I'VE BEEN CONSULTING FOR MANY. AND I HAVE HAD THE OPPORTUNITY TO WORK WITH PERINATAL CASE MANAGEMENT PROGRAMS, HOME VISITATION PROGRAMS ALL ACROSS THE COUNTRY, I'VE BEEN IN EVERY ONE OF YOUR STATES EXCEPT DELAWARE, DELAWARE, I'D LOVE TO COME AND VISIT WITH YOU. THIS IS THE THIRD EDITION OF HEALTHY MOMS HAPPY BABIES. WE'VE BEEN LEARNING FROM YOU AND MAKING MODIFICATIONS TO THE CURRICULUM BASED ON WHAT YOU NEED. IF YOU DID NOT JOIN US FOR THE FIRST PART OF HEALTHY MOMS HAPPY BABIES, THAT WHOLE PORTION WAS DEDICATED TO SUPPORTING STAFF AND DEVELOPING A TRAUMA-INFORMED ORGANIZATIONAL PRACTICE AND ALSO REALLY SUPPORTING YOU AND DOING WORK WITH HOME VISITS IN THE EVENT OF A DISCLOSURE OR IN THE EVENT -- IF YOU HAVEN'T HAD A CHANCE TO LISTEN TO THAT WEBINAR, I WOULD RECOMMEND YOU DO. AND WE'RE GOING TO MOVE ON HERE IN THESE SLIDES. TODAY WE'RE GOING TO BE FOCUSING ON REALLY LOOKING AT THE IMPACT OF DOMESTIC VIOLENCE ON PERINATAL HEALTH, AND IMPORTANT STRATEGIES. SO IF YOU'RE -- THERE'S ONE COMMENT. >> SORRY TO INTERRUPT. IN THE CHAT BOX IF YOU PLEASE MAKE SURE WHEN YOU SEE WHO IT'S GOING TO AT THE BOTTOM OF THE CHAT BOX, YOU WANT TO MAKE SURE IT'S GOING TO ALL PANELISTS AND ATTENDEES, BECAUSE IT LOOKS LIKE SO FAR MANY COMMENTS HAVE BEEN GOING TO ALL PANELISTS, WHICH MEANS NOT ALL THE ATTENDEES ARE ABLE TO SEE IT. SO IF YOU GO TO THE VERY BOTTOM OF THE CHAT BOX, WHERE IT SAYS "TO" AND YOU'LL SEE A DROP-DOWN YOU SHOULD HAVE THE OPTION TO CHECK "ALL PANELISTS AND ATTENDEES." PLEASE SELECT THAT. >> SO EVERYONE CAN SEE WHAT YOU'RE SAYING. >> YES. >> BECAUSE WE'RE GOING TO BE ASKING QUESTIONS. >> YES. >> WE'RE GOING TO TALK A ALSO BIT ABOUT THE LIMITS OF DISCLOSURE DURING PRACTICE TODAY. ESPECIALLY FOR MARGINALIZED COMMUNITIES AND IF THAT DOESN'T MAKE SENSE I PROMISE BY THE END OF THE WEBINAR, IT WILL. WE'RE GOING TO TALK ABOUT I THINK A REALLY INNOVATIVE -- FOR SOME OF THE BARRIERS THAT EXIST FOR MANY OF YOU IN THE CONVERSATIONS YOU'RE HAVING OR IN THE SCREENING YOU'RE DOING WITH THE CLIENTS THAT YOU SERVE. BECAUSE I THINK THERE'S LIMITATIONS THERE. LET'S TALK A ALSO BIT ABOUT DEFINITIONS AND PREVALENCE, BUT BEFORE WE DO THAT, THIS IS MY FIRST QUESTION. THIS IS WHERE YOU GET A CHANCE TO USE THE ALL PANELIST AND ATTENDEES BOX. WHY IS IT IMPORTANT FOR YOU TO KNOW ABOUT DOMESTIC VIOLENCE? WHAT COMES UP FOR YOU AS YOU THINK ABOUT THAT QUESTION? WHY IS IT IMPORTANT FOR YOU TO KNOW ABOUT DOMESTIC VIOLENCE? HEALTHY MOMS HAPPY BABIES THIS IS NEW FOR US. NOW THAT I DON'T SEE ANYBODY CHATTING I'M WORRIED SOMETHING HAPPENED. TO GIVE OUR FAMILIES THE HELP THEY NEED. GREAT. IF WE GO TO THE NEXT SHIED, ESSENTIALLY THE REASON THIS IS IMPORTANT, I CAN SHOW YOU DATA THAT'S CONNECTED TO EVERY SINGLE GOAL YOU HAVE IN YOUR CASE MANAGEMENT PROGRAM DURING HOME VISITATION PROGRAM. I CAN SHOW YOU HOW -- ECONOMIC READINESS, SO KEEP YOURSELF SAFE WE'RE GOING TO TALK ABOUT THAT AS WELL. IS REALLY CONNECTED TO EVERY GOAL THAT YOU HAVE, SO IF YOU'RE NOT ADDRESSING IT, WE'RE REALLY UNFORTUNATELY NOT DOING AS MUCH AS WE NEED TO SUPPORT THE WHOLE PERSON OR THE WHOLE FAMILY UNIT. I THINK -- THIS IS WHERE MY FRIENDS WHO ARE ON THE CALL TODAY WHO ARE ON THE WEBINAR WHO ARE NURSE FAMILY PARTNERSHIP FRIENDS, IT'S AN IMPORTANT CONNECTION FOR US AS TEACHERS, BECAUSE I THINK WE'VE LEARNED A LOT FROM YOUR RESEARCH. THIS IS ONE OF THE THINGS THAT HELPED FUTURES LEARN THAT WE NEED TO THINK DEEPLY ABOUT HOW TO SUPPORT PEOPLE IN HOME VISITATION. AND THIS SLIDE HERE, THE EFFECTIVENESS OF HOME VISITATION SERVICES IN PREVENTING CHILD ABUSE IS DIMINISHED AND MIGHT EVEN DISAPPEAR. SO ALL THE GOOD WORK YOU'RE DOING MIGHT DISAPPEAR IF MOM IS BEING HURT BY HER PARTNER. I'M GOING TO SAY MOMS A LOT, WE KNOW DADS CAN ALSO BE AFFECTED, BUT I'M GOING TO BE FOCUSING ON MOMS HERE IN PART BECAUSE THESE PROGRAMS ARE PRIMARILY LOOKING AT MOMS AS THE PRIMARY CAREGIVER. ONE OF YOU MENTIONED IN THE CHAT BOX THAT YOU HAVE CONCERNS ABOUT YOURSELF AND WHAT DO YOU NEED TO KNOW TO BE SAFE? AND IF YOU DO NOT CURRENTLY HAVE A PROTOCOL IN YOUR PROGRAM, I WANT TO SAY WE HAVE A TOOL FOR YOU, WE'LL BE SENDING IT AFTER THE WEBINAR, I WANT TO THANK OR FRIENDS IN VERMONT WHO WE BORROWED THEIR GREAT THINKING AND WE'VE ADDED IN ADDITIONAL THINKING, DEPENDING ON WHERE YOU ARE, WHETHER YOU'RE RURAL, WHETHER YOU'RE URBAN, WHETHER IT'S A PLACE THAT'S SNOWY SO I WANT YOU TO BE THINKING ABOUT BEING ABLE TO SLIP YOUR BOOTS ON AND OFF QUICKLY, NOT HAVE TO UNLACE ANYTHING IF YOU NEED TO GET OUT OF THE HOUSE QUICKLY. WE HAVE A TOOL FOR YOU, AND EVEN IF MY SUPERVISOR FRIENDS ON THE PHONE, IF YOU ALREADY HAVE A PROTOCOL, IT'S WORTH LOOKING AT THIS BECAUSE IN MY EXPERIENCE, AGAIN, HAVING BEEN IN ALL OF YOUR STATES EXCEPT DELAWARE MANY TIMES OVER IN MANY CASES, TYPICALLY THERE ARE THINGS THAT ARE NOT THOUGHT OF. SO I WANT TO MENTION THIS IS A RESOURCE FOR YOU. SO WHAT IS INTIMATE PARTNER VIOLENCE? THE BIG PIECE FOR ME IS IT'S NOT A ONE-OFF. THIS IS THE POWER AND CONTROL THAT SHOWS UP IN A RELATIONSHIP OVER AND OVER AND OVER AGAIN. AND IT MIGHT BE CONNECTED TO ECONOMICS, IT MIGHT BE CONNECTED TO MENTAL HEALTH, WE'LL GIVE YOU EXAMPLES OF THOSE. BUT IT'S NOT NECESSARILY PHYSICAL VIOLENCE. AND WE'RE GOING TO -- I'LL MENTION THIS AGAIN TOO, BUT LEAVING THE RELATIONSHIP IS NOT ALWAYS THE BEST, SAFEST OPTION. WE KNOW THIS IS A HUGE PROBLEM. ONE IN FOUR WOMEN IN THE U.S. WILL EXPERIENCE INTIMATE PARTNER VIOLENCE IN HER LIFETIME. I WANT TO GIVE YOU MORE CURRENT DATA, SPECIFICALLY LOOKING AT HOME VISITATION. 