# Presentation: 012343

## A Response to Domestic Violence

**IHS Violence Prevention Training**
**April 2005**

## 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.

## 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).

## 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).

## Collaboration

**Family Harmony**

**Crownpoint Hospital**

** ****Outreach Education**
**Community**
**School**
**Counseling**
** ****24-Hour Hotline**

** ****Multi-disciplinary Team**
** ****Universal Screening Policy**
** ****Assessment**
** ****Documentation**
** ****Referral **
** ****Outreach Education**
** ****School**
** ****Annual youth conference**
** ****Chapter communities**
** ****Work site**

**Police Department**
**Tribal Justice**
**Emergency Shelters**
**Tribal Social Program**

**Individual **
**Family**
**Community**

## Hospital Response Team

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

## Methods

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

## 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

## 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

## Ambulatory Care

- Alone
- (No)

- Alone
- (Yes)

- Screen in private
- room

- Yes, DV

- No DV

- Assessment
- Document
- Referral

- Agree to Photo

- Yes to Referral

- Family Harmony

- Give Safety Plan
- Brochure

- Counseling
- Emergency Shelter
- Restraining Order

- No to assessment

## 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

## Evaluation

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

## 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

## 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

## Family Harmony Project

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

## Family Harmony Project

- Men’s 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

## 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

## 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.

## 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

## 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

## 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)

## 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).

## Funding Opportunities

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

## 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.