Health Departments Help Build Local Capacity to Prevent Family Violence

Polly C. Paulson, M.P.H., M.A.
Epidemiology and Prevention for Injury Control (EPIC) Branch
California Department of Health Services

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All too often, family violence can lead to injury and death, but that is only part of the problem. Family violence can fill our safest haven—the home—with an atmosphere of dread that destroys health and emotional well being. Children growing up in violent families are often affected psychologically for many years, if not for a lifetime. The child who begins as a victim can end up a perpetrator, and the deadly legacy is passed on to a new generation.

Identifying ways to break the cycle of family violence has long been a goal of the California Department of Health Services (CDHS), Epidemiology and Prevention for Injury Control (EPIC) Branch. Government actions affect individuals and families in endless ways, and the question of what role a health department can play is not simple, especially when it focuses on trying to define what constitutes “local public health capacity in violence prevention.” Accordingly, EPIC staff decided the best approach to capacity building would be to offer local public health leaders “think time” to weigh local issues and to devise community-led solutions. This was based on our experience and the literature that has shown that “funders often do not provide financial support for…early stages of the development process, making it difficult to establish the foundation necessary to sustain partnerships and systematically plan collaborative initiatives.”1

Over the last 13 years, EPIC has provided grants to 28 county and 3 city health departments to help them build capacity for violence prevention (see map). In this EPICgram we describe some of the key outcomes that lend to program successes across the state.

California map showing counties funded by the EPIC branch

Figure 1. Violence Prevention Capacity Building Projects funded by the EPIC Branch, 1990-2003: Alameda, City of Berkeley, Butte, Contra Costa, El Dorado, Fresno, Glenn, Humboldt, Imperial, Kern, Lake, City of Long Beach, Los Angeles, Marin, Mendocino, Merced, Monterey, City of Pasadena, Placer, Sacramento, San Diego, San Francisco, San Joaquin, San Mateo, Santa Barbara, Solano, Sonoma, Stanislaus, Tulare, Ventura, and Yuba.

Background

In the first seven years of the grant-making program (1990-1997), EPIC funded nine Violent Injury Prevention (VIP) projects in counties with high rates of youth homicide. The purpose of this “seed money” was to develop local leadership and promote public health approaches to prevention of all forms of violence, including family violence. The grants were funded for an unusually long period, from four to seven years, to give local health departments enough time to firmly establish injury prevention programming within their jurisdictions. Grants helped local health departments gather and analyze local data, develop coalitions for planning and consensus building, and implement new interventions.

By 1997, six of the nine grantees had created a permanent violence prevention unit within their health departments and developed strong community programs. For example, the Los Angeles project fostered the development of a countywide VIP Coalition with more than 500 member organizations. In San Francisco, the health department used the VIP seed money to lay the groundwork for a reporting system for violent injuries. This San Francisco Violent Injury Reporting System (SFVIRS) proved so successful that the Harvard School of Public Health selected San Francisco to participate in a five-year multi-site pilot on violent injury death reporting. As a result of the pilot, the U.S. Centers for Disease Control and Prevention is building a National Violent Death Reporting System.

In 1998, funds were becoming scarce, but EPIC was still able to offer smaller grants to jurisdictions to work specifically on family violence prevention strategic planning and coalition building. This Family Violence Prevention Strategic Planning (FVPSP) project was based on the VIP experience. Once again, local health departments welcomed the opportunity to take a leadership role in crafting local solutions to family violence.

Infusing Violence Prevention into Existing Programs

Along with providing grants to local health departments, EPIC has encouraged violence prevention work in city governments. For example, through a partnership with the California Healthy Cities Project, EPIC provided small grants to two Healthy Cities to carry out violent injury prevention projects in 1996-1997. Each of these projects was successful in creative and noteworthy ways: the City of Oceanside created a community-led nonprofit organization so fundraising could be conducted for violence prevention activities. The City of Chico incorporated conflict resolution training in all elementary and middle schools.

FVPSP Grants Allowed Local Health Departments to Get Creative

With primary prevention as the goal, many of the FVPSP strategic plans developed recommendations to reduce risks for family violence, such as:

Outreach to men who seek health and social services who may also have suffered from family violence. (Fresno)
Inclusion of older adult collaborative as part of outreach education. (Kern)
Establish “Grandmother’s Houses” or safe havens where someone could just drop in and feel safe and accepted. (Lake)
Conduct training for teens to promote healthy dating. (Fresno)
Train service providers to increase their cultural competence as it relates to working with families on violence prevention. (Ventura)
Target animal control officers and animal shelter staff regarding collaboration on identifying family violence perpetrators. (Humboldt)

Planning Dividends: Related Grantee Accomplishments

In the process of developing their plans, the FVPSP grantees also succeeded in building local capacity. For example, projects were able to:

Systematically review each service system related to family violence.
Improve mechanisms for data collection; for example, improve law enforcement identification of child witnesses during domestic violence incidents. This in turn shaped education and intervention strategies.
Update related action plans.
Incorporate injury prevention strategies into existing services through coordinated efforts, such as one-stop resource centers, education of providers, and dissemination of information and referral resources to clients.

