abuse response: domestic violence/safe mom safe baby the context of our work… sharain horn rn msn...
TRANSCRIPT
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
The
Healing
Center
(since 2001)
Community Partners
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: 19-29.
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
• 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• Nurses
• Social Workers
• Physicians/Medical students
• Allied Health Professionals
• Direct Service to patients/staff• Crisis Intervention
• Advocacy/Case management
• Patient education
• Staff Consultation
• Collaborative Partnerships• 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
• 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 health-related problem.
Associated with• 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 infantExpansion 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 PlanningReferralsReporting
• 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
SMSB direct services
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)
_________________________________________________
Combined 2009-20011 SMSB clients (n=126)
SB score at Entry 24.9 SB Score at Closure 27.7*
(significant @ p<.05)
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 pregnancy-specific 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____________________________________________
__Combined 2005-20011 SMSB clients (n=239)
DVSA score at Entry 2.86DVSA Score at Closure 3.56* (significant @ p<.05)
_______________________________________________
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.