Transcript Domestic Violence The context of our work

Abuse Response:
Domestic Violence/Safe Mom
Safe Baby
The context of our work…
Sharain Horn RN MSN IBCLC
Story… why we do the work we do?
We believe….
What Domestic Violence programs and
services are offered by Aurora HC?
• Domestic Violence Response
• System wide staff education
• Community Partnerships
• Safe Mom, Safe Baby
Current Abuse Response Services
DV 1.0 fte CNS
Includes
Safe Mom
Safe Baby
(since 2005)
SATC
(20+ yrs)
1.7 RN fte
1.8 SW fte
12+ on-call SANE
Volunteer
Advocates
Community
Partners
The
Healing
Center
(since 2001)
History….
1991-2000 Informal DV services at ASLMC
2001 Domestic Violence program began with CNS 1.0 FTE
2002 IRB Approved Research Study
2005-2008 ARS-DV added Safe Mom Safe Baby (SMSB)
2008-2011 SMSB Expanded Services, Advocate Added
Prevalence of DV in health care
Abused women
presented to every type of clinical setting
in AHC study, 2002
(n = 1268)
Kramer A., Lorenzon D, Mueller G. (2004). Prevalence of Intimate Partner Violence
and Health Implications for Women Using Emergency Departments and Primary Care
Clinics. Women’s Health Issues. 14: 19-29.
Prevalence of DV in Health Care
Nearly 1 in 3 women
presenting to AHC Emergency Departments
or clinics
reported severe physical abuse or
forced sexual activity in their lifetime
Kramer A., Lorenzon D, Mueller G. (2004). Prevalence of Intimate Partner Violence and
Health Implications for Women Using Emergency Departments and Primary Care Clinics.
Women’s Health Issues. 14: 19-29.
Prevalence of DV in health care
1 in 7 women presenting to
urban emergency departments
had experienced severe physical abuse
in the past year
Kramer A., Lorenzon D, Mueller G. (2004). Prevalence of Intimate Partner
Violence and Health Implications for Women Using Emergency Departments and
Primary Care Clinics. Women’s Health Issues. 14: 19-29.
Health implications of DV
Abused women reported significantly
lower health ratings
than non-abused women (p =.00)
Kramer A., Lorenzon D, Mueller G. (2004). Prevalence of Intimate Partner
Violence and Health Implications for Women Using Emergency
Departments and Primary Care Clinics. Women’s Health Issues. 14: 1929.
Health implications of DV
The majority (63-93%) of women’s health problems
were reported by abused women
•headaches
•chronic pain
•digestive disorders
•vaginal bleeding
•depression/anxiety
Societal Costs
Tangible costs exceed $5.8 billion each year
• Productivity
• Social/victim services
• Police/fire services
• Property loss/damage
*Dept Health & Human Services, CDC, National Center for Injury Prevention and
Control. Costs of IPV Against Women in the U.S, NNVAWS. March 2003
Potential for cost savings
• In addition to the human toll, the resource and
economic burden on health systems from IPV
is clearly demonstrated
• Potential for cost savings from intervention
programs is great
• Preventing IPV
• Lessening its consequences
Caregiver Education
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Psychosocial Nursing Day
Safe at Home I and II
All Day ED Response to DV
On-line Domestic Violence Modules
Staff Meetings (Nursing, SW, other)
Informal Education
Potential health care cost savings
Routine Screening
Safe Environments that encourage disclosure
Increased Identification
Patients have more information, support & options
Decreased isolation
Increased safety
Improved health
Aurora’s current response to IPV or DV
• Health Care Provider Education
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Nurses
Social Workers
Physicians/Medical students
Allied Health Professionals
• Direct Service to patients/staff
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Crisis Intervention
Advocacy/Case management
Patient education
Staff Consultation
• Collaborative Partnerships
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Internal and external champions
Overacrching Goals – Abuse Response
Services
• Integrated, culturally-sensitive and
coordinated response to IPV
• Patients feel, hear and see environments
throughout AHC that
• support disclosure of abuse
• enhance personal safety
• Skillful assessment and interventions by
health care providers
• Collaboration with community partners
Safe Mom, Safe Baby
• A Collaborative Model of Care for
Pregnant Women Experiencing Intimate
Partner Violence (IPV)
The players
• Faculty partners
• MD & Nurse Midwife
• Nurse Case Manager
• Community partners
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Family violence advocacy
Prenatal and child care coordination
Shelter Resources
AFS
Extent of the Problem
Intimate partner violence (IPV) during
pregnancy is a national and global healthrelated problem.
Associated with
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Increased mortality, injury & disability
Worse general health (physical and emotional)
Chronic pain, substance abuse
Reproductive disorders
Poorer pregnancy & fetal outcomes
Prevelance
Violence during pregnancy is estimated to
affect between 3-20% of live births
annually
Most studies reported a range of 3.9 - 8.3%
(NVAWS 2000)
Harvard School of Public Health (HSPH) Study
(Amer J Obstetrics and Gynecology, 2006)
In women experiencing IPV in the year prior to and/or during a
recent pregnancy were:
• 40-60% more likely than non-abused women to report
hypertension, vaginal bleeding, severe nausea, kidney or UTI
and hospitalization during pregnancy
• 37% more likely to deliver preterm
• Their newborns were 17% more likely to be born underweight
• Their newborns were >30% more likely to require intensive care
upon birth
Healthcare
• Over-use of health services (even after
leaving an abusive relationship)
• Unmet needs for services
• Strained relationships with healthcare
providers
Program Design
Despite the prevalence of IPV during pregnancy, very
little is written about programs designed to address
this problem.