17% REPORTED PAST-YEAR PHYSICAL OR PSYCH LODGE CALL INTIMATE PARTNER VIOLENCE. THESE ARE I BELIEVE -- AND DEPENDING UPON WHICH GROUP OF FOLKS WE'RE LOOKING AT, WE MIGHT SEE HIGHER RATES. DEPENDING ON WHO -- IF YOU'RE WORKING WITH LOW-INCOME SINGLE MOMS, WE SEE UP TO 30% OF THOSE WOMEN EXPERIENCING IPV DURING THEIR PERINATAL PERIOD, AND IN RURAL SETTINGS IT MAY BE AS HIGH AS 50%. SO I THINK THAT'S IMPORTANT AND IT'S IMPORTANT FOR THIS NEXT SLIDE BECAUSE I'M USING IT AS A WAY TO ILLUSTRATE HOW TO THINK ABOUT YOUR DATA RELATIVE TO THE NUMBERS I JUST SHOWED YOU. AND SO THIS IS DATA FROM ILLINOIS. YOU CAN SEE IN 2017 THEY ARE REQUIRED TO SCREEN FOLKS FOR INTIMATE PARTNER VIOLENCE WITHIN SIX MONTHS OF ENROLLING. 2017, THEY DID PRETTY WELL. ALMOST 80% OF MOMS WERE SCREENED WITHIN THAT FIRST SIX MONTHS. IN 2018, 93% WERE SCREENED WITHIN THE FIRST SIX MONTHS. BUT WHAT'S REALLY INTERESTING IS THE DISCLOSURE RATE BOX. WE SEE IN 2017 THERE'S A 2% DISCLOSURE RATE, AND IN 2018, THERE'S A 4% DISCLOSURE RATE. TELL ME WHAT COMES UP FOR YOU AS YOU THINK ABOUT THIS DATA RELATIVE TO WHAT YOU JUST LEARNED ABOUT PREVALENCE. YOU CAN FLIP IT BACK SO THEY CAN SEE. 17%, 30, AND 50. WHAT ARE YOU SEEING? THE PERCENTAGES ARE ACTUALLY HIGHER. RELUCTANCE TO DISCLOSE. THANK YOU, RUTH. TRUST BETWEEN PROVIDER AND CLIENT. BEAUTIFUL. BECAUSE THAT'S -- THAT'S THE UNDERPIPING OF WHY. WHAT YOU'RE SEEING HERE IS THIS HUGE GAP, WHETHER WE'RE TALKING ABOUT 17%, 30%, OR 50%, DEPENDING UPON WHERE YOU ARE IN ILLINOIS, IF WE'RE GOING TO APPLY THAT THINKING, IT'S SORT OF WHERE FOLKS LIVE GEOGRAPHICALLY, AND IF THEY'RE SINGLE MOMS THERE'S A VERY LOW DISCLOSURE RATE AMONG HOME VISITED MOMS. AND ONE OF THE THINGS I REALLY WANT TO ALSO UNDERSCORE IS THAT WE'VE BEEN THINKING AT FUTURES A LOT ABOUT HEALTH DISPARITIES, HEALTH EQUITY, HOW IT SHOWS UP IN DIFFERENT CIRCUMSTANCES BUT PARTICULARLY FOR THE MOST MARGINALIZED GROUP. AND I ALSO THINK IT'S IMPORTANT TO LOOK AT IT AS A DISPARITY ISSUE. WE KNOW WOMEN OF COLOR ARE AT SIGNIFICANTLY HIGHER RISK FOR DOMESTIC VIOLENCE. BUT I THINK THE NEXT SLIDE IS SO, SO IMPORTANT FOR EVERYONE'S THINKING, BECAUSE WHEN WE CONTROL FOR MONEY, EDUCATION, EMPLOYMENT, THE DIFFERENCES ATTRIBUTABLE TO RACE FOR DOMESTIC VIOLENCE DECREASE OR DISAPPEAR. MEANING, IF WE WERE TO FIX THE POVERTY ISSUE, WE WOULD BE ABLE TO SEE NUMBERS THAT LOOKED VERY SIMILAR FOR WOMEN OF COLOR AND WHITE WOMEN VERSUS THIS HUGE DISPARITY WHICH HAS EVERYTHING TO DO WITH ECONOMIC DIFFERENCES. SO QUICKLY IN THE CHAT BOX, WHY WOULD A PERSON STAY IN A RELATIONSHIP ONCE INTIMATE PARTNER VIOLENCE OCCURRED? WHY DO PEOPLE STAY? FEAR OF FINANCIAL -- FEAR, LACK OF RESOURCES, STUCK, ECONOMIC CONFUSION, NOWHERE ELSE TO GO, MONEY, CHILDREN. I HAVEN'T SEEN RELIGION. BUT THAT'S CERTAINLY ANOTHER REASON. I HOPE, RIGHT, HOPE A REALLY GOOD REASON TO STAY IN A RELATIONSHIP, CULTURE. IF I DON'T STAY WITH MY PARTNER, THEN I'M GOING TO LOSE EVERYBODY IN MY COMMUNITY. CODEPENDENCY, STIGMA. BEAUTIFUL. YOU ALL HAVE THAT COMPLEXITY. PART OF THE REASON I'M ASKING THIS QUESTION IS BECAUSE I WANT YOU TO HOLD ON TO THE COMPLEXITY ABOUT WHY DO FOLKS STAY, BECAUSE WHAT WE'RE HOPING TO DO IS HAVE YOU AS HOME VISITORS OR CASE MANAGERS REALLY BE SITTING IN THE PERSON'S SHOES THAT YOU'RE WORKING WITH AND REMEMBER HOW COMPLEX IT IS BASED ON WHAT YOU'RE DOING IN THE CHAT BOX RIGHT HERE. SO I REALLY APPRECIATE YOU ALL SHARING WITH EACH OTHER. I APPRECIATE -- NEXT SLIDE. AND I WILL SAY TO YOU I MENTIONED THIS EARLIER, THIS IS ONE OF THE THINGS I REALLY LEARNED FROM ALL THESE YEARS OF DOING TRAINING FOR HOME VISITORS AND CASE MANAGERS, I HAVE -- I REALLY BELIEVE A LOT OF YOU LIKE ME A LOT OF US ARE DOING THIS WORK BECAUSE WE WANT TO FIX THINGS, WE WANT TO HELP, MAKE IT BETTER. THAT'S PART OF WHY WE'RE DOING THIS WORK. I THINK IT'S REALLY OFTEN A PROBLEM WHEN IT COMES TO INTIMATE PARTNER VIOLENCE BECAUSE SOMETIMES PEOPLE THINK, THE WAY TO FIX IT IS TO GET SOMEONE TO LEAVE. THAT JUST ISN'T THE CASE. IF YOU WERE TO LEAVE THIS WEBINAR WITH ONE THING AND ONE THING ONLY, A RELATIONSHIP CAN -- LEAVING THE RELATIONSHIP CAN NEVER BE THE GOAL OF WHAT YOU'RE DOING. LEAVING COMES WITH THE HIGHEST LIKELIHOOD FOR HOMICIDE, OR ACUTE VICTIMIZATION AND STAYING MIGHT BE THE SAFEST CHOICE. I APPRECIATE THE LAST TWO QUOTES FROM MY COLLEAGUE KATE. I THINK WE NEED TO MOVE AWAY, AND SHE THINKS WE NEED TO MOVE AWAY FROM ASKING, WHY HASN'T THE SURVIVOR LEFT? SO ASKING, WHAT CAN I DO TO SUPPORT THIS MOM WITH WHAT SHE NEEDS? I WANT TO TALK BRIEFLY ABOUT THE HEALTH IMPACT OF DOMESTIC VIOLENCE. WE'RE GOING TO GO TO THAT NEXT SLIDE AND I'M GOING TO ASK YOU TO THINK WITH ME, HOW DOES DOMESTIC VIOLENCE IMPACT WOMEN'S PERINATAL HEALTH? I'M GOING TO GIVE YOU THE CHAT BOX. YOU CERTAINLY HAVE SEEN SOME CONNECTIONS I'M SURE WITH YOUR OWN MOMS AND PROGRAMS. WHAT KINDS OF THINGS COME UP? HOW DOES IT IMPACT PERINATAL HEALTH AND BIRTH OUTCOMES? WHAT DO YOU SEE? STRESS. HIGH STRESS, NEGATIVE OUTCOMES, DEPRESSION, MENTAL HEALTH ISSUES, GOOD. APPOINTMENTS CONTROLLED BY THE PARTNER. BEAUTIFUL. MOOD DISORDERS, ISOLATION. PERFECT. LACK OF PERSONAL FEAR. ACCESS TO PRENATAL CARE. BEAUTIFUL. PREGNANCY COMPLICATIONS, FORCED TO CONTINUE DRUG USE, DEPRESSION. BEAUTIFUL. WE'RE GOING TO GO INTO THE NEXT SLIDE. ONE OF THE THINGS I DID NOT SEE, I CAN'T ALWAYS SEE ALL THE CHAT AS WITH GO FORWARD, BUT I THINK HAD IS A HA MOMENT FOR A LOT OF AUDIENCES. WHEN WE COME INTO THIS SLIDE, BY THE WAY I WOULD RECOMMEND IT'S POSSIBLE TO HAVE -- THIS IS A -- I WOULD RECOMMEND THAT YOU HAVE SOMEONE FROM FUTURES COME OUT TO HELP YOU LAUNCH THIS. WE'VE DONE THIS IN -- ACROSS THE BOARD IN MANY STATES, AND THAT REALLY MAKES A DIFFERENCE. JUST SO YOUR STAFF GET ORIENTED. BUT NOBODY I DON'T THINK MENTIONS HOMICIDE. SO 45% OF PREGNANCY ASSOCIATED SUICIDES -- I THINK AS WE'VE DONE A BETTER JOB WITH LOOKING AT MATERNAL MORTALITY AND BETTER UNDERSTANDING, WE'VE LEARNED SUICIDES ARE ALSO ATTRIBUTABLE TO INTIMATE PARTNER VIOLENCE. I LIKE THIS SLIDE BECAUSE I THINK ONE OF THE