Two glass doors and an elevator. Those are the only barriers Mary Claire Landry wants families to see between the chronic violence at home and resources Landry and dozens of others make available to them inside the New Orleans Family Justice Center (FJC).

  A few blocks from the Superdome and a few floors above the Amtrak and Greyhound station, security buzzes people in from the building's lobby through a second set of doors and up an elevator. The FJC office overlooks the U.S. Postal Service Tower's side drive on Loyola Avenue, where the sound of trucks being loaded rumbles over the faint ringtones from FJC desk phones. FJC staff members answer with a hushed, calm series of questions: Where are you? When did that happen? Did you call the police?

  Landry, FJC's executive director, points out the offices that circle the lobby: legal services, a large conference room, children's services, mental health counselors, domestic violence detectives from the New Orleans Police Department (NOPD) and her office.

  "It just takes a tremendous amount of effort to let people know what we have here," Landry says.

  FJC hosts 15 agencies, ranging from counseling to a 24-hour crisis line, which receives 11,000 calls each year. The center directly serves more than 1,200 people each year. In 2013, Landry says, it is on track to serve 1,500. "The number of incidents stays pretty much the same," she says. "What changes is our ability to connect survivors to services."

  Last year, the New Orleans Health Department launched its Domestic Violence Program as a public health initiative working in concert with the criminal justice system. The program, led by Director Kati Bambrick Rodriguez and Health Commissioner Karen DeSalvo, includes several yearslong grants totaling hundreds of thousands of dollars, with help from the U.S. Department of Justice (DOJ) and partnerships with local agencies, to help connect survivors to the resources they need, whether it's counseling, assistance in filing a protective order or shelter. It's a new step in addressing the city's overwhelming need in a state plagued by domestic violence and strapped for resources.

  Lt. Gov. Jay Dardenne appears in a new 30-second public service announcement from the Louisiana Coalition Against Domestic Violence, asking families to speak out. Dardenne chaired the Coordinating Council on Domestic Violence while serving in the state Senate and sponsored several bills to protect domestic violence survivors.

  "The problem has not abated. It seems to have gotten worse," Dardenne tells Gambit. "More often than not, women are in a relationship who can't break away. ... They don't have to live in this environment. They control their own destiny."

In its latest review of domestic homicides in the U.S., the Violence Policy Center's (VPC) 2011 report showed Louisiana with the ninth highest rate of domestic homicides — dropping from its No. 4 spot in a 2010 report. The report, which used FBI murder statistics, tracked women killed by men in incidents with one victim and one offender.

  At a meeting of the New Orleans City Council's health, education and social services committee last month, Rodriguez opened her presentation with a stark image: "Louisiana is one of the most dangerous, violent places to be a wife, a mother, a girlfriend."

  "Domestic violence isn't just men abusing women, it can be women abusing men, but also in LGBT relationships," DeSalvo tells Gambit. "Intimate partner violence, dating violence — it takes on a lot of faces."

  Louisiana Coalition Against Domestic Violence Director Beth Meeks says the VPC's ranking is optimistic. She says the formula left out dozens more deaths related to domestic violence, including incidents with multiple victims. In its response to the VPC report, the coalition wrote that Louisiana actually saw a 16 percent increase in domestic violence homicides from 2010 to 2011.

  According to its data tracking statewide crime and media reports, the coalition found 71 domestic violence-related deaths in 2011 — an additional 21 incidents that resulted in 32 deaths missed by the VPC report. Those deaths include nine incidents with multiple victims resulting in 20 deaths from a single offender.

  "Louisiana is one of the few heavily populated states that consistently rank in the top five for murders of women," Meeks says. "In Montana, one homicide can make their numbers spike."

  The 2011 VPC ranking lists Alaska at No. 2, though it found only seven deaths, meaning its rate of women killed by men is 2.01 for every 100,000 people. The report found Louisiana, at No. 9, had 39 deaths, with a rate of 1.39 per 100,000 people. In New Orleans, that rate is 2.77 per 100,000 — more than two times the national average.

  Meeks says the numbers are disproportionately high in Louisiana because of the state's lack of resources for women and Louisiana's gun laws. More than half of the country's domestic homicides were committed with a firearm, usually a handgun, according to the VPC report. In Louisiana, that homicide figure is 66 percent — nearly all of which were committed with handguns.

  The report also notes that black women are killed by men at a rate more than two-and-a-half times higher than white women, and 94 percent of those black women knew their killers. The coalition says 81 percent of murdered women in Louisiana were killed by a husband, partner or ex-partner.

  Those reports reflect a bleak era for the NOPD as it faced intense scrutiny from the U.S. Department of Justice. In 2010, the DOJ's results of a yearlong probe found NOPD failed to adequately address domestic violence cases, with complaints ranging from poor response to 911 calls to failure to perform follow-up interviews. In at least one case, the NOPD never responded at all. Between January and July 2010, the NOPD took 6,200 calls for service regarding domestic violence: 1,200 were assigned to domestic violence unit detectives, and officers in corresponding districts handled 2,700 cases, while another 1,500 reports — nearly one in four calls — went "missing."

