PARAGON  |  SPECIAL WHITE PAPER

DOMESTIC VIOLENCE AWARENESS MONTH 2026

Domestic Violence Is a Public Health and Patient Safety Emergency

The Role of Doctors of Behavioral Health in Management

Dr. Amber D. Chapman-Gray, PhD, DBH

Gray’s Trauma-Informed Care Services Corp.  |  Paragon

October 2026

Suggested citation

Chapman-Gray, A. D. (2026). Domestic violence is a public health and patient safety emergency: The role of Doctors of Behavioral Health in Management. Gray’s Trauma-Informed Care Services Corp., Paragon.

This white paper provides organizational and policy guidance. It is not legal advice, clinical direction for an individual case, or a substitute for jurisdiction-specific law, licensure rules, emergency protocols, or consultation.

Executive Summary

Domestic violence is not solely a private crisis, a social-service concern, or an October awareness topic. It is a persistent public health burden and a consequential patient-safety responsibility. In the United States, the 2023/2024 National Intimate Partner and Sexual Violence Survey estimated that 34.0% of women and 17.0% of men had experienced contact sexual violence, physical violence, and/or stalking by an intimate partner during their lifetimes (Zhang Kudon et al., 2026). These experiences are associated with mental-health harms, injury, adverse pregnancy outcomes, chronic health consequences, disrupted employment, and substantial economic costs (Bacchus et al., 2018; Guo et al., 2023; Peterson et al., 2018; White et al., 2024).

The patient-safety obligation begins wherever healthcare operations can reduce or intensify risk. Unsafe inquiry, lack of privacy, indiscriminate documentation, automatic release of sensitive notes, poorly explained reporting duties, weak referral pathways, and discharge without a viable follow-up plan can expose a victim to retaliation or leave a disclosure without meaningful support. Conversely, trained personnel, confidential and autonomy-preserving responses, direct access to specialized advocacy, and reliable follow-through can convert a clinical encounter into a safer point of connection (Health Resources and Services Administration [HRSA], 2023; National Academies of Sciences, Engineering, and Medicine [NASEM], 2024; World Health Organization [WHO], 2013).

Screening alone is not a domestic-violence program. The U.S. Preventive Services Task Force (USPSTF, 2025) recommends screening women of reproductive age, including those who are pregnant or postpartum, and providing or referring those who screen positive to multicomponent interventions with ongoing support. Evidence is insufficient to recommend for or against screening men or older and vulnerable adults for the specified forms of abuse. Organizations must apply this guidance accurately, comply with local law, and refuse the false assurance that a completed screening field equals safety.

Doctors of Behavioral Health in Management are positioned to lead the organizational work this response requires: program design, implementation, performance measurement, population-health analysis, financing, informatics, quality improvement, and interdisciplinary coordination (Arizona State University [ASU], n.d.). The degree does not create a clinical license or an exclusive occupational scope. Its value here is managerial and systems-oriented: building the infrastructure through which advocates, clinicians, leaders, information-security personnel, community partners, and people with lived experience can produce a coordinated, accountable response.

Core Directive

Healthcare, behavioral-health, public-health, and victim-service organizations should classify domestic-violence response as standing safety and quality infrastructure. Executive ownership, survivor-informed governance, protected information practices, closed-loop advocacy pathways, workforce support, equity safeguards, and routine performance review must be funded and sustained throughout the year. Domestic Violence Awareness Month (DVAM) should function as an annual accountability deadline and a recurring platform for educating and re-educating the public about domestic violence, the harms it causes, and established, evidence-based prevention methods.

Purpose, Scope, and Terminology

This white paper establishes a directive agenda for organizations that encounter people affected by domestic violence and identifies the systems-leadership functions that Doctors of Behavioral Health in Management can perform. The term domestic violence is used for the broader policy and community context; intimate partner violence (IPV) is used when the underlying evidence specifically concerns current or former intimate partners. Because much of the strongest clinical evidence addresses violence against women, findings are reported within their studied populations rather than generalized to everyone. Men and people of every gender can also experience domestic violence and require competent, accessible, and non-stigmatizing responses.

