Objective 3.4: Increase safeguards to empower families and communities to prevent and respond to neglect, abuse, and violence, while supporting those who have experienced trauma or violence

HHS increases safeguards to empower families and communities to prevent and respond to neglect, abuse, and violence, while supporting those who have experienced trauma or violence.  The Department continues its efforts to promote coordination across the government to address the full range and multiple forms of neglect, violence, trauma, and abuse across the life span.  HHS is building a resource infrastructure to ensure equitable delivery of high-quality services to support affected individuals, families, and communities.  HHS also leverages data to inform the development of effective and innovative prevention and intervention models to address neglect, abuse, and violence.

Objectives represent the changes, outcomes and impact the HHS Strategic Plan is trying to achieve.  This objective is informed by data and evidence, including the information below.

• One in three women and one in four men experience domestic violence.  Domestic violence can make it more difficult to manage chronic health conditions including diabetes and hypertension.  (Source: Family Violence Prevention and Services Program).  Perpetrators of domestic violence may limit their partners’ access to physical and mental health treatment and other needed social supports.  (Source: Current Evidence: Intimate Partner Violence, Trauma-Related Mental Health Conditions & Chronic Illness)
• Under stay-at-home orders due to COVID-19, police reports in some areas showed increasing rates of Intimate Partner Violence (IPV), even though calls to domestic violence hotlines decreased in some regions by up to 50 percent.  (Source: Alarming trends in US domestic violence during the COVID-19 pandemic)  One possible explanation is that victims of IPV delayed in reaching out for help until late stages of the abuse cycle, when violence was more severe and necessitated contacting authorities. (Exacerbation of Physical Intimate Partner Violence during COVID-19 Pandemic)
• Violence can take various forms: it can be physical, emotional, sexual, or psychological.  People of all races, cultures, genders, sexual orientations, socioeconomic classes, and religions experience IPV.  However, such violence has a disproportionate effect on communities of color and other marginalized groups.  Economic instability, unsafe housing, neighborhood violence, and lack of safe and stable child care and social support can exacerbate IPV and make it harder for victims to escape the abuse.  (Source: A Pandemic within a Pandemic — Intimate Partner Violence during COVID-19)
• Children exposed to domestic violence are at greater risk for involvement in the criminal justice system later in life, either as juveniles or adults.  (Sources: Family Violence, Special Feature; The Prevalence of Adverse Childhood Experiences (ACE) in the Lives of Juvenile Offenders)
• One in seven children experienced child abuse or neglect in 2019 with about 1,840 children dying from abuse or neglect.  Children living in poverty are five times as likely to experience abuse or neglect.  (Source: Preventing Child Abuse & Neglect)
• 47 percent of youth ages 10–24 in tribal communities received mental health services after screening, referral, or suicide attempt.  (Source: SAMHSA FY 2022 Justification of Estimates for Appropriations Committees)
• Approximately 3,076 tribal programs/organizations implemented specific mental-health related practices as an outcome of SAMHSA grant support.  (Source: SAMHSA FY 2022 Justification of Estimates for Appropriations Committees)
• More than 140,000 children in the United States lost a parent, custodial grandparent, or grandparent caregiver because of COVID-19 between April 1, 2020 and June 30, 2021.  More than 140,000 U.S. children lost a primary or secondary caregiver due to the COVID-19 pandemic )
• Orphanhood is a secondary tragedy of the COVID-19 pandemic with significant ethnic and racial disparities.  Compared to White children, American Indian/Alaska Native children were 4.5 times more likely to experience the loss of a primary or secondary caregiver, Black children were 2.4 times more likely, and Hispanic children were 1.8 times more likely.  (Source: More than 140,000 U.S. children lost a primary or secondary caregiver due to the COVID-19 pandemic)
• Substance use coercion is a prevalent but unrecognized form of abuse and is a barrier to victims’ economic stability including finances, employment, housing stability, social networks, and public benefits.  A survey of National Domestic Violence Hotline callers who had experienced domestic violence revealed that 43 percent of respondents had experienced at least one type of substance use coercion.  (Source: Understanding Substance Use Coercion as a Barrier to Economic Stability for Survivors of Intimate Partner Violence: Policy Implications)

Contributing OpDivs and StaffDivs

ACF, ACL, ASPE, CDC, HRSA, IHS, NIH, OASH, and SAMHSA work to achieve this objective.

HHS OpDivs and StaffDivs engage and work with a broad range of partners and stakeholders to implement the strategies and achieve this Objective.  They include: the Elder Justice Coordinating Council, Interagency Task Force on Trauma-Informed Care, Interagency Task Force to Monitor and Combat Human Trafficking in Persons, and National Center on Elder Abuse.

