations in monoamines (serotonin and norepinephrine), hormones of the HPA axis (corticotropin-releasing hormone, adrenocorticotropin hormone, cortisol, and dihydroepiandosterone), substance P, and neuropeptide Y.
Physical impact
Physical violence can cause injuries like fractures, burns, internal bleeding and/or organ damage.33 These injuries can cause chronic pain and ongoing discomfort. They may also lead to permanent disabilities, such as loss of mobility, blindness and deafness. Physical violence can also cause traumatic brain injury, which can cause cognitive impairment and memory loss.
Mental and psychological impact
PTSD, depression and anxiety are commonly seen in victims of violence.34 These individuals have impaired coping mechanisms and exhibit self-harm and suicidal tendencies. There is also an increased risk of substance use for individuals experiencing violence, leading to worsening mental health.
Sexual and reproductive health impact
Survivors of sexual violence may suffer from sexually transmitted infections, unintended pregnancy, complications of pregnancy and chronic health conditions, such as pelvic pain and urinary tract infections.35
Child and adolescent impact
Children who grow up in violent environments may have developmental delays (i.e., cognitive, emotional and social).36 They can also have poor academic performances and display behavioral issues. ACEs are potentially traumatic events that occur during childhood and are linked to an increased risk of violence perpetration and victimization later in life. These experiences can have a lasting impact on brain and psychological development.
Social impact
Exposure to violence impairs the ability of the individual to hold on to a job, leading to financial instability and poverty.37 The individual experiencing violence may withdraw from society, leading to worsening mental health issues. Those who experience and survive IPV may suffer from chronic medical issues and become dependent on addictive substances.
Economic impact
Violence places an increased burden on the health care system. The cost of fatal and nonfatal injuries is approximately $4.2 trillion, encompassing costs associated with health care, lost work productivity and the estimated cost of a diminished quality of life or loss of life.38 For fatal injuries, the average cost per patient who was hospitalized was approximately $45,000 in 2019, and the average cost per patient in the emergency department was nearly $5,000. For nonfatal injuries, the average cost per patient in the emergency department plus medical bills was approximately $5,800, with work loss costs totaling nearly $1,700. For those requiring inpatient care, the costs of medical bills and work loss increase to $52,000 and $7,800, respectively.
The AAFP’s policy on hate crimes “acknowledges that hate crimes directed against protected classes, including race, color, religion, gender, sexual orientation and disability status, pose specific and distinct health risks for our patients. The AAFP supports the development and implementation of anti-discrimination and hate crime laws that seek to protect victims from perpetrators. The AAFP further supports research and educational programs directed at the prevention of hate crimes and promotes interventions that address the physical and psychological health needs of hate crime survivors.”
Marginalized and vulnerable populations, including children, adolescents, pregnant persons, immigrant communities, LGBTQI+ individuals, racial and ethnic minority groups and older adults, are at an elevated risk of experiencing violence.39 An increased vulnerability to violence is associated with systemic inequities, adverse SDOH and limited access to resources and support systems. Addressing these challenges requires a trauma-informed and multi-level public health approach focused on prevention, education, support and advocacy to reduce violence and mitigate long-term consequences.
Among LGBTQI+ individuals, violence can manifest in distinct and multifaceted ways, such as bullying, denial of employment or health care, and various forms of physical and verbal assault.40 Members of the transgender community, and Black transgender individuals in particular, report higher rates of violence and underreporting.41 The issue encompasses physical, emotional and psychological harm.40 Hate crimes and assaults based on identity have persistent health effects, and transgender individuals are at an increased risk of sexual assault. Criminalization, police brutality and insufficient legal protection are factors that contribute to increased vulnerability and marginalization.42 Homophobia, transphobia, misinformation and hate speech also play a role in perpetuating violence, which can lead to mental health challenges, displacement and economic hardship.43 Comprehensive support structures and protective laws are necessary to eliminate risk and ensure the health and safety of these populations.