Language must also remain responsive to context. Victim is appropriate when emphasizing active victimization, legal rights, immediate danger, or accountability for harm. Survivor may better reflect agency, endurance, recovery, or a person’s own identification after violence. Neither term should be imposed. The operational priority is to preserve dignity, choice, confidentiality, access, and safety while keeping responsibility for abuse with the person who caused it.

Domestic Violence Is a Public Health Emergency

Prevalence Requires a Population-Level Response

The newest U.S. national estimates describe a problem too prevalent to be managed through isolated acts of goodwill. In addition to the lifetime estimates reported above, 5.2% of women and 2.3% of men reported contact sexual violence, physical violence, and/or stalking by an intimate partner in the previous 12 months. Nearly three in ten women (29.9%) reported lifetime IPV accompanied by an IPV-related impact, such as fear, injury, need for medical care, missed work or school, or another measured consequence (Zhang Kudon et al., 2026). The survey used updated methods and had a 16.5% response rate; its estimates should not be treated as directly comparable with earlier cycles. Those limitations require careful interpretation to avoid overstating or mischaracterizing the findings.

The Health Burden Extends Across the Life Course

IPV is associated with depression, anxiety, posttraumatic stress, suicidality, substance-related harms, injury, and worse overall health (Bacchus et al., 2018; Miller & McCaw, 2019; White et al., 2024). During pregnancy, a meta-analysis found associations between IPV and preterm birth (odds ratio [OR] = 1.84) and low birth weight (OR = 2.73), although the underlying studies were observational and heterogeneous (Guo et al., 2023). Public-health strategy must therefore link prevention, early identification, advocacy, clinical care, behavioral health, maternal health, and long-term recovery. No single encounter, profession, or agency can carry that responsibility alone.

The economic consequences are also structural. Peterson et al. (2018) modeled the lifetime U.S. burden associated with IPV at nearly $3.6 trillion in 2014 dollars, including medical costs, lost productivity, criminal-justice costs, and other losses. This is a lifetime model rather than a current annual expenditure estimate, but its scale reinforces the policy case: prevention and coordinated response are not discretionary community benefits. They are investments in population health, workforce stability, and institutional performance.

Domestic Violence Is a Patient-Safety Responsibility

Domestic violence usually originates outside the healthcare organization. Patient-safety accountability nevertheless begins when organizational decisions shape whether a person can disclose safely, understand options, protect sensitive information, reach an advocate, or leave with a realistic plan. NASEM (2024) identifies institutional preparedness, community partnership, continuity, and access to essential services as core features of an effective health-sector response. HRSA (2023) similarly emphasizes workforce support, community partnerships, trauma-informed and culturally responsive care, coordinated implementation, and data-guided evaluation. The implication is direct: patient safety in this domain is a designed property of the system, not a script delivered by an individual clinician.

Predictable Failure Points

A poorly designed process can create or amplify danger. A partner may be in the room during questioning, have proxy access to the electronic health record, monitor a patient portal, control transportation, or intercept written discharge materials. Clinicians may document details that are later visible to an abusive partner, promise confidentiality that law does not permit, report without explaining applicable limits, or provide a referral that requires the victim to repeat a story across multiple disconnected agencies. Research on pediatric electronic records has documented concerns about confidentiality, portal access, documentation, and unintended disclosure when IPV affects a caregiver (Randell et al., 2022). These are governance and information-design problems that training alone cannot correct.

Table 1

Domestic-Violence Failure Points and Required Patient-Safety Controls

Failure point	Safety risk	Required control	DBH–Management function
Inquiry without privacy	Coerced answers, retaliation, or suppressed disclosure	Private contact; safe language; a protocol for when privacy cannot be obtained	Workflow design and implementation testing
Uncontrolled documentation or portal release	Exposure of location, disclosure, or safety planning	Role-based access, note-type review, release rules, and audit trails	Information governance and risk review
Positive screen without active connection	Disclosure recorded but support remains inaccessible	Warm referral, advocate access, consent-based follow-up, and fallback options	Partnership design and closed-loop measurement
Unclear reporting obligations	Loss of trust, avoidable reporting, or legal noncompliance	Jurisdiction-specific policy, informed explanation, and counsel review	Policy translation, training, and quality assurance
Unsupported workforce	Inconsistent response, burnout, secondary traumatic stress, and turnover	Supervision, consultation, manageable workload, and psychological support	Workforce strategy and performance monitoring

