Catherine Sherwood-Laughlin, HSD, MPH Linda Henderson, MA Carrie Lawrence, MS

1. Community-Level Coordination on Improving Health and Well-Being of Rural Families Impacted by Domestic Violence Catherine Sherwood-Laughlin, HSD, MPH Linda Henderson, MA Carrie Lawrence, MS Hon. Michael Robbins, Superior Court I

2. Overview In May 2010, local officials in a rural Indiana county notified the Indiana State Department of Health and Indiana University that their community had experienced an significant increase in domestic violence (DV) and DV-related homicides.

3. Background of Lawrence County • Rural south central Indiana • 46,000 population • 98% white non-Hispanic • High unemployment rate - 13%

4. Objectives in Developing the Community Partnership • Assembling the Community-Campus Team • A working group was formed to identify essential team members to ensure the human capital needed to prepare for the CDC investigation. • An initial research team was created by contracting a community liaison from the community, who also served as a gatekeeper and assigning a graduate student project manager. • The community liaison defined the community and the issues of domestic violence as well as linked the project manager with key stakeholder groups for preliminary data collection

5. Objectives in Developing the Community Partnership • Bridging the Cultural Differences between the Community, Campus Partners and the CDC • The CDC defines community engagement as “the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people.”

6. Objectives in Developing the Community Partnership • A working group was established which included members from the CDC. A common language had not been developed and members of the CDC investigation team constantly used jargon in their request for information from the community. • Together the community liaison and graduate student intervened by providing insight into the understanding of what was needed by the CDC and how the CDC could communicate information needs to the community. • This process continued throughout the investigation and the dissemination of findings

7. Coordinated Response The Indiana University Office for Global and Community Health Partnerships, along with the CDC, facilitated and conducted stakeholder interviews and abstracted records at the Prosecutor’s Office, law enforcement agencies, and social service groups. Contributing factors to the incidence of DV in the Lawrence County Communities: • Cultural and social norms • Conservative southern culture – women “subservient to their men” • Family norms promoting violence – “a family expectation to fight back” • Family matter – “not to be discussed with anyone outside the family” • Economic downturn • Lost about 2,000 jobs • System challenges • Reduced social services and limited communication

8. Key Findings from the CDC “Epi-Aid” Investigation • During a two year period domestic calls 2,023 were made to law enforcement. Of that • Bedford Police Department - 880 calls • “Domestic” calls accounted for 46% of all BPD calls • Lawrence County Sheriff’s Office - 611 calls • Mitchell Police Department - 532 calls • Nearly 700 domestic violence victims sought services from the local domestic violence service provider;

9. Key Findings from the CDC “Epi-Aid” Investigation • More than 500 DV victims filed petitions for protection orders • The lives of more than 500 Lawrence County children were touched by domestic violence perpetrated on a parent or caregiver

10. The CDC Identified Challenges in the Prevention of Domestic Violence Services for Victims: • Lack of DV shelter in Lawrence County • Resources for DV victim advocacy are currently limited. • Problems with the new protocol for reporting domestic violence cases that involve children. Calls to Child Protection Services (or CPS) for suspected child abuse used to connect to local agency.

11. The CDC Identified Challenges in the Prevention of Domestic Violence Services for Batterers: • It was reported that although certain services available, they are not easily accessible to offenders who live in rural Lawrence County due to transportation issues in addition to financial barriers.

12. The CDC Identified Challenges in the Prevention of Domestic Violence The Main Challenges in Primary Prevention Efforts: • Curricula at schools not necessarily evidence-based or comprehensive enough • Deficiency of parental education services to address family risk factors • Weak collaboration among key social service and public sectors

13. The CDC Identified Challenges in the Prevention of Domestic Violence The Main Challenges in Primary Prevention Efforts: • Law enforcement • No lethality assessment • Short holding period for suspected DV offenders • Hospital • No protocols/procedures to identify DV • Need for training on DV identification for staff • Suspected DV cases not reflected in or difficult to retrieve from patient records

14. Summary of the CDC Recommendations to the Community • Schools: • Connect with Indiana Coalition Against Domestic Violence resources • Implement evidence-based programs, e.g. Safe Dates and Fourth R • Communities should consider: • Strategies to address gender and other social norms through youth engagement: e.g. Robert Wood Johnson’s Start Strong Initiative • Prevention strategies that engage multiple community sectors: e.g. “Choose Respect” • Parental education to address family risk factors, e.g. “Incredible Years” parenting training • Law Enforcement and Health Care • Use the DV lethality assessment form to assess the risk of DV homicide • Ensure that DV victims are informed about available services • Strengthen procedures for identifying patients who are victims of DV • Train appropriate staff on how to question patients who are DV victims • Improve the use of the ICD-9 coding to identify incidents involving DV and use E and V coding

15. Facilitating Next Steps • Universities and government institutions often possess bureaucratic systems that do not support, encourage or appreciate the importance of community partnerships which are mutually beneficial.

16. Facilitating Next Steps • Concluding the dissemination of findings the community has formed a coalition facilitated by the ongoing efforts of: • the community liaison • project manager • and faculty members affiliated the Office of Global and Community Health Partnerships.

17. Facilitating Next Steps • With the help of MPH students, intervention strategies and CDC recommendations have been translated and carried out. • An IU MPH Student has developed a pilot school level intervention for 4th graders

18. Identified Challenges and Barriers • The major barrier to the implementation of a comprehensive response to domestic violence in Lawrence County is: • like most rural communities -the lack of available financial resources • One of identified challenges is sustainable campus engagement • essential for fully organized and sustainable community efforts