Older adults experience unique forms of abuse, often underreported due to stigma, isolation or lack of appropriate support. This abuse can come in the forms of physical, sexual, psychological, emotional, intimidation, self-neglect, financial exploitation, senior scams, isolation and/or abandonment and failure to provide safe care.44-46 This leaves older individuals particularly vulnerable, as they may lack the physical and emotional resources and capacity to care for themselves as they age and become frailer with fewer resources for self-care.45,46 This can also include institutional abuse where the settings in which the older adults are cared for (i.e., nursing homes) are not caring for them appropriately. Signs of abuse can include weight loss, fractures or other signs of physical trauma, refusal to speak, lack of safety aid/physical support (i.e., wheelchairs, walkers, dentures) and changes in mental status.45
Validated screening instruments that identify potential older adult victims of abuse and neglect include47:
Longitudinal studies describe associations between early childhood exposures to violence (i.e., both direct and indirect) and long-term health. The ACE study has been instrumental in establishing the relationship between childhood exposures to violence and abuse and risk for poor health-related outcomes in adulthood.48 Childhood adversity, characterized as abuse (i.e., emotional, physical or sexual), neglect (i.e., emotional or physical) or household dysfunction (i.e., exposure to IPV, substance misuse or dependence, mental illness, parental separation or divorce, or incarceration), can cause toxic stress.36,48 Extended or prolonged exposure to toxic stress due to ACEs can negatively impact a child’s brain development, immune system and stress-response system, leading to long-term health impacts.36 Adverse health outcomes or unhealthy behaviors can include adult substance misuse, chronic obstructive pulmonary disease, depression, fetal death, health-related quality of life, illicit drug use, ischemic heart disease, liver disease, risk of IPV, multiple sexual partners, early initiation of sexual activities, sexually transmitted infections, smoking (and early initiation of smoking), suicide attempts, unintended pregnancies and adolescent pregnancy. 36,48
The problem is pervasive, with three-quarters of high school students reporting one or more ACEs, and one in five experiencing four or more ACEs;36 and nearly two-thirds of adults in the United States reporting at least one ACE and more than one in six reporting four or more ACEs.49
While all children are at risk, some populations are at greater risk of experiencing ACEs. Environments impacted by social inequality can contribute to toxic stress and can play a crucial role in associations between poor health outcomes and high-risk behaviors.50 One ACE study describes how childhood adversity results in social, emotional and cognitive impairment that predisposes individuals to developing health risk behaviors associated with disease, disability and social problems that ultimately result in early death.
One example is that girls and boys experiencing teen dating violence are more likely to suffer long-term negative behavioral and health consequences, including suicidal thoughts, exhibiting antisocial behavior, experiencing depression and anxiety, and engaging in unhealthy or risky behaviors.51 Another example is children exposed to bullying and harassment (including electronic media) experience more depression, anxiety, poor school performance and lower self-esteem.52
The following are validated instruments physicians can use to assess childhood trauma:
For pregnant people, the impact of violence is particularly severe.. Pregnant patients may face IPV at higher rates than nonpregnant patients,59 with detrimental effects on both maternal and fetal outcomes.60 Homicide is a leading cause of death during pregnancy and the postpartum period in the United States.61 Complications of pregnancy, including preterm labor, vaginal bleeding and premature rupture of membranes, are significantly higher for those who experience IPV, as are maternal rates of depression, anxiety, and substance use. 62
Validated screening tools for IPV include63:
Foreign-born individuals comprise approximately 14% of the U.S. population, many of whom are immigrant and/or undocumented individuals.64 They face unique vulnerabilities to violence rooted in legal, economic, and social and political exclusion. These include challenges related to limited English proficiency, cultural differences, economic instability, issues with documentation status, and the risk and fear of detainment and/or family separation.65 These factors, coupled with an increasingly hostile political climate and rising anti-immigrant rhetoric, heighten the risk of targeted harassment, slurs, verbal and physical abuse, detainment, deportation and exclusion from essential services.66
Children and adolescents, especially those living in underserved, marginalized or immigrant communities, are at increased risk of witnessing or experiencing violence, with lifelong consequences for physical and mental health.67 This includes separation from their parents, detainment in unfamiliar settings and deportation. Family physicians are well-positioned to advocate for this patient population in specific ways, such as protecting them from U.S. Immigration and Customs Enforcement in health care settings and providing them with culturally competent care and universal access to trauma-informed services.
The violence directed against health care professionals is a significant problem. Workplace violence includes physical assaults, threats, harassment and verbal abuse occurring in professional settings.68 It remains a significant concern across industries, with health care workers facing violence at disproportionately higher rates than other professions. Health care workers experience the highest nonfatal injury rates of any private industry—nearly three times the overall industry average. While health care workers make up just 10% of the workforce, they account for 48% of all nonfatal workplace violence injuries. The Occupational Safety and Health Administration recommends implementing workplace violence prevention programs in health care facilities, including panic alarms, incident tracking and staff training.69
The safety of health care workers is essential to a well-functioning health care system and thus “the AAFP condemns violence and other illegal acts against all health care professionals and urges prompt enforcement of laws prohibiting such activities. The AAFP supports classifying violent crimes against health care professionals as felonies or other charges as appropriate. The AAFP encourages health care facilities to have a security protocol in place to include security issues when orienting and training new staff, and to consider performing routine security drills or simulations. All health care professionals should be aware of their surroundings and alert to potentially threatening situations or individuals at all times. The AAFP deplores any illegal activity that interferes with patient welfare or harms those who are providing patient care. All health care professionals are encouraged to build working relationships with local law enforcement agencies.”
Violence occurs across a broad range of human relationships and complex interactions encompassed by social, cultural and economic risk factors. The CDC’s four-level social-ecological model is designed to understand violence and the effect of potential prevention strategies to protect people and communities from violence.15 The model considers the complex connection among individual, relationship, community and societal factors.
