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How are Health Care Providers and DV Advocates

Working Together? A #HCADVDay #DVAM Webinar

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Continuing Education Credits for ProvidersFutures Without Violence’s National Health Resource Center is accredited through the

Accreditation Council for Continuing Medical Education to provide Category 1 Continuing Medical Education credits (CMEs) to MDs, DOs and residents for participating in select

activities designated for CMEs. Futures Without Violence takes responsibility for the content, quality and scientific integrity of activities.

FUTURES is not accredited to directly provide Continuing Education Units to non-physician participants. However, nurses, social workers and other licensed professionals may obtain

general certificates of attendance (designated for select activities) and present these certificates to their respective accreditation boards to claim credit.

Attendees are responsible for verifying the acceptance of education credits with their respective accreditation boards.

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Who is on the webinar today?

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Webinar Speakers

Kenya Fairley, MSEd | Family Violence

Prevention and Services Act (FVPSA)

Program, US Department of Health and

Human Services

Graciela Olguin + Kate Vander Tuig |

Futures Without Violence

Judy Chang, MD, MPH | University of

Pittsburgh Magee Women’s Research

Institute

Janice Goldsborough, MS | Women’s

Center and Shelter of Greater Pittsburgh

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Today’s Objectives:

At a result of today’s training, you will be able to:

1. Define “CUES” an evidence-based intervention for addressing

domestic and sexual violence in diverse health settings.

2. Know how any health settings and DV/SA advocacy organizations

can initiate or build upon their collaborative partnerships.

3. Utilize IPVhealth.org and IPVHealthPartners.org, two online

toolkits for everything health systems and DV/SA advocates need

to promote survivor safety and health.

4. Download or order multi-lingual tools offered by FUTURES’

National Health Resource Center on Domestic Violence

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Family Violence Prevention and Services Act is the primary

federal resource dedicated to provision of domestic violence

shelters, supportive services, and related programming for

victims of domestic/dating violence and their dependents

FVPSA Grants Programs include:

State and Territorial Formula Grants

Tribal Grants

State and Territory Domestic Violence Coalitions

Discretionary Grants

Training and Technical Assistance Resource Centers

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1.28 Million Victims Served In 2017, FVPSA provided funds to

• 1,239 domestic violence shelter programs

• 247 domestic violence non-shelter programs

• 146 Tribal Domestic Violence Programs

FVPSA funded programs provided• safe housing

• crisis response

• advocacy

• legal assistance

• counseling

• safety planning

• support groups

893,298 women

88,862 men

267,300 children

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FVPSA-Funded National Training and

Technical Assistance Resource Centers

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FYSB Acknowledges

Domestic Violence Awareness Month

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Referrals for Support Related

to Abuse

Live online chat services are available every day from 7:00 a.m. to 2:00 a.m. CT at http://www.thehotline.org

Read more - http://www.thehotline.org/help/help-for-friends-and-family/

Available 24/7/365

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FVPSA Fact Sheets:

acf.hhs.gov/fvpsaFamily Violence Prevention

and Services Program

Overview

State & Tribal Domestic

Violence Services

Tribal Domestic Violence

Services

Domestic Violence Resource

Network Overview

National Domestic Violence

Hotline

NATIONAL HEALTH RESOURCE CENTER

ON DOMESTIC VIOLENCE

FREE RESOURCES FOR ADVOCATES,

HEALTH PROVIDERS AND SURVIVORS

Orders can be made through our e-commerce store. To

access the store from our website hover over the

Resources and Events at the top of the page, then click

Order Materials, or follow this link HERE.

All materials are free up to a certain amount

with a $10 flat rate shipping fee.

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National Health Resource Center:

Online Store

• All of our resources are

free to order, with a $10

flat rate shipping fee

• Hard copy resources

• Safety cards

• Posters

• Brochures

• DVDs

• PDF resources

• Most of the above

and more!

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How Can I Help You?

• Help with orders and questions like:

• “I have an LGTBQ+ event scheduled, what are the materials you

would recommend?”

• “Do you have a resource for young mothers?”

• “Is this resource still available?”

• Ask me about localizing our materials with your

organizations logo and local IPV/SA support hotlines!

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Contact information:

Graciela Olguin (they/them pronouns)

HRC/Health Program Assistant

golguin@futureswithoutviolence.org

(415) 678-5513

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Tell us in the chat!

