intimate partner violence – trends in policy across sectors · 2020-03-04 · ipv vs. dv...
TRANSCRIPT
Agenda • Overview• Policy
Recommendations Across Sectors
• Contact Us
Intimate Partner Violence –Trends in Policy Across Sectors
Presentation Developed by: Alexis Sabor and Amanda Rosenberg
Who We Are + How We Are Different
Nationally certified women & minority-owned (MWBE)
Mission driven, flexible rates
Customized solutions based on your problem
See what our clients have to say transformhc.com
• Join our
www.transformhc.com
IPV Overview
IPV vs. DV Terminology: Divergent Paths
Intimate Partner Violence ( IPV)“Describes physical, sexual, or psychological harm by a current or former partner or spouse. This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy” -Centers for Disease Control • Started appearing in literature post-1990’s per the CDC• Used by medical practitioners / clinical providers
Domestic Violence (DV)“Includes felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, […] or intimate partner, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction receiving grant monies, or by any other person against an adult or youth victim who is protected from that person’s acts under the domestic or family violence laws of the jurisdiction.” – US Dept. of Justice • Used primarily pre- 1990’s• Used interchangeably with IPV in policy, public health, and colloquially
Mitchell, Connie, and Anglin, Dierdre. Intimate Partner Violence: A Health-Based Perspective. Oxford University Press, 2009.
IPV GloballyIn 2002, the WHO released “Worlds Report on Violence and Health” which marks violence as preventable and a global public health problem.Worldwide Statistics: • 35% of women have experienced either physical and/or sexual intimate
partner violence or non-partner sexual violence. • 30% of all women who have been in a relationship have experienced
physical and/or sexual violence by their intimate partner. In some regions, 38% of women have experienced intimate partner violence.• Women who have been physically or sexually abused by their partners
report higher rates of a number of significant health problems.
In a new UN report, it was found that women killed by intimate partners or family members account for 58% of all female homicide victims reported globally last year.
“World Report on Violence and Health.” World Health Organization, World Health Organization, 2 Feb. 2015, www.who.int/violence_injury_prevention/violence/world_report/en/.“A Third of Young People Polled by UN, Report Being a Victim of Online Bullying | UN News.” United Nations, United Nations, 2019, news.un.org/en/story/2019/09/1045532.
Short- & Long-Term Effects of IPV
“Violence Prevention Initiative.” Violence Prevention Initiative, California Department of Public Health , 2017, www.cdph.ca.gov/Programs/CCDPHP/DCDIC/SACB/Pages/ViolencePreventionInitiative.aspx.
How IPV impacts social determinants of health
C Patterson, Sara, and Kirsten Rambo. “Bringing an Equity Lens to the Prevention of Intimate Partner Violence.” Millennial Health Leaders Summit. Centers for Disease Control, 2016.
How IPV impacts social determinants of health: Survivor Experiences
Education
• “He would show up at my school and physically remove me from class or lie and say one of my kids is in the hospital. He would also quit his job to make me get another job so I have to drop out of school.”
Employment
• “He would call and harass my job, would call nonstop, and would show up at my job stating that I was his wife and demanding to speak with me.”
Economic Opportunities
• “He would write bad checks out of my checking account, steal money from me, put me down, and insult me. Also, he made it to where my cars wouldn't run.”
Cynthia Hess, Ph.D., and Alona Del Rosario, M.A.. “Dreams Deferred: A Survey on the Impact of IntimatePartner Violence on Survivors’ Education, Careers, and Economic Security.” Institute for Women’ Policy Research. Economic Security for Survivors. Centers for Disease Control, 2018.
Policy: How Government is Addressing IPV
History of IPV Policies In the US 1641
American law prohibiting beating female spouses enacted in Massachusetts bay colony, but Puritans uphold “legitimate” use of force by parents, masters or husbands.
1871
Alabama is the first state to rescind a husband's legal right to beat his wife
1978
US Commission on Civil Right identifies the use of physical force in a family as a means of intimidation and coercion.
1995
California becomes first state to mandate screening for DV in hospitals.
2000
US v Morrison decides that congress exceed its power in enacting the Violence Against Women Act (VAWA) 1 and rejects arguments that violence against women impacts interstate commerce.
2000/2006
VAWA II/ III reauthorized
Mitchell, Connie, and Anglin, Dierdre. Intimate Partner Violence: A Health-Based Perspective. Oxford University Press, 2009.
IPV in the Affordable Care Act
Required that DV & IPV screening/counseling be required in women’s preventive health benefits without cost-sharing.
• This is a coverage requirement and not a screening requirement, plans will guarantee payment for when these services are rendered but are not require the services themselves to be rendered.
Prohibits discrimination based on pre-existing conditions including being a survivor of domestic abuse or violence.
Survivor exemptions to the individual mandate
• Survivors qualified for the “hardship exemption” for which there were 14 different exemptions
Established the Domestic Violence Prevention Initiative to via the IHS to provide specific support to native survivors
HRSA Recommended
Strategy to Address IPV (2017-2020)
“Women who talk to their providers about their experience of abuse are four times more likely to use an IPV intervention to which their providers refer them"
Health Resources and Services Administration, Office of Women’s Health, The HRSA Strategy to Address Intimate Partner Violence. Rockville, Maryland: 2017
IPV Policies: Stats by State
74% of States published IPV policy recommendations in the last 20 years. • 64% published IPV policy recommendations in the last 10 years.• 36% published IPV policy recommendations in the last 5 years.
