What if 166,000 was the infant mortality rate for Ohio for 2007? What if 166,000 Ohio children were poisoned by lead-based paint last year? What if 166,000 elderly adults annually were physically abused in nursing homes across the Buckeye State?
Any one of these statistics would paralyze a politician in his loafers, outrage private citizens and cause advocacy groups to, well, do something.
The actual numbers for infant mortality, lead poisoning and elderly abuse aren't that high. But what did happen 166,000 times in Ohio in 2007 is people being subjected to intimate partner violence via physical or sexual abuse. And that number doesn't include 64,000 children abused or neglected and 29,000 elderly abused or neglected last year (see "Violent Spillover," issue of Jan. 23).
Physical abuse, sexual abuse, emotional abuse, maltreatment and neglect are just a few examples of what goes on in Ohio homes. It's often dubbed "a family matter," but it's also called family violence.
Anthem Foundation of Ohio (AF-OH) believes most people have no idea what kind of violence takes place behind closed doors, and the group wants to do what it can to make this public health crisis a priority.
That lack of awareness is exactly what the White Paper on Improving Family Violence Prevention in Ohio is all about.
With the support of AF-OH, a nonprofit dedicated to "improving the health of Ohio's indigent residents," the Ohio Family Violence Project worked with the Health Policy Institute of Ohio (www.healthpolicyohio.org) to collect as much data as possible to understand the makeup and pervasiveness of family violence in Ohio.
"We were looking at not only intimate partner violence prevention but also child maltreatment and elder abuse," says Theresa Wukusick, AF-OH program director. "Looking at the intergenerational transmission of violence and the cycle of violence is a critical component of the work."
Prevent abuse before it occurs
The Ohio Family Violence Project, which was started in 2007, has three specific goals, according to the foundation's Web site (www.greatercincinnatifdn.org):
· "to increase awareness of the scope and consequences of family violence in Ohio,
· "to identify realistic and promising policies and programs for prevention and
· "to build support for implementing recommended policies and programs."
Wukusick says a number of regional coalitions throughout the state have formed — four of which are receiving implementation funding from Anthem in 2008 — to create a holistic approach to preventing family violence. While these regional groups have a sense of what's happening in their area, she says a view of the entire state was missing and thus the White Paper was funded to "identify what the numbers are, because we didn't really have anything available and certainly not in a sole source document."
Statistics for elder abuse weren't available, inconsistently reported or the reporting that was done was incomplete.
Agencies receiving reports about suspected abuse, such as adult-protective services programs, will typically send a social worker to investigate allegations of harm to elderly adults. There are no standardized practices or procedures for how each of these different agencies in Ohio's 88 counties define, document, report and address abuse.
The best conservative estimate is that 61,000 elderly Ohioans have been neglected or abused; in 2007 alone, 29,000 were reported as abused or neglected. Of those, adult-protective service agencies investigated 8,109 cases of abuse but substantiated only 3,888 cases of abuse (13 percent). Of those cases identified, only 2,175, or 8 percent, were given help in the form of mental health services or assistance with finding a new home away from the violence.
One thing is consistent among most counties: They focus their resources and efforts in trying to identify victims as opposed to preventing abuse from happening in the first place. The White Paper says this approach is an ineffective way to deal with violence in the family.
The same ineffective response to child abuse is also cited. Using 2005 data, the report says, "Child protective service agencies investigated 112,600 children in Ohio for suspected abuse or neglect, and identified 42,483 victims. Based on 64,000 new cases each year, this means that authorities conducted twice as many investigations as actual cases, but still missed identifying one of three actual cases of child maltreatment."
Using elder abuse as an example, the paper goes on to explain why so much of this abuse is never uncovered and why those who need services don't utilize what's available.
"Victims of family violence experience many barriers to accessing services," the paper says. "People may feel the services are inappropriate, unnecessary or not culturally relevant to them. Others might fear retaliation from the abuser or the community if they seek help, including being forced into a long-term care facility."
