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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		Domestic Violence Conference, Washington D.C.
DATE:		November 3, 1998

I like that story because it nicely sums up what Americans think about political promises-they're as solid as applesauce. But some promises are too important not to keep-like our promise that battered women will receive the help and support they need.And our promise that every home should be a safe home.

That's why it's a great honor to join all of you today. Because you're developing trail blazing approaches to prevent and treat domestic abuse. Because, as your conference title suggests, when it comes to addressing family violence, you'll help guide us into the new millennium. And because we've come a long way in fighting the epidemic of domestic violence, but, unfortunately, we still have a long, and difficult, road ahead of us.

.It wasn't very long ago that a battered woman was forced to suffer the cuts and bruises, the terror and tears, in silence. It wasn't very long ago that family violence was considered a family matter. And it wasn't very long ago that when a battered woman called out for help, she got the same response as Doris. In the late 1970's, Doris was living with the familiar cycle of pain and abuse. Her husband beat her when she was pregnant. He beat her after she miscarried. He beat her after she delivered children. But Doris was also forced to endure another tragedy. Because in the 1970's there were no lifelines for battered women-no safe havens to heal, no safe passageways to a better life.

When she went to doctors and hospitals, battered and bruised-in one case seven months pregnant and black and blue from head to toe. No one questioned her. No one offered a helping hand. The abuse only stopped when her husband was imprisoned for a series of crimes, including rape.

Today, two decades later, domestic violence is still causing terror and tears. But the story isn't quite the same. Because many of the calls for help are now answered. I witnessed some of these calls when I recently toured the National Headquarters of our National Domestic Violence Hotline in Austin, Texas. On the phone, there were women, like Doris, who are trying to break the cycle of domestic abuse. Since we established the hotline in February of 1996, almost 140,000 women have been able to reach out for help-24 hours a day, 365 days a year.

But we knew all along that when the switchboard starting lighting up, we had to be ready with more than statements of support. We needed to be ready with real support systems-with referrals for counseling and shelters. And we needed to create a continuum of care.a seamless system of protection and prevention.a system that protects and follows women at risk from incident to safety..a system that leaves no gaps large enough for a woman or child to fall through.and a system that can help heal shattered bones.shattered lives.and shattered dreams.

That's exactly what our Administration has fought to do.With 50 percent more funding for shelters.With tougher penalties for abusers.With better training for police, prosecutors and judges.With more community policing and prevention..And with more public-private partnerships. Just last week, I was at the White House with the Vice-President, and CEO's from companies like Liz Claiborne and Bell Atlantic Mobile, talking about what we can all do-individually and collectively-to confront domestic violence in the workplace. These are all important steps-steps we should be proud of. But they are steps to build on, not to rest on.

Because while we've made great progress in the legal and social service areas, as Doris' story pointed out, one important-and very dangerous-gap still exists in our continuum of care. We haven't focused enough on how our health care system can prevent and treat domestic violence-we simply must do better. Because a battered woman may never call the police.she may never contact a lawyer.she may never enter a shelter, but, eventually-even if it's only for a routine check-up-she will probably visit a doctor, nurse or community health worker. And we must be ready when she does. That's why this year we want to further improve identification and appropriate treatment of domestic violence by the health care system.We want to increase data collection and research about family and intimate violence.And we want to better reach out to health care professionals like you, strengthening our ability to screen, treat and prevent violence against women.

We in government cannot accomplish any of this alone. We need all of you who are on the front lines to continue to work with us to help battered women and their children move out of the shadow of abuse. And that's why I'm here. Many of you, as individuals or members of community or professional organizations, have already made important contributions.The 10 state teams participating in this conference are developing innovative strategies to address domestic violence.As I'm sure Dr. Dickey pointed out in her remarks, the American Medical Association has been working with its state associations to develop domestic violence training programs. And it has run two conferences with the American Bar Association to discuss how the organizations can attack the problem together. The Joint Commission for Accreditation of Hospitals and Health Organizations has made screening family violence one criteria for accreditation. At our Department's recent National Nursing Summit on Violence Against Women, leaders in the nursing field came from all over the country to share program ideas, protocols and experiences with domestic violence. And many hospitals and emergency rooms have begun programs for assisting and screening battered women right on site.