24% of States receive funding from the CDC to implement and evaluate IPV policy efforts. • Of those states, 18% have published their own Statewide
recommendation. The other 6% rely solely on CDC funded efforts.
20% of States have not published IPV policy recommendations.
Transform Health LLC, 2020.
IPV Policy Recommendations
by State
Legend:Green: Has Statewide Recommendations
>10 Years old <10 Years old
Yellow: Receives IPV Funding from CDC
Just CDC CDC + State Recommendation
Red: No Statewide Recommendations
Transform Health LLC, 2020.
Policy: Recommendations for Addressing IPV in Communities
A Community Approach to IPV
Structural drivers within a community ( racism, socio-economic inequity, limited resources) all contribute to the prevalence of IPV.
The National Health Resource Center on Domestic Violence offers resources tailored for specific communities and settings.
“THRIVE: Tool for Health & Resilience In Vulnerable Environments.” Prevention Institute, 2015, www.preventioninstitute.org/tools/thrive-tool-health-resilience-vulnerable-environments.
IPV Community Prevention Strategy
“The Spectrum of Prevention.” Prevention Institute, 1999, www.preventioninstitute.org/tools/spectrum-prevention-0.
Policy: Recommendations for Addressing IPV in Clinical Settings
Recommended IPV Strategies in Clinical Settings
Strategies to use before establishing a screening
assessment tool
• Create and sustain multisector partnerships, especially in social services. • Implement policies that
include IPV prevention and responses. • Provide ongoing
training for staff.• Healthcare institutions
include SDOH Assessment templates into EHRs with prompts to help guide providers.
Strategies during Screening Tool
Assessment with patient
•Incorporate SDOH into regular patient workflows using health educators, case managers, navigators and other frontline outreach staff
•Standardized data collection
•Partner with community orgs
Policy Recommendations
•Develop a plan for sustainability to help fund these services by engaging key health care stakeholders, developing an alternative payment models or other types of funding
Interiano, Ana, and Cynthia Keltner. ADDRESSING INTIMATE PARTNER VIOLENCE AS A SOCIAL DETERMINANT OF HEALTH IN CLINICAL SETTINGS. CALIFORNIA IPV & HEALTH POLICY LEADERSHIP COHORT, Sept. 2018.
National IPV Screening Tools
PRAPARE (Protocol for Responding to and Assessing Patients’ Assets, Risks and Experiences): Nationwide tool developed by the National Association of Community Health Centers and others to assess a patient’s social risks.
http://www.nachc.org/research-and-data/prapare/
National IPV Screening Tools
Patient Social Needs Screening Toolkit: developed by Health Leads.
https://healthleadsusa.org/resources/the-health-leads-screening-toolkit/
National IPV Screening Tools
USPSTF Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: ScreeningRecommends that clinicians screen for IPV in women of reproductive age and provide or refer women who screen positive to ongoing support services.
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/intimate-partner-violence-and-abuse-of-elderly-and-vulnerable-adults-screening1
Patient Experience in Clinical Settings
What happens when a patient screens positive for IPV?
Most IPV expert sources suggest this general workflow:• Ask if the patient is safe and what types of supports
would be helpful. • Make a referral to an intimate partner violence
support agency or to counseling/social services/mental health for the adult or adolescent victim and their children.
• Schedule a follow-up appointment for the next week. • Notify protective services if there are safety concerns
about a child
Cultural Competency is Key
• Providers must elicit specific info about the patient’s beliefs and experience with abuse, share general information about IPV relevant to that experience, and provide culturally accessible resources in the community
“The National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings.” Futures Without Violence, 27 Aug. 2014, www.futureswithoutviolence.org/national-consensus-guidelines-heath-care-settings.
Barriers to Care
Lack of provider/ hospital resources
Funding, Time, Incentives
Language barriers between providers and patients
Lack of cultural competency
Family members/the abuser attending patient visits
Patient lack of reporting
Fear of leaving, Denial, Unknown abuse
Inconsistent use of screening tools
Why do multi-sector IPV policies matter? Because they help.
“I didn't tell anyone about the abuse because I didn't want anyone to down me, and [my doctor] didn't down me. She would just make sure I was OK.”
“I am finally after almost 20 years of wanting to go to college going to attend this fall! I am very excited, and living here [at my program] and taking advantage of the resources has allowed me to do this.”
“… She told me her daughter was in a similar situation…So, I felt a lot more comfortable…And that's why I'm here today.”
“I owe everything on my dream board coming true to [my program]. I had two more babies, and we just got my daughter a puppy for her birthday. My children are secure and confident, with healthy lifestyles and joyful personalities.”
“If I didn’t have my community, I wouldn’t be here. I wouldn’t have that belief in myself.”
Cynthia Hess, Ph.D., and Alona Del Rosario, M.A.. “Dreams Deferred: A Survey on the Impact of IntimatePartner Violence on Survivors’ Education, Careers, and Economic Security.” Institute for Women’ Policy Research. Economic Security for Survivors. Centers for Disease Control, 2018.
Tracy A Battaglia, et al. “Survivors of intimate partner violence speak out: trust in the patient-provider relationship.” Journal of general internal medicine vol. 18,8 (2003): 617-23. doi:10.1046/j.1525-1497.2003.21013.x
Questions?
@TransformHC
Follow us
Contact us
[email protected]@[email protected]
www.transformhc.com
Find us
Get In Touch With Us