Violence, Abuse & Safety

Skip anything

Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Doctor or nurse: Care for injuries and health, at the person's pace.
• Social worker or advocate: Options, support services and safety planning, if wanted.
• Counselor: Emotional support, if and when the person wants it.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A small set of places chosen for contrast, not a ranking or a representative survey: Global, South Africa, Brazil, Occupied Palestinian territory, Nepal, China, Norway, United States, Australia. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

• Global · Guidance · 2013

  WHO's 2013 guidelines on intimate partner and sexual violence say the privacy and confidentiality of the consultation, including discussing medical-record documentation and the limits of confidentiality with women, should be a priority.

  What others could learn: Privacy and the limits of confidentiality, including what goes in the medical record, can be discussed openly rather than left implicit. The remarks on the same recommendation say providers should discuss options and support women in their decision-making.

  Conditions, limits and source

  Conditions that matter:

  Needs a private space, time and staff with good communication skills. If a provider cannot offer first-line support, the guideline says someone else in the same or an easily accessible setting should be immediately available. Legal reporting duties differ by jurisdiction and are not described in this record.

  Cannot be inferred:

  Does not show that privacy or confidentiality discussions change health or safety outcomes. Does not state any jurisdiction's reporting law. Does not show how often consultations are private in practice.

  Limits:

  Guidance, not an evaluation of services. WHO grades the evidence for recommendation 1 as indirect, drawing on the experience of people working with survivors and on psychological first aid. Published in 2013 and written about women; it does not address men or older people specifically.

  Source: World Health Organization, Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines (Section 1 'Women-centred care', recommendation 1, remark (b), printed pp. 16-17 (PDF p. 26); the recommendation on the same page lists first-line support, a private consultation, and informing women of the limits of confidentiality). Where: Global. Population: Women who experience intimate partner violence or sexual violence and are seen by health-care providers. Published 2013-06-20; retrieved 2026-10-12.

• Global · Guidance · 2014

  WHO's 2014 clinical handbook describes first-line support for women subjected to violence as five tasks, remembered as LIVES (listen, inquire about needs and concerns, validate, enhance safety, support), meeting emotional and practical needs together.

  What others could learn: Support can follow the woman's lead. The handbook says to respect her wishes and decisions, not to expect decisions immediately, and, if she decides not to report to the police, to respect that and let her know she can change her mind.

  Conditions, limits and source

  Conditions that matter:

  The handbook says first-line support does not necessarily take long or need additional resources. It assumes a provider who can talk with the woman alone, with no one older than age 2 able to overhear, and who knows local referral services.

  Cannot be inferred:

  Does not show that LIVES improves safety or health outcomes. Does not show how widely it is used. Does not describe any jurisdiction's reporting law.

  Limits:

  A practical handbook that applies the 2013 WHO guidelines; it is not an evaluation. Written about women; 2014 edition (document WHO/RHR/14.26). The handbook includes example wording for asking about violence; that wording is deliberately not reproduced in this record.

  Source: World Health Organization, Health care for women subjected to intimate partner violence or sexual violence: a clinical handbook ('First-line support', printed p. 14 (PDF p. 22); 'Always respect her wishes and decisions', printed p. 30 (PDF p. 38); 'What if she decides not to report to the police?', printed p. 36 (PDF p. 44)). Where: Global. Population: Women subjected to intimate partner violence or sexual violence who see a health-care provider. Published 2014-10-09; retrieved 2026-10-12.

• South Africa · Reported experience · 2018

  In a 2016 qualitative study of 10 sexual assault survivors at three hospitals in South Africa's Eden District, authors found client-held official documentation strongly enabled follow-up care, and individualized, patient-centered care further improved access.

  What others could learn: The authors report that every participant given a follow-up appointment on official stationery kept it, and they recommend this low-cost step. They also found that follow-up was not integrated into established chronic care services, a missed opportunity.

  Conditions, limits and source

  Conditions that matter:

  Whether carrying a written appointment home is safe depends on the person's situation; the study did not examine this. Negative prior experiences with police, courts and health services were barriers to follow-up.

  Cannot be inferred:

  Does not report district-wide attendance rates. Does not show that documentation causes attendance; it reports participants' accounts. Does not address intimate partner violence or men specifically.

  Limits:

  Small sample from one district. Recruitment was limited by incorrect or unanswered phone numbers in the sexual assault register, so people who were hard to reach may be missing. Two child participants were represented by caregivers. Interviews used a multilingual interpreter.

  Source: African Journal of Primary Health Care & Family Medicine (Holton, Joyner and Mash), Sexual assault survivors' perspectives on clinical follow-up in the Eden District, South Africa: A qualitative study (Abstract, Results; full text (PMC6018593), Discussion, on appointments given on official stationery). Where: South Africa (Eden District, Western Cape; three hospitals). Population: Ten female sexual assault survivors, including girls aged 9, 10 and 15; caregivers were interviewed on behalf of the two youngest. Published 2018-05-30; retrieved 2026-10-12.

• Brazil · Reported experience · 2018

  Ten women interviewed at a reference center in Campinas, Brazil, said they went through police, legal, health and social services first and found few effective responses; authors identify care as the most relevant response factor.

