This is another episode in our series about topics you may not think of when you think of public health. This week, Lexi Fahrion talks with Hannah Rochford about intimate partner violence (IPV), the roles that social and economic stress play, and the impact of the COVID-19 pandemic on IPV. Read more about Hannah and her work at iprc.public-health.uiowa.edu/2021/10/06…revention/

Find our previous episodes on Spotify, Apple Podcasts, and SoundCloud.

Lexi Fahrion:

Hello, everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Lexi Fahrion, and if this is your first time with us, welcome. We’re a student-run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and out of the field of public health.

I’d like to start off today with a content warning, because we’re going to be discussing intimate partner violence and the systemic factors that contribute to it, especially during the COVID-19 pandemic. I just wanted to give all listeners a heads up in case this is something that may be triggering.

Lexi Fahrion:

Our phenomenal guest today is Hannah Rochford, a fourth-year PhD student in the Department of Health Management and Policy. Hannah has interned with the CDC’s National Center for Injury Prevention and Controls Division of Violence Prevention and collaborates with a number of violence researchers at the University of Iowa, including Dr. Corinne Peek-Asa with the University of Iowa Injury Research Prevention Center, Dr. Kari Harland in the Department of Emergency Medicine, and Dr. Mark Berg with the Public Policy Center.

Lexi Fahrion:

Last year, their team created a compendium of secondary data sources and a commentary that explores the research challenges to understanding the relationship between COVID-19 and rates of injury and violence. Hannah’s interest in violence prevention and research experience has provided her with expertise around systemic factors that contribute to intimate partner violence or IPV, including COVID-19 and what health policy’s role is in preventing, identifying and responding to IPV. Thanks so much for being here with us today, Hannah.

Lexi Fahrion:

Let’s get right into our questions for today. To start off Hannah, can you tell us a little bit about yourself and how you got into the field of intimate partner violence and violence prevention?

Hannah Rochford:

Absolutely. Iowa born and raised. I was an undergrad here at the University of Iowa also, but in a different field. So, we would be here all day if I try to tell my winding path into public health and violence prevention in full, but I guess, in summary, a series of very unplanned experiences kind of brought me into this space. I stumbled into public health doing research in another space and then really fell in love with this idea of the best solution to any problem being preventing that problem. Around the same time, a separate set of experience has helped me understand how common and how damaging violence within families and partnerships is.

Hannah Rochford:

So, merging those two realizations and learning how to leverage public health strategies to prevent this type of harm has allowed me to kind of find my professional passion, and I’m grateful for that.

Lexi Fahrion:

Absolutely. I think that winding path that you mentioned is incredibly common, both in the field of public health and many fields overall, lots of people seem to stumble into their passions through experience, and I think that’s a kind of amazing way to figure out where you belong. To dive into more of what you were just saying, you’ve mentioned intimate partner violence or IPV several times. Can you kind of define that term for us and talk about the prevalence of IPV before the COVID-19 pandemic?

Hannah Rochford:

Yeah, absolutely. It’s a really good question. When we think of intimate partner violence, it’s a term that continues to evolve, but generally, kind of broadly, when I say intimate partner violence, what I refer to are a number of harmful behaviors in which one member of an intimate or romantic partnership, be that a marriage or a domestic partnership or a dating relationship or a co-parent relationship exert control over the other in an abusive way. So, there’s considerable variation in terms of how abuse in a relationship can present, and physical violence is often kind of what comes to mind when we think of intimate partner violence.

Hannah Rochford:

But other harms can also occur. Either in lieu of, or in addition to physical violence, IPV circumstances can include any combination of isolation or financial abuse, reproductive and sexual abuse, psychological violence and/or social abuse, which essentially means leveraging one’s children or other key social relationships to manipulate another person, in addition to kind of what classically comes to mind in terms of physical violence.

Lexi Fahrion:

As you were providing that definition, it kind of struck me on how broad intimate partner violence or IPV is. I think that normally we’ve heard this term, domestic violence. Is there a difference between IPV and domestic violence or does IPV kind of fall under the umbrella of domestic violence?

