The State & Community Intimate Partner Violence & Perinatal Depression Resource Development Project:...

IPV/PD: A Comprehensive Approach

The State & Community Intimate Partner Violence & Perinatal Depression Resource Development Project:

Policy and Legislation & Standards of Care

Health Resources and Services Administration

&Social Solutions International, Inc.

August 2012


Webinar Moderators

Moderators:

• Keisher Highsmith, DrPHDirector of Special Initiatives and Program Planning and EvaluationHRSA/Maternal and Child Health Bureau

• Kristen Stier, MAResearch and Logistics AssociateSocial Solutions International, Inc.

• Gloria Aponte Clarke, MPHSenior Policy AssociateAltarum Institute


Webinar Speakers

Speakers:

• Jeanette Valentine, PhDDirector, Business DevelopmentPathways LA

• Lisa L. Derrick, M.Ed. BAMProject DirectorSouth Phoenix Healthy Start, Maricopa County Department of Health

• Kim DartezExecutive DirectorFamilyTree Health CareWomen of Color-Chair, The AZ Coalition Against Domestic Violence


Objectives

• Provide examples of existing Standards of Care for Intimate Partner Violence and Perinatal Depression

• Describe the process of implementing Standards of Care in your organization

• Describe the role policy and legislation play in addressing IPV/PD

• Provide examples of strategies/tactics used to advance policy and legislative initiatives concerning IPV/PD


Toolkit Goals – Policy and Legislation

• Provide an overview of the policy process and why it is important in addressing IPV/PD

• Highlight select federal and state policies related to IPV/PD


Toolkit Goals – Standards of Care

• Provide an overview of the importance of having IPV/PD Standards of Care Guidelines

• Provide an overview of national resources and IPV/PD Standards of Care Guidelines

• Provide an overview of training materials and resources available to help address IPV/PD


Grassroots to Treetops:How Local Programs Can Impact Policy &

Legislation on Intimate Partner Violence & Perinatal

Depression

Jeanette Valentine, Ph.D.LA County Perinatal Mental

Health Task ForceLos Angeles CA

August 2012


Learning Objectives

1. To understand how to have an impact at different levels of policy processes

2. To appreciate the breadth and depth of influence that local programs have


Key Principles

1. Know your audiences

2. Appreciate your power

3. Apply advocacy tools


Audience

• Elected and Appointed Officials• Community Leaders• Business Leaders• Thought Leaders


Power

• Knowledge• Passion• Access


Tools & Tactics

• Inform & Educate• Collaborate• Mobilize• Lead


Know Your Audience

THERE ARE MULTIPLE AUDIENCESIN THE POLICY PROCESS

• One Bright Idea:• Define your community

• – GEOGRAPHY OR DEMOGRAPHICS – • & determine who has a stake in it


Audience, cont.

LEGISLATIVE & BUDGETARY:

• For Elected Officials – Geography Counts


Audience - Officials

ELECTED AND APPOINTED OFFICIALS

• Legislative Bodies• Legislative Committees

• Administrative Agency Heads• Special Commissions

• Staffers• Appointed Officials


Civic Leaders

Community LeadersThought LeadersBusiness Leaders


Power - Knowledge

•Problems•Solutions

•Costs of doing nothing•Costs of doing something


Power – Sources of Knowledge

•Experts Speak: Evidence-based & Best Practices

•Experience Speaks: Personal Stories•Wisdom Speaks: Community-defined

Evidence


Power - Passion

• Authentic Voice• Urgent Need

• Actionable Solutions


Power - Access

• Voters• Civic Leaders

• Media• Clients & Other Community

Residents• Agency Partners & Collaborators


Tools & Tactics

INFORM & EDUCATE

• Testimony

• Briefings

•Cost & Outcomes Data

• Survivor Stories

•Model Legislation, Regulations, Policies

•Community News & Media Outlets


Tools & Tactics, cont.

COLLABORATE

• Strategic Partnerships

• Coalitions

• Task Forces


Raise a Crowd!

MOBILIZE

• Strategic Partnerships

• Coalitions

• Task Forces

•Clients

•Community Residents


Tools & Tactics - Lead

• Identify Champions

• Draft Legislation and Policy Language

• Develop grass roots leadership & advocacy skills


Illustrations: LA County Perinatal Mental Health Task Force

http://maternalmentalhealthla.org

Assembly Concurrent Resolution 105

Designating May as Perinatal Depression Awareness Month

Proclaimed the month of May of each year to be Perinatal Depression Awareness month across the state of California and requested that a number of

stakeholders work together to explore ways to improve women's access to mental health care at the local and

state level, facilitate increased awareness about perinatal depression, explore and encourage the use of prenatal screening tools and improve the availability of effective treatment and community support services.

http://maternalmentalhealthla.org/


Illustrations


Assembly Concurrent Resolution 53

Kelly Abraham Martinez Act

Urges hospital providers, mental health care providers, health plans, and insurers to invest resources to

educate women about perinatal depression risk factors and triggers.