One of the most promising of these programs is WomanKind, which provides services in three Minnesota hospitals, and is currently being evaluated by us. In 1986, Susan Hadley, a community-based battered women's advocate at Fairview Southdale Hospital near Minneapolis, created a one person, around-the- clock, domestic violence and intervention program that provided information and referrals to battered women in the emergency room. Today, Womankind is a formal department within the Fairview health care system. Its services include 24-hour per day case management, advocacy, crisis intervention, hospital- wide training, domestic violence support groups and ongoing assistance after a woman leaves the emergency room. But Womankind not only provides a lifeline for countless battered women, it also demonstrates the difference that a single person can make in the battle against domestic violence.And it serves as an excellent model for how we can attack domestic abuse in our changing health care world.

Because revolutions in our health care delivery system-including managed care-have confronted us with a whole new set of questions that face everyone from patients to insurers: How can we build the trust that's necessary for a woman to confide about domestic violence when she may be seeing a variety of doctors and nurses? How do we ease a woman's fears about privacy? How can we take the prevention strategies that are at the heart of managed care and apply them to domestic violence? The point is, how do we ensure, in this new world of health care, that no woman or child falls through the cracks?

We can successfully address these questions only if we meet four challenges.and only if we understand that fighting domestic abuse through the health care industry is not a one-person sprint. It's really like running a great relay race- Where the ultimate prize is a lot more important than a gold medal or a blue ribbon.Where the success of the team's efforts depends on the performance of each runner, each giving their all..And where the pivotal moment is that second when the baton is passed from one runner's hand to another's.

When it comes to domestic violence, the starting line for treatment and prevention is usually when a woman walks-or is carried-through the door of an emergency room or doctor's office. And just like the relay runner, every health care professional must be prepared. And that's the first of our four challenges. In a managed care environment, a woman doesn't generally have one doctor-a Marcus Welby or Ben Casey taking care of her throughout her life. So it's particularly important that every doctor, nurse, physician's assistant and midwife is learning about domestic abuse right along with anatomy and physiology.

Our 1997 survey of Women's Health in the Medical School Curriculum showed that of the 117 American and Canadian medical schools responding, 76 percent taught about domestic abuse as part of another required course. However, this could mean that during a lecture only 15 or 30 minutes is devoted to the topic. Only 12 percent require a separate course in domestic violence, and only 17 percent offer a distinct elective in the topic. Even more disturbing were the results of our 1995 National Survey of Hospitals. Of the 495 American hospitals that completed the questionnaire, only 5 offer distinct residency programs in women's health, and only 17 offer fellowship programs. Of the 5 residency programs, none specifically address domestic violence or rape. And of the 17 fellowships, only Pittsburgh's VA Medical Center offers it's fellows the option of rotating at a battered woman's shelter or rape crisis center.

Doctors-and other health care professionals-need to know the signs of abuse, what questions to ask, and how to screen women from all cultures and ethnic groups who may have suffered domestic abuse. They need to know that if they suspect child abuse, they also need to screen the parents. And they need to continue learning throughout their careers with refresher courses and seminars so they can effectively identify and screen battered women.

Together with many of you, we're working to develop effective training models and curricula. We've teamed up with Group Health of Puget Sound to test the effectiveness of training in improving the help that battered women receive. And I'm especially pleased that, just this month, all the major nurses associations in the country joined with us to craft a long-term national strategy to address domestic violence. At the heart of this strategy is the development of recommendations for universal domestic violence education at all levels. All of these efforts will help ensure that Doris' experience is never repeated.