Screening Is Not a Complete Intervention

Organizations should align screening practice with the population, setting, evidence, and law. The 2025 USPSTF recommendation applies to women of reproductive age, including pregnant and postpartum women; it pairs screening with evaluation and referral to multicomponent interventions that provide ongoing support. The Task Force concluded that evidence was insufficient for screening men for IPV and for screening older or vulnerable adults for caregiver abuse (USPSTF, 2025). WHO (2013) does not recommend universal screening of every woman at every healthcare encounter; it supports appropriate clinical inquiry and a first-line response that centers practical care, listening, validation, safety, and connection to support.

The implementation gap appears after the question is asked. An implementation-oriented review found a median screening reach of 80% across studies but only 47% in emergency-department studies; among patients who screened positive, a median of 32% received a referral, and evidence of long-term sustainment was limited (Miller et al., 2021). The USPSTF evidence review likewise found that screening accuracy and effective referral matter, while multicomponent interventions, not the screening act by itself, are the relevant pathway to benefit (Feltner et al., 2025). A dashboard that celebrates completion rates while ignoring privacy, response quality, referral uptake, and unintended harm is measuring activity, not safety.

The IRIS cluster randomized trial demonstrates the value of a system rather than a solitary prompt. Training, practice support, and a direct referral pathway to specialized advocacy increased identification and referral in primary care (Feder et al., 2011). The trial did not establish that screening alone reduced violence. Its operational lesson is that healthcare teams require a prepared response and an accessible advocacy partner before they seek disclosure.

Trauma- and Violence-Informed Care Must Be Operational

Trauma-informed language is insufficient when policies remain coercive, fragmented, or unsafe. Trauma- and violence-informed care extends attention beyond individual symptoms to ongoing violence, structural inequity, and the conditions that shape access and trust (Wathen & Mantler, 2022). Operational practice protects emotional and physical safety, explains choices and limits, avoids forced disclosure, supports autonomy, uses culturally responsive pathways, and treats advocacy as a specialized professional function. It also recognizes that people may decline services because the available option is unsafe, inaccessible, financially impossible, or inconsistent with their priorities.

Evidence supports disciplined implementation while cautioning against overstatement. A systematic review of reviews and realist synthesis found promising effects of trauma-informed care across healthcare settings, but implementation and outcome measurement varied substantially (Goldstein et al., 2024). A meta-analysis of trauma-informed interventions for women experiencing IPV found improvements in depression and anxiety, while effects on posttraumatic stress symptoms were less consistent (Chu et al., 2024). Organizations should therefore define what trauma-informed practice requires, monitor fidelity and experience, and revise the system when evidence or lived experience shows harm.

The DBH–Management Systems Leadership Role

Domestic-violence response is an interdisciplinary operating system. It requires clinical judgment, survivor-defined advocacy, legal and compliance analysis, privacy and security expertise, community partnership, financing, workforce development, data governance, and continuous improvement. No doctorate substitutes for those professions. The DBH in Management can serve as the integrator who translates evidence into workflows, aligns stakeholders, establishes measures, tests implementation, and holds the institution accountable for sustainment.

The official DBH–Management curriculum includes implementation science, population-health data, quality and performance measurement, business and finance, informatics, program design, legal and ethical issues, and interdisciplinary management (ASU, n.d.). This competency profile aligns with the organizational work required here. It is not evidence that DBH graduates, as a class, improve domestic-violence outcomes. A DBH professional’s responsibilities must remain consistent with the person’s underlying credentials, institutional authority, demonstrated competence, and applicable law.

Table 2

Competency-to-Function Crosswalk for DBH–Management Leadership

DBH–Management competency	Domestic-violence systems function
Implementation science	Translate evidence into a staged workflow; test barriers, adaptations, fidelity, and sustainment.
Quality and performance measurement	Build process, outcome, equity, and balancing measures; review variation without rewarding unsafe volume.
Population health	Identify access gaps and patterns across service lines while protecting small groups from re-identification.
Informatics and data governance	Coordinate privacy review, portal safety, access controls, documentation standards, and audit processes.
Business and finance	Develop the budget, staffing model, partner agreements, reimbursement strategy, and sustainability case.
Interdisciplinary management	Clarify roles and decision rights across advocacy, clinical care, security, legal, compliance, and community partners.