Hannah Rochford:

Sure. That’s a good question too. Domestic violence maybe is kind of the more classic term, right? And as we think about how our relationship norms have changed with time, the terminology has kind of changed too. Domestic, thinking about what that word conventionally means of the home. When we think about intimate partner violence a long, long time ago, it was kind of more exclusive to marriages, to in-home settings. But again, as our partnership forms or relationship styles have kind of diversified, I think intimate partner violence has kind of become the more inclusive, the more sweeping term.

Hannah Rochford:

Neither are correct or incorrect, but intimate partner violence, I think kind of makes space for partnerships other than marriages, if that makes sense.

Lexi Fahrion:

That makes a lot of sense, and I think it’s important in any field to have definitions evolving with changing circumstances and expectations over time. I’m curious to know, over time as these definitions have evolved and changed, have the demographics of those primarily affected by intimate partner violence evolved and changed, and if so, can you talk a little bit about that?

Hannah Rochford:

Sure. Yeah. That’s a very important question. And the short answer is yes. To be sure, intimate partner violence affects all groups of people. It’s a very cross cutting experience across racial groups, across different life chapters in terms of age, across all socioeconomic classes, all genders and so forth, but as with most public health challenges, inequities create disproportionate burdens for groups that have historically held lower social power. These groups include members of the LGBTQIA+ community, the black community, the indigenous community, other communities of color, women, undocumented individuals, those who struggle with housing insecurity, economic insecurity, with substance use challenges, and other either demographic or circumstantial groups that have again, historically been marginalized.

Lexi Fahrion:

That makes a lot of sense. That seems to be quite similar to a lot of other health disparities that we see with particular health outcomes in public health. Your answer there kind of led into my next question and kind of touched on a lot of it actually, but I’m curious to know more about how these social ecological factors affect the health outcome of IPV. For anyone that doesn’t know, socioecological factors are anything social or environmental in your life that can affect your health aside from just like bacteria and genetics and things like that.

Lexi Fahrion:

This could be anything from the neighborhood that you live in to your race, to your stress levels, to federal policies that impact your health. I’m curious to see if there are any more of those socioecological factors that really stand out to you.

Hannah Rochford:

Yeah, certainly. As you’ve mentioned, the socioecological model is a really helpful model within public health. If we can, I don’t know, paint a little bit of a mental picture for our audience today, if we think of a socioecological model, it might be helpful to think of, kind of nesting dolls, if you’re familiar with those. We have a big circle and then smaller circles kind of nested within that. We all exist in these nested systems. At the very core, our smallest circle in the middle are my individual level characteristics. So, my circumstances, my demographics, and as we mentioned, these are some big important factors in terms of shaping my risk for IPV experiences.

Hannah Rochford:

But as we kind of move out, acknowledging we all exist in kind of these nested systems, we have a larger society, we exist within various communities, and within those communities, we also have different relational networks. At each of these system levels, we can observe factors that elevate one’s risk for IPV perpetration and victimization. If we, again, we talk about the individual level a little bit, so beginning at maybe those lower levels, violence theory helps us understand that our close relationships, especially in our formative years, help us develop social schemas or these holistic cues for reading and responding to situations that we encounter.

Hannah Rochford:

These also help us develop a sense of social control or understanding that. I can’t really behave willy-nilly because there’s long-term consequences to my actions, but if I exist in kind of a hostile environment in these formative years, I will learn to interpret social interactions very differently, and we’ll be more sensitive to any perceived threat than someone who does not. And/or if again, I lack important social attachments early in life, I will struggle to learn to regulate my conduct.

Hannah Rochford:

This in mind, policies that support family stability, security, healthy parenting practices can help prevent the development of antisocial tendencies of low social control and social schemas that may promote hostile behavior or aggression as an individual grows. Then, if we can again, keep zooming out through those levels, moving past individual and past relational to the community level, factors that shape the prevalence of violence include a lot of different environmental factors, like you mentioned, right?

Hannah Rochford:

Things like the density of alcohol outlets, the accessibility and acceptability of legal resource pathways, residential segregation and neighborhood poverty are also big factors that shape how an individual experiences violence. Then again, our largest, our most general level at the societal level, factors that shape IPV include social and cultural norms surrounding how we think of violence as a means to resolve conflict, whether that’s really acceptable, whether that’s only acceptable in certain situations, or that’s something that we really don’t think is okay, and then, again, move formerly, I guess health and economic and educational and social policies all shape the extent of inequities between and stressors that are experienced by groups in society.