The majority of articles addressing IPV during
pregnancy focus on describing the prevalence or
factors associated with abuse .
The relatively few publications addressing IPV-related
interventions – investigated a single intervention in a
clinic or community setting (screening, counseling,
non-professional mentoring)
SAFE MOM SAFE BABY
Is a nurse-led, evidenced based collaborative
model of care that:
• removes system barriers and silos of service
• by creating a seamless continuum of care for
pregnant women
• within outpatient/in-patient settings as well as
the community in which she lives
• by helping her engage with caregivers and
navigate the complexities of criminal justice,
legal and social service systems in the
community
SMSB Program Goals
• Create a consistent and sustainable response to IPV
in perinatal health settings
• Improve safety behaviors of pregnant abused women
• Monitor health outcomes of mothers and infants
• Develop a collaborative model of care for survivors of
IPV that can be replicated in other health care
settings to improve outcomes
Objectives
Design and Implementation 2005-2008
• Identify abused women via enhanced screening by educated
caregivers
• Provide targeted assessment & stage-based interventions by
a team of nurse case manager and IPV advocate
• Enhance the well-being and safety of mother and infant
Expansion and Sustainability 2008-2011
• Expand the program institutionally and within community
• Provide outreach to Latina community by hiring a bilingual
advocate
• Plan for and ensure sustainable funding
Components of SMSB
• Educate caregivers
• Responsive, on-site
consultation and
direct services
• Ongoing case
management and
advocacy
SMSB Referrals
Healthcare Setting
• Safe healthcare environment
• Routine screening every
trimester/postpartum
“Safety is of the utmost
importance for you and your
baby”
• Timely services onsite
“As part of comprehensive
women’s health, we have a
specialist that could continue
to talk with you and help with
your concerns”
Screening
ACOG recommends screening every trimester & postpartum
Abuse Assessment Screen (AAS)
1. Have you ever been emotionally or physically abused by your partner
or someone important to you?
2. Within the last year, have you been hit, slapped kicked or otherwise
physically hurt by someone
3. Since you’ve been pregnant, . . . .
4. Within the last year, has anyone forced you to have sexual activities?
5. Are you afraid of your partner or anyone you listed?
*AAS – Abuse Assessment Screen developed
by Nursing Research Consortium on Violence
and Abuse - National Consensus Guidelines
for Screening Pregnant Women – Family
Violence Prevention Fund/ACOG
Documentation
Electronic Health Record (EPIC)
Screening templates
Cascading screens for further assessment
and interventions
Safety Planning
Referrals
Reporting
SMSB direct services
• Patient-centered & stage-based
interventions
• Tangible support i.e. housing,
transportation, baby supplies,
legal advocacy, restraining orders
• Liaison to community services
• Ongoing case management up to
6 months post-partum
Client
SMSB : Assessment
• Intake Form
 Danger Assessment (Campbell 2004)
 Safety Behaviors Assessment (adapted
McFarlane 1998)
 Edinburgh Postnatal Depression Scale
 DVSA (Dienemann and Campbell 1999)
Stages of Change
DVSA – Domestic Abuse Survivor
Assessment (Dienemann & Campbell
1999) by provider and client
Movement in stages of change toward
healthy behaviors and a life free of
abuse - Stage-matched interventions
Safety Behaviors
SMSB Clients adopted significantly more safety
behaviors
 Safety Behaviors Assessment (adapted McFarlane 1998)
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Combined 2009-20011 SMSB clients (n=126)
SB score at Entry
SB Score at Closure
(significant @ p<.05)
24.9
27.7*
Birth Outcomes
SMSB clients
achieved birth outcomes comparable to the
overall population of pregnant women
delivering at ASMC
despite their increased risk for premature
and low-birth weight infants
Staff
• Approximately 1000 caregivers are educated
annually regarding domestic violence and health care
• Perinatal caregivers receive ongoing pregnancyspecific formal and informal education
• Caregivers acknowledge more readiness to screen
patients when they know there are onsite resources
and additional expertise available to them and their
patients
Patient Story
Healthcare and
Community
Partnership
Outcomes
SMSB clients grew in their readiness
for change
• Marked progression from contemplation to action
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Combined 2005-20011 SMSB clients (n=239)
DVSA score at Entry
2.86
DVSA Score at Closure
3.56*
(significant @ p<.05)
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Safe Mom, Safe Baby- Client Video
In closing
• Addressing Abuse with
patients is a process of
examining our own personal
experiences and attitudes.
• Abuse is one of the most
critical health issues for
women and children. The cost
of ignoring it is just too great.
• Addressing this issue does not
take too much time it probably
saves time and cost in the long
run.