THINGS THAT WE SAY TO OURSELVES WHEN WE THINK ABOUT POOR OUTCOMES FOR PREGNANT WOMEN, WE THINK ABOUT PREECLAMPSIA. HEMORRHAGE. OTHER COMPLICATIONS. I APPRECIATE PREGNANCY ASSOCIATED HOMICIDE AND SUICIDE ACCOUNT FOR MORE DEATHS THAN ANY OF THE THINGS WE USUALLY THINK ABOUT AS A TRADITIONAL CAUSE OF MATERNAL MORTALITY. I DON'T THINK THAT'S PART OF THE CONVERSATION THAT'S NECESSARILY HAPPENING, AND I'M HOPING THAT AS A RESULT OF THIS FOLKS WILL BE STARTING TO THINK ABOUT THAT. PLEASE UNDERSTAND ONE OF THE REASONS WE SHOWED YOU THIS DATA IS THAT IF YOU'RE HAVING A CONVERSATION WITH ONE OF YOUR CLIENTS IN YOUR PROGRAM, THERE'S NOTHING WRONG WITH SAYING, HEY, THE REASON WHY WE'RE ASKING YOU ABOUT WHAT'S GOING ON IN YOUR RELATIONSHIP IS BECAUSE OF THIS. SO FEEL FREE TO USE THESE -- AS TOOLS FOR YOURSELF AS WE MOVE FORWARD, AND ANISSA WILL BE SENDING THESE SLIDES TO YOU. YOU ALL MENTIONED BEHAVIORAL HEALTH ISSUES. WE KNOW FOLKS ARE MORE LIKELY TO USE OR CONTINUE TO USE DRUGS AND SMOKE ETC. WHILE PREGNANT IF THEY'RE IN A VIOLENT RELATIONSHIP. AND SOMEONE -- I LOVED IT BECAUSE WHEN I ASKED -- THERE'S A LOT OF WISDOM ON THIS PHONE. WHAT KIND OF OUTCOMES DO YOU SEE, SOMEONE SAID SOMETHING ABOUT A PARTNER FORCING OR PRESSURING HER TO CONTINUE TO USE SUBSTANCES. AND AT THE OUTSET OF THIS TALK TODAY, I TALKED A LITTLE BIT ABOUT HOW VIOLENT -- HOW POWER AND CONTROL SHOWS UP IN RELATIONSHIPS. AND I THINK THIS HOTLINE SURVEY THAT WAS DONE REALLY ILLUSTRATES HOW POWERFUL POWER CONTROL CAN BE. I'M GOING TO SAY THESE WERE WOMEN WHO WEREN'T NECESSARILY PREGNANT AT THE TIME THEY CALLED IN TO THE NATIONAL DOMESTIC VIOLENCE HOTLINE, BUT WHAT IS USEFUL HERE IS THAT YOU CAN SEE HOW POWER AND CONTROL IS SHOWING UP AROUND DRUGS. YOU CAN SEE 26% OF THE WOMEN WHO CALLED IN USED SUBSTANCES TO REDUCE PAIN BECAUSE THEY WERE BEING ABUSED. 27% WERE PRESSURED OR FORCED TO USE ALCOHOL OR OTHER DRUGS. AND THEN 15% TRIED TO GET HELP FOR SUBSTANCE USE, AND 60% SAID PARTNER OR EXPARTNER TRIED TO PREVENT OR DISCOURAGE THEM FROM GETTING HELP. YOU CAN SEE HOW POWER CONTROL IS SHOWING UP HERE IN THIS SLIDE. I DON'T KNOW IF ANYBODY MENTIONED THE IMPACT ON DELIVERIES, BUT WE KNOW PRETERM BIRTH AND LOW BIRTH WEIGHT BABIES ARE SOMETHING THAT CAN HAPPEN IN A VIOLENT RELATIONSHIP. WE ALSO KNOW MOMS ARE MORE LIKELY TO STOP BREASTFEEDING EARLY, AND IT COULD BE BECAUSE THE PARTNER SEES THE BREASTS AS HIS AND NOT THE BABIES, IT COULD BE THAT IT'S REALLY STRESSFUL AND THAT IMPACTS YOUR ABILITY TO PRODUCE MILK, IT ALSO COULD BE THAT IT'S EASIER TO MOVE A BABY TO THE SIGH WITH A BOTTLE. IF YOU HAVE A MOMMY WHO IS NOT CONTINUING TO BREASTFEED OR CONCERNED ABOUT IT, THAT MIGHT BE AN INDICATION YOU SHOULD HAVE A CONVERSATION WITH HER ABOUT WHAT'S GOING ON IN HER RELATIONSHIP. SOMEONE MENTIONED DEPRESSION. AND I THINK ESPECIALLY FOR THOSE MOMMIES WHO HAVE PERSISTENT POSTPARTUM DEPRESSION, WE SEE THAT THEY'RE FIVE TIMES MORE LIKELY TO BE IN THAT ABUSIVE RELATIONSHIP BECAUSE THAT -- SO THAT SHOULD BE A CLINICAL A HA MOMENT ABOUT GEE, I WONDER WHAT ELSE IS GOING ON HERE. YOU ALL MENTIONED MORE LIKELY ISOLATION IS PART OF POWER AND CONTROL, MAYBE ACTS OF CARE AND THE DATA SUPPORTS THAT, NOT BEING ABLE TO INITIATE PRENATAL CARE OR MISSING APPOINTMENTS IS SOMETHING ELSE THAT WOULD BE AN INDICATOR FOR YOU. AND THEN WE KNOW THAT WOMEN WHO ARE IN ABUSIVE RELATIONSHIPS ARE AT AN INCREASED RISK TO HAVE RAPID REPEAT PREGNANCY. AND ONE OF THE OTHER THINGS WE'VE BEEN THINKING A LOT ABOUT IS HOW POWER CONTROL SHOWS UP AROUND REPRODUCTIVE HEALTH. WE SEE HERE IN THE SECOND BULLET A MALE PARTNER'S DESIRE FOR OR AGAINST PREGNANCY MAY OVERPOWER WOMEN'S REPRODUCTIVE DECISIONS, MEANING IF YOU HAVE A PARTNER WHO IS SORT OF VERY TRADITIONAL AND IN A -- IF YOU'RE IN A RELATIONSHIP CHARACTERIZED BY MALE DOMINANCE, WE MIGHT SEE MORE PRESSURE AROUND NOT BEING ABLE TO USE BIRTH CONTROL OR EVEN PRESSURE TO HAVE AN ABORTION IN THOSE CASES. WHAT PERCENTAGE OF YOUR CLIENTS' PREGNANCIES HAVE BEEN UNPLANNED? WHAT WOULD YOU SAY? HOW MANY OF YOUR MOMMIES TELL YOU OR YOUR CLIENTS TELL YOU, 90%, 80%. SO I THINK ACROSS MANY STATES THERE ARE HYPERSAGES. ONE OF THE THINGS WE WANT YOU TO BE THINKING ABOUT IS THIS MISSION, THE NEXT SLIDE, AND THAT'S THIS IDEA OF REPRODUCTIVE AND SEXUAL COERCION. THIS IS WHEN A PARTNER WANTS YOU TO BECOME PREGNANT AS A WAY TO CONTROL YOU. AND IT MAKES SENSE THAT RAPID REPEAT PREGNANCY IS CONNECTED TO THIS AS WELL, BECAUSE IT MAKES IT HARDER TO LEAVE. THE MORE BABIES YOU HAVE, THE HARDER IT IS TO GET OUT OF THAT RELATIONSHIP, THE MORE COMPLICATED IT IS, THE HARDER IT IS TO FINISH YOUR SCHOOLING, THE HARDER IT IS TO DO A LOT OF DIFFERENT THINGS. AND SO A LOT OF FOLKS AREN'T NECESSARILY THINKING ABOUT THIS, AND I'M -- THESE ARE NOT ALL THE SLIDES IN THE HEALTHY MOMS HAPPY BABIES CURRICULA, IT WAS VERY PAINFUL TO LET SOME OF THEM GO FOR TODAY'S WEBINAR, BUT I DID WANT TO MENTION THIS, AND THERE'S A LOT MORE PIECES THERE, I'M GOING TO TALK ABOUT REPRODUCTIVE COERCION VERY QUICKLY. THERE'S CERTAINLY MORE INFORMATION IN THE CURRICULA. AND I LIKE THIS, I'M JUST GOING TO READ IT BECAUSE I THINK IT SHOWS HOW POWER AND CONTROL IS SHOWING UP. THIS IS A 17-YEAR-OLD, THE FIRST COUPLE TIMES THE CONDOM SEEMS TO BREAK EVERY TIME. YOU KNOW WHAT I MEAN? THAT WAS JUST FUNNY, LIKE THE FIRST SIX TIMES THE CONDOM BROKE. SIX CONDOMS, THAT'S KIND OF RARE. I CAN UNDERSTAND ONE, BUT SIX TIMES, AND AFTER THAT WHEN I GOT ON THE BIRTH CONTROL, HE WAS ALWAYS SAYING, YOU SHOULD HAVE MY BABY, YOU SHOULD HAVE MY DAUGHTER, YOU SHOULD HAVE MY KID. IF WE WERE LIVE TOGETHER I WOULD SAY SO DID THE CONDOM BREAK SIX TIMES? THE WISDOM OF THE AUDIENCE WOULD BE, NO. I THINK THIS IS SHOWING UP, IT'S NOT NAMED, IT'S NOT SOMETHING THAT PEOPLE NECESSARILY ARE THINKING