Illustrations, cont.


Perinatal Depression Awareness Month Proclamation:

A proclamation issued by the County of Los Angeles declaring May of every year to be Perinatal Depression Awareness Month



Illustrations – National Legislation


California Assembly Bill 159/2009 Healthy Mothers Act

Established and convened a statewide perinatal mood and anxiety disorders task force to develop recommendations and educational materials for the State Department of Public Health's perinatal health programs.



Some Concluding Thoughts

CHALLENGES & OPPORTUNITIES

•Time, talent and treasure to conduct policy work are limited in local programs, but …

•Policy and systems change is embedded in the Healthy Start mission

•Individuals at every level of the policy-making process want to hear from you, but …

•The message has to be policy-relevant and actionable


Contact Us

Jeanette Valentine, PhDDirector, Business DevelopmentPathways LA3550 W. 6th Street-Ste 500Los Angeles CA 90020Ph: 213-427-1651Email: [email protected]


A Comprehensive Approach for Community-Based Programs to Address

the Intersection of Intimate Partner Violence & Perinatal Depression: Policy

and LegislationKristen Stier, MA

Social Solutions International, Inc.

August 2012


Policy and Legislation

Understanding the process for creating policy and legislation is an important part of addressing Intimate Partner

Violence (IPV) and Perinatal Depression (PD), whether it is at the

local, state or federal level


Public Policy Making

• Citizens Being Heard• Writing the Bill• Formulating the Policy• Policy Implementation• Policy Evaluation


Federal Policies

• Violence Against Women Act• Affordable Care Act


State Policies

• Massachusetts legislated the creation of a commission to strengthen PPD support programs in the state, including treatment, screening and public-awareness efforts

• New Jersey law requires health care providers to screen women who recently have given birth for postpartum depression, and provides funding to do so.


State Strategies

• Mandated Screening of IPV.• Mandated Reporting of IPV.• Home Visiting Programs• New Parent Programs• Workgroups/Consortia for Perinatal

Health• Health Care Providers’ Trainings• Awareness Campaigns


Policy Brainstorming Tool

• What are the key issues and challenges around IPV/PD in your community? Consider awareness of the issues, stigma, rates of IPV/PD, and resources available for screening, referral and treatment.

• Are there policies that would help your organization be able to screen, refer and treat women for IPV/PD?

• What are some policy ideas for how to address IPV/PD in your community?


Healthy RelationshipsIntegrating IPV/PPMD Standards of Care and Service into Healthy Start

PracticeLisa L. Derrick Program Director

South Phoenix Healthy Start, Phoenix Arizona

Kim Dartez Executive Director Family Tree Health Care, Tempe Arizona

and Women of Color-Chair, The AZ Coalition Against

Domestic ViolenceAugust 23, 2012


Outline of Presentation

• Introduce SPHS method of integrating IPV screening with PPMD screening

• Present key components of Standards of Care and Service

• Overview of SPHS IPV/PPMD strategies

• Tools, techniques and training for SPHS staff

• Community involvement in migration and sustainability


Screening Tools and Methods

Perinatal Mood Disorders

– Edinburgh Depression Scale

– Self administered or facilitated by CHW

– Pregnant and post partum participants

– 10 questions– Focus on feelings in past

week– Scores of 10 or above

receive referral and plan for follow up

– Crisis intervention on Q10– Re administer within 2

weeks, if no follow up– Supervised by RN and MSW

Intimate Partner Violence

– Modified Abuse Assessment Screen (AAS)

– Administered by CHW– All female participants– 4 questions– Focus on real acts of violence

and strong fear over the past year or since last visit

– Yes answers receive referral and plan for follow up

– Crisis intervention for injuries– Re administer within 2 weeks,

if no follow up– Supervised by RN and MSW


Key Components of Standards of Care and Service

• All women are screened for PPMD and IPV upon initial intake and routinely

• Affirmative screening = referrals to programmatic and community resources

• Affirmative results = Level 1 Risk with at least 4 contacts per month; at least 1 face to face

• Readiness for change is assessed and documented• Barriers to follow through on referrals are identified• Plans for overcoming barriers and follow up care are

created and documented• In person support provided to first visits or group• All HS staff are initially trained and receive annual

training and regular in-services• Critical incident briefings conducted within 2 working

days


Strategies and Interventions

• Crisis Support Referrals– Mental Health Crisis Line– Crisis Housing & Nursery for Respite

• Medical Care– Center for Healthcare Against Domestic

Violence• Legal Services• Pro bono therapeutic counseling• Peer led support groups

– Teen specific– Adult specific– Language/Culturally Specific

• Community-based support groups


Tools, Techniques and Training

• Staff Training• IPV and PPMD 101• Motivational interviewing• Crisis Intervention

resources• Standards of

Care/Protocols• Legal processes• Infant Mental Health

• In-services• Data on IPV and PPMD• Teen Dating Violence vs.

