February 2005

Grant Results

SUMMARY

From July 2002 through December 2003, investigators from the Philadelphia Women's Death Review Team — a collaboration of agencies in that city led by the Philadelphia Health Management Corporation — conducted a review of all deaths in the year 2000 of women ages 15 to 60 who lived there at the time of their death.

The purpose of the review was to identify those women who died through intimate-partner violence and to facilitate citywide cooperation around the issue of violence in women's lives.

Key Findings
Project staff reported the following findings, based on data from 2000, in a report entitled Analysis of Deaths to Philadelphia Women Ages 15 through 60, 2000:

  • The proportion of homicides of women that were the direct result of intimate-partner violence was higher in Philadelphia than in the rest of the nation but had declined over a four-year-period.
  • African-American women died at a higher rate than white women in Philadelphia.
  • Fifty percent of the violence-associated deaths of Philadelphia women in 2000 were related to drugs and/or alcohol.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this project with a $50,000 grant for data collection and meetings.

 See Grant Detail & Contact Information
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THE PROBLEM

Violence against women is a public health problem that has devastating consequences for women, their children and their families. The FBI's Uniform Crime Report indicates that abusive partners or ex-partners murder approximately 2,000 to 4,000 women in the United States each year, and that husbands or boyfriends kill more than twice as many women as are murdered by strangers.

According to the project director, while evidence suggested that the deaths of many Philadelphia women were related to domestic violence, before the establishment of the Philadelphia Women's Death Review Team in 1998, no mechanism existed for accurate documentation leading to the implementation of effective prevention strategies and corrective action.

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BACKGROUND

The Philadelphia Women's Death Review Team, founded in January 1998, is a multi-agency, interdisciplinary effort in Philadelphia County to prevent the violence-related deaths of Philadelphia women between the ages of 15 and 60. The broad goals of the team are to:

  1. Increase knowledge and awareness in the community about violence against women.
  2. Use its findings to improve domestic violence policies and practice.
  3. Reduce the number of Philadelphia women who die from violence associated with their intimate partners, which the project director defines as a pattern of violent and abusive behaviors inflicted by spouses, ex-spouses, boyfriends and girlfriends, and ex-boyfriends and ex-girlfriends.

The team also includes other violence-associated causes of death in its assessment of violence against women. According to the federal Substance Abuse and Mental Health Services Administration, substance abuse, HIV/AIDS and suicide are associated with violent lives.

Therefore, the team examines not only homicides, but also all cases of premature death of women in Philadelphia County in which the cause or manner of death is known to have an association with violence.

The team, which is led by the Philadelphia Health Management Corporation, the Philadelphia District Attorney's Office, the Philadelphia Department of Public Health, and Women in Transition (a local nonprofit organization that seeks to empower women endangered by domestic violence and/or substance abuse), includes representatives from government agencies, law enforcement, courts, hospitals, domestic violence services, advocacy groups and other community agencies. (See the Appendix for a complete list of participating organizations.)

The four objectives of the team are to:

  1. Track the incidence and prevalence of violence-related deaths of women.
  2. Identify the degree to which intimate-partner violence contributes to the community's premature mortality rate.
  3. Identify patterns and trends in violence-related deaths of women.
  4. Formulate key policy and practice recommendations to improve the systems that serve and protect women and their children.

The team has four interdependent components:

  1. The core leadership committee, which meets monthly to provide guidance and oversight.
  2. The clinical screening committee, which examines death certificates for adequacy of information, and determines which cases should be forwarded to the review team for further review.
  3. The review team, which meets monthly to systematically review the deaths of Philadelphia women selected for review by the clinical screening committee.
  4. The policy committee, which meets quarterly to continue discussions about issues that arise during monthly case-review meetings, to review domestic violence policies and death prevention strategies, and, as appropriate, to create subcommittees that work to refine the team's recommendations.

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THE PROJECT

The core leadership committee met monthly to oversee the direction of the team. The clinical screening committee reviewed all deaths (1,474) of Philadelphia women between ages 15 and 60 that occurred in 2000. Deaths falling within one or more of the following categories received a full review from the review team:

  • Homicide.
  • Suicide.
  • Undetermined cause.
  • Drug- or alcohol-related natural death.
  • AIDS- or HIV-related disease.
  • Death due to adverse drug reactions.
  • Death of women within a year of giving birth.
  • Death in questionable circumstances.
  • Inadequate death certificates.

The review team reviewed each of the cases selected by the clinical screening committee to identify the role, if any, that intimate-partner violence played in the life and death of each woman. In those cases where there was a known history of violence, and in cases where an intimate partner murdered the decedent, the review team identified policies, laws, regulations, system changes and/or services that, if implemented, might have prevented the death of the women. The members of the review team were able to provide additional information for 198 (60 percent) of the 330 cases selected for full review.

The policy committee held five meetings on issues raised during the monthly case review. The topics of the meetings were:

  • Women's substance-abuse treatment.
  • Child witnesses of suicides.
  • Sex workers in Philadelphia.
  • Firearms and domestic violence.
  • Prioritization of issues facing women at risk of violence in Philadelphia.