Hannah Rochford:

Another important violence theory is called strain theory, and essentially this helps us understand when an individual is faced with severe persistent stress from economic insecurity or discrimination, or again, otherwise an individual will feel kind of a pressure to take steps to reduce that stress or retaliate against that source of strain, and in doing so violent behavior can occur.

Lexi Fahrion:

I think that was an excellent explanation of the socioecological model in this context, and I think that’s where a lot of disconnect lies within people. Understanding that we’re all influenced by systems and our health is influenced by the systems that we live in, from the smallest thing to maybe our individual experiences, all the way through, as a child, all the way through our formative years. That was, again, an excellent explanation. I would encourage anyone listening to try to think about health problems in that context.

Lexi Fahrion:

We’ve talked a lot about the socioecological model and we’ve established that a lot of different things go into causing and perpetuating IPV. I think we’ve all realized during the COVID-19 pandemic that this pandemic has put a lot of strain on our social, economical, and environmental systems. What kind of clued you and your team in as researchers that hey, COVID is having a major effect on this and we really need to get on this issue?

Hannah Rochford:

That’s a great question. We see COVID appearing in a myriad of research spaces, far beyond just the most direct communicable disease research, it’s shaping our communication and it’s shaping finances, and it’s shaping most, if not all, facets of our existence in some way or another. So, it’s understanding how the implications of those impacts is really important for the research community to do in general.

Hannah Rochford:

In terms of COVID, in the context of violence within intimate partnerships and within families, COVID placed major social and economic stress on many households. COVID also alienated people from healthy stress coping mechanisms, and COVID isolated people from others outside of their immediate household and concurrently limited their access to privacy within their household. These factors kind of make a perfect storm for violence to occur, to then increase in severity and for individuals in danger to face even more barriers than normal in reaching safety.

Hannah Rochford:

Again, some examples of these might be, I am in an unsafe home. I am probably not really going to have the privacy to be able to call victim services for support that I would in the event COVID wasn’t happening and I was outside of my house more regularly. Or again, perhaps in non-COVID circumstances, I would have the economic means to secure alternative housing for myself and distance myself from whoever was harming me. Those were some again, important barriers that made it challenging for victim survivors to distance themselves from harm within COVID.

Hannah Rochford:

Again, those big kind of systemic stressors maybe didn’t create violence necessarily. But again, certainly foreseeably increased the presence of physical violence in already abusive relationships and/or increase the severity of the violence that was occurring.

Lexi Fahrion:

That seems to make a lot of sense with a lot of the data and just facts that we’ve heard throughout the pandemic. That kind of brings me back to something that you brought up a little bit earlier in your definition of IPV, which is that intimate partner violence is not just limited to romantic relationships, and during COVID, we saw this issue of potentially a lot more people being brought into households that weren’t normally there, whether it’s extended family or friends for their own safety or for the economic wellbeing of the unit. I’m kind of curious to know if that exacerbated this issue of IPV as well.

Hannah Rochford:

That’s a really good question. I guess when we think of household, maybe a better word to use is your exposure bubble, and really, peak COVID times, and still even now, we’re all being conscious of who we are in person with for extended periods of time. Even if it was not someone that I was cohabitation with necessarily, my significant other was probably someone that I included kind of in that exposure bubble. Even if we don’t have this kind of more classic domestic violence circumstance with a shared residence, the fact that I am more isolated than I was previously becomes really important.

Hannah Rochford:

It becomes easier for a perpetrator to kind of exert abuse, physical or otherwise, if they have the security of knowing their victim isn’t necessarily being inadvertently watched or inadvertently observed by their usual social network. A coworker isn’t really going to be in this same position to observe strange behavior or minor injuries, or their family and friends, again, aren’t going to be with them or with them in person nearly as much as before COVID was with us.