Bullying• Female to male and

same sex IPV• CDC Guide to IPV during

pregnancy

• Community and Consortia Awareness• IPV and PPMD 101• Power and Control

Dynamics• Roots of Violence• International Trafficking

• Male Support Services• Fathers Mentoring Fathers• Court and Custody• Financial Stability

“Violence is a problem for many women. Because it affects health and well-being. I ask all my participants about it.”


IPV Referral

• Referral card recommends screening all patients for domestic violence.

• The card lists screening questions to ask on one side.

• The other side lists hotlines and helpful phone numbers.

• Card is in both Spanish and English.


IPV PPMD Referral Card

• The Referral for Services Card has a space to include:– The reason for the referral– Date/Time– Signatures– And emergency number for help


Family Tree Healthcare

Peer Led Support GroupsMeeting Topics for Discussion

1. Introduction – Our story (confidentiality and safety)2. Definition of Intimate partner/dating violence awareness, prevention and warning signs of abusive relationships and prevention.3. Healthy relationships; tools needed for a healthy relationship, qualities of a healthy partner.4. Health disparities and healthy choices5. Identifying internalized racism, mainstream privilege and overcoming institutionalized racism and oppression.6. Character Counts (resources for character education- best practices)7. Youth conflict resolution (National youth violence prevention resource center)8. Goal setting; how to create and achieve short and long term goals9. Provide resources, referrals and community linkages, safety planning


FTHC Peer Led Support Groups

Steps to get your group started

1. Decide frequency of meetings. Be sure to remember this is best if it is for the long haul so do not commit to an unreasonable schedule. Choices may include weekly, monthly or quarterly.

2. Meetings should have a maximum of 8 participants. ( When having maximum number try to have an assistant in case someone may need one on one attention.) We want to keep the meeting flowing if possible. WE ARE NOT THERAPISTS and this is a community support group. If someone is in need of a professional, we can offer referrals from the resources supplied by FTHC.

3. The average group should be 90 minutes. You can however include an extra 15 minutes at the beginning for introductions when your group is first beginning.

4. Groups can be conducted in ten series cycles. The above meeting topics are a general guide, the last week is for any follow-up or extra discussion.


Peer Led Support Groups, cont.

• 5. You can design your group to either allow the same participants to continue or have new participants every ten groups meetings.

• 6. Secure location, (best places are neutral and non-threatening such as nail or hair salon, school, community centers and libraries) have signed confidentiality agreement with owners and/or management of business or property.

• 7. Think of innovative ways get participation. Some ways participants are invited are: a) word of mouth, b) social media (can call the group by another name), d) contacting the local Jr. and high schools. Particularly the counselors and the nurses of the school would be familiar with who would benefit from the support group. Be sure and share the ways you recruit with other facilitators.


Tools for Peer Led Support Groups

1. DV 101, include power and control wheel2. Multicultural perspectives3. Confidentiality4. Safety5. Communication and facilitation skills6. Meeting structure and navigating the meetings7. Develop a plan8. Contingency planning and resources


Community Involvement

• Train the Facilitator Workshops• Business, Civic and Faith based

Groups • Annual Conference


Lessons Learned

• Create a culture of support and trust • Work with entire families• Self care is important


Contact Us

Lisa L. Derrick, M.Ed. BAMProgram DirectorSouth Phoenix Healthy Start~ Maricopa County Department of Public Health Community Health ActionOffice of Family Health Services2737 W. Southern Avenue, Suite 8 ~ Tempe, AZ 85282602-438-7812 Office ~ 602-304-1166 Main Numberhttp://www.maricopa.gov/Public_Health/Community/Programs/HealthyStartfacebook.com/MCDPH | twitter.com/Maricopahealth | www.WeArePublicHealth.org