  What others could learn: The authors conclude that assistance was fragmented and depended on the individual professional's attitude. In the full text, two women rated health units negatively, citing missing mental health staff, and women reported health professionals offering help to the partner.

  Conditions, limits and source

  Conditions that matter:

  Depends on a structured network of specialized services for women and on ongoing education of the professionals in it, as the authors note. Mental health staff were not always available in health units, per two participants.

  Cannot be inferred:

  Does not measure how often health services respond well. Does not describe other Brazilian cities. Does not show which response led women to the center.

  Limits:

  Small sample from one service in one city. All participants had already reached the reference center, so women who never reached it are not represented. Health services were one of several sectors described.

  Source: Revista Latino-Americana de Enfermagem (Baragatti and colleagues), Critical path of women in situations of intimate partner violence (Abstract, Results; full text (PMC6091378), Results, health services subsection). Where: Brazil (Campinas, São Paulo state; one reference center). Population: Ten adult women who experienced intimate partner violence and were followed up at a municipal reference center between 2013 and 2016. Published 2018-08-09; retrieved 2026-10-12.

• Occupied Palestinian territory · Measured outcome · 2025

  In a 2025 evaluation of HERA domestic violence training in four West Bank primary care clinics, disclosures and referrals fell in three of the four clinics versus the prior year; authors cite COVID-19, lack of time, provider fear and rotation.

  What others could learn: Training alone may not raise disclosure. Providers reported that women hesitate to disclose because clinic spaces lack privacy, and the authors note a need for psychosocial support for women who do not want referral.

  Conditions, limits and source

  Conditions that matter:

  A national referral system for domestic violence exists. Provider fear of retaliation, rotation between clinics, time pressure and views of domestic violence as a private family matter affected practice, per provider interviews.

  Cannot be inferred:

  Does not show whether the training helped or harmed women. Does not separate the training's effect from pandemic disruption. Does not represent all primary care in the territory.

  Limits:

  Four clinics; before-and-after registry counts with no comparison group, overlapping the COVID-19 pandemic. Women patients were not interviewed. The Provider Intervention Measure is named only; its items are not reproduced.

  Source: BMC Primary Care (Joudeh and colleagues), Evaluation of a domestic violence training and support intervention in Palestinian primary care clinics in the west bank: a mixed method study (Abstract, Results; full text (PMC11969874), Results, barriers reported by providers). Where: Occupied Palestinian territory (West Bank; four primary care clinics). Population: Front-line primary care providers (post-training interviews with 20 providers and 2 trainers) and women patients disclosing domestic violence (clinic registry counts). Published 2025-04-04; retrieved 2026-10-12.

• Nepal · Measured outcome · 2024

  A 2022 assessment of 28 public health facilities in Madhesh Province, Nepal, found two-thirds had designated rooms for physical examinations, but only a minority had separate rooms for counseling.

  What others could learn: Private space for counseling is a resource to plan and check, not assume. The authors report that hospitals with one-stop crisis management centers showed readiness, while primary health care centers lacked dedicated counseling rooms.

  Conditions, limits and source

  Conditions that matter:

  Only around 28% of facilities had trained staff in managing violence against women. A psychosocial counselor was available in four hospitals and two of 17 primary centers. Guideline implementation and referral networks were weak, per the authors.

  Cannot be inferred:

  Does not show what survivors experienced or whether private rooms change disclosure or outcomes. Does not describe other provinces.

  Limits:

  One province. Facility and provider reports, not observation of consultations or survivors' views. The abstract's 'two-thirds' corresponds to 64% in Table 7. Instruments are named only; items are not reproduced.

  Source: Health Policy and Planning (Deuba and colleagues), Assessing the Nepalese health system's readiness to manage gender-based violence and deliver psychosocial counselling (Abstract; full text (PMC10883662), Results, Table 7 (64% with separate rooms for physical and genital examinations; 46% with separate rooms for counseling)). Where: Nepal (Madhesh Province; 11 hospitals and 17 primary health care centers). Population: 46 health care providers interviewed in public hospitals and primary health care centers. Published 2024-02-22; retrieved 2026-10-12.

• China · Reported experience · 2022

  From focus groups with 32 nurses, social workers and medical social workers in Hong Kong, authors conclude elder abuse interventions should address safety and tangible support while respecting older clients' autonomy and privacy.

  What others could learn: The authors list respecting client autonomy and privacy, rapport building, active listening and progressing at the client's pace as essential skills, alongside tangible support and work across disciplines and agencies.

  Conditions, limits and source

  Conditions that matter:

  The authors state that, at publication in 2022, reporting elder abuse was not mandatory in Hong Kong for lay persons or professionals. Family relationships are often complex; the authors suggest involving supportive peers.

  Cannot be inferred:

  Does not show that autonomy-respecting approaches reduce abuse. Does not report older adults' own preferences. Does not give advice on any reporting duty.

  Limits:

  Professionals' views, not older adults' own accounts. Online, single-profession focus groups; the authors note that social desirability may have shaped what participants shared. One city.

