IHSACF Domestic Violence Demonstration Project IHS Intentional Injuries Course Albuquerque, NM April

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IHS/ACFDomestic ViolenceDemonstration
ProjectIHS Intentional Injuries
CourseAlbuquerque, NM April 5, 2005Anna
MarjaviFamily Violence Prevention
Fundanna_at_endabuse.org
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Family Violence Prevention Fund

• National non-profit working to end domestic
  violence.
• Based in San Francisco with offices in Boston and
  Washington, DC
• Public education, judicial/legal, immigrant
  communities, workplace, healthcare, children, and
  international.
• Funded by DHHS to operate National Health
  Resource Center on Domestic Violence

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(No Transcript)
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Why Native Communities?

• A recent report from the U.S. Bureau of Justice
  Statistics found that Native women
• five times more likely to be a domestic violence
  homicide victim
• highest rates of DV
• twice as likely to be victims of violent crimes
  committed by an intimate partner
• three times as likely to be victims of sexual
  assault

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Health Implications

• A review of the medical charts of 100 female
  patients between the ages of 15 and 99 with
  visits to Warm Springs Health and Wellness Center
  over the past 10 years revealed that
• 58 (58) had medical documentation of domestic
  violence at some point in their lives.
• the incidence of depression, alcohol abuse, drug
  abuse, chronic pain syndrome, and suicide
  attempts were higher in women with a history of
  domestic violence, than those without.

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In the Beginning

• Partners Indian Health Service, Administration
  for Children and Families, Sacred Circle, and
  Mending the Sacred Hoop
• September 2002, FVPF piloted new project working
  with 9 Indian/Tribal/Urban healthcare sites on
  institutional reform for DV

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Nine Participants

• Rosebud IHS, Rosebud, SD
• Gerald L. Ignace Indian Health Cnt., Milwaukee,
  WI
• Ketchikan Indian Corp., Ketchikan, AK
• Mississippi Band of Choctaw Indians, Choctaw
  Health Center, Choctaw, MS
• Houlton Band of Maliseet Indians Health Clinic,
  Houlton, ME

• Feather River Tribal Health, Inc., Oroville, CA
• Partially funded projects
• Zuni Comprehensive Community Health Center, Zuni,
  NM
• Warm Springs Indian Health Center, Warm Springs,
  OR
• Crownpoint Healthcare Facility/Family Harmony
  Project, Crownpoint, NM

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What did we want to accomplish?

• develop and strengthen the clinical practice,
  public education and outreach efforts around DV
• build the domestic violence training capacity and
  leadership within these facilities
• develop culturally appropriate tools
• raise visibility that DV is a public health issue
  in AI/AN communities
• disseminate model and tools nationally

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Getting Started

• multi-disciplinary Leadership Teams at every
  participating site
• partnerships between healthcare staff and local
  domestic violence advocacy organizations

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Getting Started

• Two training were held in San Francisco and
  Albuquerque addressing
• Dynamics of domestic violence and sexual assault
• Health effects of domestic violence including
  issues specific to the OB/Gyn setting
• Routine assessment for domestic violence,
  intervention, and follow-up
• Domestic violence reporting requirements and
  legal issues
• Connection to HIV/AIDS, pediatric-setting
  response
• IHS data collection, documentation and coding

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Policy Procedure

• Feather River Tribal Health Inc. developed a
  domestic violence protocol for medical, dental
  and behavioral health departments.
• Houlton Band of Maliseet Indians sought
  achieved Tribal Council approval for medical and
  workplace PP.
• Warm Springs Health Wellness posted theirs to
  the IHS womens health website.

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Training

• Ketchikan conducted a Domestic Violence in the
  Workplace training to all staff (130 FTE) as
  part of annual safety fair.
• Instituting ongoing training such as Warm Springs
  mandate that staff complete an online PowerPoint
  training by a set deadline.
• Feather River created a domestic violence
  training module for medical and dental.
• All day all-staff mandatory training at Houlton.
• Crownpoint/Family Harmony provided 5 trainings
  throughout course of Phase I.
• Zuni trained all staff in 6 months.

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Inquiry and Assessment

• Feather River screens all women 12-80 yo.
• Choctaw created a screening tool for use in
  Womens Wellness Center
• Crownpoint/Family Harmony conducts universal
  screening of all females 18 and older.
• Gerald Ignace created a written form with
  multiple questions social worker follow-up
  support.
• Zuni PHS screens outpatient, inpatient
  medical/surgical, OB and home health visits,
  females 13 and up.

