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Response to domestic violence improved

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WASHINGTON – An innovative program funded by two federal agencies, and implemented by some of the nation’s leading domestic violence organizations, showed dramatic success at improving the health system’s response to domestic violence at Indian, tribal and urban health care facilities across the United States. When the program began in 2002, just four percent of women at Indian Health Service facilities were screened by doctors and nurses for domestic violence.

By 2009, when the program ended, 48 percent of women who sought services at these facilities were being screened. A new report offers a series of recommendations to continue the progress and ensure that many more American Indian/Alaska Native domestic violence victims get the help they need when they seek medical care at clinics and hospitals.

Building Domestic Violence Health Care Responses: A Promising Practices Report” finds that, over the course of the program, annual routine assessment for intimate partner and domestic violence of Native women increased 12-fold. That is because the program offered an effective response to violence, identified best practices to raise awareness, improved clinical responses, and strengthened community partnerships to help victims of domestic and sexual violence. Numerous studies have found that rates of domestic violence are appreciably higher for Native women than for women of any other race or ethnicity. A 2008 Centers for Disease Control and Prevention report found that 39 percent of Native women reported being victims of partner violence some time in their lives.

The program, which was funded by the Administration for Children and Families, U.S. Department of Health and Human Services, and IHS, engaged more than 100 Indian, tribal and urban health care facilities as well as domestic violence advocacy programs across the country to improve the health system response to domestic violence. It was conceptualized and managed by the Family Violence Prevention Fund in partnership with faculty from Sacred Circle and Mending the Sacred Hoop Technical Assistance Project. Indian health centers in 18 of the 35 states with federally recognized tribes participated; the project included work with the Cherokee, Choctaw and Navajo tribes, among others.

“The Indian Health Service is proud to have been a part of this groundbreaking project,” said Dr. Yvette Roubideaux, IHS director. “As a practicing physician in Arizona, I saw first-hand the effects of domestic violence on my patients, their families and communities. I have real hope that more health care providers and tribal communities will learn from the promising practices identified in this report.”

“The Administration for Children and Families funded this work in conjunction with IHS because it is so important that we find solutions to domestic violence in Native communities,” said Bryan Samuels, commissioner, Administration for Children, Youth and Families. “This project offers real hope for Native women facing violence, that their health providers will recognize the abuse and know how to help them and their children.”

“In Indian country, health care providers are often the first responders to domestic violence, and the health care setting offers a critical opportunity for early identification and primary prevention of abuse,” said Anna Marjavi, FVPF program manager and co-author of the report. “This report is designed to share all of our lessons learned from this innovative project. We call on all Indian health and community advocacy programs to use this tool to strengthen their communities’ responses to violence.”

In addition to increasing rates of assessment, the IHS/ACF Domestic Violence Project:

  • Trained staff members from more than 100 Indian, tribal and urban health care facilities, and domestic violence advocacy programs across the country on domestic violence health system change.
  • Developed community-wide domestic violence response teams that include staff from health care, judicial, law enforcement, community programs and tribal councils.

  • Developed patient education materials including two posters targeting men and boys with prevention messages specific to domestic violence.

  • Tailored the Electronic Health Record to integrate domestic violence routine assessment and implementation of screening reminders.

  • Raised public awareness and promoted social norm change through community walks, billboard campaigns, candlelight vigils, radio/TV shows, Public Service Announcements, and staff participation in health fairs, rodeos and pow wows.

And helped victims of domestic violence and sexual assault get the help they need to support their healing from the abuse and promote their health and wellness.

“We need to build on the successes of the IHS/ACF Domestic Violence Project and fund more programs to continue this remarkable progress,” said FVPF President Esta Soler. “Tribal communities will benefit if we replicate the promising practices and materials we’ve developed, continue to integrate domestic violence and sexual assault into trainings that improve the health care responses to violence, and strengthen the tribal response to sexual assault. We also must expand our work to engage men as role models, address the impact of violence on children, and do more to teach the next generation that violence is never the answer.”

Since 2002, the FVPF and its partners have been working to improve the response to victims of domestic violence in Indian health facilities and tribal communities across the United States. This project included work in Alaska, Arizona, California, Colorado, Maine, Minnesota, Mississippi, Montana, North Carolina, New Mexico, New York, Oklahoma, Oregon, South Dakota, Utah, Washington State, Wisconsin and Wyoming. “Building Domestic Violence Health Care Responses in Indian Country: A Promising Practices Report” was produced by the FVPF in collaboration with Mending the Sacred Hoop Technical Assistance Project and Sacred Circle. It is available online.