A Response to Domestic Violence

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A Response to Domestic Violence

• IHS Violence Prevention Training
• April 2005

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Objectives

• Recognize the importance of a collaborative
  approach to domestic violence.
• To recognize the importance of developing a
  health care DV response team.
• Become aware of varying strategies to reduce
  domestic violence.

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Problem Statement

• 37 of all women who sought emergency room care
  were related to domestic violence injuries (Rand,
  1997).
• fatal intimate partner violence is higher among
  American Indian/Alaska Native women in New Mexico
  (4.9 per 100,000) than among Anglo (1.8) or
  Hispanic (1.7) women (Arbuckle, 1996).

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Problem Statement

• In the U.S., approximately one in five female
  high school students reports being abused by a
  dating partner (Silverman et., al 2005).
• 40 of girls age 14-17 report knowing someone
  their age who has been hit or beaten by a
  boyfriend (Children Now, 1995).

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Collaboration
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Hospital Response Team

• Multi-disciplinary Approach
• Administration
• Nursing (emergency room, ambulatory care)
• Physician
• Mental Health
• Family Harmony Project
• Security Personnel
• Switchboard Operator

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Methods

• Hospital employee survey
• Knowledge, attitude and behavior
• Administered survey in ambulatory care
• Train health care providers (offer CEUs)
• Assessment
• Documentation
• Referral

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Method

• Develop and implement an universal DV policy in
  ambulatory care
• Screening all women 16 and older at all visits
• Private room with no kids present
• Hospital Policy
• Provide emergency 24-hour shelter when needed

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Methods

• Education
• Department meetings
• Signage This facility screens for domestic
  violence
• Pocket size brochures and posters in the
  restrooms and patient rooms
• Posters in the hospital and clinic
• Outreach education at youth conference, chapter
  houses

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Challenges

• Nurses felt uncomfortable with DV screening.
• Felt it was a personal issue.
• Overcoming obstacles
• Screening for DV was part of employee evaluation
  performance
• GPRA indicators

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Evaluation

• Medical chart reviews (2x a year)
• Screening practice
• Positive cases
• Referral
• Outreach education
• School, youth conference, worksite
• Training new providers
• Employee education

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Results

• June 2004 Chart Review
• 50 women in GRPA age group are being screened
• 38 of women in GPRA age group not being screened
  for DV in Emergency Room

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Family Harmony Project

• Established in 1994, 501c 3 Non-Profit
• Service 6 counties
• Federal and Tribal Funding
• IHS funds to support training other health care
  facilities to develop a DV team
• Type of Services
• Crisis intervention service
• Linkage to the Criminal justice system
• File restraining order
• Provide transportation to emergency shelter

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Family Harmony Project

• Outreach education
• Counseling services to victims and perpetrators
• 24-hour toll free hotline
• volunteers

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Family Harmony Project

• Mens Group
• 17 week program (includes parenting)
• After completion of 17 weeks
• Individualized plans
• Check in once a week and taper off
• Can rejoin the group if desire

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Family Harmony

• October (National Domestic Violence Month)
• Proclamation Signing
• Candle walk vigil against domestic violence
• DV education in the school, chapter communities,
  and worksites
• Participate in the Red Ribbon parade

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Family Harmony Project

• Results
• According to 1997 Navajo Nation Tribal Family
  Court data, 698 domestic violence Tribal
  Restraining Orders (TRO) were filed.
• Estimated that 98 of all DV TROs are result of
  physical abuse.
• 98.8 of the TRO through FH included physical
  assault.

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Risk Factors for Perpetration

• Individual level
• Beliefs, attitudes, witnessing violence
• Relational level
• Interpersonal and verbal interaction
• Family relationship, norms
• Community level
• Social norms
• Institutional structures, policies, and procedures

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Recommendations

• Multiple Strategies to reduce violence
• A. School-based intervention
• Violence prevention
• What is a healthy relationship (changing
  attitudes, behavior, norms through education)
• B. Community and worksite interventions
• Changing attitudes, knowledge, norms
• through education/awareness
• Parenting classes
• Counseling for victims, families, perpetrators
  (shelters)
• Increase awareness Tribal leaders, police
  officers, etc.,
• C. Workplace policies addressing DV

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Crownpoint Hospital Interventions

• Collaborations Police Department, school, Dept
  Youth Program, Tribal Behavioral Health, Tribal
  Justice Dept, State Teen Court Association,
  Family Harmony, etc.
• Youth-led Interventions (addressing multiple risk
  factors)
• Teen Court
• Youth in Action
• 3rd 5th Protecting You/Protecting Me classroom
  curricula
• Parenting Classes
• Project Alert
• Life Skills
• Adolescent Social Action Program (ASAP)
• Ropes Course
• Peer Assistance Leadership (PAL)

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Future Plan

• Family Harmony and Crownpoint Health Care
  Facility to assist other hospital to develop a DV
  health care response team.
• Apply for more funding to maintain services.
• Crownpoint Health Care team to expand screening
  to PHN home visits.
• IHS Head Quarters to include DV prevention in
  wellness plan guidelines for new and expanding
  facilities (under discussion).

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Funding Opportunities

• Grants.gov
• IHS Injury Prevention Grant
• IHS HP/DP Grant Due June 1, 2005

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References

• Arbuckle, J., Olson, L., Howard, M., Brillman, J.
  1996. Safe at home? Domestic Violence and other
  homicides among women in New Mexico. Annual
  Emergency Medicine, 27(2)210-215.
• Children Now/Kaiser Permanente poll, December
  1995.
• Rand, MR. 1997. Violence-related Injuries Treated
  in Hospital Emergency Departments. U.S.
  Department of Justice Bureau of Justice
  Statistics. Washington, D.C.
• Silverman, JG., Raj, A., Mucci, LA., Hatha, JE.
  2001. Dating Violence Against Adolescent Girls
  and Associated Substance Use, Unhealthy Weight
  Control, Sexual Risk Behavior, Pregnancy, and
  Suicidality. Journal American Medical
  Association, 286, 5, 2001.