The DBH leader must also protect the integrity of advocacy. Effective advocacy is survivor-defined, flexible, relational, and directed toward safety, resources, rights, and self-determined goals; it is not simply case management or compliance with an institution’s preferred plan (Sullivan & Goodman, 2019). DBH-led infrastructure should strengthen access to specialized advocates and compensate community expertise. It should never absorb advocacy into a generic clinical workflow or treat survivor voice as a ceremonial consultation.

A Directive Organizational Agenda

The following actions are minimum governance expectations for organizations seeking a credible domestic-violence response. They should be adapted to setting, population, law, and available community resources, but they should not be reduced to an annual awareness message.

Table 3

Directive Organizational Agenda

No.	Requirement	Minimum organizational standard
1	Assign executive ownership and decision authority.	Name an accountable executive sponsor, a qualified operational lead, and a multidisciplinary governance group. Define who can change workflow, approve information controls, commit funds, and resolve interdepartmental barriers.
2	Complete a safety-centered readiness assessment.	Map the current journey from first contact through discharge and follow-up. Test privacy, interpreter access, reporting rules, portal visibility, documentation, after-hours response, transportation, disability access, and referral capacity.
3	Establish safe inquiry and response standards.	Use private, nonjudgmental, evidence-aligned inquiry; explain confidentiality limits before disclosure when feasible; offer universal education where appropriate; and create a response for situations in which privacy cannot be secured.
4	Build closed-loop advocacy pathways.	Formalize partnerships with domestic-violence programs and culturally specific services. Use warm, consent-based connections, clarify handoffs, maintain fallback options, and measure whether access occurred—not merely whether a number was given.
5	Govern sensitive information as a safety asset.	Review structured fields, free text, proxy access, automated after-visit summaries, billing artifacts, release rules, interoperability, and audit logs. Collect only information that serves care, safety, law, or an explicitly defined quality purpose.
6	Make equity and accessibility testable requirements.	Assess language access, disability accommodations, rural and transportation barriers, digital surveillance, immigration concerns, economic coercion, racism, gender stigma, and the availability of culturally responsive partners. Aggregate results carefully enough to detect inequity without exposing identities.
7	Prepare and protect the workforce.	Train by role, not by generic attendance. Provide supervision, consultation, debriefing pathways, realistic workloads, and psychologically safe escalation. Domestic-violence advocates face secondary traumatic stress; workplace support and protective conditions matter (Slattery & Goodman, 2009).
8	Share governance with survivors and advocates.	Compensate lived-experience partners, establish privacy and participation safeguards, and show how recommendations changed policy or design. No person should have to disclose personal trauma to earn a governance role.
9	Measure safety, access, quality, and unintended effects.	Use a balanced scorecard that includes process, experience, outcome, equity, workforce, and harm indicators. Stratify only when privacy can be preserved, and investigate variation rather than using metrics to pressure disclosure.
10	Fund sustainment before launching.	Budget for leadership time, advocates, training, interpretation, technology changes, partner capacity, data review, and continuous improvement. A pilot without a maintenance owner, renewal decision, and resource plan is not a sustainable program.

Twelve-Month Implementation Roadmap

Table 4

Phased Implementation and Evidence of Completion

Phase	Required actions	Evidence of completion
0–90 days	Assign governance; inventory current policy and partners; conduct safety and privacy risk assessment; define scope, law, and escalation routes; establish baseline measures.	Signed charter; role map; risk register; counsel/compliance review; partner capacity map; baseline report.
Months 3–6	Co-design workflow with advocates and lived-experience partners; revise documentation and portal rules; train pilot teams; test private inquiry and warm referral.	Approved workflow; information-governance controls; training competency results; completed simulation and failure review.
Months 6–12	Pilot, monitor, and adapt; review equity and balancing measures; strengthen partner capacity; prepare spread and sustainment decision.	Monthly dashboard; documented adaptations; safety-event review; budget and staffing plan; executive go/no-go decision.
Annually at DVAM	Publish an accountable progress summary; renew agreements; complete workforce and privacy audit; set the next improvement priorities.	Board review; public or internal report; renewed partner agreements; funded annual work plan.

