Recognizing family violence as a serious public health issue

Stephanie Montesanti

A tool being developed by an Edmonton researcher will assess the readiness of Alberta’s primary health care clinics to offer effective family violence interventions and support to their patients.

Stephanie Montesanti, a health policy and systems researcher in the School of Public Health, says the primary healthcare sector is the ideal place to offer family violence interventions. “It’s the entry point into the healthcare system and the first and sometimes only point of contact with professionals who can facilitate access to specialist support, whether that’s for mental health or a family violence specialist or a trauma counsellor.”

Family violence is a serious public health issue in Alberta, which consistently has the third-highest rate of domestic violence reported to police among Canadian provinces, says Montesanti. Alberta also has the second-highest rate of self-reported spousal violence in the country. Under-reporting to police is particularly seen in vulnerable populations such as Indigenous and Black Canadians, immigrants and refugees.

Women and children account for two-thirds of all individuals affected by family violence in Canada, according to Statistics Canada, and exposure to family violence in children can result in social, behavioural, emotional and cognitive problems.

Montesanti says domestic violence rates have escalated during the COVID-19 pandemic, with Alberta hotlines reporting a 57 per cent increase in calls in the early months.

“Economic and social stressors brought on by the pandemic have been affecting the wellbeing of families and there’s a greater risk of violence and conflict in the home,” she says. Problems are being seen even in households with no previous experiences of violence.

"Ideally, Alberta’s primary healthcare sector would have a standardized response to family violence."

This issue has devastating consequences not only for the women and children involved but also for communities and the healthcare system, says Montesanti. Domestic violence victims make greater use of the healthcare system—including inpatient hospitalization, primary and specialty care, and mental healthcare.

Primary healthcare providers play a vital role in early detection of violence, says Montesanti.

In Alberta, this sector includes Primary Care Networks (PCNs), the dominant model for primary healthcare delivery in the province. Indigenous primary healthcare clinics are an alternative model. Both involve team-based care, with family physicians, nurses, dietitians, mental health counsellors and other allied professionals working together.

Ideally, Alberta’s primary healthcare sector would have a standardized response to family violence involving a comprehensive set of proven interventions. But before that can happen, Montesanti’s research project is evaluating how ready clinics are to implement family violence programming. Do the physicians and staff need specialized training? Does the PCN’s leadership support taking on this work? How closely does the clinic collaborate with social services in the community? Is the workplace culture receptive to new ways of doing things?

Montesanti has been working with about 20 healthcare professionals to understand the barriers that may deter PCNs from currently offering family violence interventions. Building on their expertise, she will launch a pilot project of the readiness tool in two Alberta clinics—the WestView Health Centre PCN in Stony Plain and the Elbow River Healing Lodge in Calgarythis fall.

Suzanne Squires is a physician and president-board chair of the WestView PCN, which serves 75,000 patients in 12 member clinics. She believes it’s important for her organization to be involved in Montesanti’s pilot project because even comprehensive PCNs like hers have more work to do in ensuring that all team members are properly trained and ready to support patients who are currently experiencing or at-risk of domestic violence, or have been in their past.

Research has shown that children who suffer adverse events in childhood, such as family violence, are more likely to suffer from chronic diseases in adulthood, including mental health issues and addiction, chronic obstructive pulmonary disease (COPD), coronary artery disease and even cancer, adds Squires.

 “I feel quite strongly that we need to better recognize and try to help people who are struggling with family violence because it’s our duty in the role we have as family doctors and the scope we’re committing to, but also in terms of education and preventing chronic disease,” says Squires.

Stephanie Montesanti is supported by the Stollery Children’s Hospital Foundation and the Alberta Women’s Health Foundation through WCHRI.