ABOUT, BUT I KNOW YOU ALL ARE INTERESTED IN SUPPORTING MOMS AND PREGNANCIES -- I CERTAINLY HEAR ABOUT CELEBRITIES WHO HAVE EXPERIENCES LIKE THIS. HE THREW AWAY THE BIRTH CONTROL PILLS, IT'S SO ROMANTIC. EXCEPT NO THE SO MUCH IF YOU DON'T WANT TO BE PREGNANT. WE'VE HEARD ABOUT IDEAS BEING PULLED OUT, YOU NAME IT, WE'VE HEARD ABOUT IT. JUST FEAR ABOUT EVEN GETTING ON BIRTH CONTROL, OR TALKING TO THE PROVIDER ABOUT BIRTH CONTROL. IS THAT SOMETHING THAT WOULD POTENTIAL -- YOU CAN SEE THIS SHOWING UP IN DIFFERENT KINDS OF WAYS. I THINK THE ONE THING I WANT TO MENTION TO ALL OF YOU IS THAT AROUND SORT OF HOW POWER CONTROL SHOWS UP, IF YOU'VE GOT A PARTNER TRYING TO GET YOU PREGNANT WHEN YOU DON'T WANT TO BE, THEY'RE MONITORING WHEN YOU GET YOUR PERIOD. INITIALLY WHEN WE WERE DOING OUR WORK AROUND REPRODUCTIVE COERCION WE SAID, WELL, WHAT ARE THE METHODS THAT ARE HARDER FOR HIM TO EFFECT? DEPO-PROVERA MIGHT BE A GOOD EXTREME, BECAUSE HE CAN'T NECESSARILY FEEL IT OR SEE IT, BUT THE PROBLEM WITH THOSE MEDS ADDS IS IT CHANGES YOUR BLEEDING PATTERN. SOMETIMES YOUR PERIOD CAN GO AWAY, SOMETIMES YOU HAVE BE ODD SPOTTING, ETC. THE ONLY METHOD OF CONTRACEPTION THAT WE SORT OF FEEL LIKE REALLY COULD HELP SOMEBODY IN THIS PREDICAMENT OF A PARTNER TRYING TO GET YOU PREGNANT AND NOT FEELING LIKE IT'S SAFE TO LEAVE THE RELATIONSHIP OR NOT WANTING TO LEAVE THE RELATIONSHIP, IS REALLY THINKING ABOUT THE COPPER T/IUD. BECAUSE YOU GET YOUR PERIOD AT THE SAME TIME EVERY MONTH, AND WHAT WE WORKED WITH PROVIDERS TO DO IS TO BE TRAINED TO CUT OUT THE STRINGS ON THE END SO THE PARTNER COULDN'T FEEL IT TO PULL IT OUT. IT'S A VERY SAFE METHOD OF BIRTH CONTROL, IT'S GOOD FOR 12 YEARS AND IT'S POTENTIALLY LIFE-CHANGING FOR SOMEONE WHO IS IN THIS KIND OF SITUATION. AND AGAIN, I'M JUST GLOSSING OVER THIS INTERVENTION, THERE'S MORE INFORMATION ON THE SAFETY CARD, HEALTHY MOMS HAPPY BABIES THAT WE'LL SEND TO YOU. THERE'S INFORMATION ON PLAN B THERE, BUT I WANTED TO GIVE YOU A LITTLE BIT OF AN IDEA OF WHAT THE HARM REDUCTION STRATEGY IS, BECAUSE I KNOW A LOT OF FOLKS WHO DO HOME VISITATION OF PERINATAL CASE MANAGEMENT AREN'T FAMILIAR WITH THIS PARTICULAR INTERVENTION. SO I WANT TO MAKE SURE YOU HAVE THAT IN YOUR POCKET WHEN YOU LEAVE THE WEBINAR TODAY. I LOVE THIS PICTURE SO MUCH. I LOVE IT BECAUSE I THINK THAT LITTLE GIRL, SHE'S LEARNING THE BEST SECRET IN THE WORLD FROM THE OTHER LITTLE GIRL, AND THAT'S HOW WE FEEL ABOUT CUES. SO I'M HOPING THAT YOU ARE EQUALLY EXCITED AND INSPIRED BY THE END OF THIS WEBINAR. ONE OF THE THINGS WE REALLY FEEL LIKE THIS IS HOME VISITOR CENTRIC OR PERINATAL CASE MANAGER CENTRIC CURRICULA BECAUSE WE'VE BEEN NOT ONLY LOOKING AT THE DATA BUT ALSO LOOKING TO YOUR EXPERIENCES AND MAKING MODIFICATIONS. IT'S ALMOST BEEN 10 YEARS NOW SINCE THE INITIAL HEALTHY MOMS HAPPY BABIES WAS LAUNCHED. SO WE KNOW IT'S HARD FOR YOU ALL TO START CONVERSATIONS, WE KNOW IT CAN -- SCREENING CAN BE FRUSTRATING. WE ALSO KNOW AS I TALKED ABOUT A LOT IN THE LAST WEBINAR, IF YOU DIDN'T GET A CHANCE TO HEAR IT, IT MIGHT BE HELPFUL FOR YOU, HOW VICARIOUS TRAUMA OR PERSONAL TRAUMA MIGHT REALLY AFFECT WHAT IS HAPPENING. IN TERMS OF HOW COMFORTABLE YOU ARE HAVING THESE CONVERSATIONS OR HOW COMFORTABLE YOU ARE WITH YOUR DISCLOSURE. SO OUR STRATEGY AROUND CUES IS TO ADDRESS MANY OF THESE THINGS. WE ALSO KNOW YOU'RE INCREDIBLY IMPORTANT TO SURVIVORS. WHEN WOMEN TALK TO HEALTH CARE PROVIDERS AND I INCLUDE HOME VISITORS AND CASE MANAGERS, AND HEALTH CARE, THEY'RE MORE LIKELY TO GET HELP, OR A LITTLE BIT OF SUPPORT, SO THAT MAKES A DIFFERENCE TOO. WHAT I'M GOING TO ASK YOU TO DO COLLECTIVELY, THERE'S -- I DON'T KNOW HOW MANY OF YOU ARE ON THE PHONE AT THIS POINT, BUT JUST TAKE A SECOND AND CLOSE YOUR EYES AND THINK ABOUT YOUR COMFORT LEVEL WITH HEARING A DISCLOSURE OF DOMESTIC VIOLENCE. ARE YOU IN THE BLUE? DO YOU KNOW WHAT TO DO, DO YOU KNOW WHAT TO SAY, DO YOU KNOW WHERE TO GO, WHERE TO REFER? YOU GOT THIS, YOU'RE TOTALLY COMFORTABLE WITH IT? ARE YOU IN THE YELLOW AREA, YOU SORT OF KNOW WHAT TO DO, OR ARE YOU IN THE FIVE, VERY UNCOMFORTABLE? PLEASE, PLEASE DON'T SAY THAT'S A PROBLEM FOR YOU. BECAUSE I'M SCARED TO DEATH OF HEARING A YES. I'M NOT GOING TO ASK YOU TO SHARE THAT PUBLICLY, BUT I AM GOING TO ASK YOU TO PINPOINT IT RIGHT NOW FOR YOURSELF, BECAUSE I'M GOING TO ASK AT THE END AND I WANT TO SEE IF THE NEEDLE HAS CHANGED. I LOVE THAT SOME OF YOU ARE VERY COMFORTABLE. GREAT. FOR ANYBODY WHO IS NOT, AND ISN'T GOING TO WRITE VERY UNCOMFORTABLE, I WANT YOU TO KNOW WE GOT YOU AND HOPEFULLY WE'RE GOING TO GIVE YOU STRATEGIES TO FEEL MORE COMFORTABLE. I'M GOING TO ASK YOU THE QUESTION I'M GOING TO ASK YOU TO TYPE IN THE CHAT BOX RELATIVE TO THIS. HOW MANY OF YOU HAVE PERSONALLY OR KNOW SOMEONE WHO HAS EVER LOVED LEFT SOMETHING OUT OF A MEDICAL HISTORY ON PURPOSE, OR MISREPORTED INFORMATION TO THEIR HEALTH CARE PROVIDER? MY REAL QUESTION IS WHAT WERE THEY WORRIED ABOUT? BEING JUDGED. WHAT ELSE WERE THEY WORRIED ABOUT? PRIVACY. WHAT ELSE ARE THEY WORRIED ABOUT? WHY AREN'T PEOPLE TELLING US THEIR STORIES. JUDGMENT. WORRIED ABOUT REPORTING. WHAT ELSE? I KNOW SOMEONE. WHY WERE THEY AFRAID TO SAY WHAT WAS GOING ON? WHAT DO YOU THINK? PRIVACY, JUDGMENT, WHY DON'T PEOPLE TELL US HAVING THEIR CHILDREN TAKEN AWAY, BEAUTIFUL. CONSEQUENCES COULD HAPPEN, PRESSURE TO CHANGE. FEAR OF MORE HARM, BEAUTIFUL. SO AGAIN, I PRESSURED YOU ALL AS AN AUDIENCE ON THE WEBINAR TO SHARE YOUR EMBARRASSMENTS, FEAR OF CONSEQUENCES, BECAUSE YOU COME UP WITH BEAUTIFUL LIST, FAMILY MATTERS, WHICH MEANS CULTURALLY MAYBE WE DON'T TALK ABOUT OUR STUFF. RIGHT? SO I AM HOPING YOU WILL ALL REMEMBER WHAT THE WISDOM OF THIS CHAT BOX, BECAUSE I THINK THIS IS REAL FOR THE FOLKS THAT YOU SERVE. AND THE SAME WAY IT'S REAL FOR US. AND ONE