Coordinated Community Responses to Domestic Violence in Six Communities: Beyond the Justice System. Social Service and Health Care Providers


There is no formal coordination among social service providers in Baltimore. In general, if an agency has a client who needs domestic violence services like legal assistance, crisis counseling, or shelter, they refer the person to the House of Ruth, which is widely recognized as the primary domestic violence service provider for the area. In fact, standard police procedures provide a card to domestic violence victims containing information only about the House of Ruth. If a client needs services other than those provided by House of Ruth, particularly substance abuse treatment or intensive mental health services, the House of Ruth will refer the client to other agencies in the community. House of Ruth staff are also involved with a couple of citywide organizations that deal with homelessness, although domestic violence is not a primary focus of these meetings.

Historically, child welfare agencies and domestic violence service providers have different philosophical orientations which strain relationships between these service providers. In Baltimore, the House of Ruth and Child Protective Services (CPS) have a "good faith" agreement to work together. While this signed agreement does not give specific protocol for interagency case management, CPS staff reported that it facilitates a continuing dialogue between the agencies by reminding each party to respect the other's different goals. According to CPS staff, many of their cases have a current or past history of domestic violence, and while not all these families seek services from the House of Ruth, there is clearly a significant overlap in the populations that both agencies serve.

Several medical providers in the Baltimore community are working to develop and implement protocol for screening and responding to domestic violence. The Baltimore City Health Department, Sinai Hospital, and Healthy Start (a program to address health issues among pregnant women and mothers with young children) are presently developing responses to domestic violence. While these agencies did not jointly develop their protocols, they have all contacted the DVCC coordinator to discuss their projects.

The Health Department, recognizing domestic violence as a public health issue, has been formulating a domestic violence response for public health clinics as part of their special initiative on injury prevention. The department is currently developing a mandatory screening policy for public health clinics, which they plan to implement shortly. The project has compiled a guide of approximately 30 resources in the city and county that provide services to battered women, which clinic staff can use to refer battered women to services. To date, this effort has been carried out almost entirely by one Health Department staff person and an intern, with little involvement by clinic staff. However, the Health Department consulted with at least five service providers in the area in developing the protocol. The project coordinator hopes to obtain funding soon to train clinic staff and to produce the resource guide.

Although not a direct health care provider, Healthy Start, which is a program under the Baltimore City Health Department, addresses health care issues among women who are pregnant or have children under the age of three. Healthy Start, in conjunction with the House of Ruth, currently provides three hours of domestic violence training for all staff at Healthy Start centers. Healthy Start has also developed domestic violence screening protocol for case managers to use during home visits, but the protocol are not yet fully implemented. Under these protocol, staff will mostly refer women identified as domestic violence victims to the House of Ruth for services, although they may also refer to a Healthy Start social worker, if one is available. These efforts seek to promote client well-being and worker safety. Since the case managers often visit clients in their homes, they need to pay special attention to the family dynamics and potentially volatile situations. Healthy Start also addresses domestic violence issues with their clients' male partners as part of the men's services groups provided in the Healthy Start centers.

Sinai Hospital is one of four Maryland hospitals participating in a state pilot project for domestic violence screening programs. The Domestic Violence Medical Response and Advocacy Project involves a direct service component financed by the individual hospitals and a formal evaluation component to be conducted by domestic violence experts and medical researchers. Sinai Hospital's program was not fully implemented at the time of the site visit, but it was expected to begin shortly. Under the planned program, staff in the emergency room and several other departments will screen for domestic violence and refer battered women to the project coordinator. The project coordinator will conduct the client assessment, which is used for research purposes, and also provide short-term counseling services and case management for battered women during her working hours. The coordinator will also train hospital staff in the new protocol and will train other staff to work with victims when she is not working. Eventually, the program plans to provide support groups and community outreach and also to work more with the police department and State's Attorney's Office. The project is in its first of three years, and if it proves successful, it may be expanded to other hospitals in the state.