Lexi Fahrion:

I think that brings up a great point that we all kind of, maybe recognized during this pandemic, whether it affected us directly or affected others, is that we were all really cut off from our normal routines, and through that, cut off from a lot of resources that are just present in our normal routines. In the situation of IPV, where we now know that it’s not just limited to domestic partners, I’m thinking of people who are cut off from those in their lives who may have been mandatory reporters, like school teachers, or maybe people in HR departments, who are kind of trained or have gone through some sort of training to recognize these signs and symptoms in others.

Lexi Fahrion:

I think that, that’s definitely something we need to recognize as a consequence of this pandemic, is that lack of access to normal resources. With that, we’ve talked about how much strain was put on our system during COVID-19, economically, socially, we all went through these major changes. A lot of those factors that have added pressure or changed are ones that affect IPV. I’m curious to see if you know if there was a jump in either prevalence or incidents of intimate partner violence over the pandemic.

Hannah Rochford:

Sure. No, that’s a very good question. Given data challenges, we only have kind of an empirical glimpse into the full impact of COVID-19 on violence within families and partnerships. But again, the empirical glimpse that we do have kind of aligns with our theoretical suspicions, right? That since the onset of COVID-19, there has been more calls for service or 911 calls related to intimate partner violence concern. There’s been more emergency department utilization for intimate partner violence related concerns.

Hannah Rochford:

Again, these other kinds of proxy outcomes that we can make use of, and this pattern of increase was particularly visible within our initial lockdown period that spring and summer of 2020. So, it’s difficult to make really sweeping causal statements about which of the theorized COVID related factors are driving most of this increase, but we do have empirical reason to suspect that COVID has increased the prevalence and increase the severity of IPV outcomes.

Lexi Fahrion:

That makes a lot of sense. That’s interesting that you often have to rely on these kind of secondary or proxy sources for this data, which leads me directly into my next set of questions, which are all around this lack of data and information that we have. It’s so interesting to me that we live in such an information-driven world where you can find out virtually anything within seconds if you have access to the internet. It’s kind of mind blowing that we just don’t have access to this incredibly important data. Can you talk a little bit about why that is and why we’re lacking this information?

Hannah Rochford:

Totally. This is a major challenge, kind of a cross violence outcomes. Not just intimate partner violence, but child maltreatment, teen dating violence, sexual violence, and so forth. The nature of these public health challenges really make valid, reliable data a challenge to come by, especially attaining that in a timely manner. There are kind of four major camps of large secondary data for intimate partner violence outcomes.

Hannah Rochford:

There’s data from our justice sector, data from our health sector, and data from large surveys, and data from fatal violence surveillance systems. Each of these kind of carry their own benefits and challenges. The justice sector data, to start there maybe, is also referred to as official crime data. Essentially this represents the crimes that are officially reported to police. In the event a crime is not reported to the police or if a crime is reported, but that jurisdiction opts not to report to the larger crime databases, kind of at a national level, then that incident is kind of lost from our data.

Hannah Rochford:

Also, the nature of this data underrepresents the experiences of many communities of color, undocumented populations and other groups that may have reason to be hesitant to seek out criminal justice involvement after experiencing violence. So, this creates a major health equity concern as if the data I’m using systematically excludes the experiences of some groups, the solutions or the policy changes that I’m deriving from that data may or may not equitably support the needs of everyone in a population.

Hannah Rochford:

Similarly, health sector data only represents those with sought healthcare after a violent event. So, if for any reason, an individual doesn’t feel they can, or otherwise isn’t able to seek this care, or if care is sought but a provider doesn’t recognize that as an act of violence, or doesn’t code the injury in a way that indicates it was a result of violence, that’s also not captured in the data that we have. Further, the health sector data often tells us a lot about the nature of the injury. That’s the purpose of the providers, the individuals who are generating the data, but lacks important circumstantial variables that are often present in official crime data and can be really important for, again, unpacking the patterns of a violent behavior empirically.

Hannah Rochford:

Then the nature of IPV makes survey data, kind of that third camp of data, challenging from ethical and safety perspectives. Even the longest standing and the most rigorously conducted crime victimization survey, the National Crime Victimization Survey, or the NCVS, has major challenges with under-reporting of IPV given these surveys are conducted in-person in someone’s home. In the event I’m being harmed and my perpetrator’s in the next room, I probably won’t be super forthcoming with those experiences.