How are you celebrating or commemorating

Health Cares About Domestic Violence Day

and/or Domestic Violence Awareness

Month?

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CUES: An Evidence-based Intervention

C Confidentiality

UE Universal Education + .

……Empowerment

S Support

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Main Resources and New Resources!

• Is Your Relationship Affecting

Your Health? General Health

Safety Card

• Did You Know Your Relationship

Affects Your Health? Repro

Health Safety Card

• Sex, Relationships, and Respect

on Campus Safety Card

• Beyond Halal and Haram:

Muslims, sex, and Relationships

Muslim Youth Safety Card

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Shifting From…

“No one is hurting you at home, right?”

(Partner seated next to client as this is

asked — consider how that felt to the

patient?)

“Within the last year has he ever hurt you or hit you?”

(Nurse with back to you at her computer screen)

“I’m really sorry I have to ask you these questions, it’s

a requirement of our clinic.” (Screening tool in hand --

What was the staff communicating to the patient?)

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The Heart of Being Trauma Informed

What if we

challenge the limits

of disclosure

driven practice?

(Miller, 2017)

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Normalizes conversation

and provides an opportunity

for clients to make the

connection between

violence, trauma, health

problems, and coping

Universal Education

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CUES: Who/When?

Who does it? Every health center is different. May

be medical assistants, behavioral health, providers

(MD, NP, PA), or nurses.

Who gets it? All adolescents, female patients,

LGBTQ-identified patients…depends on your

practice!

When? At least annually; with disclosures at next

follow-up apt; new relationships; or onset of new

health issues possibly connected to IPV/HT

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C: Confidentiality: See patient alone, disclose limits of confidentiality

UE: Universal Education + Empowerment—How you frame it matters

Normalize activity:

"I've started giving two of these cards to all of my patients—in case it’s ever

an issue for you because relationships can change and also for you to have

the info so you can help a friend or family member if it’s an issue for them.”

Make the connection—open the card and do a quick review:

"It talks about healthy and safe relationships, ones that aren’t and how they

can affect your health....and situations where youth are made to do things

they don’t want to do and tips so you don’t feel alone.”

S: Support:

Validating statements, harm reduction/health promotion, warm referral

CUES: Trauma Informed + Evidence Based!

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Evidence in Support of CUES Intervention

Among women in the interventionwho experienced recent partnerviolence:

• 71% reduction in odds for pregnancy coercion compared to control

• Women receiving the intervention were 60% more likely to end a relationship because it felt unhealthy or unsafe

(Miller et al. 2010)

Intervention Results:

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Power of CUES Intervention

Clients were overwhelmingly positive about CUES:

84% stated they would bring a friend to the health

center if they were experiencing an unhealthy

relationship (Miller, 2015)

Following CUES staff training and

implementation:

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More Than Broken Bones and Black Eyes

Examples of health

conditions associated

with IPV include:

• Asthma

• Bladder and kidney

infections

• Circulatory conditions

• Cardiovascular

disease

• Fibromyalgia

• IBS

• Chronic pain

syndromes

• Central nervous

system disorders

• Gastrointestinal

disorders

• Joint disease

• Migraines and

headaches

(Black/CDC, 2011)

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Traumatic Brain Injury and Strangulation

Studies show a range of 40%-91% of women

experiencing IPV have incurred a traumatic brain

injury (TBI) due to a physical assault (Campbell, 2018)

More than two-thirds

of IPV victims are strangled

at least once { the average is 5.3 times per victim }

(Chrisler & Ferguson, 2006 Abbott, 1995; Coker, 2002; Frye, 2001; Goldberg,

1984; Golding, 1999; McLeer, 1989; Stark, 1979; Stark, 1995)

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IPV and Behavioral Health Co-Morbidities

• Anxiety and/or depression

• Post-traumatic stress disorder (PTSD)

• Antisocial behavior

• Suicidal behavior

• Low self-esteem

• Emotional detachment

• Sleep disturbances

• Substance dependency(Tjaden P, 2000; Coker AL, 2002)

Research suggests that women may also be more likely than

men to use prescription opioids to self-medicate for other

problems including anxiety or stress. (McHugh 2013)

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Mental Health and Substance Use Coercion

Abusers rely on

stigma related to

mental health and

substance abuse

to undermine and

control their

partners. (Warshaw, 2014)

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Provider Barriers in Addressing IPV