But once a health care professional correctly identifies a woman as a possible victim of abuse, we're now faced with our second challenge. We must ensure that battered women are not afraid to talk to a health care professional-or even to seek treatment. Because even if we educate every health care professional in the country about domestic abuse, we won't have the seamless system we envision, and we still won't be able to help battered women, if they are unwilling to talk about-or even acknowledge-the abuse. Many women are scared that their privacy won't be protected.They may be scared that they will suffer the violent consequences when the batterer is arrested.They may be scared that they can't support themselves, or their children, if their abusive husband or partner is taken into custody.Or they may be scared that they will lose their health insurance.

It's tragic that the initial response of too many insurance companies was to deny thousands of battered women insurance, or re-insurance, because they viewed abuse as a pre-existing condition. But under the recently passed Kennedy-Kassebaum legislation, it's illegal for insurance companies to discriminate based on a pre-existing condition when a person transfers from one plan to another. We need to make sure battered women know this. We need to make sure that no battered woman is afraid to walk through the doors of her doctor's office out of fear that domestic abuse will be used to close the door to affordable health care. And, as our Administration has made clear, we need Congress to pass legislation that will balance our national priority interests-including law enforcement-with the legitimate needs of personal privacy.

But let's assume that a woman feels comfortable enough to disclose her abuse to the medical professional that's treating her. Then what? That's our third challenge. If we want this seamless system to work, doctors and other health care professionals and institutions need to see themselves as part of a much larger community-collaborating to successfully treat and prevent domestic violence.

That's why we've teamed up with the Rhode Island Department of Health, and its partners in the health care, academic, law enforcement and advocacy communities, to produce a statewide program to reduce domestic violence. One of the main goals of the program is to provide technical assistance for the development of a seamless system of public education, victim identification training and referral protocols. Because, as Doris' case illustrates, identifying the abuse is only part of the responsibility. I realize that with doctors and professionals being asked to do more in less time, this isn't easy. But health care professionals need to know what community resources, such as shelters, counseling centers, support services and law enforcement remedies, are available. They need to be ready to make referrals and recommendations. And they need to help ensure that a battered woman knows the options, so she can receive the aid she needs.

Yet, in order to develop strategies and interventions to prevent domestic violence, we need to come to terms with the true scope and nature of the problem. And that's our fourth and final challenge. But we can't meet this challenge if we continue to disagree about which numbers to cite or which definitions to use when discussing domestic abuse. The two National Family Violence Surveys conducted over the last twenty years didn't ask important questions about stalking, emotional abuse or sexual abuse.And the Department of Justice's Crime Victimization Survey asked if a person was ever the victim of a crime of violence committed by someone they knew. In order to answer yes, a woman has to believe that physical, sexual, or emotional abuse is a crime. I know that it's extremely difficult to obtain reliable and valid data on the prevalence and incidence of domestic violence. But until we get agreement on regular tracking, definitions and epidemiological data, we can't see the whole picture.we can't develop trustworthy rates over time. we can't gain a better understanding of trends. and we can't measure our progress.

We are moving forward on this front, and that's important. In the next few months, a new household survey on domestic violence, that was funded by our Department and the National Bureau of Justice Statistics, will provide data on prevalence; impact; severity; which domestic violence services are being utilized; and the characteristics of battered women and their abusers. Hopefully, this will provide a clearer picture of the problem.

But one survey is simply not enough. We need those regular surveys that monitor the health and well being of our nation to incorporate domestic violence as a relevant indicator. We need more data from health care professionals that's based on thorough screening of domestic abuse victims. And we need a better understanding of program effectiveness, as well as cost. Above all, we need to stop arguing about the numbers, and instead focus our attention on the problems, their solutions-and the women and children who need our help.

Working as partners, I've no doubt that we can meet our four challenges.And we must. Because the women who suffer the pain of domestic abuse are our mothers and daughters, our colleagues and friends. And because, in the words of Robert Frost, we have promises to keep..a promise that every home will be a safe home.a promise that battered women will have safe havens to heal and the tools to rebuild their lives.and a promise that no woman must endure the indignity of having her body attacked.her mind assaulted.and her spirit assailed.. I know that we can keep these promises, and so help every woman win the race for a better life.