Accountability Measures That Matter

No single metric can represent safety. Organizations should review a small, balanced set and interpret it with advocates, frontline teams, and lived-experience partners. Appropriate measures may include the percentage of eligible encounters in which privacy was achieved; the percentage of positive screens or disclosures offered an advocate connection; successful warm connections when consent was given; timeliness of response; patient-reported respect, choice, and usefulness; gaps by language, disability, geography, or service line; confidentiality or portal-release incidents; workforce confidence and secondary-trauma indicators; and completion of corrective actions.

Targets must avoid coercive incentives. A rising disclosure rate may indicate improved trust, greater prevalence, better documentation, or measurement change; a falling rate may indicate reduced harm or an unsafe process. Referral volume does not demonstrate access, and access does not prove safety. Data must be reviewed with context, privacy protection, and a clear plan for action. HRSA’s (2023) implementation framework and the healthcare implementation literature support this continuous, data-guided approach.

Use DVAM 2026 as a Governance Deadline

DVAM can focus attention, but awareness without operational change can become institutional theater. For 2026, leaders should use October as the deadline to present a domestic-violence safety report, confirm partner agreements, review privacy and portal controls, disclose the status of corrective actions, and approve the next year’s budget and work plan. Public communications should direct people to safe, accessible support and should not imply that leaving is simple, that disclosure is always safe, or that a single service pathway fits every victim or survivor.

The work must continue beyond October for as long as it is needed. Domestic violence does not follow an awareness calendar, and systems reliability cannot be produced by a campaign. The institutional test is whether a person who encounters the organization on an ordinary day receives privacy, accurate information, meaningful choice, competent care, an accessible advocate, and a response that does not create additional danger.

Conclusion

Domestic violence is a public health emergency and a patient-safety responsibility because its reach is structural and organizational design can protect or endanger a person seeking help. The response must be governed infrastructure for privacy, advocacy, trauma- and violence-informed care, workforce readiness, equity, measurement, and continuous improvement. DBH–Management leaders can integrate this work within their authority and scope while strengthening, not replacing, victim, survivor, advocate, clinical, and community expertise. DVAM 2026 must move the field from awareness to accountable, year-round action.

References

Arizona State University. (n.d.). Behavioral health (management), DBH. Retrieved October 22, 2026, from https://degrees.asu.edu/masters-phd/major/ASU00/NHBVHMDBH/behavioral-health-management-dbh

Bacchus, L. J., Ranganathan, M., Watts, C., & Devries, K. (2018). Recent intimate partner violence against women and health: A systematic review and meta-analysis of cohort studies. BMJ Open, 8(7), e019995. https://doi.org/10.1136/bmjopen-2017-019995

Chu, Y.-C., Wang, H.-H., Chou, F.-H., Hsu, Y.-F., & Liao, K.-L. (2024). Outcomes of trauma-informed care on the psychological health of women experiencing intimate partner violence: A systematic review and meta-analysis. Journal of Psychiatric and Mental Health Nursing, 31(2), 203–214. https://doi.org/10.1111/jpm.12976

Feder, G., Davies, R. A., Baird, K., Dunne, D., Eldridge, S., Griffiths, C., Gregory, A., Howell, A., Johnson, M., Ramsay, J., Rutterford, C., & Sharp, D. (2011). Identification and referral to improve safety (IRIS) of women experiencing domestic violence with a primary care training and support programme: A cluster randomised controlled trial. The Lancet, 378(9805), 1788–1795. https://doi.org/10.1016/S0140-6736(11)61179-3

Feltner, C., Peat, C., Asher, G. N., Wright, S., Vaughan, J., Middleton, J. C., & Jonas, D. E. (2025). Screening for intimate partner violence and for caregiver abuse of older or vulnerable adults: An evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA, 334(4), 339–355. https://doi.org/10.1001/jama.2025.2449

