Some survivors of domestic violence do not seek outside assistance, except when asking healthcare providers to mend their broken bones or asking the courts for orders of protection. These two points of community contact offer unique opportunities for interventions to end the violence, says U. of I. psychology professor Nicole Allen, an expert in community responses to domestic violence. Allen spoke to News Bureau life sciences editor Diana Yates.
You led a study of how a dozen health care facilities in a community in the Midwest implemented (or failed to implement) a protocol for universal domestic violence screening. Why should health care providers ask their patients about domestic violence?
Domestic violence survivors are at greater risk of injury, but also suffer a variety of other chronic health conditions including arthritis, chronic pain, headaches, sexually transmitted diseases and stomach ulcers. Many individuals also go to the doctor when they are sick or for routine physical exams. Thus, health care providers have a unique opportunity to engage in prevention and intervention – even when someone is not actively seeking help regarding domestic violence in their lives.
When health care providers ask about violence in the home, they validate survivors’ experiences and create opportunities for intervention that might not otherwise arise. If a survivor chooses to disclose to a health care provider, they can be linked to desired resources and supports. And even if they choose not to disclose, just by asking, health care providers communicate that survivors are not alone, and that abuse is not condoned or ignored in the health care community.
What prevented some medical providers from offering screening?
It is surprisingly difficult to get healthcare providers to engage in routine screening for domestic violence. We found that violating privacy is a common concern, which is somewhat ironic given that health care providers routinely gather personal information from their patients. Still, there are strong social taboos about violating the privacy of the home without some mandate to do so.
Many providers cited time constraints as a barrier, and some noted that their institutions did not make screening a priority or provide tools or resources to support such efforts. Some providers said that they were not sure what to do if someone disclosed that they were experiencing domestic violence.
What policies or practices make such screening more likely?
Having clear written policies that are enforced is a must. Administrators ought to communicate that screening is a priority and then pay attention to whether or not it actually occurs. Some agencies accomplish this by regularly auditing charts and publicizing the percent of charts in which screening was documented.
Having protocols so that providers know what to say, how to handle difficult situations (for example, if a partner refuses to leave the room during an exam), and how to respond to disclosures is essential. Providers should have clear, written guidelines regarding expectations, the knowledge and skills to engage in screening and institutional support to respond to disclosures.
You also study how and whether family violence coordinating councils influence judicial behavior in domestic violence cases. What is the purpose of these councils?
Just about every facet of the community can play a role in creating an effective, coordinated response to domestic violence. Not only health care providers, but schools, businesses, employers, law enforcement, courts, faith settings and human service agencies all have a stake in ending domestic violence. Coordinating councils bring these stakeholders together. Typically, this involves working collaboratively to provide local or regional community education and systems reform. For example, a community may choose to implement a new prevention education curriculum in schools. Local law enforcement may adopt a common protocol for responding to domestic violence, and address changes in the law as they occur (regarding possession of firearms, for example). Courts may develop new child visitation programs to increase survivor safety when there are joint custody arrangements. Employers may change assistance policies to explicitly address domestic violence. Local restaurants may use paper placements that educate patrons about domestic violence and local resources. Ideally, such coordinated action across systems communicates that domestic violence is not the norm and is not acceptable.
Do such councils actually make a difference to those seeking orders of protection? If so, how so?
Our study found that the formation of councils was associated with survivors being more likely to return to court for plenary (longer-term) orders of protection after receiving emergency (short-term) orders. Many councils in our study had an explicit goal of improving access to orders of protection. Some created pamphlets that described the process of seeking an order and listed local resources that could assist with the process. These were then distributed to survivors when they sought paperwork from circuit clerks to file an order. Such initiatives often facilitate new relationships and fuel subsequent action. For example, some courts chose to co-locate advocacy services in the courthouse rather than just make referrals to outside agencies.
Councils also become a venue through which stakeholders become more educated about each other’s roles and about the dynamics of domestic violence. This can serve to create more educated responders – in the courts and in other systems. Our study was important because it tied the formation of councils to a desired systems change. Yet, orders or protection are just one piece of a complicated puzzle in the response to domestic violence.
How does community engagement (or lack of engagement) with domestic violence issues affect victims and perpetrators of domestic violence?
A common outcome of domestic violence is social isolation, which can compound survivors’ risk. This may be part of how power is exerted in an abusive relationship – to separate a survivor from family and friends. Ignoring the widespread reality of domestic violence may provide implicit support for its persistence. In contrast, when a wide variety of stakeholders – from local employers to faith communities – actively address the issue, they encourage community accountability for such violence that extends beyond the criminal justice system. Law enforcement and the courts can play a critical role in addressing safety issues, but a cultural transformation requires broad engagement. This involves actively reaching out to survivors and respecting their decisions (including the decision to stay with an abusive partner at given points in time), being tenacious and unconditional in our offers of support, and being sensitive to the complex safety issues that survivors face.