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FINDINGS

Project staff reported the following findings, based on data from 2000, in a report entitled Analysis of Deaths to Philadelphia Women Ages 15 through 60, 2000:

  • The proportion of homicides of women that are a direct result of intimate- partner violence is higher in Philadelphia than in the rest of the nation, though this proportion has declined over a four-year period in Philadelphia County. Twelve women were known to have died directly as a result of intimate-partner violence in Philadelphia in 2000. Eight of those who died were African Americans. None of the women was known to have contacted any local domestic violence agencies for assistance for past battering episodes, though five of them had previously sought Protection from Abuse orders.
  • African-American women die at a higher rate than white women in Philadelphia County. Vital statistics indicate that 58 percent (850) of the deaths of Philadelphia women between the ages of 15 and 60 were of African-Americans, who comprise 44 percent of the Philadelphia population, whereas 40 percent (583) of the deaths were of whites, who comprise 50 percent of the Philadelphia population.
  • Fifty percent (163) of the violence-associated deaths of Philadelphia women in 2000 were related to drugs and/or alcohol. This includes 102 cases where a woman's death was a direct result of an adverse effect of drugs (overdose). Of those 102 deaths, 75 percent (76) of the women were known to have had contact with the substance-abuse treatment or criminal justice systems.
  • Forty-six women reviewed by the team died of AIDS in 2000.
  • Twenty women died either while pregnant, or within a year of giving birth.
  • At least 113 children under the age of 18 lost a mother to a violence-related death in 1999. At least 15 children directly witnessed the death of their mother or found her body in 2000.

Recommendations

One of the policy committee meetings — on women's substance-abuse treatment — resulted in the following recommendation. The committee submitted recommendations from the other meetings to the Philadelphia Health Commissioner for approval; as of January 2005, approval was still pending.

  • Increase funding for substance-abuse treatment facilities to provide follow-up on women clients after their discharge from residential treatment. Several cases that the team reviewed involved women who died of a drug overdose shortly after being discharged from substance-abuse treatment. The policy committee identified lack of sufficient funding as the reason for insufficient aftercare and follow-up.

Communications

Project staff wrote a report, Analysis of Deaths to Philadelphia Women Ages 15 through 60, 2000, and made six local and statewide presentations and seven national presentations. (See the Bibliography for details.)

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LESSONS LEARNED

  1. The data are only as strong as the people sitting around the table. Maintaining consistent agency involvement and ensuring complete information from all the partners is essential. (Project Director)

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AFTER THE GRANT

With annual funding from the City of Philadelphia Department of Public Health, the team is continuing its surveillance of violence-related deaths of Philadelphia women. On June 8, 2004, the team sponsored the first annual "Sex Workers Health and Safety Summit: A Day of Dialogue. " The summit, which was attended by 150 people, provided a citywide forum for sharing information about the issues and challenges faced by sex workers, including health care, the judicial process, and safety.

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GRANT DETAILS & CONTACT INFORMATION

Project

Reviewing Premature Deaths of Philadelphia Women to Help Develop Policies and System Responses to Prevent Violence

Grantee

Philadelphia Health Management Corporation (Philadelphia,  PA)

  • Amount: $ 50,000
    Dates: July 2002 to December 2003
    ID#:  045332

Contact

Caroline West
(215) 985-2500
caroline@phmc.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Member Agencies Reviewing 2000 Deaths

  • Adult Probation
  • Anti-Violence Partnership of Philadelphia
  • Children's Crisis Treatment Center
  • Congreso de Latinos Unidos
  • District Attorney's Office
  • Department of Public Health
    • Behavioral Health System
      • Community Behavioral Health
      • Coordinating Office for Drug and Alcohol Abuse Programs
    • Division of Early Childhood, Youth and Women's Health
    • Office of Medical Examiner
    • Division of Information and Reimbursement Systems
    • Office if the Commissioner
    • Office of Mental Health and Retardation
      • Children's Unit
  • Department of Human Services
    • Division of Children and Youth
  • Grief Assistance Program
  • Thomas Jefferson University Hospital
  • Lutheran Settlement House
  • Philadelphia Legal Assistance
  • Philadelphia Health Management Corporation Research and Evaluation Department
  • Philadelphia Police Department
    • Homicide Unit
    • Special Victims Unit
  • Hospital of the University of Pennsylvania
  • Women Against Abuse
  • Women in Transition
  • Women Organized Against Rape

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

West C, Gleason K, Keylor A, West MP, Hacker R, Yusem P, Angert M, Smith CA. Analysis of Deaths to Philadelphia Women Ages 15 through 60, 2000. Philadelphia: Philadelphia Women's Death Review Team, March 2004.

Presentations and Testimony

Caroline G. West, "Community Review of Homicides of Women: Findings from the Philadelphia Women's Death Review Team," at the Annual Meeting of the Homicide Research Working Group, June 6–8, 2003, Sacramento, Calif. Proceedings of the 2003 Annual Meeting available online.

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Report prepared by: Barbara Matacera Barr
Reviewed by: Robert Crum
Reviewed by: Molly McKaughan
Program Officer: Jeane Ann Grisso