Having accurate data with which to compile the report was a challenge because the collection of information isn't well funded, nor is it a priority for many of the cash-strapped agencies that encounter victims. The authors underscore this fact by noting that only 51 percent of local law enforcement agencies — 373 of the 679 in Ohio's 88 counties — "submitted complete monthly reports on domestic violence" to the Ohio Attorney General's Office "despite their bring required to do so by law. Perhaps more disturbing, nine community police agencies (i.e. not including college or metro park forces) submitted reports each month yet recorded no incidents for the entire year."
The need to 'step back and think'
After the white paper was released in February, Anthem held a series of forums throughout the state to discuss the data and talk to people at the grassroots level in order to fill in some of the information gaps and learn what's needed to build momentum behind awareness and education efforts. Wukusick attended these, including one held May 16 in Cincinnati.
"One of the things that stood out for me was a passion and interest from local folks to do something about this issue," Wukusick says, "(and) some frustration with not having adequate resources to do that."
Prevention does work, according the White Paper. The review of several home-visitation programs in which nurses make regular, structured home visits to low-income, first-time mothers are believed to have prevented many cases of maltreatment. While economic studies of these programs are rare, one called the Nurse-Family Partnership provides proof of effectiveness.
"Several analyses concluded that the program yields $2.88 to $5.68 in cost savings for every dollar invested," the paper says.
Experience statistics are also scarce but more prevalent than economic studies.
"Carefully evaluated school-based programs in North Carolina and Ontario, Canada, significantly reduced dating violence among teens for up to four years," the paper says.
Wukusick hopes the information, and lack thereof, will get people thinking.
"We infrequently take a step back and think about the collective implication of what's happening and what that could and should mean for us as a community ... for advocates in the field, for service providers, for individual folks," she says.
For Ohio, it means an infusion of $3.5 billion, according to the paper: $1.1 billion in direct services provided to victims of intimate partner violence and child abuse (mental health services, medical treatment, foster care, etc.) with the remainder being indirect costs such as finding a new home, repeating a quarter or semester at college and, when a death occurs, the loss of a lifetime of earnings for a family.
Wukusick believes the impact of these unpleasant statistics is largely ignored because people would prefer to avoid the topic.
"My guess is that most folks know someone who has been impacted by intimate-partner violence, child abuse maybe," she says. "Elder abuse we know so little about, but with increasing numbers of aging baby boomers and an increasing older adult population there's a growing concern about issues there.
"There's oftentimes a reluctance to say anything. It's a family secret. We don't like to talk about this issue. It's uncomfortable."
What Is Family Violence?
Family violence includes acts that are physically abusive, sexually abusive and/or emotionally abusive and occur between family members. In cases where one family member is dependent on another, family violence also includes neglect. We use the term 'family' broadly to describe relationships delineated by blood, legal status, commitment, dependency and living arrangement.
What makes family violence different from other types of violence is that it occurs in the context of a trust relationship and generally represents a pattern of behaviors occurring over time. Because of these characteristics, the consequences of such violence are especially harmful and complex. Conversely, preventing family violence can also help avoid a wide range of other problems. Common types of family violence include:
· Child maltreatment: When a family member or caretaker neglects basic needs or inflicts physical, sexual and/or emotional abuse. Neglect is the most common type of child maltreatment, followed by physical and then sexual and emotional abuse.
· Intimate partner violence: When physical, sexual and/or emotional violence occurs in the context of a current or former relationship. A perpetrator often abuses power in order to control his or her partner.
· Elder abuse: When a family member or caretaker neglects basic needs, financially exploits an elder or inflicts physical, sexual and/or emotional abuse. Neglect is the most common type of elder abuse reported to adult protective services, followed by financial exploitation and then emotional, physical and sexual abuse.
Any introduction to family violence must acknowledge the gendered nature of the problem. Men are responsible for the overwhelmingly majority of violent crime, and family violence is no exception: Especially in the area of intimate partner violence, men are much more likely than women to harm their partners.
From the White Paper on Improving Family Violence Prevention in Ohio, Anthem Foundation of Ohio. Download the paper at www.healthpolicyohio.org/publications/OhioFamilyViolence.html.
To learn more about what the local Cincinnati coalition is doing to help educate people about what makes up a healthy relationship and programs that are available to help prevent family violence, call the FAMILY VIOLENCE PREVENTION PROJECT at the YWCA at 513-361-2144 or visit www.embracehope.org.