Hannah Rochford:

Even if I’m safe, having to discuss traumatic things without any sort of beneficial purpose attached to it, like receiving healthcare or supporting a victim services provider in helping me, or supporting an investigation, that’s not ideal either in terms of supporting that victim’s well-being. The best quality data that we have, arguably are the fatal violence surveillance system data. The CDC has the NVDRS or The National Violent Death Reporting System, and this compiles violent deaths across all states and circumstances, and includes really rich circumstantial variables.

Hannah Rochford:

However, because it only includes instances of fatal violence, worked on using this data, will never benefit the people whose death’s populate it. Our window to prevent the terrible thing that happened to them has passed. We can only learn from these missed opportunities in hopes of protecting others. It doesn’t feel really warm and fuzzy. I guess another kind of sweeping challenge that I should mention across all of these categories of data sources is that the time that it takes to compile and organize these datasets to be able to administer them to researchers is considerable. It’s a lot of work.

Hannah Rochford:

So, when a major event like COVID happens and we’re needing to take steps, kind of in an expedient way to protect our population, we have very limited evidence base with which to do so. We have kind of these small scale hospital specific or jurisdiction specific, or victim service organization specific, slices of data, where we don’t really have access in real time or at least in the short term to these larger quantitative data sources.

Hannah Rochford:

Again, it’s important, as qualitative work is in this space, that too can take a lot of time to generate. The COVID IPV specific work that’s been done thus far has made very creative use of very finite amounts of data, but it’s difficult to generalize these smaller scale works to guide major sweeping policy decisions.

Lexi Fahrion:

Thank you, Hannah, for that overview of data sources. I previously wasn’t aware of where this data was coming from, and I would venture to say that other folks aren’t as well. This does lead me into my next set of questions that I kind of want to probe into what you just said a little bit more. But before we do that, I want to clarify a couple of things for listeners. Hannah mentioned these things called quantitative and qualitative data. So, just to give some definitions, quantitative data is your numbers based statistical data.

Lexi Fahrion:

How many people experienced X versus Y, it’s all basically numbers. And it’s very, in terms of data aggregation, it’s pretty quick to get. On the other hand, qualitative data, it’s more about lived experiences and it’s typically gathered through interviews or surveys with more kind of open-ended questions and provides a really rich, really valuable source of data, but it does take a lot longer to gather compared to quantitative data.

Lexi Fahrion:

Now that we’ve kind of clarified that, I want to jump into a couple of questions I had about what you just talked about. You mentioned two different types of sources. You mentioned justice sources, so like law enforcement, police settings, and then healthcare sources. I’m curious to know if workers within these two sectors, both healthcare and the justice sector, are trained to recognize and then handle this type of violence specifically.

Hannah Rochford:

I hope so. I think there’s considerable variation in terms of the, not only what types of training, but the caliber of training that professionals across sectors are exposed to. I also think there’s something to be said for the importance of in-field experience, having a training or attending a webinar, or reading a book, kind of with these guidelines is one thing, but having again, an extended period of experience where you’re learning to recognize some of, especially the more subtle indicators of harm goes a long way.

Hannah Rochford:

I think it would be lovely in the event, kind of a rigorous comprehensive training was part of the curriculum for again, our justice sector professionals, for our health care professionals. Again, you mentioned the importance of mandatory reporters, which gave me a thought that I want to come back to a little bit later, so it would be again beautiful if that would be something that again, was universally delivered.

Hannah Rochford:

But we’ve run into this challenge of this public health challenge is important, but so are all of our public health challenges, and individuals have a very finite amount of time and energy to be able to consume and then implement, act on all of these different trainings. I think, while that would be phenomenal and valuable, probably is a challenging aspiration to implement.

Lexi Fahrion:

Yeah, absolutely. I’m thinking specifically of healthcare workers who were so burdened by the pandemic, who were just kind of focused on keeping people alive, keeping people off ventilators and just handling these things as they came. I could see how it would be easy for things like intimate partner violence training, and maybe just awareness of other health issues. It would be easy for that stuff to slip through the cracks, especially in the face of this outright emergency caused by COVID.