Strategies

Promote coordination across the federal government to address the full range and multiple forms of neglect, violence, trauma, and abuse across the life span, including gender-based violence

• Increase coordination within HHS OpDivs and StaffDivs and partner with other federal departments on violence prevention and trauma initiatives that create opportunities for an integrated federal response.
• Engage community health workers to expand outreach and access to interventions for those impacted by neglect, violence, trauma, and abuse.
• Develop national awareness and prevention initiatives focused on violence, trauma, neglect, and abuse as public health issues.
• Educate and empower families and communities, including tribes and territories, to recognize and respond to signs of violence and trauma and understand the importance of and need for a comprehensive public health approach.
• Support broad awareness of the historical trauma experienced in American Indian and Alaska Native communities and implement evidence-based approaches to healthcare delivery that takes into account past and on-going violence and trauma across tribes.
• Bolster early intervention, prevention, public awareness, and comprehensive access to services for individuals who have experienced human trafficking.

Build resource infrastructure to ensure equitable delivery of high-quality services to support affected individuals, families, and communities

• Strengthen networks and increase resources—including resources to ensure adequate staffing—for state, local, tribal, territorial, community- and faith-based organizations focused on the prevention of and recovery from violence, trauma, neglect, and abuse as they make investments in programmatic advancement, cross-system coordination, equipment, and culturally- and linguistically-appropriate shelter and other services and service delivery.
• Facilitate and support access to healthcare and behavioral health services for anyone who is surviving domestic violence, dating violence, family violence, and sexual violence, including 24-hour confidential hotline, shelters and programs, and a network of state coalitions and national technical assistance providers.
• Enhance resources for hotlines that provide referrals and service connections to those impacted by violence, including the National Domestic Violence Hotline, the StrongHearts Native Help Line, and the National Human Trafficking Hotline.
• Design innovative skills-based training and technical assistance to the networks, grantees, and programs that serve individuals, families, and communities impacted by neglect, violence, trauma, and abuse.
• Create assessment tools and engage stakeholders to identify gaps in prevention, holistic treatment, and integrative care for underserved communities, including tribes and territories.

Leverage data to inform the development of effective and innovative prevention and intervention models to address neglect, violence, trauma, and violence

1. Strengthen surveillance systems to gather prevalence data across all HHS programs and appropriately identify resources for public health and human services solutions.
2. Disseminate evidence-based strategies to promote safe, stable, and nurturing relationships and environments for adults, children, families, older adults, and persons with disabilities, including the communities in which they live.
3. Advance the development, access, and use of standards, guidelines, regulations, and electronic reporting to improve the quality and timeliness of public health data collection.
4. Establish policy and guidelines that emphasize evidence-based decision making for assisting those who have experienced trauma or violence.
5. Support a coordinated program of research focused on refining, testing, and implementing evidence-based practices for primary and trauma-related services, including screening, prevention, and treatment across relevant settings that serve youth and adults.
6. Address gaps in knowledge about intimate partner violence prevention programs for American Indian and Alaska Native communities, for racial and ethnic specific communities, and for underserved communities.

Performance Goals

The HHS Annual Performance Plan provides information on the Department’s measures of progress towards achieving the goals and objectives described in the HHS Strategic Plan for FY 2022–2026.  Below are the related performance measures for this Objective.

• Increase the capacity of the National Domestic Violence Hotline to respond to increased call volume (as measured by percentage of total annual calls to which the Hotline responds)
• Decrease the percentage of children with substantiated or indicated reports of maltreatment that have a repeated substantiated or indicated report of maltreatment within six months
• Increase the number of potential trafficking victims identified by the National Human Trafficking Hotline
• Increase the percentage of placement designation of referrals of Unaccompanied Children (UC) from Department of Homeland Security within 24 hours of referral
• Increase Intimate Partner (Domestic) Violence screening among American Indian and Alaska Native (AI/AN) Females
• Increase the number of prevention and response strategies from CDC’s resource Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence being implemented by state and local health departments funded through the multistate ACEs cooperative agreement
• Expand the number of evidence-based resources on best practices and core components of trauma-informed care for clinical practice that are available on the National Center for Injury Prevention and Control website

Learn More About HHS Work in this Objective

• National Tribal Behavioral Health Agenda: A blueprint for improving the behavioral health of American Indians and Alaska Natives.
• President’s Interagency Task Force to Combat Human Trafficking and Senior Policy Operating Group (POG), Victims Services Subcommittee: Publishes an information repository of federal services available to those experiencing human trafficking.
• Support to Holocaust Survivors, Older Adults, and Family Caregivers: ACL awarded a five-year, $4.935 million per year, cooperative agreement to The Jewish Federations of North America (JFNA) to expand people oriented, trauma-informed (PCTI) services and supports for Holocaust survivors and other older adults with histories of trauma, and their family caregivers.  JFNA, in partnership with a broad network of local and national agencies that serve older adults and family caregivers, will work to further PCTI services throughout the Aging Services Network.
• Tribal Action Plan (TAP): The TAP coordinates resources and programs to help tribes achieve their goals for preventing and treating substance use disorders.
• Tribal Training and Technical Assistance Center: The Center provides training and technical assistance resources on mental health, substance use disorders, suicide prevention, and mental health promotion using the Strategic Cultural Framework.