Identifying families in need can make a difference, with family physicians and other clinicians playing an important role in screening for violence and referring them to community supports while addressing the poor health consequences inherent in cycles of violence.70 Promising parent-child interaction therapy or dyadic treatment allows for parents and children to be treated together to enhance the quality of parenting and lead to more positive outcomes for both parents and children.71,72 Safe, stable, and nurturing relationships and environments create positive experiences for children and mitigate and prevent ACEs.73
At the policy level, several states may be using Medicaid funds to cover violence-interruption and community-based prevention services—an acknowledgment that violence prevention is health care. These efforts demonstrate a pathway for sustainable investment in upstream supports that strengthen families and communities.
Violence, traumatic stress, and patients of family physicians
Since violence and traumatic stress affect patients’ presentation to family physicians in many ways, they must be understood in the context of patients’ lives. Asking questions about patients’ experiences with violence and resultant stress within the context of SDOH screening tools help patients realize that violence and health conditions are related. This approach enables patients to talk about violence within the circumstances of their health.
Many physicians worry about the tools and time it takes to address violence. Fortunately, toolkits like the AAFP’s EveryONE Project’s Addressing Social Determinants of Health in Primary Care and the National Association of Community Health Centers’ Workflow Implementation guide help them create efficient team-based workflows. And billing mechanisms now exist to reimburse time spent screening for and navigating SDOH.
Common billing opportunities related to SDOH in the outpatient primary care setting remain available and are evolving. For example, the HCPCS code G0136 for social needs assessment, which can currently be used as an add-on service with Medicare annual wellness visits, where there is no cost-sharing for the patient;74 screening for and incorporating SDOH as a risk element of medical decision making to level up E/M coding;75 and integrating care management services and codes for chronic care management,76 community health integration and principal illness navigation77 to bill for the time care teams spend on tasks navigating patients’ needs resulting from SDOH screening (i.e., accessing community-based resources). While Medicare approach to specific codes may change over time, SDOH assessments can often be incorporated into existing services such as E/M visits. For the most current coding guidance, physicians should refer to resources maintained by professional organization, such as AAFP’s guidance on GO136 SDOH Assessment.
Understanding which patients are at risk of violence, the presentation of violence in patients and the effects of violence on mental and physical health helps family physicians provide better care to patients in need. Certain presentations (e.g., anxiety, depression, PTSD and other mental health disorders; chronic pain syndromes, such as fibromyalgia and pelvic pain; and multiple somatic complaints) can be related to violence.30,78,79 Also, some patient populations are more likely to be at risk for or have already experienced violence.30 For patients with certain presenting symptoms, conditions, or risks, it may be appropriate to use a screening tool specific to violence. The United States Preventive Services Task Force provides a grade B recommendation for violence screening women of reproductive age, including pregnant and postpartum women, and a grade I recommendation for older and vulnerable adults.80 Other subpopulations are not explicitly addressed.
Brief and validated screening tools for adult populations of all genders are appropriate for routine IPV screening in primary care, including HITS and HARK.63 For patients with ongoing risks, it is particularly important to counsel them on the acute and long-term risks posed by exposures to violence, harm-reduction strategies, and how to access local and national emergency resources.
Family physicians have expertise in:
This knowledge and skill set make family physicians ideal candidates to provide care and referral for patients exposed to and experiencing violence. Their care teams and office staff should also be trained to identify patients who may be experiencing violence and respond to their needs. Many patients have strong relationships with the care team and other staff members within a primary care office and may disclose to them about their exposures to violence. A comprehensive response includes the following steps:
Family physicians are uniquely positioned to prevent, recognize and respond to violence across the lifespan. Asking about exposure to violence can be a meaningful intervention in its own right, offering not only insight, but also a pathway to healing, education and empowerment. When done in a trauma-informed, patient-centered manner, such conversations can reduce future risk and improve trust in the clinical relationship.
Clinical prevention strategies
Within the clinic, family physicians can integrate violence prevention into routine care, and their influence extends far beyond exam room walls. Family physicians are trusted messengers, capable of shaping both policy and practice in ways that meaningfully reduce the health impacts of violence.
Family physicians can also use their clinical practice and office environment to educate patients about positive skills that may reduce the risk of violence. Information on healthy relationships may help reduce the risk of teen dating violence and IPV. Evidence regarding the clinical burden of victimization and the prevalence of patients reporting perpetration clearly defines a role for family physicians in the recognition and appropriate referral for treatment of perpetration as a primary prevention strategy. For adolescent patients, discussing their dating relationships and safety can help them understand appropriate behaviors they may not have considered before.
Family physicians have many opportunities to influence policies and bring together resources for communities to help patients cope with violence and its effects on health. Many family physicians are on local school boards where policies on school bullying are developed, and they work with law enforcement to have domestic violence response teams, as well as serving in nursing homes where older adult neglect often occurs. It is the responsibility of family physicians to create and contribute to policies that reduce violence and promote community health.
References
(1994) (December 2025 BOD)