  The report notes that neither the NOPD's operations manual nor the domestic violence unit's manual contained any guidelines for 911 protocol, identifying and documenting injuries (including failing to note symptoms of strangulation or ask follow-up questions related to strangulation), and procedures for follow-up investigations. The report notes one case where a neighbor heard screams and called 911, yet the neighbor was never interviewed. "The absence of specific guidance for officers and detectives not only impedes effective response and investigations," the report notes, "but also creates potentially dangerous conditions for victims."

  The report also quotes a victim of domestic violence who asked that the 911 dispatcher tell officers not to tell the batterer that the victim was calling — or was inside the house — an instruction the officers ignored. "They did it the way they wanted to do it," the victim said.

  The three domestic violence unit detectives were "not permitted to do field work" due to the high volume of calls, while training for first-responding officers was "grossly inadequate," the report says.

  Despite more than 300 officers receiving training in domestic violence procedure between April 2010 and December 2010, "the department has yet to fully leverage the considerable tools and resources to enhance its response to domestic violence," the report says. None of the reports the DOJ reviewed included victim referrals to FJC.

  Orlando Williams, one of NOPD's three Domestic Violence Unit detectives, says the unit has seen sweeping changes in the department's handling of domestic violence cases. The unit is notified on all felony cases in domestic violence calls — that includes aggravated battery, home invasion, aggravated assault and kidnapping. Though the unit doesn't handle homicides and other major crimes, it does track incidents related to domestic violence. Each detective in the unit typically handles 15 to 20 cases a month, as well as assisting on protective orders and issuing warrants. Its arrests made and warrants issued so far this year total 2,012.

  The unit, housed in the FJC since 2007, regularly teaches officers in the department about its domestic violence policies and procedures, and NOPD's academy class spent a day alongside detectives at FJC in September. The unit also received instruction recently from Tulane University regarding the latest procedures for identifying strangulation that's not easily visible. Williams says the domestic violence unit has become more approachable, thanks in part to FJC, as more people come directly to detectives rather than call 911 and wait.

  "We'll just go ahead and handle it," he says. "We'll literally stop what we're doing and take the case from there."

Nashville's domestic violence division in its Metropolitan Police Department, which was named among the country's best in 2000 by the National Institute of Justice, made 1,278 felony arrests and 3,797 misdemeanor arrests in domestic violence incidents in 2012.

  Early figures for 2013 are on par with 2012 arrests.

  Those figures closely mirror New Orleans' numbers. NOPD typically receives 10,000 to 11,000 calls per year to respond to domestic disturbances, with 4,000 arrests made annually. Landry says many calls come from the same households. In Nashville, calls to 911 for domestic disturbances, however, hit more than 17,000 last year, and 15,313 in 2013.

  Landry says there are thousands of victims who never call the police — victims fear arrest, intimidation and the stigma of disrupting a family or drawing police attention to the neighborhood.

  Deon Haywood, director of the New Orleans women's health organization Women with a Vision, says her group's challenge is removing the shame and stigma associated with domestic violence.

  "You may be living in a situation where you don't have a job, or family members think if you leave you're taking food out of your children's mouths, or what are you going to do to take care of yourself or your kids if you've been a stay-at-home mom," Haywood says. "A lot of women fear that, so they may stay in that situation believing it's the best choice for the kids, and they'll deal with it."

  In May 2012, arsonists targeted Women with a Vision's Mid-City office, where stacks of reproductive health brochures and HIV-prevention displays were specifically torched. It briefly moved its office inside First Grace United Methodist Church, and it now operates inside the ArtEgg Studios in Mid-City. The group recently bought a building at 1820 N. Claiborne Ave., and Haywood says she hopes to open its door in spring 2014. Last month, the DOJ's Office of Violence Against Women awarded Women with a Vision a grant to address domestic violence outreach for black women and LGBT individuals.

  Haywood also wants to address implicit bias in law enforcement — what she says is stereotyping that discriminatively targets minorities. "The stereotype of black women is the angry black woman," Haywood says. "If you're not cowering in the corner and you're not frail or weak, then you can't be a victim, because you're angry.

  "If you live in a society where all you ever heard about this particular population is something negative ... you're going to see that when you approach them, unless we get past that," she says. "If nobody looks like you, you feel like no one can relate to your experience. ... You still feel isolated, as isolated as you were when you were in that situation."

  The city's domestic violence program also wants to address gender bias and improve access to services for the LGBT community. Among the 3,420 protective orders issued to victims in Orleans Parish in 2012, Rodriguez says none were for LGBT.

  Tania Tetlow, director of Tulane University's domestic violence clinic, says unlike civil injunctions, it is a crime to violate a protective order. She adds that many people in Orleans Parish seeking protective orders typically do so without an attorney, which can make filing difficult. Legal services available through the clinic and Southeast Legal Services within the FJC offer to help file protective orders for victims.