Kim DartezExecutive DirectorFamily Tree Health CareTempe, AZ 85282 Office ~ 480-529-1686www.familytreehealthcare.org

https://owa.maricopa.gov/OWA/redir.aspx?C=1a3c8efd67a74dd29a6e5fcc791be6c1&URL=http://www.maricopa.gov/Public_Health/Community/Programs/HealthyStart

https://owa.maricopa.gov/OWA/redir.aspx?C=1a3c8efd67a74dd29a6e5fcc791be6c1&URL=http://www.maricopa.gov/Public_Health/Community/Programs/HealthyStart

https://owa.maricopa.gov/OWA/redir.aspx?C=1a3c8efd67a74dd29a6e5fcc791be6c1&URL=http://www.facebook.com/MCDPH

https://owa.maricopa.gov/OWA/redir.aspx?C=1a3c8efd67a74dd29a6e5fcc791be6c1&URL=http://www.twitter.com/Maricopahealth



http://www.wearepublichealth.org/

http://www.familytreehealthcare.org/


A Comprehensive Approach for Community-Based Programs to Address the Intersection of Intimate

Partner Violence & Perinatal Depression: Standards of Care

Kristen Stier, MASocial Solutions

International, Inc.

August 2012


Standards of Care Guidelines and Recommendations for Intimate Partner Violence and Perinatal Depression


Screening is Important

• 80% of women are comfortable with the depression screening process (Buist, 2006)

• 90% of women are comfortable with the IPV screening process (Zeitler, 2005).

• Less than 50% of women are screened for perinatal depression. (Seehusen, 2005).


Intimate Partner Violence (IPV) Screening

• IPV Screening Tools:• Woman Abuse Screening Tool (WAST)• Composite Abuse Scale

• IPV Standards of Care:• Framing statement - show that screening

is done universally and not because IPV is suspected.

• Confidentiality – discuss exactly what state law mandates that a physician must disclose. (ACOG, 2012).


Intimate Partner Violence Screening Resources

• ACOG Committee Opinion on Intimate Partner Violence

• Futures without Violence

• National Resource Center on Domestic Violence


Perinatal Depression (PD) Screening

PD Screening Tool• Edinburgh Postnatal Depression Scale (EPDS)

PD Standards of Care• Provide resources and referrals for ante- and

postpartum women for culturally and linguistically appropriate, evidence-based treatment and services

• Provide partners and family members with information about the signs and symptoms of PD and assist women with accessing services


Perinatal Depression Screening Resources

• The Commonwealth Fund

• U.S. Preventive Task Force

• American Academy of Pediatrics (AAP) and American Congress of Obstetricians and Gynecologist (ACOG) Guidelines for Perinatal Care


IPV/PD Screening

• Antenatal Psychosocial Health Assessment (ALPHA).

• Preconceptionalal Screening and Assessment Project (PSAP) Integrated Screening Tool.


Screenings Tools for IPV and PD

Screening Tool Target Population

Risk Factors Assessed

Source

Antenatal Psychosocial Health Assessment (ALPHA)

Pregnant Women

Child AbuseWomen AbusePostpartum DepressionCouple DysfunctionPhysical Illness

Website

Composite Abuse Scale (CAS)

Women in clinical settings

Physical, emotional, and combined abuse and harassment

Website


References

• American College of Obstetricians and Gynecologists. (2012). Committee opinion on intimate partner violence, No. 518. For more information visit the following website: acog.org/~/media/Committee%20Opinions/Committee%20on%20Health%20Care%20for%20 Underserved%20Women/co518.ashx?dmc=1&ts=20120123T1907367975

• Buist, A.; Condon, J., Brooks, J., Speelman, C., Milgrom, J., Hayes, B., Ellwood, D., Barnett, B., Kowalenko, N., Matthey, S., Austin, MP., & Bilszta, J. (2006). Acceptability of routine screening for perinatal depression. Journal of Affective Disorders, 93(1), 233-237.

• Seehusen, D., Baldwin, LM., Runkle, G., & Clark, G. (2005). Are family physicians appropriately screening for postpartum depression? Journal of the American Board of Family Medicine, 18(2), 104-112.

• Zeitler, M., Paine, A., Breitbart, V., Rickert, V., Olson, C., Stevens, L., Rottenberg, L., & Davidson, L. (2005). Attitudes about intimate partner violence screening among an ethnically diverse sample of young women. Journal of Adolescent Health, 39(1), 119.e1-119.e8.


Contact

Kristen Stier, [email protected] Solutions International, Inc.8070 Georgia AvenueSuite 201Silver Spring, MD 20910Phone: 1-866-901-6583Fax: 1-866-369-6809


Contact Information

For more information, questions, or comments about The State & Community Intimate Partner Violence (IPV)

& Perinatal Depression (PD) Resource Development Project, please contact:

Keisher Highsmith, Dr.P.H.Project Director

[email protected] of Health and Human Services

Health Resources and Services AdministrationMaternal and Child Health Bureau

Division of Healthy Start and Perinatal Serviceswww.mchb.hrsa.gov

mailto:[email protected]

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