• Comfort levels with initiating conversations

with patients about IPV

• Feelings of frustration with patients when

they do not follow a plan of care

• Not knowing what to do about positive

disclosures of abuse

• Lack of time

• Vicarious trauma or personal trauma

• Child protection service involvement

(CPS) /Deportation reporting fears

(Sprague, 2012)

Clinicians

identified

the

following

barriers:

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FOUR TIMES more likely

to use an intervention such as:

• Advocacy• Counseling

• Protection orders• Shelter

• or other services

Healthcare Providers Make a Difference

(McCloskey, 2006)

Women

Who Talked to

Their Health

Care Provider

About

Experiencing

Abuse Were:

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Poll it out…

In what ways are you partnering with your local

DV/SA/HT agency or health center?

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Building Partnerships!

READINESS

Perceived

Support

Awareness

Self-Efficacy/

Power

READINESS MODEL FOR IPV VICTIMS

The Final Model

Judy Chang, MD, MPH Associate Professor Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, Assistant Dean of Medical Student ResearchUniversity of Pittsburgh Magee Women’s Research Institute

"She said to me one day, ‘Did you ever stop and realize that you have the right to decide what’s acceptable and what isn’t?’ And that planted a seed in me. I didn't leave then, maybe four or five years later. And ever after that, every time he acted strange, I’d think, ‘This isn’t acceptable.’ So she really planted the seed. It took a long time for me to act, but she more than helped.”

“He sat there and he looked at me. And the look in his eyes like he was really interested and wanted to hear what I said. He didn’t just playact on it. He actually heard what I said and listened to me and kept that eye contact.”

How can health providers help?• Prior recommendations focused on

screening/asking women about IPV

What is the point of asking about IPV?• Diagnosis?

• Awareness?

• Dialogue?

Positive Consequences of Asking About IPV Realization that IPV is a problem

◦ “I needed somebody to make me see, to remove the blindfold over my eyes”

Decreased sense of isolation

◦ “I felt pretty good that somebody was concerned about me, about my life, about my baby.”

Feeling that provider cares

◦ “Just with a simple caring word, you feel that you are really worthwhile; that they care about you, that somebody else cares about our situation”

Negative Consequences of Asking About IPV

Feeling judged by the provider

◦ “It’s the way they’re asking. Sometimes a lot of doctors are really condescending to people.”

Disappointment in provider’s inadequate response to disclosure

◦ “He said, ‘I don’t have time to talk about that right now.’”

Survivors’ Advice to Providers

• Give a reason for asking

• ‘‘Don’t be just asking to ask for your own sake. Ask because you’re there to offer help.’

• Create a safe and supportive environment

• Use nonjudgmental tone/words

• Speak with the woman alone

• Make resources available regardless of disclosure

• ‘‘You want them [providers] to know the truth, but you’re too scared to tell them. So you want them to read your mind, but they can’t. . ..’’

• Respect autonomy

• ASK HER WHAT SHE WANTS/NEEDS

• Do not give direct advice

Respect Autonomy

“. . . Nothing came from me because everybody told me what I

should do. I do not know what I would have said then [if

someone had asked her what she wanted to do]. I probably

would have said, ‘‘I do not want the divorce right [now]’’

because I did not at the time. But I went for one because

everyone said I should. And I still regret it, even if it was the

right thing. I regret it because I did not do what I wanted. I

did what everybody else wanted me to do.”

Awareness

‘‘I personally think that if a physician is interested

in helping people from violent backgrounds, then maybe

some sort of awareness posters and stuff. So that when you come in, you can see that they are interested . . .. [It] would make people realize that this place is safe and that they want to help.’’

National Domestic Violence Hotline

• 1-800-799-SAFE

Empowerment

• “When you start to talk, to tell them [health care providers] what you are really going through in your life, they [they abusers] start to lose the control they have over you.”

• Brainstorming/strategizing plans for safety

• What things can you do to keep help you if the violence starts up again?

• When counseled, women will increase the number of safety promoting behaviors

McFarland Am J Nursing 2004

Support

• “It helps us to believe in ourselves. People respect doctors. And when a doctor says something, you know that it looks better on you that somebody that’s professional would actually believe in you.”

• I am so sorry that you are going through this. I want you to know that you do not deserve any of it. No one deserves to be afraid and hurt by the people who are supposed to love them.

• Please know that we are here to help in whatever way we can. What can I do that would be most helpful to you?

