| Fall 2001;
Volume 2, Number 2|
Feature: Violence and Healthcare
Interview with Jacquelyn CampbellConducted by Sarah Park
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HHPR: Domestic violence or Intimate Partner Violence (IPV) has traditionally been viewed as a criminal justice issue. When did it become a health care concern?
JC: I track it back to 1985 when former Surgeon General Everett Koop called together a group of experts to talk about violence as a public health problem. Violence in general, up until that point, had not been defined as a health problem. Family violence child abuse, wife abuse, and elder abuse were three of the topics considered at the conference. Later, Mark Rosenberg, Jim Mercy, and a lot of other people at the CDC were instrumental in looking at violence as intentional injury. Framing violence under an injury framework took it squarely into the health domain.
HHPR: When were the first IPV studies published in health-related journals?
JC: They were published before Koops conference. In 1979, two pioneers of the violence field, Evan Stark and Anne Flitcraft, wrote one of the hallmark violence articles in the International Journal of Health Services. It was about domestic violence and its interface with a big healthcare system. In 1977, Barbara Parker and Dale Schumaker published the first nursing research on domestic violence in the American Journal of Public Health. This was the first article about domestic violence published in a mainstream public health journal.
Doctors, Victims, and the Police
HHPR: According to the Family Violence Prevention Fund (FVPF), a
well-respected national domestic violence organization with a strong and
unique emphasis on healthcare, Healthcare providers are often in the
best position to help victims of domestic violence and their children
but only if they are trained to screen patients for domestic violence, to
recognize the signs of abuse, and to intervene effectively. What makes
the position of healthcare providers unique?
JC: The reason that may be is because many battered women do not seek help from the criminal justice system or a shelter until things are really bad. And thats probably as it should be. We in the health care system see women before it gets bad. We may see them for minor injuries or when mental health problems related to abuse first start.But even more importantly, we see women on a regular basis at primary care visits and prenatal care visits.
HHPR: Do you feel that there is greater trust between a victim and a healthcare provider than between a victim and the criminal justice system?
JC: Not necessarily. It depends on what the persons experience has been with the criminal justice system. What is more telling is the fact that people perceive and rightfully so that the criminal justice system and the health care system have two different functions. The criminal justice system doesnt come into play until the woman is defining the violence as a crime.
We have lots of evidence that when the violence first begins, the victim does not perceive it as a crime. When these episodes first begin, the victim is very invested in trying to fix the problem behind the episodes rather than seeking a criminal justice remedy. The same with shelters; women dont usually think about shelters. One of the key things healthcare providers can do is be the bridge that allows the woman to see that shelter services and advocacy services might be very useful for her.
HHPR: What are your views on mandatory reporting of domestic violence by health care professionals to the police?
JC: Mandatory reporting has been a difficult issue to sort through. On the face of it, it seemed like a really good idea that allowed the criminal justice system to be involved quickly and, hopefully, to prevent further injury and serious problems.
Women often are very pleased to have someone else take the responsibility of calling the police. If the police get involved, the woman can say it was the doctor who did it. However, there is a significant minority of battered women who are concerned that they would be in more danger if the police were called. Some women say that if they knew there was mandatory reporting they just wouldnt tell their healthcare provider about the abuse.
We are researching what is happening with mandatory reporting and whether or not it is keeping women out of jeopardy. Once we have some really good studies, maybe we can figure out a viable mandatory reporting system.
National Domestic Violence LegislationThe Violence Against Women Act of 2000 (VAWA 2000) passed with overwhelming support in both the House and Senate and was signed into law by former President Clinton last fall. It provides $3.3 billion over five years to address domestic violence, with law enforcement and shelter services receiving $925 and $875 million respectively.
HHPR: Several new VAWA 2000 programs have been slated to receive funds, including a study of state laws addressing insurance discrimination against victims of domestic violence. Aside from this, there seems to be little mention of healthcare issues. Can you explain the absence of a role for healthcare providers in this legislation?
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