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Public Education

• Creation of public education materials such as
  the Mississippi Band of Choctaws poster
  featuring a child with the headline Domestic
  Violence and Children Witnessing violence always
  has an impact on children! for display in
  waiting areas and patient rooms.
• Development of a series of domestic violence
  educational screen savers to run on computers in
  exam rooms (Warm Springs Health Wellness
  Center).
• Hospital displays.

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Community Involvement

• Gerald Ignace Indian Health Service staffs
  distribution of domestic violence materials at
  local pow wows.
• Use of radio and local television to raise
  awareness such as Warm Springs Health Wellness
  Centers public service announcements on domestic
  violence through a local radio station.
• Media newspaper articles, cable-access shows,
  hospital newsletter/web.

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Evaluation

• Choctaws chart review of 87 patients who were
  screened in the Womens Wellness Center. Twenty
  five had a past/present history of DV 60 were
  negative for lifetime DV and 2 patients did not
  participate.
• Crownpoint/Family Harmony review of 124 medical
  records revealed screening increased from 31 to
  51. Referrals from the Crownpoint hospital to
  the Family Harmony Project during 2003 were 69.
• Ketchikan conducted a medical chart review of all
  women seen for annual exam, prenatal or
  traumaevaluated screening, ID and referral and
  provided follow-up training to nursing/medical.

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Other Efforts

• Coloring contests with children in elementary
  schools banner making at summer camp engaging
  kids through quizzes teen dating violence
  luncheon
• Button making contests
• Candlelight vigil community walks
• Banners displayed in courthouse and around town
• Including DV flyers and stickers with all Tribal
  employee checks
• Ketchikan presented project results at Rural
  Physicians Conference
• Warm Springs created domestic violence intra-net

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Phase II

• A year and a half marked end of Phase I (spring
  04)
• IHS and ACF offered refunding for second phase
• Phase II will last seventeen months
• October 1, 2004- March 1, 2006.

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Participants

• All 9 sites invited to reapply at 1 of 2 levels
• 15k to continue with institutional reform
• 30k to continue with institutional reform and
  provide training to outlying I/T/U facilities,
  and provide training to newly selected sites.
• Eight of nine original sites reapplied
• 4 were selected under each category
• Seven new sites joined (30-35k each)

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Continuing Sites

• Feather River Tribal Health, Inc. (Oroville, CA)
• Rosebud IHS Hospital (Rosebud, SD)
• Zuni Comprehensive Community Health Service
  (Zuni, NM)
• Mississippi Band of Choctaw IndiansChoctaw
  Health Center (Choctaw, MS)
• MENTOR SITES (30k)
• Ketchikan Indian Corporation Tribal Health
  Clinic (Ketchikan, Alaska)
• Warm Springs Health Wellness Center (Warm
  Springs, OR)
• Houlton Band of Maliseet Indians (Houlton, ME)
• Crownpoint Healthcare Facility/Family Harmony
  Project (Crownpoint, NM)

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New Sites

• Cherokee Indian Hospital (Cherokee, NC)
• Chinle Comprehensive Healthcare Facility (Chinle,
  AZ)
• Crow/Northern Cheyenne Hospital (Crow Agency, MT)
• Kaw NationKanza Health Clinic (Kaw City, OK)
• The N.A.T.I.V.E. Project Inc. (Spokane, WA)
• United American Indian Involvement, Inc. (Los
  Angeles, CA)
• Utah Navajo Health System (Montezuma Creek, UT)

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Phase II Meetings

• October, 2004 Kick-off meeting in Boston, MA
  followed by National Conference on Health Care
  Domestic Violence
• Second project meeting will be held April 26-27,
  2005 in Portland, OR
• Third final meeting will likely be held in
  winter, 2005

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Project Goals

• Work with new sites to conduct institutional
  reform as piloted in Phase I
• Work with continuing sites to increase
  leadership, conduct outlying training, national
  conference presentations, and solidify model for
  distribution.
• Secure funding to continue work beyond Phase II.

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Project Goals

• Development of
• new AI/AN specific educational manual
• model policy procedure
• assessment tools
• Exploring dental response
• Reporting requirements of Tribes, IHS

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Recent Success

• Feather Rivers lead article in IHS The Provider
  highlighting chart review results
• Choctaw recently completed 30 min. Community
  Video to highlight local DV resources as
  orientation for all new healthcare employees.

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Chinle

• Chinle will work with the local DV group ADABI
  to lead a community involvement and education
  project to create a mural on the hospital walls
  promoting family wellness, harmony, safety and
  healing. Artists include students from a local
  school art program, the boys and girls club, and
  the 21 Century Program (youth after school
  development program).

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• Anna Marjavi
• Family Violence Prevention Fund
• anna_at_endabuse.org
• 415-252-8900 x22
• www.endabuse.org/health