OF THE THINGS I HAVE BEEN THINKING A LOT ABOUT RELATIVE TO HEALTHY MOMS HAPPY BABIES IS THAT WHEN WE STARTED THIS WORK MANY YEARS AGO, I WOULD DO A TRAINING AND I WOULD TEACH YOU HOW TO WORK WITH THOSE PEOPLE OVER THERE. AND I SAY -- I JUST HAZED MYSELF FOR HAVING DONE IT THAT WAY. AND I THINK PART OF WHAT WE'RE TRYING TO DO IS UNDO SOME OF THAT. BUT JUST LIKE EACH OF US MIGHT HAVE GOOD REASONS, WE DON'T TALK TO OUR HEALTH CARE PROVIDERS OR OUR SISTER DOESN'T TALK TO THEIR HEALTH CARE PROVIDER, OR WE MISINFORMED OUR HEALTH CARE PROVIDER BECAUSE OF FEELING VULNERABLE OR ASHAMED OR WHATEVER, OUR CLIENTS DO THE SAME THING. SO PART OF OUR QUESTION TO OURSELVES IS, HOW DO WE MAKE IT SAFER FOR THEM? HOW DO WE HELP THEM SEE -- FEEL SEEN BECAUSE WE HAVE MORE POWER OVER THEM, BECAUSE WE'RE THE HEALTH CARE PROVIDER? AND WHAT CAN WE CHANGE ABOUT MAKING THINGS SAFER, ESPECIALLY AROUND SOMETHING AS IMPORTANT AS INTIMATE PARTNER VIOLENCE? THE CASE WAS MADE ABOUT WHY THAT WAS SO IMPORTANT AT THE BEGINNING OF THE WEBINAR. YOU CAME TO THIS, SO WHAT'S A MOM'S GREATEST FEAR? WHAT DO WE KNOW -- THE MOMS IN YOUR PROGRAMS ARE AFRAID OF? WE KNOW THEY'RE WORRIED ABOUT HAVING THEIR KIDS TAKEN AWAY. SUPPORT STAFF, IF MANDATORY REPORTING WAS NOT AN ISSUE SHE WOULD TELL THE NURSE EVERYTHING ABOUT THE ABUSE. THIS IS QUALITATIVE DATA. I SAY NO WHEN MY HOME VISITOR ASKS ABOUT ABUSE BECAUSE THAT'S HOW YOU PLAY THE GAME. PEOPLE ARE AFRAID OF SOCIAL SERVICES. LET'S THINK ABOUT THE POPULATION WE'RE SERVING HERE. WE'RE SERVING THE POOREST OF THE POOR IN YOUR STATES, OFTEN DISPROPORTIONATELY FOLKS OF COLOR. AND THERE'S A LONG-STANDING HISTORY OF CHILD WELFARE INVOLVEMENT, SYSTEM INVOLVEMENT, AND A LOT OF FEAR ASSOCIATED WITH THAT. SO WHO DO WE CHANGE THE THEME? AND I THINK THE OTHER THING WE'VE REALLY LEARNED FROM THIS PARTNERSHIP, AND ALSO FOR ANY OF YOU DOING THIS WORK ON THE GROUND, YOU KNOW THIS, YOU'RE THE ONES THAT TOLD US THIS, THAT IT FEELS YUCKY TO SCREEN SOMEBODY. SO I WANT YOU TO THINK ABOUT THIS FOR A SECOND. IF I WERE TO COME TO YOUR HOUSE AND HAVE LUNCH WITH YOU TODAY, YOU'RE GOING TO MAKE ME A SANDWICH OF SOME SORT. MAYBE IT'S A HUMMUS SANDWICH, A TURKEY SANDWICH, MAYBE IT HAS SWEET TEA, MAYBE AIL HAVE LEMONADE. AND WE'RE SITTING AND I'M ADMIRING HOW YUMMY THE SANDWICH IS AND WE'RE TALKING ABOUT YOUR LIFE AND YOUR KIDS, AND I CAN'T IMAGINE SAYING TO YOU WHILE WE'RE HAVING LUNCH, GEE, HAS BILL HIT, KICKED, SLAPPED, OR CHOKED YOU IN THE LAST YEAR? BECAUSE THAT'S NOT WHAT I WOULD EVER SAY TO YOU. AND I THINK ONE OF THE THINGS WE'RE LEARNING, AND THAT'S WHAT THIS SLIDE IS ALL ABOUT, IS STRUCTURED SCREENING TOOLS AND ENROLLMENT DOESN'T PROMOTE DISCLOSURE OR EXPLORATION OF A WOMAN'S EXPERIENCES OF ABUSE BECAUSE SORT OF LIKE ME SITTING DOWN AT YOUR LUNCH TABLE AND ASKING YOU A QUESTION THAT WAY. AND IT MAKES BULLET POINT MAKES SENSE. WOMEN ARE MORE LIKELY TO DISCUSS VIOLENCE WHEN THE NURSE INITIATES NONSTRUCTURED DISCUSSION, WHEN THEY ACTUALLY TALK TO THEM, FOCUSING ON PARENTING OR SAFETY, OR HOW IS IT GOING, RIGHT, WE'RE MORE LIKELY TO TALK WHEN WE FEEL SAFE. AND WHEN OUR BACKS AREN'T UP AGAINST THE WALL. WHAT WE'RE REALLY ASKING THE FIELD TO THINK ABOUT IS THIS NOTION OF A BRAVE SPACE. IF YOU THINK ABOUT A BRAVE SPACE, WHAT COMES INTO YOUR MIND? YOU CAN USE YOUR CHAT BOX AGAIN. WHAT COMES INTO YOUR MIND AS YOU THINK ABOUT A BRAVE SPACE? LEANING INTO THE DISCOMFORT. BEAUTIFUL. EXACTLY. COMFORTABLE ENOUGH TO PROMOTE CONVERSATION. WHICH IS BRAVE. AND IT'S NOT SOMETHING NECESSARILY EVERY PROGRAM SETS US UP TO DO. MAYBE THAT WASN'T PART OF OUR TRAINING. SO WE'RE HOPING TO SORT OF HELP WITH THAT. I ALSO THINK THIS IS ABOUT POWER CONTROL. WE'RE ASKING THE FIELD TO THINK ABOUT HOW DISCLOSURE DRIVEN PRACTICE, RIGHT, SO -- DRIVES WHAT HAPPENS IN YOUR INTERACTION, SO I LOVE THAT, A BRAVE SPACE IS WHEN YOU'RE ENCOURAGED TO SHARE YOUR TRUTH AND ARE LISTENED TO WITH GENUINE CONCERN AND CARE. NOW I WANT YOU TO THINK ABOUT TRAINING, AND I WANT YOU TO THINK ABOUT A WALL. IF YOU PUT YOUR FINGERTIPS TOGETHER ON THE TABLE AND MAKE WHAT WE USED TO THINK AS A SOCCER NET WITH, OR HOCKEY NET WITH, PUT YOUR FINGERS TOGETHER AND THINK ABOUT THIS. SO IF I ASKED YOU THIS QUESTION, AND YOU'RE LOOKING AT YOUR OWN FINGERS AS YOU'RE DOING THIS, THE I WANT YOU TO GET BACK TO THE QUESTION I ASKED EARLIER ABOUT THE LUNCH TABLE WITH THE TURKEY SANDWICH AND SWEET ICE TEA. IF I HAD ASKED YOU IF YOU HAD BEEN KICKED OR PUNCHED OR WHATEVER THE SCREENING QUESTION IS ON YOUR FORM, IF I ANSWER "NO," ALL OF THE INFORMATION CONTINUES TO STAY WITH THE HOME VISITOR OR THE PERINATAL CASE MANAGER. ALL OF IT. BECAUSE THE ONLY WAY THAT THAT HOCKEY NET OR THE WALL GETS PUT DOWN IS IF I SAY YES. JUST THINK ABOUT THAT FOR A SECOND. THE ONLY WAY YOUR CLIENTS GET INFORMATION ON HOW TO GET SUPPORT OR HELP OR INFORMATION ABOUT INTIMATE PARTNER VIOLENCE IS IF THEY SAY YES TO YOU. AND THE EARLIER IN TODAY'S WEBINAR YOU SAW HOW -- ILLINOIS IS A BEAUTIFUL CASE EXAMPLE FOR MANY OTHER STATES, AND I DON'T KNOW ABOUT CANADA, MAYBE YOU'RE DOING MORE UNIVERSAL EDUCATION THERE, BUT I WANT YOU TO THINK ABOUT THAT FOR A SECOND. YOU'VE GOT SOMEWHERE BETWEEN 17 OR 30 OR 50% OF YOUR CLIENTS WHO ARE EXPERIENCING INTIMATE PARTNER VIOLENCE AND 2-4% ARE DISCLOSING. THAT'S PRETTY MUCH ACROSS THE BOARD. THERE'S SOME STATES DOING BETTER JOBS, WISCONSIN, MY FRIENDS FROM WISCONSIN, THEY'VE BEEN DOING A LOT OF WORK ON TRAUMA-INFORMED SUPPORT. SO THEY'RE SEEING DIFFERENT KINDS OF THINGS THERE. BUT I WOULD SAY MOST OF YOU ARE IN THIS BOAT. SO AS WE'RE THINKING ABOUT BRAVE SPACES, WHAT I'M ASKING US TO THINK ABOUT IS STEPPING AWAY FROM OUR SCREENING MENTALITY TO GIVING YOU CONVERSATION. AND I'M ALSO GOING TO SAY TO ALL OF YOU, I DON'T WANT YOU TO LOSE YOUR