Health Care Systems Must Rethink Approach to Domestic Violence: Experts

News | May 2, 2018


Kaitlin Ugolik Phillips
Managing Editor, North Carolina Medical Journal

919.445.6157 (office)


Media Release


Morrisville, NC (May 2, 2018)

Domestic violence is the primary form of trauma experienced by children in North Carolina’s welfare system, but responses to this problem vary in philosophy, focus and funding. In the current issue of the North Carolina Medical Journal, Leslie Starsoneck of Chicago’s Adler University and George Ake of Duke University argue that health care systems must reconsider domestic violence.


Increased attention on adverse childhood experiences (ACEs) has led many health care systems to focus more directly on the effects of substance abuse, divorce, sexual abuse and neglect, but according to Starsoneck and Ake, the domain of domestic violence is still lacking consensus. There is significant disagreement about how to define domestic violence and competing ideas about how to reduce and prevent it.


While some people believe that abusive parents have “lost the right” to their children, others argue that with the right kind of help, parental relationships can be a vital part of healing for children who have experienced or witnessed domestic violence. Clinical approaches also differ widely, as the authors explain in the article, noting that some experts oppose “pathologizing” children while others believe in more comprehensive interventions.


The problem this creates, according to the authors, is that no one “owns” this problem, meaning there is little guidance for how to address it.


“By not having systems in place that recognize the framework of trauma, we’re making a decision not to coordinate our efforts or collect data to understand the impact of domestic violence,” said Starsoneck. “We’re still disagreeing over some major philosophical issues and approaches and that continues to hold us back.”


The answer, the authors argue, is to focus on data-based collaboration between and across systems.


“If we’re not working this out, it leaves many kids disconnected from the really great work that is trauma informed,” said Starsoneck.


To read the full article, “Reconsidering Our Domestic Violence System,” by Leslie Starsoneck and George Ake, as well as other NCMJ articles, visit



The North Carolina Medical Journal is a journal of health policy analysis and debate co-published by the North Carolina Institute of Medicine and The Duke Endowment. The NCMJ publishes six issues per year. To learn and read more, visit