Progress in Addressing Domestic Violence in Indian Country

Progress in Addressing Domestic Violence in Indian Country

At the July 13th, 2010 briefing at the National Press Club in Washington, D.C., Futures Without Violence, formerly Family Violence Prevention Fund joined other leading health, Native and violence prevention experts to release a new report that documents dramatic improvements in the health system’s response to domestic violence at Indian, Tribal and Urban health care facilities across the United States.

When the program began in 2002, just four percent of women at Indian Health Service facilities were screened by doctors and nurses for domestic violence. By 2009, when it ended, 48 percent of women who sought services at these facilities were being screened for abuse – and preliminary data shows that 62 percent of women at some sites are now being screened.

The new report offers a series of recommendations to continue the progress and ensure that many more American Indian/Alaska Native domestic violence victims get the help that they need when they seek medical care at clinics and hospitals.

Numerous studies have found that rates of domestic violence are appreciably higher for Native women than for women of any other race or ethnicity. A 2008 Centers for Disease Control and Prevention report found that 39 percent of Native women reported being victims of partner violence some time in their lives. The new report, Building Domestic Violence Health Care Responses: A Promising Practices Report documents an effective response, finding that, over the course of the program, annual routine assessment for intimate partner and domestic violence of Native women increased 12-fold.

Funded by the Administration for Children and Families (ACF) and Indian Health Service (IHS), which are both part of the U.S. Department of Health and Human Services, the program engaged more than 100 Indian, Tribal and Urban health care facilities as well as domestic violence advocacy programs to improve the health system response to domestic violence. It was conceptualized and managed by Futures Without Violence in partnership with faculty from Sacred Circle and Mending the Sacred Hoop Technical Assistance Project. Indian health centers in 18 of the 35 states with federally recognized tribes participated; the project included work with the Cherokee, Choctaw and Navajo tribes, among others.

It was effective “because it offered a multi-faceted response to violence, offering community supports and legal services when women needed them, improving the way health care providers respond to women disclosing violence, raising awareness of domestic and sexual violence in local communities, and strengthening community partnerships to help victims of domestic and sexual violence,” IHS Chief Medical Officer Dr. Susan Karol said at the briefing.

ACF Acting Associate Commissioner Debbie Powell concurred, noting that the project taught “important lessons... We will do all we can to continue integrating domestic violence and sexual assault into trainings that improve the health care response to violence, and continue strengthening the tribal response to sexual assault,” she said.


In addition to increasing rates of assessment, the IHS/ACF Domestic Violence Project:

  • Trained staff members from more than 100 Indian, Tribal and Urban health care facilities, and domestic violence advocacy programs across the country on domestic violence health system change.
  • Developed community-wide domestic violence response teams that include staff from health care, judicial, law enforcement, community programs and Tribal councils.
  • Developed patient education materials including two posters targeting men and boys with prevention messages specific to domestic violence.
  • Tailored the Electronic Health Record to integrate domestic violence routine assessment and implementation of screening reminders.
  • Raised public awareness and promoted social norm change through community walks, billboard campaigns, candlelight vigils, radio/TV shows, Public Service Announcements, and staff participation in health fairs, rodeos and pow wows.
  • And helped victims of domestic violence and sexual assault get the help they need to support their healing from the abuse and promote their health and wellness.

“In Indian country, health care providers are often the first responders to domestic violence, and the health care setting offers a critical opportunity for early identification and primary prevention of abuse,” said Anna Marjavi, Futures Without Violence Program Manager and co-author of the Promising Practices report. “This report is designed to share all of our lessons learned from this innovative project. We call on all Indian health and community advocacy programs to use this tool to strengthen their communities’ responses to violence.”

Native Advocates Speak Out

Jane Root, Director of the Maliseet Domestic Violence and Sexual Assault Program for the Houlton Band of Maliseet Indians (a Tribe in Northern Maine), told the packed room about the story of “Linda,” a middle-aged woman with grown children who was married to an abuser for years. The abuse was well known in her small tribal community, and family members asked “Linda” to get help many times. But the first time she actually got help was when she disclosed the abuse to a nurse at a clinic.

As a result of the screening, “Linda” eventually filed charges against her husband, left the abusive relationship, and entered a transitional housing program. “‘Linda’ may never have called an advocate, she more than likely would never have reported the crime, if not for the screening that all women utilizing our health clinic receive,” Root said.

Al Garcia, Associate Director of the Robert Sundance Family Wellness Center, United American Indian Involvement, Inc. in Los Angeles, shared a similar experience. He said that, as a result of a positive screen for domestic violence, “Sandra” was able to become a survivor of domestic violence and improve life for herself and children. “Today, her children are not exposed to violence, nor do they witness it,” Garcia said. “Her boys have less of a chance to become future abusers and batterers, and a better chance to develop healthier relationships as teens and beyond.”

Moving Forward

“We intend to continue building on the successes of this project,” said Sacred Circle Anti Sexual and Domestic Violence Specialist Elena Giacci. “That begins by sharing this report and letting others learn from our work, and implement [it so] communities can create an effective response in their town.”

Since 2002, Futures Without Violence and its partners have been working to improve the response to victims of domestic violence in Indian health facilities and tribal communities across the United States. This project included work in Alaska, Arizona, California, Colorado, Maine, Minnesota, Mississippi, Montana, North Carolina, New Mexico, New York, Oklahoma, Oregon, South Dakota, Utah, Washington State, Wisconsin and Wyoming.

Building Domestic Violence Health Care Responses in Indian Country: A Promising Practices Report was produced by Futures Without Violence in collaboration with Mending the Sacred Hoop Technical Assistance Project and Sacred Circle. It is available online.

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