Learning Objectives
After the training, participants will be better able to:
1
Identify two barriers to home visitors doing domestic violence (DV) assessment with clients.
2
Describe why universal education using the Young Mom Strong Kids safety card is important for helping clients experiencing DV.
3
List action steps in a safety plan that a client can take if she feels unsafe.
4
Explain how developing a Memorandum of Understanding (MOU) with your domestic violence agency can enhance home visitation services.
Group Think
How are teens different from adults?
Self Reflection: On a Scale of 1 to 5
How comfortable are you with a positive disclosure of domestic violence?
Barriersto Identifying and Addressing Domestic Violence
Home visitors identified the following barriers during the implementation phase of a perinatal home visitation program to reduce domestic violence (DV):
1
Comfort levels with initiating conversations with clients about DV
2
Feelings of frustration and stress when working with clients experiencing DV.
3
Concerns about personalsafety when working in homes where DV may escalate.
Barriers Continued
- Home visitors report fearing that clients who divulge DV may suffer greater abuse at the hand of their abuser in retaliation for divulging the secret.
- Barriers to screening include:
- Shame and embarrassment for discussing DV perceived by home visitors and women who experience abuse
- Fear of losing the woman’s and child’s participation in the home visiting program that aims to help them
Relationship Assessment Tool
1
Read the cover sheet about scoring.
2
Discussion of scoring
3
Discuss how to change language for same sex partners.
Exercise: Think about the most difficult home visitation case you have and answer questions for that client.
a
Score your tool.
b
How many of you scored 20 or higher?
c
How do these questions differ from a question like: “Have you been hit, kicked, slapped by a current/former partner?”
Which Screening Tool Is Your Program Using?
- Thoughts about the Relationship Assessment Tool and questions asked?
- Could you use this in combination with a screening tool that looks at physical violence only?
Group Discussion
- Starting and ending conversations about difficult or stigmatizing issues like domestic violence can be challenging during home visits.
- We take care of ourselves by presenting questions and educational messages in a way that feels most comfortable to us.
True Domestic Violence Screening Stories
“No one is hurting you at home, right?” (Partner seated next to client as this is asked)—How do you think that felt to the client?
“Within the last year has he ever hurt you or hit you?” (Nurse with back to you at her computer screen)—Tell me about that interaction…
- “I’m really sorry I have to ask you these questions, it’s a requirement of the program.” (Screening tool in hand)—What wasthe staff communicating to the client?
“She assumed I wasn’t one of those people…”
Who do you find most difficult to ask about domestic violence?
How do your assumptions get in the way of this work?
Add Your Heading Text Here
- Under the Affordable Care Act all home visited moms are to be screened routinely for DV
- Prevalence of DV is 14-52% among HV moms
- State average positive disclosure rate: 4-5%
- Why were moms not telling us what was happening to them?
What t s a Mother 1st Greatest Fear?
“If mandatory reporting was not an issue, she would tell the nurse everything about the abuse…”
- “I say no [when my home visitor asks about abuse] because that’s how you play the game… People are afraid of social services. That’s my biggest fear…”
- “Like I was saying about my friend, the reason she don’t [disclose] is because she thinks the nurse is going to call children’s services…she avoids the nurse a lot.”
No matter what your state law actually says about whether or not childhood exposure (no direct physical abuse or neglect to the child) to domestic violence is reportable, clearly it is an issue either way for moms and maybe even for you.
Identification and Assessment of Intimate Partner Violence in Nurse Home Visitation
Results:
- The use ofstructured screening tools at enrollment does not promote disclosure or in-depth exploration of women’s experiences of abuse.
- Women are more likely to discuss experiences of violence when nurses initiate non-structured discussions focused on parenting, safety or healthy relationships.
Show of Hands
How many of you have or know someone who has ever left something out of a medical history or intentionallymisreported information to their health care provider?
Why? What were they worried about?
- Did the way this question was worded matter?
Unpacking: What About Cultural, Religious or Other Barriers?
What is getting in the way for you with your clients?
Is their mother-in-law or other relative always with them?
Partner won’t leave her side?
Deportation concerns?
Barriers and solutions: was there something that was hard that you figured out?
Being Trauma-Informed = Understanding Fear
Group Check In:
- What other things are your clients worried about? Why else might they not want to share information with you?
- How do you make it more comfortable for them?
- What other issues or concerns specific to your population might be important to address that are not reviewed in the slides?
Universal Education and Screening for DV
- To overcome barriers created by mandatory reporting we need to combine universal education with screening for DV.
- Starting with universal education followed by face to-face screening can facilitate conversation.
Group Activity
Take a couple of minutes and read the card carefully.
- How does using the safety card support both staff and clients?
- Pay attention to what stands out for you
SAFETY First
- Never screen for domestic violence in front ofa partner, a friend or family member.
- Never use a family member to interpret domestic violence education or screening tools.
- Never leave domestic violence information around or in a packet of materials without first finding out if it is safe to do so.
Quick Activity
Turn to the person next to you or behind you and give them your card and, in turn, they should give you theirs.
What happens when you give the card to someone?
Review Card and Debrief
What did you notice about the first panel of the card?
What about the size of the card?
Do you think it matters that it unfolds?
Why might this card be useful to a survivor of domestic violence?