Lexi Fahrion:

That makes this, and so many other issues, so hard to address, because we recognize that there are major problems within our society and we have people out here kind of saying that they’re an issue, but where do we put the burden? And how do we address putting that issue onto people who are already so burdened by things like COVID-19, if you’re a healthcare worker? That leads me into my next question, which is about prevention, and how we can prevent this in the first.

Lexi Fahrion:

You mentioned that you got your three-year love of prevention, and that’s kind of how I got to where I am today. There’s that famous quote that, an ounce of prevention is worth a pound of cure. I really buy into that, and I’d vouch that a lot of others do too. Do you think that getting better data and upping our data collection measures, especially around intimate partner violence could help us better our prevention efforts toward this issue? And if you do, can you kind of talk about that a little bit?

Hannah Rochford:

Sure. No, I wonder a lot about this too. Our field, we’re very good at sniffing out problems and it takes a long time and a lot of smart diligent people to again, collaborate and figure out how we really uproot this kind of ugly problem. I think there’s a huge amount of untapped data, kind of across the sectors that victim survivors encounter as they’re navigating these experiences. The challenge is finding a way to aggregate this in an automated way that isn’t super burdenful for the professionals who are already working really hard and whose jobs are again, nuanced enough, not adding to their plate, but having the data be high quality and available in a timely way.

Hannah Rochford:

That’s the aim. Again, we mentioned our justice sector in our healthcare sectors already, but our victim services sector is also super important. I think there’s a huge amount of untapped data within that space. Understandably so, victim services sector needs to be extremely careful in terms of confidentiality from a safety perspective. So, finding a way to support, not only the aggregation and automation of that, but doing so in a way that absolutely does not put any victim survivor who’s receiving services at risk of being identified.

Hannah Rochford:

But in the event we could overcome those challenges and victim services calls, an intake into shelter setting those information could be, again, somehow automatically entered into a central system in semi-real time, a lot of really meaningful work could be done. However, the infrastructure that would be required to achieve something like that in a space that’s already pretty profoundly underfunded with extremely overworked professionals makes that feel unlikely, at least in the near future. There’s conversations around making jurisdiction crime reports mandatory rather than optional.

Hannah Rochford:

So, giving us more kind of a census of violent crime data and also standardizing what and how that’s reported. Again, shifting more towards an automated data entry system to make reports available for researchers more so in real time, or as close real-time as possible would be really helpful, but again, require major infrastructure investment, and still wouldn’t necessarily overcome the equity challenges that we’ve mentioned that are kind of attached, especially to data in this space.

Hannah Rochford:

Or again, kind of the analogous effort within the health sector is maybe mandating that positive intimate partner violence screenings that are performed within the health sector space, are somehow automatically submitted into some central data hub, again, could be quite helpful, but again, maybe wouldn’t overcome the lack of circumstantial data challenge and would also require major investment. All of that said, well, I think, taking steps towards these aspirational improvements is worthwhile.

Hannah Rochford:

I don’t think that we can let the perfect be the enemy of the good. As a research community and being scrappy and being creative with what we have, and then making careful methodologic decisions with the limitations of our data in mind are imperative while that data infrastructure is gradually improving. We can’t twiddle our thumbs in hopes that perfect data will drop in our lap someday. It’s important to again, do the best we can with what we have.

Lexi Fahrion:

The perfect being the enemy of the good is a quote that I say pretty much all the time to myself and in my public health classes, and then the work that I do. I think, especially being in academia, as you and I both are right now, it’s really easy to get caught up in striving for perfection. That’s not a bad thing. We always need to be striving for systemic change and being the best that we can be. But in the meantime, I think it’s important to remember that there is groundwork that we can be doing that happens on a much faster pace while we’re also striving for those systemic changes. We’ve talked a lot about data and I want to go back to that.

Lexi Fahrion:

We’ve talked a lot about how better data collection could really help us address this issue of IPV and the associated disparities. But I want to go back to the systems level thinking that you talked about with your nesting doll analogy earlier. I know the better data could solve a lot of issues, but if we were to look at systemic changes, what kind of systemic changes would need to happen to kind of reach this gold standard of intimate partner violence prevention?

Hannah Rochford:

No, I think that’s a great question, and two things come to mind. When we reflect back on our prevention history within the intimate partner violence space, there’s kind of two kind of antiquated pillars in my view. A lot of our prevention strategies have been very concentrated, kind of at that individual level and there has been far fewer efforts that are tapping into our more systemic prevention opportunities at particularly the community and the societal levels.

