A paradigm for developing a comprehensive treatment protocol for survivors of domestic violence.

Domestic violence poses a serious threat to the health of women and children, and to the family as a whole. Nevertheless, responses to this type of violence, particularly in developing countries, are still vague, isolated, and limited to initiatives by the government and by nonprofit agencies. Domestic violence is a type of gender-based violence that includes several forms of physical, sexual , psychological, and economic abuse against women. It occurs within the social context of wom-en's subordination and their familial bonds. Domestic violence is essentially a behavioral-social problem that will not be solved by just treating the survivors' injuries in a hospital emergency room. Following international commitments, such as the Convention on the Elimination of All Forms of Discrimination against Women, which was adopted in 1979 by the United Nations General Assembly (1), many countries have approved specific legislation on domestic violence. However, these laws will not eliminate domestic violence unless they are enforced and there are appropriate referrals for health treatment. Health care is an essential component of the services required for the comprehensive treatment of survivors of domestic violence. Health care is as vital as the justice system, law enforcement agencies , social service agencies, schools, the media, churches, and the communities served by each of these organizations. Research has been instrumental in setting intervention priorities, such as in understanding individual and societal factors related to domestic violence (2), in learning about the " critical path " that women who are victims of domestic violence follow as they seek help and try to escape the violence (3), and in evaluating the effect that different types of legal sanctions have on preventing perpetrators from performing additional acts of violence (4). On the basis of a favorable legal foundation, the significant research experience that has been accumulated , and especially with adequate allocation of human and financial resources, the various sectors concerned with domestic violence would be ready to define institutional policies and procedures so that courses of action for interagency collaboration could be established (Figure 1). For there to be a successful process of integration among health services, the police, and social services agencies, these entities will need to set common goals for en