| Fall 2001;
Volume 2, Number 2 |
Feature: Violence and Healthcare
Interview with Esta Soler and Lisa JamesContinued
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Screening for What?HHPR: What are doctors looking for when they screen women?
LJ: Doctors have to look for more than just injuries. When we first started doing this work, we trained healthcare providers on how to identify signs and symptoms for victims of violence. As we learned more from research on the whole host of health problems that are associated with domestic violence, we recognized that you cant screen based on indicators alone. Otherwise youre going to miss a huge portion of the victims who are coming into the healthcare setting. Routine screening is a critical component of an intervention. Victims have said in research that simply bringing up the issue is one of the most important interventions.
HHPR: How prevalent is screening?
LJ: Healthcare providers are generally not screening for domestic violence, or intervening, so they need training. Screening and training go hand in hand in any policy. You dont want to have a situation where a provider is screening without knowing what to do with the answer. You dont want a doctor to be very uncomfortable if a victim says, Yes, actually, this is happening to me.
[Editors Note: Thomas B. Cole, MD, wrote in the Journal of the American Medical Association (Vol. 284 No. 5, August 2, 2000): Although the American Medical Association and the American College of Obstetricians and Gynecologists [have] recommended that physicians screen female patients for intimate partner abuse [p]racticing physicians say one of the reasons they are reluctant to screen all their patients is the lack of scientific evidence that screening makes a difference for womens health.]
National Legislation: A Criminal Justice LensHHPR: Domestic violence was first recognized as a healthcare policy issue in the 1980s. Yet, most legislation, including the Violence Against Women Act, which was re-authorized in 2000, has not included a role for healthcare providers. How do you explain this absence?
ES: The Violence Against Women Act from September of 1994 was part of President Clintons work on crime control legislation. VAWA was one of many components to a large omnibus crime bill that the President signed into law on, I believe, September 13, 1994. And health never got in there in part because VAWA was always written as a crime bill.
It was supposed to provide resources to prosecutors and to police officers and a little bit to the judiciary and to victim advocates who work in the criminal justice system. We have never, at this point in time, had a bill with the health piece of the strategy that has reached the same kind of prominence as the criminal piece.
HHPR: What do you see as the history or significance of VAWA?
ES: When it passed in 1994, it was the first major piece of legislation subsequent to the Family Violence Prevention and Services Act, which was adopted in the early eighties. It was a bill that funded shelters in the United States. This was the first time that there was a recognition that we have a social problem on our hands that required an expenditure and a political will to do something about it. Before that, I think the Family Violence Prevention and Services Act was a relatively small bill and a relatively small appropriation.
VAWA, by being part of a crime bill at a time in this country when crime was a big issue, raised the level of the concern. When you have social problems, you need public visibility, because without it, you have no public policy because people dont think its a social problem. So I think that was the biggest positive.
HHPR: Do you think that the next re-authorization might introduce healthcare programs?
ES: I dont know if it will be in VAWA. What were working on, and what we hope to build support for, is a whole public health strategy, and a prevention strategy, to deal with the issue of domestic violence. Thats our challenge. Whether it ends up in VAWA or in a separate piece of legislation (its governed by separate congressional committees because prevention and public health are very different from crime control in this country), were going to push for it.
We feel its critical because right now, the response that we have out there is narrow, and we should be figuring out how to intervene earlier with families that are riddled with domestic violence. And we also have to ask ourselves, How do we prevent it? We cant just wait for a horrific act to happen and then provide resources. Its just not the right thing to do.
Medical Privacy Protection: Preventing Further AbuseHHPR: You had mentioned that 22 states had passed legislation related to medical privacy for victims of domestic violence. Is the Federal Standards for Privacy of Individually Identifiable Health Information legislation, the Department of Health and Human Services new medical privacy regulations, a national bolster to the state-wide legislations, or do they differ greatly?
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