Hannah Rochford:

Then the second kind of antiquated prevention strategy element, I guess, there’s been centering on helping victims protect themselves rather than preventing the creation of perpetrators or perpetrating behavior. When we think of things like self-defense classes or knowing, in the event I’m in the middle of a violent event, to avoid the bathroom or other areas with lots of hard surfaces, or having a taser or Mace with me a lot of the time, those are problematic for a number of reasons. It isn’t to say that there aren’t circumstances where those things are good or important, but there’s a number of problems with placing the burden of prevention on victims, right?

Hannah Rochford:

This can inadvertently suggest that if you have experienced these harms, you must not have taken the appropriate steps to protect yourself, and that’s very problematic. Second, let’s say I am an individual, and I recognize some unhealthy behaviors, kind of some red flags early in a relationship and I distance myself from that, or I am even further kind of encountering a violent event and find a way to distance myself and get to short-term safety. That’s good. That’s something that we want to have happen, but I don’t think all of our prevention eggs can be in that basket, because even if we mitigate kind of these isolated, harmful events, once a victim has kind of distanced themselves from that perpetrator, the perpetrators tendencies will probably just displace to somebody else, who may or may not be in a position to protect themselves.

Hannah Rochford:

I think ideally, our primary prevention needs to center on mitigating the development of perpetrators in perpetrating behavior and not on positioning and expecting victims to have these array of tools to protect themselves should they experience violence. As we noted previously, I think achieving that goal entails really systemic changes across our socioecological levels. I also think I want to emphasize, as we think about prevention on a continuum, primary prevention, yes, should center on the prevention of the development of perpetrators, but secondary and tertiary prevention that are very centered on supporting victim survivors with the resources that they need for long-term safety and healing are still very important.

Hannah Rochford:

I certainly don’t want to minimize the importance of those. I guess the other piece that comes to mind, as we think about this prevention ideal, is that our recourse pathways that are kind of normative for perpetrators to go through after it’s been identified, that they have been harming their partner are kind of notoriously ineffective at preventing future acts of harm. You did this thing that we wish you hadn’t have done, and you had a consequence, but we haven’t taken our opportunity to, again, work with you and position you to not display this type of behavior in the future.

Hannah Rochford:

Taking that tertiary prevention piece and flipping it into a primary prevention opportunity, I think is really important. Re-examining how we approach perpetrators who have already displayed this behavior as an untapped prevention opportunity is worthwhile.

Lexi Fahrion:

Definitely. I think we see examples of this opportunity, to hit that tertiary prevention measure, all the time. One example that comes to my head is sexual assault on college campuses. A lot of the rhetoric is typically towards the women who are victims. Not only women, but the victims themselves to not walk alone at night or to carry some sort of protective device, when we could be tapping into the perpetrators themselves and preventing the violence from the start. With that, I’m kind of curious to know, do you know of any of examples of prevention at that level that are going on right now, or that have been successful at the small scale level that you can talk about?

Hannah Rochford:

Sure. There are some evidence-based prevention tools that are, again … There’s some excitement in the field around, however, as I mentioned, these are very concentrated on the individual or relational level. There’s a program called coaching boys into men where it encourages male role models to work with young male athletes who may be susceptible to absorbing toxic masculine concepts to reframing how young men think of masculinity and how young men think of violence as a coping mechanism. There’s been some success there.

Hannah Rochford:

Again, just to name an example, and there’s again, other similar programmatic efforts. Again, while these are good and while these are important, I think there’s really untapped space in terms of our system level changes. When we talked earlier about the importance of formative years and the social schemas that I form and the self control level that I form and the strains that I’m exposed to, I think we have major policy opportunities to support stability and security and healthy parenting practices. So, we are, again, thinking really far upstream in terms of prevention and that is not only protective for potential victims, but also protective and helpful for the health outcomes and the quality of life of individuals at risk for developing perpetrating behavior. All of that is important.

