Each year more than two million women are seriously assaulted by their male partners (Council on Scientific Affairs, American Medical Association, 1992). Countless others suffer less serious physical abuse as well as verbal or emotional abuse. The needs of battered women and their batterers span several service systems, and may require interventions by one or more of the criminal and civil justice systems, social service, health, or mental health care agencies, and support systems for battered women and their families.
Battered women sometimes seek relief through the criminal justice system, which historically has served as the main vehicle in a community's formal response to domestic violence. The National Crime Victim Survey (NCVS) found that 56 percent of women who had been victims of a violent crime committed by an intimate partner reported the incident to the police (Bachman, 1994). Women have different reasons for contacting law enforcement agencies. In the NCVS, half of the victims of domestic violence called on law enforcement as a means to punish the perpetrator while 28 percent wanted to stop the violence or prevent it from occurring again (Bachman, 1994). In recent years, the criminal justice system has moved toward a proactive approach in which the response to domestic violence is not dependent on the victim's participation. Mandatory arrest, probable cause arrest, and pro-prosecution (i.e., "victimless" prosecution) policies are efforts to take the responsibility off the victim for determining whether or not to pursue legal remedies. The relief available through the civil justice system has also improved in some communities with changes in the use of and remedies available through protection orders.
Battered women may also access domestic violence shelters and services instead of, or in addition to, criminal justice measures. Until the late 1970s, few shelters or services existed specifically for domestic violence. A decade later there were more than 800 shelters for battered women in the United States (Gelles and Straus, 1988). These programs frequently provide a number of services in addition to shelter, such as counseling, legal assistance, and advocacy. Despite their wider availability, shelter services are not used by most battered women. Gelles and Straus found that less than 2 percent of women who were severely abused reported seeking help from a battered women's shelter during the prior year, and no victims of minor violence sought help from shelters (Gelles and Straus, 1988). A couple of factors may contribute to the small proportion of women using shelter services. In many communities, the services may be inadequate to serve all battered women who request services from the shelter (Gelles and Straus, 1988 and Council on Ethical and Judicial Affairs, AMA, 1992). Also, leaving the abuser and going to a shelter, or seeking help in obtaining a protection order are major decisions used as a last resort by many women.
The health care system often unwittingly provides another important source of services for battered women, although traditionally it has not played an active role in identifying or intervening in domestic violence. Battered women seek treatment for traumatic injuries resulting from the abuse (e.g., bruises, cuts, broken bones, etc.), and for primary care complaints related to the abuse (e.g., chronic headaches, abdominal pains, sleeplessness, depression, etc.) (Council on Scientific Affairs, AMA, 1992). Research indicates that more than one-fifth, and perhaps as many as one-third, of women receiving care in hospital emergency departments have symptoms related to domestic violence (Council on Scientific Affairs, AMA, 1992). Most commonly, women seeking such health services do not identify themselves as battered women and the health care providers do not identify them as such. Most women using health services in relation to symptoms caused by battering are not in touch with any other services where they do self-identify. Therefore, the health care system provides an access point to battered women who are not being served by other systems. In recent years some health care providers have become increasingly aware of this issue and have developed policies to screen for domestic violence and to intervene in these cases. Some jurisdictions require health care providers to report domestic violence to law enforcement agencies. Thus, health care systems represent important intervention points for expansion of community-wide systems of response to domestic violence, but attempts to use them this way will raise many important issues that do not surface when women themselves identify battering as the problem.
Other service systems such as alcohol and drug treatment programs, child protective services, and programs for the homeless are also very likely to have clients who suffer from domestic violence, and may also have clients who are perpetrators. At this time these systems are even less likely than health care systems to identify the existence of domestic violence among their clients, or to intervene and offer services if domestic violence issues become apparent. However, a few communities are beginning to work with one or more of these systems to bring them into the domestic violence service network. In addition, a few of the communities we visited are taking steps to broaden their network further to include businesses and corporations through their employee assistance programs, and clergy as both opinion-setters and potential first points of supportive service contact (through pastoral counseling). To the extent possible, this study tried to identify communities in which some of these more expanded networks were in the process of development so we could explore the issues involved.