FEDERAL FUNDING OR YOUR STATE FUNDING, AND I KNOW THERE ARE SCREENING TOOLS REQUIRED BY YOUR PROGRAM. AND I'M NOT GOING TO SUGGEST YOU DON'T DO THEM OR DON'T DO THEM IN THE WAY YOU'RE SUPPOSED TO. PLEASE HEAR ME RIGHT NOW. WHAT I AM GOING TO SUGGEST IS PRIOR TO DOING THAT, LET'S THINK ABOUT WHAT WE ALL HAVE LEARNED COLLECTIVELY AND MAKE A DIFFERENCE IN THE WAY THAT WE APPROACH THESE ISSUES. AND I THINK PART OF THE REASON WE WANT TO DO THIS, HAS EVERYTHING TO DO WITH HEALTH EQUITY. WE WANT TO BE THINKING ABOUT SOCIAL JUSTICE AS PART OF HEALTH. AND WHAT WE MEAN WHEN WE SAY HEALTH EQUITY, NO ONE IS DENIED THE POSSIBILITY TO BE HEALTHY FOR BELONGING TO A GROUP THAT HAS HISTORICALLY BEEN ECONOMICALLY OR SOCIALLY DISADVANTAGED. I ALSO THINK THAT'S A BRAVE SPACE FOR US TO BE THINKING ABOUT. AROUND RECOGNIZING THAT OUR -- THE COMMUNITIES WE SERVE HAVE BEEN SO OVERSYSTEM INVOLVED AND THERE'S SO MUCH RACISM CONNECTED TO SO MANY OF THE OUTCOMES THAT WE SEE IN PROGRAMS THAT WE HAVE TO BE DOING THIS WORK VERY DIFFERENTLY. I WILL TELL YOU THIS WAS MY A HA MOMENT. WHEN ANISSA SENDS OUT THE MATERIALS AFTER THE WEBINAR, A LINK TO THIS ARTICLE WILL ALSO BE INCLUDED. BUT I THINK THIS WAS THE A-HA MOMENT FOR ME, AND I'M EMBARRASSED TO SAY THAT BECAUSE I'VE BEEN DOING THIS WORK A LONG TIME, THIS IS 2018 AND I'VE BEEN DOING THIS WORK, HOME VISITATION FOR PROBABLY 25 YEARS AT THIS POINT. AND I HADN'T REALLY GOT IT UNTIL I READ THIS ARTICLE. AND THE TITLE IS "WHY AMERICA'S BLACK MOTHERS AND BABIES ARE IN A LIFE-OR-DEATH CRISIS" AND THE ANSWER IS DISPARITY AND DEATH RATES HAS EVERYTHING TO DO WITH THE LIVED EXPERIENCE OF BEING A BLACK WOMAN IN AMERICA. I DON'T KNOW IF ANY OF YOU READ THE SAME ARTICLE, BUT WHAT WAS SO IMPORTANT ABOUT IT IS THAT THEY WEREN'T JUST LOOKING AT -- OH, THE REASON WHY WE HAVE HIGHER RATES OF BLACK INFANT MORTALITY HAS EVERYTHING TO DO WITH POVERTY. AND IN FACT, WHAT THEY WERE LOOKING AT IS MIDDLE CLASS WOMEN WHO HAD THE SAME ACCESS AND HEALTH CARE PROVIDERS, THEY ALSO HAD INCREDIBLY HIGH INFANT MORTALITY AND HIGHER MATERNAL MORTALITY COMPARED TO THEIR WHITE COUNTERPARTS. AND SO THAT'S WHAT WE'RE TALKING ABOUT. WE HAVE TO GET IN FRONT OF THESE SYSTEMS THAT ARE IMPACTING THE MOMS AND THAT INCLUDES THE WAY WE APPROACH INTIMATE PARTNER VIOLENCE, BUT I ALSO IT'S ASKING US TO UNPACK THE MEDICAL SYSTEM AT LARGE AND HOW IT IMPACTS THE FOLKS WE SERVE. SO RACE ISN'T A RISK FACTOR IN MATERNAL HEALTH. RACISM IS. AND I HAVE TO SAY THIS IS AGAIN FROM THAT ARTICLE THAT IT IS -- FOLKS WANT TO SAY BLACKNESS IS THE PROBLEM, NOT BIAS. WE THINK THAT ABSOLUTELY IT'S NOT THE BIAS. THIS NEXT SLIDE, REALLY USING ILLINOIS AS A WINDOW INTO WHAT WE KNOW MANY OTHER STATES LOOK LIKE, I THOUGHT THIS WOULD BE HELPFUL. WE KNOW NON-HISPANIC BLACK WOMEN ARE SIX TIMES AS LIKERY TO DIE OF PREGNANCY-RELATED CONDITIONS AS NON-HISPANIC WHITE WOMEN IN THE STATE OF ILLINOIS. THEY'RE THREE TIMES LIKELY TO DIE WITHIN A YEAR OF PREGNANCY AS COMPARED TO WOMEN OF ANY OTHER RACE OR ETHNICITY AND HOMICIDES ACCOUNT FOR 15% OF ALL PREGNANCY-ASSOCIATED DEATHS FOR BLACK WOMEN. IN CONTRAST, HOMICIDE IS A VERY RARE CAUSE OF PREGNANCY ASSOCIATED DEATHS FOR WHITE WOMEN, SO WE CAN SEE THIS HUGE DISPARITY AND I DON'T KNOW IF ANY OF YOU FOLLOWED THE CASE OF SERENA WILLIAMS, AND LOOKING AT HER EXPERIENCE. SO SOMEONE WHO HAS LOTS OF ACCESS, LOTS OF MONEY, AND IT HAS EVERYTHING TO DO WITH DOCTORS NOT LISTENING TO BLACK WOMEN, WOMEN OF COLOR, IN THE SAME WAY THEY LISTEN TO WHITE WOMEN. THAT'S ONE OF THE PIECES THAT WE'RE TRYING TO SORT OF UNPACK AND CHANGE AS PART OF OUR CONVERSATION, REALLY THINKING ABOUT INTIMATE PARTNER VIOLENCE AS WELL. I CAN'T SHOW THIS UNFORTUNATELY AND THIS IS A REALLY POWERFUL TED TALK, THIS IS A WOMAN WHO CALLS HERSELF A RADICAL DOULA. I ADMIRE HER AND HER WORK AND I THINK THIS IS A BEAUTIFUL TED TALK, IT'S ABOUT 15 MINUTES LONG. AND THIS IS SOMETHING THAT YOU COULD DO AS A TEAM, TO LOOK THIS UP ON YOUTUBE AND TALK ABOUT IT, AND THINK ABOUT ITS IMPACT ON WHAT YOU WANT TO BE DOING IN YOUR PROGRAMS. BUT FOR THOSE OF YOU WHO DON'T KNOW ABOUT JENNY JOSEPH, SHE'S AN AMAZING MIDWIFE OUT OF FLORIDA, AND SHE'S BEEN -- SHE HAS TURNED THIS WHOLE DISPARITY ISSUE UPSIDE DOWN RELATIVE TO THOSE LOW BIRTH WEIGHT BLACK BABIES, THE LIKELIHOOD OF BLACK MOMMY DYING, THE LIKELIHOOD OF LOW-INCOME AND ALSO INFANT DEATH. SHE'S MANAGED TO TURN THE WHOLE SYSTEM UPSIDE DOWN THROUGH CHANGING THE WAY SHE DOES CARE, WHICH HAS EVERYTHING TO DO WITH NOT ADHERING TO THE MEDICAL MODEL AS PART OF WHAT THEY'RE DOING. SO WHAT I LOVE ABOUT THIS TED TALK IS THAT WHEN I THINK ABOUT HOW TO HEAL COMMUNITY, I THINK IT'S ABOUT THE PARTNERSHIPS THAT CAN HAPPEN BETWEEN THE OB/GYN, THE HOME VISITOR, THE ONGOING CASE MANAGEMENT, AND THEN HOW YOU'RE USING THE POWER OF OTHER WOMEN TO HEAL OTHER WOMEN AND SUPPORT OTHER WOMEN TO CHANGE THE GAME. SO I MENTIONED THIS BEFORE, BUT I THINK ONE WAY TO ADDRESS THE ISSUE OF HEALTH EQUITY IS CHANGING -- CHALLENGING A LIMITED DISCLOSURE DRIVEN PRACTICE. WHICH MEANS WE HAVE SET UP THIS WORLD AROUND, DID THIS BAD THING HAPPEN TO YOU, YES OR NO? DID THIS BAD THING HAPPEN TO YOU, YES OR NO? AND CONTINUE OUR SYSTEM WHICH IS SET UP SO WE DON'T HELP PEOPLE WHO ARE TOO AFRAID, TOO UNSURE, DON'T TRUST US YET, OF HOW -- HAVE HAD BAD EXPERIENCES, WE SET THEM UP TO NOT HAVE THE INFORMATION THAT THEY NEED, AND WE HAVE TO CHANGE THAT IF WE REALLY CARE ABOUT HEALTH EQUITY AND ADJUSTING ISSUES -- ADDRESSING ISSUES OF RACE IN OUR COUNTRY. THE UNIVERSAL EDUCATION IS A WAY TO DO THIS. AND THE WAY WE'VE DONE THIS AND WE'VE DONE A LOT OF RESEARCH ON THE SAFETY CARD INTERVENTION, THIS IS OUR HEALTHY MOMS HAPPY BABIES CARD IF YOU HAVEN'T SEEN IT BEFORE. IT'S ABOUT THE SIZE OF A BUSINESS CARD, IT'S MULTIFOLDED, IT HAS