  Source: BMC Geriatrics (Yan and colleagues), Strategies to build more effective interventions for elder abuse: a focus group study of nursing and social work professionals in Hong Kong (Abstract, Conclusions; full text (PMC9762662), Results, theme 'Essential skills and attitudes'). Where: China (Hong Kong SAR; seven hospitals and organizations). Population: 32 frontline professionals: social workers in senior support, domestic violence and elder abuse shelters, medical social workers, and emergency unit nurses. Published 2022-12-19; retrieved 2026-10-12.

• Norway · Reported experience · 2017

  Eight women in South-East Norway who experienced partner violence in pregnancy were never asked about it in antenatal care; those with immigrant backgrounds reported language barriers and favored professionally trained interpreters experienced with partner violence.

  What others could learn: A main barrier was husbands accompanying women to antenatal care; some women feared a midwife might raise the topic later in front of the husband. A private conversation, with a professional interpreter where needed, addresses what participants described.

  Conditions, limits and source

  Conditions that matter:

  Needs access to professional interpreters trained on violence, and midwives' time and communication skills. Fear that the Child Welfare Service would take children after disclosure was a reported barrier.

  Cannot be inferred:

  Does not test whether interpreters improve disclosure or safety. Does not represent all immigrant women in Norway. Does not describe practice in other maternity services.

  Limits:

  Small sample, all recruited from crisis shelters, so women who did not reach a shelter are not represented. One interview used an interpreter. The authors call for research on how interpreters affect conversations about violence.

  Source: BMC Pregnancy and Childbirth (Garnweidner-Holme and colleagues), Talking about intimate partner violence in multi-cultural antenatal care: a qualitative study of pregnant women's advice for better communication in South-East Norway (Abstract, Results; full text (PMC5395889), Results, sub-themes on being accompanied by the husband and on the use of a professional interpreter). Where: Norway (South-East Norway; three crisis shelters). Population: Eight women who experienced intimate partner violence during pregnancy: five with immigrant backgrounds and three ethnic Norwegians. Published 2017-04-19; retrieved 2026-10-12.

• United States · Service in operation · 2022

  In its first two years, an emergency department elder abuse team at one New York academic hospital saw 200 patients; 75% of those with high or moderate suspicion left with changed living arrangements or new home services.

  What others could learn: An on-call interdisciplinary team gave emergency clinicians expertise they lacked; 94% of surveyed providers saw merit in similar programs elsewhere. Team roles include supportive counseling and involving Adult Protective Services and police as appropriate.

  Conditions, limits and source

  Conditions that matter:

  Needs social workers, an interdisciplinary team reachable from the emergency department, community agencies and shelter places for older adults. The authors suggest telehealth consultation for small or rural emergency departments. Reporting duties are not described in this record.

  Cannot be inferred:

  Does not show that patients' safety or well-being improved. Does not show what older adults wanted. Does not describe emergency departments beyond one urban academic center.

  Limits:

  Single site. Patients were not followed after discharge, so whether safety improved is unknown, as the authors state. Older adults' own views and wishes about the changes were not reported. A change in living situation is not itself evidence of benefit.

  Source: Journal of the American Geriatrics Society (Rosen and colleagues), Vulnerable Elder Protection Team: Initial experience of an emergency department-based interdisciplinary elder abuse program (Abstract, Results; full text (PMC9669128, author manuscript), Methods (team roles) and Discussion (limitations)). Where: United States (New York, one academic emergency department). Population: 200 older adults seen by the team; 62% judged by the team to have high or moderate suspicion of elder abuse. Published 2022-07-21; retrieved 2026-10-12.

• Australia · Reported experience · 2019

  Of 12 Aboriginal women interviewed about antenatal routine enquiry for partner violence in Australia, seven reported positive impact; cultural safety, continuity of care, nonjudgmental asking, and support and validation were conditions for benefit.

  What others could learn: Reported benefits included naming the abuse, a sense of connection, unburdening, taking steps to safety and enabling informed care. Two women reported negative impacts: one a sense of intrusion, the other disengagement from the health service.

  Conditions, limits and source

  Conditions that matter:

  The authors tie the need for safe interventions to inflated rates of statutory intervention and widespread institutional racism affecting Indigenous women. Continuity of care depends on stable staffing.

  Cannot be inferred:

  Does not measure safety or health outcomes. Does not represent all Aboriginal women or communities. Does not show whether routine enquiry should be adopted elsewhere.

  Limits:

  Abstract only; the full text was not retrieved because the publisher host was blocked. Small sample. Sites and dates are not stated in the abstract. Routine enquiry is named only; its questions are not reproduced.

  Source: Culture, Health & Sexuality (Spangaro and colleagues), 'Yarn about it': Aboriginal Australian women's perceptions of the impact of routine enquiry for intimate partner violence (Abstract). Where: Australia (author affiliations in New South Wales; recruitment sites not stated in the abstract). Population: 12 Aboriginal Australian women who received antenatal care that included routine enquiry for intimate partner violence. Published 2019-01-02; retrieved 2026-10-12.

• The sourced examples include guidance, reported experience, measured outcome, service in operation. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.