Family Violence Prevention as Population Health: A Q&A With Melissa Graves

In March 2024, Melissa Graves became the president of The Center for Family Safety and Healing at Nationwide Children’s Hospital.

The Center for Family Safety and Healing (TCFSH) works to fully address all aspects of family violence, including child abuse and neglect, teen dating abuse, intimate partner violence (IPV) and elder abuse through a multidisciplinary, coordinated response – and it provides a forum for education, advocacy and ongoing research. The vision of The Center is to end family violence and create safe, thriving communities.

The Collaboratory recently talked to Graves about family violence prevention, population health and The Center for Family Safety and Healing.

Collaboratory: Family violence can seem personal or individual. How is it a community or “population health” issue?

Melissa Graves: That’s similar to asking how one person’s health is a “population health” issue. As we know, health starts at home. A child is more likely to be healthy if they live in a family that has financial security and a stable place to live, can support school participation, and has access to healthy food and health care.

A community is more likely to be healthy overall when those things are in place. When a family faces barriers to these basic needs, their health outcomes can be diminished, as is the health of the community, which in turn fuels more barriers for families. 

There is a strong correlation between safety, including the many types of interpersonal violence such as intimate partner violence, and child abuse and health outcomes. Financial security, housing and health care barriers, for example, have tremendous impact on children and adults experiencing violence in the home. 

So, this is also a health equity issue. Domestic violence and child abuse happen in every community regardless of race, education or socio-economic status. They are prevalent, pervasive and preventable. At the same time, communities that are marginalized due to discrimination and disinvestment experience higher risk and additional barriers when experiencing an abusive relationship. 

C: How do you prevent family violence, then, and make it less prevalent?

MG: Changing norms around gender roles and healthy relationships, putting policies and resources in place that support healthy thriving families for all people, and having a robust safety network to support children and adults experiencing abuse when it does happen.

Some people do not know what a healthy relationship looks like. They may be experiencing domestic violence, but that can be an abstract concept and something that doesn’t feel applicable to them. We often hear survivors say, “I just thought that was normal.” 

Education and awareness can help shift attitudes, behaviors and expectations, both for people who are experiencing abuse and for the people around them to understand how best to support others. 

The Center’s Green Flags campaign is another program that helps, by helping teenagers understand what respectful, healthy relationships can look like.

Another highly effective prevention intervention are our home visiting programs. The Center’s evidence-based programs, Healthy Families America (HFA) and Nurse-Family Partnership (NFP), improve pregnancy outcomes and reduce child abuse and the number of children in the child welfare system by encouraging prevention health practices that address child abuse and screen for intimate partner violence.

Another strategy that some may not think of as preventative is flexible financial assistance. Children can enter or remain in the child welfare system because parents may be food insecure or lack a safe place to sleep. Someone experiencing intimate partner violence may just need money for a security deposit or to pay back utilities to leave and not return to a dangerous relationship. Having this resource available can avert injury and trauma as well as higher-cost interventions such as child welfare, law enforcement and emergency departments.

The Center supports and helps disseminate strong parenting programs across the region. The Positive Parenting Program, or Triple P, and other evidenced-based parenting programs help caregivers to develop parenting skills that strengthen families and reduce risk.

C: What if family violence has already occurred? How can you make a population health impact then?

MG: Family violence isn’t just what happens to one person. The surrounding people, the surrounding community, and the surrounding systems are all deeply impacted.

Cases of abuse are rarely isolated incidents; they are often repeated. More than 80% of intimate partner violence survivors experience a chronic issue going forward. It may be physical or psychological or both – post-traumatic stress disorder, suicidality or substance abuse. In the case of child abuse, there are much higher rates of behavioral concerns, challenges in school or becoming involved in an abusive relationship. These are not just individual life outcomes. There is a ripple effect for family health and stability and significant costs to health care, school, criminal justice and the economy. 

C: What makes you hopeful in the face of this complex and challenging issue?

MG: The degree to which Nationwide Children’s Hospital has invested in addressing family violence by establishing The Center was visionary decades ago when it began and continues to set the pace among pediatric hospitals.

Every initiative at The Center is aimed at preventing abuse, offering safety, trauma-informed responses and healing when violence does occur, and breaking the cycle of family violence that is often intergenerational. As we move forward at The Center, we will continue working to reach more families with deeper impact.

Speaking of impact, another amazing opportunity in addressing family violence within the Nationwide Children’s ecosystem is the research opportunities it brings. While individual-level interventions are somewhat easy to assess, evaluation of comprehensive, multi-level, combinations of programs and system-wide reforms is much more challenging.