PANELS ON IT, THE IDEA OF THE CARDS IS THEY'RE TO HELP YOU AS A HOME VISITOR OR CASE MANAGER HAVE CONVERSATIONS ABOUT WHAT HEALTHY AND SAFE RELATIONSHIPS ARE, AND WHAT TO DO FOR ONES THAT AREN'T. -- >> I'M GOING TO PULL UP THIS CARD FOR YOU. AND I'M GOING TO DROP A LINK IN THE CHAT BOX SO YOU CAN ALL TAKE A LOOK AT IT AS REBECCA IS TALKING ABOUT IT. >> GREAT. THANK YOU. I LOVE IMMEDIATE GRATIFICATION. CAN YOU SWIPE IT UP AND DOWN SO I CAN SHOW PEOPLE? OR IS IT LOCKED? >> I WANT TO ASK, CAN EVERYONE SEE THE CARD ON THE SCREEN? I'M ALSO GOING TO DROP IT IN, BUT -- >> THIS IS THE OLDER VERSION, AND IT COULD -- IT GIVES YOU A SENSE OF IT. CAN WE GO BACK TO THE FRONT IMAM, AND THEN WE UN-- HOW IS IT GOING ON THE FIRST PANEL, AND THE NEXT PANEL, ON BAD DAYS, WHICH NORMALIZES THE FACT WE ALL HAVE BAD DAYS, AND THEN IT TALKS ABOUT COPING STRATEGIES. ANYWAY, THIS IS A NEWER VERSION, BUT IT GIVES YOU A SENSE OF WHAT IT LOOKS LIKE. AND HOW IT FOLDS UP. >> I'M GOING TO DROP IT IN THE CHAT BOX, AND WE'LL SEND THE NEWER VERSION AFTER THE WEBINAR. >> IT'S IN ENGLISH AND SPANISH AS WELL. HOW IS IT GOING? THIS IS HIGHLIGHTING THE FIRST PANEL OF THE CARD. ALL MOMS DESERVE HEALTHY RELATIONSHIPS. I CAN TELL YOU THAT WORD "DESERVES" WE SPENT A LOT OF TIME ON THIS. FOLKS LOVE THAT WORD. WHAT DO I DESERVE? WHAT AN INTERESTING PAUSE MOMENT THAT IS. WHAT DO I DESERVE? RESPECT AND KINDNESS. SO FOR FOLKS WHO REALLY HAVE COME FROM VERY DIFFICULT CIRCUMSTANCES, WE'RE LAYING OUT SOME STUFF THAT MAYBE THEY NEVER CONSIDERED BEFORE. SO I THINK IT'S REALLY POWERFUL FOR YOU -- IS IT'S POWERFUL TO BEGIN WITH SOMETHING POSITIVE RATHER THAN HAVING -- THE IDEA AROUND THIS CARD IS THAT IT -- YOU HAVE REQUIREMENTS AROUND SCREENING, YOU'RE GOING TO GO OVER THIS CARD PRIOR TO DOING A SCREENING, AND USE IT AS A TOOL TO SUPPORT YOU AND THE -- HERE'S THE MATCH POX OF THE SAFETY CARD. THIS IS HOW YOU BEGIN YOUR SCRIPT. OF COURSE YOU TWEAK IT TO MAKE IT YOURS. BUT HERE'S AN EXAMPLE OF WHAT WE HAVE LEARNED FROM OUR RESEARCH. I STARTED GIVING TWO OF THESE CARDS TO ALL OF MY MOMS. YOU MIGHT WANT TO SAY, I WENT TO THIS TRAINING OR I SAW A WEBINAR, AND I HEARD ABOUT THIS, AND I THOUGHT, WOW, I'VE BEEN USING THESE WITH MY FRIENDS, AND I STARTED GIVING THESE OUT TO ALL OF MY CLIENTS. TWO OF THESE CARDS. THIS TWO-PART IS IMPORTANT. IT TALKS ABOUT HEALTHY RELATIONSHIPS AND WHAT TO DO FOR ONES THAT AREN'T SAFE, I GIVE YOU TWO SO YOU HAVE THE INFO ON HOW TO HELP A FRIEND OR FAMILY MEMBER, BECAUSE WE ALL KNOW SOMEONE WHO HAS OR NEED HELP. TELL ME WHY THAT'S THE MAGIC THOUGHT. WHAT HAPPENS WHEN WE DO IT THIS WAY? WHAT HAPPENS IN THAT MOMENT? WHAT DID WE JUST DO? WE'RE NOT TARGETING THEM. NICE. MADE A BRAVE SPACE. YEP. EMPOWERED THEM. MAKES IT UNIVERSAL. EMPOWERS THEM TO USE IT TO HELP OTHERS. YES. RIGHT? WE MADE IT SAFE FOR THEM TO TAKE IT, BECAUSE NOW IT'S NOT JUST ABOUT THEM, WE ALSO DID THIS OTHER REALLY COOL THING. THAT EMPOWERMENT STUFF, I WANT YOU TO THINK ABOUT WOMEN WHO ARE TOLD THEY'RE WORDSLESS, STUPID, NOBODY WOULD WANT THEM, ETC. SOMEONE WHO HAS HAD THE HARDEST CIRCUMSTANCE. AND COULDN'T TELL YOU ABOUT IT. AND WHAT HAPPENS WHEN YOU SAY, I THINK YOU'RE SOMEONE WHO CAN MAKE A DIFFERENCE IN THE LIFE OF SOMEONE ELSE. SHE SITS UP A ALSO STRAIGHTER, RIGHT? AND THAT'S WHAT THIS IS ABOUT. REALLY RECOGNIZING THAT THERE'S AN INCREDIBLE AMOUNT OF POWER IN SAYING, "I THINK YOU HAVE INCREDIBLE VALUE AND YOU'RE SOMEBODY WHO CAN MAKE A DIFFERENCE." THAT LEADS US INTO THIS NEXT SLIDE. ALTRUISM REALLY MATTERS. WE DO THIS WORK BECAUSE WE LIKE GIVING BACK, RIGHT? I'M GOING TO ASSUME, EVERY SINGLE PERSON ON THIS WEBINAR CAME TO THIS WEBINAR BECAUSE YOU ARE DOING WORK IN DOMESTIC VIOLENCE PROGRAM, YOU ARE WORKING IN HOME VISITATION, WORKING WITH PREGNANT MOMS, WORKING TO MAKE A DIFFERENCE IF THEIR LIVES. YOUR CLIENTS ARE NO DIFFERENT THAN YOU ARE. AND I THINK IT MAKES SO MUCH SENSE. THE POWER OF SOCIAL SUPPORT IS MORE ABOUT MUTUALIALITY THAN ABOUT GETTING -- THE NEED TO GIVE, TO MATTER AND MAKE A DIFFERENCE. WE FIND MEANING IN CONTRIBUTING TO THE WELL-BEING OF OTHERS. AND SO DO OUR MOMMIES AND OUR CLIENTS. AND THAT SHIFT CHANGES OUR CONVERSATION AROUND HEALTHY AND SAFE RELATIONSHIPS BECAUSE I CAN'T MAKE YOU LISTEN TO IT FOR MYSELF BECAUSE I'M NOT READY YET, BUT CAN I LISTEN TO YOU TALK ABOUT HOW THESE THINGS WORK TO HELP SOMEBODY ELSE? I CAN. AND MAYBE I CAN STORE THAT INFORMATION AWAY FROM MYSELF FOR WHEN I'M READY TO UNPACK WHAT'S DOING ON IN MY RELATIONSHIP. SO THIS IS ACTUALLY ONE OF THE THINGS, IN SOME WAYS IT'S PERFECT THAT ANISSA FOUND THE LINK TO THE OLD CARD, BECAUSE THIS WASN'T ON THERE. I THINK THIS IS PART OF THE MAGIC THOUGHT, THIS IS THE PANEL THE CLIENTS LIKE SO MUCH. EVERYONE FEELS HELPLESS AT TIMES, LIKE NOTHING THEY DO IS RIGHT. ISN'T THAT REAL? AND SO CONNECTING WITH OTHER MOMS ABOUT WHAT'S HARD, WHERE YOU FIND STRENGTH MIGHT YOU FEEL LESS ALONE, MIGHT HELP THEM FEEL LESS ALONE. THIS IS A GREAT EXAMPLE OF A PLACE WHERE YOU COULD AS A HOME VISITOR HOVER TO TALK ABOUT HOW FOLKS CAN USE THIS FOR SOMEBODY ELSE, BUT IN THE PROCESS YOU'RE ALSO IF THEY HAPPEN TO BE THAT 50%, 30% OR 17%, WE'VE ALSO GIVEN INFORMATION FOR THEM AS WELL. SO CUES. HOW DOES THIS WORK, WHEN DO WE DO IT? I WANT TO SAY SOMEBODY IN THE CHAT BOX WAS SO SMART AND SAID WE -- I COULDN'T HAVE CONVERSATIONS BECAUSE THE PARTNER WAS IN THE ROOM. AND THAT'S TRUE. WE CAN'T DO CUES IN FRONT OF PARTNERS OR FAMILY MEMBERS FOR ANYONE WHO IS PERHAPS NOT DEALING WITH HOW POWER AND CONTROL IS SHOWING UP AROUND A THAN PA, BUT MAYBE IT'S THE MOTHER-IN-LAW. I KNOW THAT'S TRUE FOR SOME FOLKS. WE ALSO REALLY WANT TO MAKE SURE WE'RE NOT DOING IT IN FRONT OF FRIENDS OR FAMILY MEMBERS OR EXTENDED FAMILY MEMBERS AS WELL. WE NEVER WANT TO LEAVE CARDS WITHOUT