  "You don't have to wait for an abuser to come and beat you up again. If he's outside your door, you can call the police and they have the power to arrest him just for being there," she says. "It also should signal to police that this a dangerous situation and they should take it seriously."

While New Orleans offers several women's resource centers and shelters, Louisiana doesn't have any between Lafayette and Monroe. Parishes are required to partner with domestic violence services, though many providers service several parishes at a time.

  "The majority of places are just barely keeping their heads above water and not working on the same systemic changes as New Orleans," Meeks says.

  FJC serves 200 families through its shelter program. If a family can't enter a shelter and needs to escape, FJC can set them up in one of three hotels in the city, or provide bus fare to get to a family member out of town. But shelters are a last resort; it means uprooting the family and moving children.

  "Sometimes we're booked to the ceiling," Landry says. "If someone calls us, we have to find a place. If they're in danger, we have to do that."

  And in New Orleans, Landry says, there's a demand for affordable housing — forcing a terrible choice: Do families need safety or a dependable roof over their heads?

  In an attempt to grapple with the financial gap, the Health Department partnered with the city's Women, Infants and Children program (WIC) to meet families impacted by domestic violence. Sixty-five percent of children in New Orleans under age 5 qualify for WIC services. More than 64,000 families visited WIC sites in 2012, and the city estimates 66,000 people will visit WIC this year. WIC now screens for domestic violence as part of its standard intake. It also screens discretely, with pamphlets available in the sites' bathrooms. More than 1,200 women were screened between March 1 and Sept. 23, though only a handful of participants were deemed "at-risk." None of the participants followed up on their referrals.

  DeSalvo says it's a common challenge in screening programs. "Women are afraid and they don't want to admit it," she says. "They worry about their services being taken away, or their children." Next year, the health department will partner with WIC, the Centers for Disease Control and Prevention and Tulane School of Public Health to add parenting education at WIC sites, including information about domestic violence and how to help parents deal with conflict and behavioral changes.

Those behavioral changes, particularly in children enduring domestic abuse at home, in poverty, in neighborhoods surrounded by violence, have deep impacts on their long-term mental and physical health. As the city struggles with violent crime rates and a cyclical effect of crime and incarceration, doctors and the health department are concerned about a link between children experiencing violence in their homes and at-risk behavior later in life.

  Dr. Elizabeth "Birdie" Shirtcliff is a University of New Orleans professor and behavioral endocrinologist who studies how early experiences can affect a person's physiology, and what those physiological changes have to do with behavior.

  "Early life stress, whether child abuse or poverty or poor relationships, family-level violence, domestic violence, all of those things really exert a powerful effect on the physiology of the kid, even when it's things not directly happening to the kid," she says.

  Stress response to family violence also can affect lungs and promote asthma, DeSalvo says. "That constant pressure on your body physiologically changes your lungs and brain and ability to respond to any new change or stress," she says.

  Shirtcliff says children who are chronically exposed to stress can develop "callous emotional traits," disengaging a fight-or-flight response and making it difficult to perceive both negative and positive emotions. In children experiencing intermittent abuse — occasional fights at home or drunken beatings — their stress hormones may be chronically elevated. All these experiences impact the body's allostatic load, the physical consequences of stress and trauma, which can lead to disease, aging and early death.

  Shirtcliff measures saliva in her Stress Physiology in Teens (SPIT) program, which finds that stress impacts production of saliva to ward off viruses, leaving bodies working harder to keep minor things at bay. Shirtcliff says the body's constant exposure to stress can even affect gene expression, unraveling DNA and shortening telomeres, which cap the chromosomes attached to DNA. Shirtcliff says telomeres shorten under stress, leading to early aging and cancer.

  That wear and tear is reversible, Shirtcliff says. Children and families need warm, sensitive caregiving and a positive, nurturing environment. "All you have to do is improve it and it gets better," she says. "It's not a lost cause at all. It's going to be work, though. One of the reasons we haven't seen improvement is because we haven't tried."

In the health department's $29.8 million budget for 2014, more than $13 million comes from the city's general fund, and $14 million comes from federal funding, with $1.8 million tied to foundation grants. Children and family services account for 11.8 percent of the budget. The Blueprint for Safety is the department's criminal justice-wide response to domestic violence using a model based on policies used in St. Paul, Minn. It's funded by a two-year, $200,000 grant from the Office of Violence Against Women.

  "In a domestic violence situation, the survivor should feel that they're not alone and it's not their fault and there's help available," DeSalvo says. "We want people to access services so we can help get them back on their feet. That's easier said than done.

  "Culturally we have a ways to go in this community to make sure we're not victimizing the survivor ... that we're working to empower him or her. ... The more people know the phone numbers and things like FJC exist, the better off women are going to be."

Resources for families dealing with domestic violence

Crescent House (504) 866-9554

Louisiana Domestic Violence Hotline (888) 411-1333

Metropolitan Center for Women & Children (504) 837-5400

Metropolitan Crisis Response Team (504) 826-2675

NEW ORLEANS Family Justice Center (504) 592-4005