October 29, 2009 — Summary of "The Dangerous Shortage of Domestic Violence Services," Iyengar/Sabik, Health Affairs, September 2009.
Domestic violence is a preventable but serious public health problem in the U.S., with more than 30 million people in the country experiencing some type of domestic violence each year. However, little information exists about the availability of federally funded services for people who experience domestic violence. Radha Iyengar, an assistant professor in the Department of Economics at the London School of Economics, and Lindsay Sabik, a graduate student in health policy at Harvard University, used the National Census of Domestic Violence Services to analyze the services available through domestic violence intervention programs in the U.S. Over a single 24-hour survey period in November 2006, 160 programs responded to service requests from 48,350 people. However, more than 5,000 of those requests could not be met because of a shortage of resources.
For the study, Iyengar and Sabik compiled a list of existing domestic violence programs, which they defined as "nonprofit, nongovernmental organizations whose primary mission is to provide services to victims of domestic violence," based on the definition used in the 2005 Violence Against Women Act. The included programs were eligible for several federal grant schemes, including the Family Violence Prevention Services Act, the Victims of Crime Act and VAWA. The researchers identified various available domestic violence programs through state coalitions that coordinate the federally funded programs, as well as through e-mail distribution lists for domestic violence service providers. They identified 2,016 domestic violence programs, which they said is "believed to be an almost complete universe of federally funded domestic violence programs."
According to the researchers, the National Census of Domestic Violence Services uses a "snapshot approach" that requires local domestic violence programs to report an unduplicated, anonymous count of people who used their program during a single twenty-four-hour period. The census includes information about individual programs, their characteristics and the services they provide.
The survey used in the study was conducted over a 24-hour period in November 2006. The researchers categorized the programs into three mutually exclusive service groups: emergency shelters, transitional housing and nonresidential services. They classified services as either individual -- including one-on-one counseling, safety planning, housing support and legal services -- or group -- including support groups for adults or children, job training programs and counseling. The researchers also measured hotline calls and community education. Lastly, they measured requests for services that were unmet because of inadequate resources. According to the study, this measurement could "include duplicates because people might have contacted multiple programs during the survey period to request assistance" and "included people who were referred to other community organizations."
The researchers found that 48,350 people were served during the 24-hour period, not including hotline calls and community education sessions. Most of the people were women. There was a "critical need" for safe temporary living quarters, with an estimated 14,518 people in need of emergency shelter in one night. Nearly 65% of the programs provided some type of emergency shelter, but there was a significant unmet need for longer-term housing. One-fourth of programs provided emergency shelter only.
The researchers also found that the domestic violence programs offered a variety of counseling and advocacy services. Individual services accounted for 40% of services, with more than half that used by nonresidential clients. In the 24-hour period, approximately 11 hotline calls were answered per minute, and 35% of activities the programs conducted were in the form of public education.
More than 5,000 requests for services could not be met because of a lack of resources, the researchers reported. In nonurban areas, 2.17 of every 100,000 people did not receive needed services, compared with a national average of 1.75 per 100,000 people. According to the researchers, many of the respondents said that they typically served more people in one day than they served on the day of the survey.
"Domestic violence is a major public health problem," and although the U.S. health care system is "an important point of intervention, efforts to increase safety and prevent future violence rely heavily on community-based domestic violence programs," according to the researchers. They wrote that "expanding the use of public health tools to measure the extent of and response to domestic violence is crucial to effective intervention," as only about one in seven domestic assaults are reported to law enforcement. In 2005, the National Crime Victimization Survey estimated domestic violence rates at 3.6 per 1,000 females annually, which corresponded to an average daily rate of .98 per 100,000 females. The study found a daily rate of 13.52 per 100,000 women, which suggests that "the need for services may be higher than previously thought."
One of the study's key findings is a need for both short- and longer-term housing for people who experience domestic violence, especially in rural, economically disadvantaged and minority communities, the researchers wrote. Although emergency shelters are able to meet some of this need, previous research shows that domestic violence survivors "experience major barriers in obtaining and maintaining housing and often return to their abusers because they cannot find long-term housing," according to the study. More than one-fifth of programs surveyed reported offering only emergency housing and not transitional housing.
According to the researchers, "The most worrisome result from this survey is that 5,183 requests for service went unfulfilled in a single day because of a lack of resources." They added that although there are several different grants to pay for the services for domestic violence survivors, "it is clear that these services are insufficient to fully meet the needs of their communities. ... Given the dire nature of domestic violence circumstance as they seek safety, this inability to provide crisis services may be dangerous, if not deadly, for many Americans."