Grantees also succeeded in bringing together various governmental and community groups to work on violence prevention. Accomplishments in coalition building included:

Improved data collection and sharing among agencies. (most grantees)
Increased overall communication among agencies and community groups (all grantees)
Increased participation of local courts in coalitions. (Imperial)
Reached consensus on a common definition of “family violence”. (all grantees)
Enhanced community perception of Public Health as a “key player” in community violence prevention. (all grantees)
Enhanced cooperation across jurisdictions. (all grantees)
Provided training for coalition members on media advocacy and social marketing. (Sonoma)
Created alliances and partnerships, which flourished after the funding period ended. (all grantees)

The FVPSP grants set in motion some changes that no one foresaw. Here are some examples of new entities and positions that were also created:

A Domestic Violence Unit in a district attorney’s office. (Fresno)
A Domestic Violence Death Review Team. (Fresno)
A Multi-Disciplinary Interview Center providing “one-stop” child abuse assessment. (Ventura)
A public health position of “Domestic Violence Resource Specialist”. (Fresno)
A domestic violence screening and education component incorporated into a Maternal and Child Health program. (Berkeley)

Finally, a number of the projects incorporated short-term activities to give participants a tangible taste of success during the planning process. The following are examples of the small accomplishments that often fueled enthusiasm for pursuing some of the more distant and difficult goals:

A resource card in languages other than English. (Long Beach)
A teen dating video to prevent violence. (Kern, Fresno)
A website to disseminate the strategic plan. (Marin)
A health department family violence protocol. (Butte)
A public service announcement for a high risk ethnic community. (Long Beach)

The Future of Family Violence Strategic Planning

Currently, EPIC is seeking funds to extend the planning process to additional health departments. However, EPIC’s Violence Prevention Unit staff are also investigating other avenues to continue to build local capacity in violence prevention. For example, plans are underway for a statewide violence prevention network of local health departments that would include resource exchange, technical assistance and training opportunities.

In the Words of the Grantees

From Glenn County: "The most significant outcome and product of the Family Violence Strategic Planning Project was the development of a relatively permanent community organization for the development of needs assessments. This group has brought together individuals and organizations from diverse communities and socio-economic cultures, to bring ideas and data together for sharing and building a focused response to community exigency. There exist within the community many great opportunities and sufficient data to make meaningful changes and exact findings to make these changes a reality."

From Contra Costa County: "The work of the violence prevention committee…acted to energize and create linkages between many of the agencies and individuals working on this issue in the county. Different perspectives, as well as information was shared. Smaller community groups became "known" to larger non-profits and included in their program planning and implementation."

From Santa Barbara County: "The Public Health Department has embraced the concept that family violence is a public health issue, has identified a place for addressing the problem in the Department's overall Strategic Plan, and has positioned itself among other County departments and its collaborative partners in the community as a leader in prevention…Professionals who have primarily focused on the intervention needs of our communities, and how to improve our coordinated response to family violence that is already occurring, are now becoming familiar with the distinct and different work of prevention. They now are beginning to realize the importance of preventing the conditions, events, situations or risk factors that result in the initiation of family violence, and also the importance of promoting protective factors in the first place."

From Solano County: "Our project has enhanced community dialogue about the lack of coordination of family violence prevention activities in Solano County…Through our attempts to engage the community in our strategic planning process, the issue is being kept 'front and center.' Our assertion that health education principles should be used for planning and evaluation has continued to benefit the community after our project was completed.

Summary

While there is often funding to conduct specific interventions, rarely do health departments and communities have the opportunity to engage in up front planning and development to address complex issues such as family violence. EPIC’s VIP and FVPSP projects have demonstrated that communities not only welcome this opportunity, but they are often transformed by it—each of the major community systems drawn into this process are able to enhance their own capacity in violence prevention.2

References

Maciak, BJ, Guzman, R, Santiago, A, Villalobos, G, and Israel, B.Establishing LA VIDA: a community-based partnership to prevent intimate violence against Latina women.Health Education and Behavior 1999; 26 (6): 821-840.
Wolff T.The future of community coalition building.Am J Community Psychology 2001; 29 (2): 263-8.

Additional References

Veazie, MA, Teufel-Shone, NI, Siverman, GS, Connolly, AM, Warne, S, King, BF, Lebowitz, MD, Meister, JS. Building community capacity in public health: the role of action-oriented partnerships. J Public Health Management. 2001; 7 (2): 21-32.

Polly C. Paulson, M.P.H., M.A., The California Wellness Foundation’s Violence Prevention Initiative Fellow with EPIC, took the lead in preparing this EPICgram.

If you have any comments or questions regarding this EPICgram, please contact Stacy Alamo Mixson, M.P.H., Violence Prevention Unit, EPIC Branch at (916) 552-9852, or email salamo@dhs.ca.gov.

If you have questions or comments regarding Family Violence Strategic Planning, please contact Deborah Cohen at (916) 552-9853, or email dcohen@dhs.ca.gov

This publication is also available online at http://www.dhs.ca.gov/epic.

The California Department of Health Services, Epidemiology and Prevention for Injury Control (EPIC) Branch publishes EPICgrams to inform the public about injury patterns, prevention programs, and opportunities to protect the lives and health of all Californians.

Arnold Schwarzenegger, Governor, State of California
S. Kimberly Belshé, Secretary, Health and Human Services Agency
Sandra Shewry, Director, Department of Health Services
Alexander Kelter, M.D., Chief, EPIC Branch
Roger B. Trent, Ph.D., Chief, Injury Surveillance and Epidemiology Section
Barbara Alberson, M.P.H., Chief, State and Local Injury Control Section
Stacy Alamo Mixson, M.P.H., Chief, Violence Prevention Unit

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