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   Hopkins in Baltimore Series

National leaders presented challenges and solutions for addressing intimate partner violence

“One of the first steps to addressing a problem is to identify it. And we know providers are not routinely screening for domestic violence,” said Carmen Alvarez, assistant professor at the Johns Hopkins University School of Nursing.

Alvarez was one of five panelists who spoke at “Addressing Intimate Partner Violence: Local Considerations and Global Lessons.” The discussion, co-sponsored by UHI and the School of Nursing, was the third event in the Hopkins in Baltimore series. The panelists, all faculty at the school, are national experts on intimate partner violence.

Alvarez said that research indicate that providers ask their patients about domestic violence only 10 percent of the time. Even when patients present with likely injuries, the percentage increases only to 80 percent—suggesting that there is great room for improvement.

Panelists and School of Nursing Dean Patricia Davidson said that the school has a long history of success in addressing women’s issues. To tackle the problem of identifying and preventing domestic violence, researchers have developed a number of screening tools and interventions.

For example, panelist Jacqueline Campbell, professor and the Anna D. Wolf chair in the School of Nursing, developed the Danger Assessment, which is a tool that helps to determine the level of danger an abused woman is in and the likelihood that she might be killed by an intimate partner.  The tool can be used by medical providers, home visitors and even women themselves, through an app.

“Domestic violence transcends all socioeconomic classes, all races, all religions, all nationalities,” Campbell said. Having a tool like the Danger Assessment encourages providers and lay home visitors to address this issue directly and with confidence.

One focus of the panelists was intimate partner violence among youth, especially those who drop out of school or become parents at a young age.

Panelist Kamila Alexander, an assistant professor at the School of Nursing, studies these youth.  “We know quite a bit about people connected to schools.” She studies the “disconnected” youth, those who leave school early.  “We know that the way young people form relationships in their early years predicts how they will form relationships in the future. Early violence predicts later violence.”

Alexander said researchers, clinicians and others are beginning to acknowledge that people are not “either a victim or a perpetrator. Sometimes they are both, and often they are communicating through violence.” She that many youth who begin “communicating through violence” are simply responding to traumatic experiences of their own, experiences that need to be treated to break the cycle of violence.

Campbell agreed, adding, “We try to teach kids to do differently. But when they are presented with what appears to be a threat, they aren’t thinking about consequences. We need to apply what we know about trauma. We have to do healing work, not just teaching work.”

Some examples of that kind of “healing work” that panelists have seen used to break the cycle of violence include art and drama therapy, which allow youth to process their own traumatic experiences.

“It is important to meet young people where they are,” Campbell said.

Panelist Phyllis Sharps is the Elsie M. Lawler chair of the School of Nursing. She is a professor, associate dean for community and global programs, and director of the Center for Global Initiatives. Her work focuses on violence against pregnant women. She talked about how changes in society have meant re-thinking how researchers think about and discuss intimate partner violence. “We cannot always make the assumption that a woman, even a pregnant woman, will have a partner of the male gender.”

Like the other panelists, she noted that more girls and women are reporting being offenders, and many male offenders often report childhood experiences of sexual and physical violence. However, she added, when researchers study serious episodes of intimate partner violence—those that result in major injury or homicide—the victims by far are women.

“We need to do interventions to give people the ability to communicate as partners and parents, without violence” she said.

Campbell said research demonstrates that youth who report experiencing violence in the home is far more predictive of future violence in their lives—either as victim or perpetrator—than violence in the streets.  One type of trauma compounds the other, she added.

Finally, panelists talked about the importance of going beyond screening to provide both intimate provider victims and their offenders with a host of necessary services—legal support, education, counseling, health care, etc.—in order to change their future.

“One of the ways we can all be supportive is by emulating what a healthy relationship looks like—including with ourselves,” Alexander said. 

The event was the third in the Hopkins in Baltimore series, a program created to stimulate conversations on each Johns Hopkins campus about ways the university and the community can work together to effect change. The next event in the series is planned for Feb. 29, 2016.

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