On Wednesday, April 30, Futures Without Violence and the National Health Collaborative on Violence and Abuse (NHCVA) conducted a Capitol Hill briefing to address strategies to utilize the health care system in a way that can prevent family violence. Speakers included Richard Krugman, MD, the Office of Health Affairs, University of Colorado Denver; Deb Levine, MA, Executive Director, Youth + Tech + Health; Diana Cheng, MD, Project Connect Maryland; Howard Koh, MD, MPH, Assistant Secretary for Health, Department of Health and Mental Hygiene; and Brigid McCaw, MD, MPH, Chair, National Health Collaborative on Violence and Abuse.
Dr Krugman, discussed his work on child abuse and neglect issues. He was a member of the U.S. Advisory Board on Child Abuse and Neglect when they issued their findings in 1990. He summarized what was concluded then, and continues even today, that we have hundreds of thousands of children being abused and neglected each year. Further, that the system we have designed to address these families is dysfunctional and that we end up spending billions of dollars a year to address the failure to respond. He concluded that the Commission he was on had too many recommendations (31), and because they did not offer Congress a “silver bullet” to fix the situation, the recommendations were ignored. He also noted a lack of commitment to the issue by all administrations, noting the Clinton Administration’s lack of interest in the topic at the time he was on the Commission.
Dr Krugman also talked about the need for much more research, pointing out that children respond differently to being victims of abuse but we have a limited ability to understand this result. He suggested that the March of Dimes model might be the best model for advocacy, noting their history of forming in response to the past polio epidemics of the forties and fifties that took a little over 1,000 lives per year. They mobilized around a single cause and grew from there.
Dr.Cheng focused her discussion on recent research and on-going work in Maryland. Starting in Baltimore, research determined that the number one killer of women who are pregnant or within a year of their pregnancy was homicide. Further work and research determined that in two-thirds of these homicides the perpetrator was the partner or former partner. In some instances these homicides also include the infant. They also determined through surveys of pregnant women that 7 percent were experiencing physical abuse during their pregnancies. Building on these finding Maryland is working on addressing intimate partner violence (IPV), training providers including Obstetricians and Gynecologists, and integrating IPV assessment into Title X Family Planning Programs and other health provider contacts.
Additionally, the briefing highlighted further opportunities in health care to reduce domestic and dating violence and adverse childhood experiences (ACE), and new technology (apps) that promote safe and healthy relationships.