Jun 25, 2010
Rebecca: Thanks so much for taking time to talk with me today about all the great work you are doing at Rose Brooks.Â In fact, we have been so impressed with your work and the direction it is taking with the public health-domestic violence shelter relationship that the Family Violence Prevention Fund staff have started calling your approach to this work the “Rose Brooks Model.” The model refers to your partnership with local residency and family planning programs providing on-site health services at the shelter and the new assessment you are doing for reproductive coercion as part of this program. Can you tell me more about your work?
Sara: Sure. Well, you know the story of how this all started.Â It began when you came to the shelter and started asking women about the intersection between their violent relationships and their reproductive health.Â And there was a woman who asked you if we could do testing for gonorrhea and chlamydia that day.Â You came out and asked our staff if this was something we could do and we said no, not at this time, but we could look into it. From there, we started working with local community clinics to be able to offer pregnancy testing, STI/HIV testing, and other services onsite in the shelter.
Rebecca: Was this hard to get off the ground?
Sara: Not really. We already were working in most of the hospitals in the Kansas City Metro area providing on-site advocacy for victims of violence through our Bridge Program, and we had been working with providers and doing education about the impact of violence on health for many years with many clinics and hospitals. So they knew us, we had established a relationship.Â And we were already providing some services for moms’ and kids on-site.Â This was just a big expansion of what we were already doing.
Rebecca: So tell me about the whole assessment for reproductive coercion. How did this work with the medical folks and the shelter staff?
Sara: I won’t lie; it was harder with the shelter staff. The whole pregnancy thing, considering offering plan B, it didn’t really sit well with all the staff.Â It was outside of their comfort zone-often for ethical beliefs.Â So we didn’t offer it as part of the original work. The providers could offer it and they didn’t have a problem implementing the reproductive coercion assessment tool.
Rebecca: What questions are the providers asking and when are these ‘clinics?’Â How do the shelter clients find out about the clinics?
Sara: We have flyers throughout the shelter and women are told multiple times during their stay that we have a ‘free clinic’ with limited services -like immunizations for kids, ear infection checks, diabetes check, blood pressure check, etc. the last Tuesday of the month. We worked it out an agreement with doctors from Goppert Trinity Family Care Clinic and residence from their program. A doctor and a resident rotate through the shelter on the last Tuesday of the month.Â We are also working on providing an on-call system where they can take phone calls from us during the month and sometimes do drop in visits as needed.Â Our work together has really been wonderful. We also brought in additional free local community clinic on the same last Tuesday, so we could provide STI/HIV testing. It’s funny, when we started training the providers in both of these settings, they were shocked, just like I was about the number of women that said “yes” to our questions and that this was a significant issue for women that they were seeing.Â When Goppert Trinity doctors would get someone who needed a pregnancy test, we would have that available for them.Â If they were providing services to an individual that had concerns with STI or HIV testing, they sent them to our partnering clinics who are working there right alongside of them.Â And if the community clinic had someone who needs something they can’t take care of, they send them over to the doctors-it works really well.Â Â We also work with another local clinic on the third Wednesday of each month to provide on-site services for diabetes and cholesterol checks.Â They will also make appointments with women who are in need of mammograms, pap smears, and breast exams. The clinic will provide transportation so the women can attend their appointment.
Rebecca: So no one at shelter has to know the reason for visit-women could be asking for a pregnancy test or a blood pressure check and no one would know?
Sara: Exactly. It kind of ‘normalizes’ everything. I also wanted to mention that the therapist also asks their clients the same reproduction coercion questions. Most women stay in shelter 90-180 days so between the therapist on-site and the free clinic-I would say most if not all women are screened for reproductive coercion and are referred to the on-site clinic or other local clinics if they need something like an IUD or Implanon, you know,Â a method that their partner won’t know about. Also, we have a MOU with the pharmacy and they deliver medications that the doctors may order for women or for current medication they may already have and that really helps.
Rebecca: So you told me about what is happening with screening in the shelter and with the therapist. What happens when women first come to shelter? Are folks using this as an opportunity to screen for unwanted sex/birth control sabotage and offering emergency contraceptives (EC)?
Sara: You know, I mentioned it has been harder to implement with shelter staff.Â We need more time to provide education to shelter staff on reproductive coercion, how screening questions will help support a woman in her decisions, and the options including EC that are available to her.Â At this point we consider it to be a medical intervention, best handled by the medical staff.Â I haven’t really been thinking about this part as much since I coordinated the Bridge Programs within the hospitals. But let me make some calls and see about this after the interview.
Rebecca: That would be great.Â Thanks. So give me your final thoughts on how do you think this change has effected women in your shelter?
Sara: Once we became aware of it (repro coercion), it just made sense to change the questions we were asking clients. For our women in shelter, having access to medical services in a safe way without looking over their shoulder–it is part of rebuilding and taking control back. What do these medical resources mean to these women? They are priceless.
Rebecca: Thank you so much for this amazing work, Sara.
Author’s note: Twenty minutes after we finished this interview, Sara called back to say that Management had agreed to incorporate the screening questions into the initial shelter intake and to ask new residents whether they wanted information about EC.Â Management felt very strongly that it was time and staff seem to be on board with this intervention being part of helping women regain control in their lives.Â Â We will education staff through trainings on reproductive coercion and options such as EC.