Goldstein, E., Chokshi, B., Melendez-Torres, G. J., Rios, A., Jelley, M., & Lewis-O’Connor, A. (2024). Effectiveness of trauma-informed care implementation in health care settings: Systematic review of reviews and realist synthesis. The Permanente Journal, 28(1), 135–150. https://doi.org/10.7812/TPP/23.127

Guo, C., Wan, M., Wang, Y., Wang, P., Tousey-Pfarrer, M., Liu, H., Yu, L., Jian, L., Zhang, M., Yang, Z., Ge, F., & Zhang, J. (2023). Associations between intimate partner violence and adverse birth outcomes during pregnancy: A systematic review and meta-analysis. Frontiers in Medicine, 10, 1140787. https://doi.org/10.3389/fmed.2023.1140787

Health Resources and Services Administration, Office of Women’s Health. (2023). Preventing and responding to intimate partner violence: An implementation framework for HRSA-supported settings of care. https://www.hrsa.gov/sites/default/files/hrsa/owh/ipv-implementation-framework.pdf

Miller, C. J., Adjognon, O. L., Brady, J. E., Dichter, M. E., & Iverson, K. M. (2021). Screening for intimate partner violence in healthcare settings: An implementation-oriented systematic review. Implementation Research and Practice, 2, 26334895211039894. https://doi.org/10.1177/26334895211039894

Miller, E., & McCaw, B. (2019). Intimate partner violence. The New England Journal of Medicine, 380(9), 850–857. https://doi.org/10.1056/NEJMra1807166

National Academies of Sciences, Engineering, and Medicine. (2024). Essential health care services addressing intimate partner violence. The National Academies Press. https://doi.org/10.17226/27425

Peterson, C., Kearns, M. C., McIntosh, W. L., Estefan, L. F., Nicolaidis, C., McCollister, K. E., Gordon, A., & Florence, C. (2018). Lifetime economic burden of intimate partner violence among U.S. adults. American Journal of Preventive Medicine, 55(4), 433–444. https://doi.org/10.1016/j.amepre.2018.04.049

Randell, K. A., Ragavan, M. I., Query, L. A., Sundaram, M., Bair-Merritt, M., Miller, E., & Dowd, M. D. (2022). Intimate partner violence and the pediatric electronic health record: A qualitative study. Academic Pediatrics, 22(5), 824–832. https://doi.org/10.1016/j.acap.2021.08.013

Slattery, S. M., & Goodman, L. A. (2009). Secondary traumatic stress among domestic violence advocates: Workplace risk and protective factors. Violence Against Women, 15(11), 1358–1379. https://doi.org/10.1177/1077801209347469

Sullivan, C. M., & Goodman, L. A. (2019). Advocacy with survivors of intimate partner violence: What it is, what it isn’t, and why it’s critically important. Violence Against Women, 25(16), 2007–2023. https://doi.org/10.1177/1077801219875826

U.S. Preventive Services Task Force. (2025). Screening for intimate partner violence and caregiver abuse of older or vulnerable adults: U.S. Preventive Services Task Force recommendation statement. JAMA, 334(4), 329–338. https://doi.org/10.1001/jama.2025.9009

Wathen, C. N., & Mantler, T. (2022). Trauma- and violence-informed care: Orienting intimate partner violence interventions to equity. Current Epidemiology Reports, 9(4), 233–244. https://doi.org/10.1007/s40471-022-00307-7

White, S. J., Sin, J., Sweeney, A., Salisbury, T., Wahlich, C., Montesinos Guevara, C. M., Gillard, S., Brett, E., Allwright, L., Iqbal, N., Khan, A., Perot, C., Marks, J., & Mantovani, N. (2024). Global prevalence and mental health outcomes of intimate partner violence among women: A systematic review and meta-analysis. Trauma, Violence, & Abuse, 25(1), 494–511. https://doi.org/10.1177/15248380231155529

World Health Organization. (2013). Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. https://www.who.int/publications/i/item/9789241548595

Zhang Kudon, H., Zhu, S., Chen, B., Breiding, M. J., Leemis, R. W., Zhang, X., Schwank, A., & Basile, K. C. (2026). The National Intimate Partner and Sexual Violence Survey: 2023/2024 intimate partner violence data brief. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/nisvs/media/pdfs/intimatepartnerviolence-brief.pdf