Lexi Fahrion:

Thank you. It sounds like there are some great examples of work being done to prevent this issue and it sounds like there are a lot of opportunities for work at that individual, and furthermore, at the systemic level that could be done to improve our prevention efforts. I kind of want to end it on that note of all these great opportunities for change. I want to go into our last question that we ask all of our guests, which is, what is something that you thought you knew, maybe going into your field or your research, that you later realized that you were wrong about?

Hannah Rochford:

Sure. Gosh, so many things. Like I said, a handful of things come to mind. One big one and a few small ones, so I’ll talk fast, and cut me off when we’re out of time. But I guess, even if we don’t have time to talk about the others, I think it took me a while to fully understand how vital it is to defer to a victim survivor as the expert on their own circumstances. That sounds really intuitive and like, it would be an easy thing to do, but it can be so tempting if we are supporting someone navigating a dangerous or an abusive relationship, to want to jump in and just yank them out. Intervene to distance the person that we care about from this terrible thing. But unfortunately, it doesn’t, and it can’t work that way.

Hannah Rochford:

If someone hasn’t reached a point where they’re ready to leave, or if someone maybe is ready to leave, but isn’t able to for major safety or logistic barriers to doing so, thinking that we know better and trying to force their hand to get out, because we’re ready for this nightmare to be over for them, can invite kind of a slew of negative consequences. If we think back to our earlier discussion, remember IPV is about control, right? A perpetrator takes away a victim’s control over their own existence.

Hannah Rochford:

Even if we have the best of intentions, trying to take over on behalf of a victim that we love essentially does the same thing. It takes away their control. So, our ultimate goal has to be to empower the person that we care about, reinforce that they’re deserving and respect, and take cues from them as to what they need to reach safety and to reach healing. I guess on a related note, I didn’t always appreciate how unhelpful it is to villainize a perpetrator to a victim, where if we vocalize that we think an abusive partner is, maybe not our favorite person, even if we’re right and they’re totally the worst, if our victim isn’t in a position to act on that and to leave, we’ve just isolated them further.

Hannah Rochford:

Given we’ve expressed this negative view, the victim that we care about will probably not be very forthcoming with us about the negative things that they’re experiencing and will probably be hesitant to reach out to us even if they really needed help or are in some sort of imminent danger. This creates a huge barrier to support, and it can make it even more difficult for a victim to reach safety when this is already so challenging to do.

Hannah Rochford:

As difficult it is to watch someone go through the ups and downs of an IPV circumstance, the most important things that we can do is to not let them be isolated further, to make sure that we’ve established ourselves as a safe place for them to come to talk. And second, by not letting our emotions take precedent over theirs. This is their journey and this is their healing and their healing is contingent on again, getting control over their own circumstances again, not just shifting from a harmful controlling party to a party that’s trying to help.

Hannah Rochford:

I guess the second one that comes to mind is quick, so I’ll sneak it in. I underestimated the extent to which perpetrators can be deceptive, but I don’t anymore. We have to remember that a perpetrator convinced their victim that they were wonderful enough for the victim to want their companionship and to develop an emotional bond with them and feel compelled to stay, even after bad things began to happen. Effective perpetrators can have a way of making themselves feel very decent and very likable, and that would be unthinkable that they’d be capable of such a thing, which isn’t to say that we need to be paranoid about everyone we encounter, but it is to say that when a victim tells us something, we need to listen.

Lexi Fahrion:

Absolutely. I think that those are such difficult skills I would imagine to learn and they come through a lot of experience, it seems like. But I hope that for myself and all of our other listeners, those are things that we can take away and recognize within our own lives. I want to thank you again, Hannah. That’s all the time we have for today, but this was a really important conversation about an issue that can often go untalked about. I want to wrap up by saying that if you, or someone you know, is experiencing intimate partner violence or abuse, you can contact the National Domestic Violence Hotline for immediate support at 80799-SAFE.

Lexi Fahrion:

Or if you’re here at the University of Iowa, you can reach out to the Women’s Resource and Action Center at wrac.uiowa.edu. If you’re here in Iowa City, you could reach out to the Domestic Violence Intervention Program at 800-373-1043. Thanks so much for listening.

Alexis Clark:

This episode was hosted and written by Lexi Fahrion, edited and produced by Alexis Clark. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues. Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Stay happy, stay healthy, and keep learning.