Washington state fell six spots in the 2019 America’s Health Rankings for Women and Children report this year, a significant drop for a state ranked 11th last year.
The reason? Not traditional health care measures like health provider visits, insurance coverage or immunizations. Instead, the fall can be linked to social determinants of health, including intimate partner violence, homelessness, lack of supportive neighborhoods and teen suicide, according to Dr. Janice Huckaby, one of the report researchers.
Washington ranked 42nd of 50 states for intimate partner violence and 43rd for homeless family households.
“It’s probably an opportunity for political and community leaders to say, ‘How can we better support families or individuals, whether that’s more affordable housing or in our schools or substance use disorder treatment or telehealth counseling or things like that that would be unique to the communities?’ ” Huckaby said.
The report’s findings dovetail with another recent report that looked specifically at women and children in Spokane County.
“Changing Our Forecast: State of Women and Children” found similar public health challenges, from birth to adulthood, that affect both women and children locally. One of those challenges is domestic and intimate partner violence.
Spokane County has a higher rate of domestic violence offenses than the state average, with 10.4 offenses per 1,000 residents reported in 2016, compared to a state average of 7.4. The Spokane Regional Health District estimates that one in three women in the county have experienced domestic violence. Family violence was identified as the No. 1 issue in a separate, recent community needs assessment.
The local report was timely, said Heather Hamlin, executive director of the Women Helping Women Fund, which produced the report with the health district in May.
“This is the first time a report like this has been done in Spokane,” she said. “We’re committed to updating a dashboard for three years.”
The Spokane Regional Health District estimates there are 3,900 confirmed victims of domestic violence each year in the county with many more cases unconfirmed.
Why exactly Spokane has such high rates of domestic violence is not clear, but reported offenses to law enforcement agencies have increased in recent years.
From 2017 to 2018, domestic violence related offenses in Spokane County increased from 7,191 to 7,866, and 70% of the victims were women, a Spokesman-Review analysis of data from the Washington Association of Sheriffs and Police Chiefs shows.
Research shows that domestic and intimate partner violence, whether physical or verbal, has a direct impact on survivors’ and witnesses’ mental and physical health.
Law enforcement agencies document injuries from domestic violence offenses in the WASPC annual report. In 2018, law enforcement agencies in Spokane County reported 3,900 domestic violence-related aggravated and simple assaults. There were five murders, 115 rapes and 247 serious injuries reported in the county related to domestic violence. Nationally, more than half of homicides are intimate partner violence-related, a 2017 CDC analysis shows.
Oftentimes survivors will not report physical injuries, however, so these numbers are likely an understated look at the impact of physical violence in the community.
“For a lot of people there are health difficulties long-term because the majority of people who have violence in the home … do not have their wounds tended,” said Deborah Svoboda, social work researcher and professor at Eastern Washington University.
The Spokane Regional Health District estimates domestic violence accounts for $6.7 million in hospital charges each year.
Intimate partner and domestic violence often lead to trauma for survivors, which can develop into lasting psychological health issues, research shows.
Almost two decades ago, researchers concluded women experiencing verbal or physical abuse are more likely to report both poor physical and mental health.
Violence that occurs in the home or within relationships can cause more complex trauma, Svoboda said, especially when patterns of coercive behavior emerge.
“The reason this is so traumatic is that you live with people, but you also love them or have loved them or they are your parent, and so there’s such a deeper dynamic to family violence,” Svoboda said.
More than one in five adolescents in Spokane County have witnessed adult violence, the “Changing Our Forecast” report found. Witnessing violence is considered an adverse childhood experience, or ACE, which can create trauma for youth when they are young and when they have grown up too. Trauma is not always obvious, however.
Edie Rice-Sauer, the executive director of Transitions, which supports women and families experiencing homelessness in Spokane, shared stories of how complex trauma can be for her clients.
“The kind of impact for kids, who have ACEs and are seeing those things all the time, it’s part of the fabric of their everyday life, and we have no idea that impact,” she said.
Domestic and intimate partner violence can lead to homelessness.
In 2018, 1,789 people receiving services or housing reported experiencing domestic violence in Spokane County, data from the city’s homeless management information system show. Of those receiving services in the region, 52%, or 931 people, were identified as currently fleeing domestic violence in 2018.
While the data is not exact due to the anonymity of entries and the possibility of duplicate entries, leaders of community organizations agree there is a need for more services for domestic and intimate partner violence survivors in Spokane County.
Rice-Sauer said 90% of the women Transitions serves at Miryam’s House, a nine-room transitional house for homeless women, and at their transitional living center, which has 15 apartments for women with children experiencing homelessness, are coming out of situations with domestic violence or intimate partner violence. Transitions rarely has vacancy in these two programs, Rice-Sauer said, and they have had to turn away families.
The YWCA, which serves survivors of intimate partner violence and their children, has 11 rooms in its Spokane shelter and can shelter five households in Spokane Valley. St. Margaret’s Shelter, operated by Catholic Charities, has 17 rooms for families, as well as a unit for domestic violence survivors and a unit for sexually exploited children.
Hope House, run by Volunteers of America, has 36 beds. Jon Carollo, director of development, said they have to turn away women almost every night. He said about 48% of the women staying at Hope House have experienced domestic violence in the last year. Hope House serves anyone who identifies as a woman and those who identify as gender nonconforming and nonbinary, but they do not take children or dependents. Carollo said they are breaking ground on a new shelter this November for women.
“What the whole system is lacking right now is just capacity,” Carollo said. “And the challenge is we don’t have enough funding to support 80 women in the new shelter, but we are living life like it will come because Spokane needs to keep women safe.”
October is Domestic Violence Awareness Month, and community stakeholders released a documentary this month featuring a survivor’s story in a concerted effort to raise awareness about a problem traditionally considered a private rather than public concern.
A comprehensive community strategy, beyond shelters and a hotline, is needed to begin to lower rates of violence, Svoboda said. That includes expanding services for survivors in Spokane County, which are all currently located in the city of Spokane, she said.
“You have to take into account all these rural communities that have lack of access,” Svoboda said.
Nonwhite, ethnic minority women are adversely impacted by intimate partner violence, research shows, and Svoboda said a comprehensive strategy would need to include all voices, like the Latino, African-American, Native American, immigrant and LGBTQ communities.
“It really needs to be culturally relevant to the diversity that we have here,” she said.
Creating a comprehensive plan to address domestic violence will require both funding and resources.
“Most communities do not have that kind of money and resources, but I really believe that the Spokane region has the expertise and some resources,” Svoboda said.
Where funding goes is often determined by elected officials and community leaders, she said.
“It does take the will of policymakers, business community and religious community to step up and say, ‘We’ve got to look at the culture shifts and (how) social norms work to get changes happening,’ ” she said.