READINESS

Perceived

Support

Awareness

Self-Efficacy/

Power

READINESS MODEL FOR IPV VICTIMS

The Final Model

Health Initiatives

at the

Women’s Center & Shelter of Greater Pittsburgh

Intake for Shelter clients includes the following:

◦ Untreated illness

◦ Injuries requiring medical attention

◦ Plan B necessity

◦ Pregnancy test

◦ Traumatic brain injury

“Healthcare for Underserved Populations” program

Volunteer physician and University of Pittsburgh medical students

Shelter clients can sign up to be seen onsite Monday evenings

Psychiatric nurse onsite

◦ Clients are referred by the staff Wellness Team and can be seen on Mondays

◦ Nurse provides assessment/triage for psychiatric consult

Psychiatrist available two times per month for medication

Pediatrician onsite

◦ Children of Shelter clients can be seen on Thursdays

◦ Visit includes “Health Chat” with moms:

Q&A

Preventative education

Health Advocacy is available to ALL Women’s Center clients. The Medical Advocacy Coordinator provides:

◦ List of locations that provide medical care and prescriptions, dental and Ob/gyn to the uninsured and underinsured

◦ Information on obtaining Plan B free of charge

◦ Information about Ob/gyn healthcare providers that are sensitive to the needs of DV/SA survivors

◦ Assistance with applying for the Affordable Care Act and Medicaid

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Population Specific

American Indian/Alaska Native

College Campus

Hawaiian Communities

HIV+ and HIV testing

Lesbian, Gay, Bisexual, Questioning (LGBQ)

Parents

Pregnant or parenting teens

Transgender/Gender Non-conforming persons

Women across the lifespan

and coming soon…a new card for Muslim youth

All cards are available in English and most are

available in Spanish.

Primary care (general health) card is available in

Chinese, Tagalog, and soon Vietnamese, Korean,

Armenian and French

Setting Specific and Topical

• Adolescent Health

• Behavioral Health

• HIV

• Home Visitation

• Pediatrics

• Primary Care (General Health)

• Reproductive Health and Perinatal

National Health Resource Center on DV:

Setting/Population-specific Safety Cards

www.ipvhealth.orgDeveloped by and for health centers in

partnership with domestic violence programs

Resources for Partnership Building

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Questions for Janice, Judy or FUTURES?

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2017-2018 Project Catalyst Participating

States:

AR, CT, IA, ID, MN

National Initiative: Project Catalyst Phase I

Project Catalyst: Statewide

Transformation on Health

and Intimate Partner Violence

5 State Leadership Teams include

partners from each state’s:

Primary Care Association

Department of Health

Domestic Violence Coalition

Training and TA: FUTURES

Evaluation: University of

Pittsburgh

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Project Catalyst: Phase II Funding Announcement

FUTURES will provide selected Leadership

Teams $75,000 per state/territory, in addition to:

hosting one Kick-off Meeting in San Francisco

(January 15-16, 2019)

one in-person state/territory Training of Trainers

(with CME for MDs/DOs)

one in-person administrative meeting

online trainings, free patient and provider tools,

and participation in a learning community to share

challenges and successes, and technical

assistance as needed.

Partners submit one application from

a state /territory’s:

Primary Care Association

Department of Health and

Domestic Violence Coalition

Application Deadline: Friday,

November 9, 2018 by 5:00pm

PST/6:00pm Mountain/7:00pm

Central/8:00pm Eastern

• The period of funding is: December

1, 2018 - September 30, 2019.

For more information see:

https://www.futureswithoutviolence.org/project-catalyst-

statewide-transformation-health-ipv/

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Interested in learning more?

Join us on Thursday, October 18th

Thursday, Oct. 18th, 2018

(1 hour: 11am PST/12pm Mountain/1pm Central/2pm Eastern)

A one hour webinar for interested applicants to learn more about the project and ask any questions about the funding announcement.

To register, visit:

https://futureswithoutviolencewebinars.adobeconnect.com/ehx8ajbzg3up/event/registration.html

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Not too late to plan a DVAM event!

Visit our online action kit for ideas!

https://www.futureswithoutviolence.org/hca

dvday-action-kit/

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Thank you!

Thanks to Kenya, Judy and Janice!

Fill out an evaluation for this webinar to get a

CME or participation certificate:

https://www.surveymonkey.com/r/2J6J9XH