Bridging prevention and practice: public health and family violence

Public health approaches the primary prevention of family violence by focusing on surveillance, the identification of risk factors, and the development, evaluation, and dissemination of interventions. Physicians and other health care providers are crucial in this process because they are in a unique position to identify at-risk individuals and populations and to implement both broad-based and targeted preventive and intervention initiatives. Incorporating public health principles into medical education and medical practice not only can reduce the severity of this epidemic by strengthening efforts in early detection and expert intervention but also can create effective primary prevention, an important necessary step towards eradicating every disease or condition. This article discusses the role of public health professionals in preventing family and intimate violence. It notes specific findings from public health research, including the cycle of violence and the need to incorporate issues of abuse across the life span, and other factors, into medical education. Addressing family and intimate violence in a caring and sensitive manner is difficult, and incorporating public health principles into medical education and medical practice can forge an effective partnership between medical practitioners and public health professionals. This new partnership represents both an important challenge and a unique opportunity to understand family and intimate violence and thus to develop and evaluate effective short- and long-term solutions. A public health approach to the primary prevention of family violence entails surveillance, the identification of risk factors, and the development, evaluation, and dissemination of effective interventions. The US Centers for Disease Control is developing definitions and criteria for family violence, collecting data on the prevalence of partner violence, identifying salient risk factors, and determining which interventions are effective. Once the scientific process has determined effective interventions, the public health community utilizes established systems of information dissemination to deliver this information to practitioners in the community. The integration of efforts by health care, public health, law enforcement, education and public information, and social services is essential. Although physicians are often the first and only point of contact for battered women, they receive little or no education on how to identify, manage, and refer affected women. Education and training for physicians should begin in medical school, with emphasis on the cycle of violence across the life span, development of safety plans, legal options and reporting requirements, and referral methods. Different formats should be used to ensure that all medical students have ample opportunity to practice history taking. Training in family violence prevention is especially important for health care staff in emergency departments, maternal and child health, substance abuse and mental health, migrant and rural health, gerontology, the Indian Health Service, and health services for the homeless.