Identifying population-level
domestic violence prevention
strategies in Maryland
Aamir Bharmal, MD
MPH Candidate
Johns Hopkins Bloomberg School of Public Health
Supervisor: Russ Montgomery, PhD
Office of Population Health and Improvement, DHMH
May 8, 2015
Project Introduction & Overview
• Maryland State Health Improvement Process (SHIP)
• Domestic Violence Indicator
• Identify strategies for domestic violence prevention
• Develop evidence-based report on best practices
Public Health Significance
• Domestic Violence:
• Common
• Significant downstream
health effects
• Major cause of female
homicides
• Preventable
Photo source: http://bernieslilwomencenter.org/tag/domestic-violence/
Methods/Approach
• Interviews with stakeholders:
•
•
•
•
•
Maryland Network Against Domestic Violence
Rhode Island Coalition Against Domestic Violence
DHMH Maternal and Child Health Bureau
Expect Respect
Baltimore City Health Department
• Identify best practices and evidence-based
recommendations
• Focus on primary and secondary approaches that could
be applied to wider populations
Civilian Advocates Program
• Trialed in UK by Domestic Violence Matters
• Community health workers in police stations
• Provide after-hours support and advocacy
• Take advantage of window of opportunity when
victims are seeking help
Civilian Advocates Program
Benefits and Limitations
Benefits
• Fewer return calls
• Increased shelter use
• Increased support service
use
• Increased legal advice
use
Limitations
• Developing connections
with another department
• Progressively increasing
caseloads of clients
Civilian Advocates in
Maryland Context
• Could be tied to Lethality Assessment Program
• Administer through Rape Recovery Centers
• Role for program on college campuses
Photo Source: http://fredericksburgrealestateblog.com/snatched-from-the-clutches-of-domestic-violence-mels-story/
Expect Respect Program
• School-based program with
three phases:
1.
2.
3.
Photo Source: http://en.wikipedia.org/wiki/Ontonagon_School#/media/File:2009-0617-Ontonagon-school.jpg
School-wide campaign on
bullying, harassment, and
violence
Leadership training for
select students to become
advocates against violence
and change school culture
Support groups for highrisk students with skills
building for relationships
Expect Respect Benefits and
Limitations
• Benefits
• Better knowledge of
healthy relationships
• Improved relationship
skills
• Skills awareness
• Talks about bullying
• Focused on victims
AND perpetrators
• Limitations
• Need school buy-in
• Fitting into curriculum
• Program attendance
Expect Respect in Maryland
Context
• Standardizes school-based programming
• Can apply to areas with high violence rates
• Adjunct to Dating Matters program in Baltimore
City
• Needs school engagement
Project Connect
• Already administered by Maternal and Child Health
Bureau
• Builds on USPSTF recommendations for violence
prevention
• Train health care providers at family planning centers
with the four C’s:
•
•
•
•
Confidentiality
Conversation
Card
Connect
Photo Source: http://womenshealth.gov/project-connect/images/project-connect.png
Project Connect
Benefits/Limitations
• Benefits
• Reaches high-risk family
planning center
population
• Already in Maryland
• Preliminary surveys
promising
• Limitations
• Evaluation ongoing
• Need more data on
provider screening
behaviors
Limitations and Challenges
• Difficult to measure domestic
violence outcomes and gauge
effectiveness of interventions
Photo Source: http://www.hbook.com/wpcontent/uploads/2015/01/challenges-ahead.jpg
• Some indicators are
problematic (e.g. ER visits) and
are in the process of being
changed
• Success hinges on culture
change
Bottom Line
• Domestic Violence is a serious societal problem that
is preventable
• Prevention strategies that are integrated in schools,
health centers, and law enforcement can reach
vulnerable groups in many areas of society
• Difficult to measure effectiveness but suggested
programs rooted in prevention principles
Acknowledgments
• DHMH
•
•
•
•
•
Russ Montgomery
Laura Herrera
Alice Bauman
Diana Cheng
Casey Fay
• Baltimore City Health
Department
• Olivia Farrow
• Expect Respect Program
• Barri Rosenbluth
• Maryland Network Against
• Rhode Island Coalition
Domestic Violence
Against Domestic Violence
• Michaele Cohen
• David Sargent
• Lucy Rios
References
1.
Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J.,
& Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS):
2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control
2.
“Intimate Partner Violence in the U.S.: Injury and Treatment,” U.S. Bureau of Justice Statistics,
accessed February 12, 2015, http://www.bjs.gov/content/intimate/injury.cfm.
3.
World Health Organization, Global and Regional Estimates of Violence against Women: Prevalence
and Health Effects of Intimate Partner Violence and Non-Partner Sexual Violence, 26 (2013), accessed
February 12, 2015,
http://www.who.int/reproductivehealth/publications/violence/9789241564625/en/index.html
4.
Maryland Network Against Domestic Violence. Domestic Violence in Maryland. 2014.
http://mnadv.org/about-domestic-violence/domestic-violence-in-maryland/. Accessed March
12, 2015.
5.
Maryland Department of Health and Mental Hygiene. Maryland State Health Improvement
Process (SHIP). 2014.
6.
Maryland DHMH. Maryland Female Homicides : A Comparison of Intimate Partner Violence
Associated Deaths to Non-Intimate Partner Violence Deaths. Baltimore, MD; 2014.
7.
Wolfe DA, Jaffe PG. (1999). Emerging Strategies in the Prevention of Domestic Violence.
Domestic Violence and Children; 9(3): 133-44.
References Cont’d
8.
Kelly L, Bindel J, Burton S, Butterwo D, Cook K, Regan L. Domestic Violence Matters : An
Evaluation of a Development Project Home Office Research Studies. London, UK; 1999.
9.
Ball B, Tharp AT, Noonan RK, Valle LA, Hamburger ME, Rosenbluth B. Expect respect
support groups: preliminary evaluation of a dating violence prevention program for at-risk
youth. Violence Against Women. 2012;18(7):746-762. doi:10.1177/1077801212455188.
10.
McCloskey, L. A., Lichter, E., Williams, C., Gerber, M., Wittenberg, E., & Ganz, M. Assessing
Intimate Partner Violence in Health Care Settings Leads to Women’s Receipt of Interventions
and Improved Health. Public Health Reports. 2006; 121(4), 435–444.
11.
Warshaw C, Sullivan CM, Rivera E a. A Systematic Review of Trauma-Focused Interventions for
Domestic Violence Survivors.; 2013.
12.
Sullivan C, Alexy C. Evaluating the Outcomes of Domestic Violence Service Providers: Some
Practical Considerations and Strategies. Natl Resour Cent Domest Violence. 2011.
http://www.vawnet.org/applied-research-papers/print-document.php?doc_id=380. Accessed
March 16, 2015.