THE CLIENT THINKING IT'S CLEAR THAT IT'S OKAY TO DO SO. YOU DON'T WANT TO LEAVE IT IN A PACKET OF INFORMATION, WE WANT TO CHECK IN WITH HER. AND I WILL SAY IN THE INTERVENTION, WHEN YOU OFFER SOMEONE TWO CARDS FOR THEMSELVES OR OTHERS, IN MY EXPERIENCE THEY TAKE THE CARD, THEY MIGHT STICK THEM IN THEIR WALLET, IN PART OF THEIR PURSE, THEY'LL LOOK AT THEM WITH YOU, BUT I THINK THERE'S A CLEAR INDICATION SOMEONE HAS PUT IT IN THEIR PURSE IT'S PROBABLY FINE TO KEEP THEM. BUT WE DON'T WANT TO LIVE THEM ON THE COUNTER. WHO GETS THEM? ALL FEMALE CLIENTS. IT'S NOT THAT I DON'T KNOW THAT MALE CLIENTS MIGHT NOT BE EXPERIENCING VIOLENCE, AND I FOE FOR SOME OF YOU YOU DO HAVE CLIENTS YOU'RE SCREENING -- MALE CLIENTS YOU'RE SCREENING FOR FOR DOMESTIC VIOLENCE BECAUSE THEY'RE THE PRIMARY CAREGIVER OF THAT CHILD. SO I WANT TO SAY TO ALL MY FRIENDS ON THE PHONE WHO ARE FRUSTRATED AND WANT MORE TOOLS, THERE IS A TOOL COMING. WE ARE WORKING ON MAKING AN ADAPTATION SO YOU CAN USE THAT AS A TOOL WITH THE DADS IN YOUR PROGRAM. FOR NOW, FOR THIS INTERVENTION, IT'S ALL FEMALE CLIENTS. WHEN DO WE GET IT -- WHEN DO THEY GET IT? ON THE FIRST VISIT FOR SURE, SO THEY HAVE THE INFO EVEN IF THEY DROP OUT OF THE PROGRAM, WE KNOW SOME OF YOU ARE WORKING WITH A HOMELESS PREGNANT WOMAN, MAYBE YOU'LL SEE THEM ONCE, MAYBE YOU'LL SEE THEM ONCE IN THE BEGINNING AND ONCE AT THE END OF THE PREGNANCY. YOU ALSO WANT TO THINK ABOUT USING IT BEFORE THE SCREENING TOOL TO SMOOTH THE SEGUE. LET'S SAY YOU'RE GOING TO DO THIS AS PART OF YOUR WELCOME KITS, WHEN YOU -- SOMEONE ENTERS YOUR PROGRAM, AND LET'S SAY YOU HAVE 30 TO 60 DAYS TO DO YOUR SCREENING FOR IPV. YOU'RE GOING TO PULL IT BACK OUT THEN AND USE IT AS A REMINDER ABOUT HEALTHY AND SAFE RELATIONSHIPS BEFORE YOU GET INTO THAT QUESTION. BECAUSE WE WANT TO AGAIN GIVE THE INFORMATION BEFORE SOMEONE IS IN A SITUATION TO SAY TO US, NO, THAT'S NOT HAPPENING TO ME. ALSO I MENTIONED VERY BRIEFLY REPRODUCTIVE COERCION. CONTRACEPTION AND PREGNANCY SPACING, THAT COPPER T/IUD INTERVENTION. WHEN YOU ARE GETTING IN THE THIRD TRIMESTER OR THE POSTPARTUM VISITS, IF YOU'RE HAVING THOSE CONVERSATIONS, THERE'S A COUPLE PANELS OF THE CARD THAT ARE SPECIFIC TO THOSE ISSUES THAT I LOVE THAT PANEL THAT TALKED ABOUT TOO BUSY TO DECIDE AROUND PREGNANCY. IS IT YOU, IS IT YOUR PARTNER, IS IT SOMETHING TO DECIDE TOGETHER? THAT CAN BE A GREAT WAY TO EXPLORE IN CONVERSATION IF SHE MIGHT NEED SOME ADDITIONAL SUPPORTS AROUND METHODS OF CONTRACEPTION THAT HE CAN'T HELP WITH. WE'RE GOING TO GO TO THE NEXT SLIDE, PLEASE. CUES. THE C STAND FOR CONFIDENTIALITY, YOU WANT TO SEE CLIENTS ALONE. AND TALK ABOUT LIMITS OF CONFIDENTIALITY, WHAT YOU'RE GOING TO HAVE TO -- WHAT YOU WOULD BE REQUIRED TO REPORT, WHAT YOU'RE NOT REQUIRED TO REPORT. I'M SAYING THIS HERE BECAUSE A FEW OF YOU LIVE IN STATES THAT HAVE REQUIREMENTS AROUND REPORTING TO CHILD WELFARE WITH DISCLOSURES OF DOMESTIC VIOLENCE. JUST A FEW OF YOU. I WILL SAY TO YOU THAT IN MY EXPERIENCE HAVING BEEN IN ALL THE STATES EXCEPT DELAWARE, I DON'T CARE WHAT YOUR STATE LAW IS, TYPICALLY YOUR CLIENTS THINK THAT THIS IS SOMETHING THEY NEED TO REPORT TO CHILD WELFARE AND IT'S ALSO SOMETHING YOUR HOME VISITORS THINK AS WELL. SO WE REALLY WANT TO TALK ABOUT, YOU WANT TO MAKE IT CLEAR THAT IN YOUR STATE, YOU WANT TO MAKE IT CLEAR THE GUIDELINES IN YOUR STATE, YOU CAN IMAGINE FOR SOMEONE WHO IS IN A STATE WHERE YOU WOULD AUTOMATICALLY BE REPORTING, THAT WOULD BE A BIGGER BARRIER TO SOMEONE TELLING YOU THEIR STORY, BECAUSE THEY WOULD BE WORRIED ABOUT THEIR CHILD BEING TAKEN AWAY. YOU REALLY WANT TO TALK ABOUT THAT, BUT I THINK UNIVERSAL EDUCATION CREATES SO MUCH OPPORTUNITY FOR MAKING A DIFFERENCE. THAT'S WHAT THE UE STAND FOR, UNIVERSAL EDUCATION AND EMPOWERMENT. HOW YOU FRAME THIS CONVERSATION, THAT THAT REALLY MATTERS. YOU REMEMBER WE SAW THE SCRIPT BEFORE, APPROXIMATELY, I STARTED GIVING TWO OF THESE CARDS OUT TO ALL OF MY MOMS. YOU MIGHT SAY CLIENTS, I DON'T KNOW WHAT YOUR WORD WOULD BE. I DON'T KNOW HOW YOU WOULD MAKE IT RELEVANT TO THE PERSON IN FRONT OF YOU, SO PLEASE, FEEL FREE TO TWEAK THE WORDS TO MAKE IT REAL TO THE PERSON IN FRONT OF YOU. BECAUSE RELATIONSHIPS CHANGE. I ALWAYS -- I WOULD ACTUALLY RECOMMEND THAT YOU HAVE -- GIVE THE CLIENT TWO CARDS AND HAVE ONE IN YOUR OWN HAND AND OPEN IT UP SO THEY CAN SEE HOW IT WORKS. IT TALKS ABOUT HEALTHY AND SAFE RELATIONSHIPS, YOU CAN POINT TO THAT PANEL OF THE CARD, ONES THAT AREN'T, HOW THEY CAN AFFECT YOUR HEALTH AND PREGNANCY, AND IT CONNECTS THINGS YOU MIGHT NOT OTHERWISE SEE, LIKE HOW SUBSTANCE ABUSE OR DEPRESSION CAN BE CONNECTED TO HARD RELATIONSHIPS. YOU CAN SEE HOW YOU COULD TWEAK THAT SCRIPT TO -- HAVING MORE BABIES CAN BE CONNECTED TO HARD RELATIONSHIPS. AND THEN THE S, SUPPORT. ON THE BACK OF THE CARD THERE'S A SAFETY PLAN AND A 24/7 TEXT AND HOTLINES THAT HAVE FOLKS WHO REALLY UNDERSTAND COMPLICATED RELATIONSHIPS. AND YOU CAN TALK TO ME ABOUT ANY HEALTH QUESTIONS OR ISSUES THAT YOU HAVE. NOW, THE S PART FOR SUPPORT IS REALLY IMPORTANT, BECAUSE ONE OF THE THINGS WE KNOW FROM RESEARCH IS THAT IT MADE A DIFFERENCE FOR THEM TO FEEL LIKE THEY KNEW THERE WAS A PLACE TO GO IF THEY NEEDED IT. AND THAT WAS REALLY POWERFUL FOR THEM. AND ALSO FOR THEM TO KNOW THEY HAVE THAT. ONE OF THE THINGS I OFTEN SAY TO EXPAND ON THIS IS, SO IF YOU'VE GOT A FRIEND AND YOU DON'T KNOW HOW TO HELP, YOU CAN CALL THE NATIONAL DOMESTIC VIOLENCE HOTLINE ON THE CARD OR TEXT THEM AND SAY, HOW DO I HELP MY FRIEND IN THIS SITUATION? AND THEY'LL GIVE YOU IDEAS ABOUT THAT. THAT'S ONE OF THE THINGS TO THINK ABOUT, HOW CAN WE USE THIS AS A WAY TO PROMOTE COMMUNITY HEALING AND EDUCATION, IN A WAY THAT HELPS THE FOLKS WE SERVE. SO WE'VE DONE A LOT OF RESEARCH ON THESE CARDS, SO I LOVE THE -- I HAD THE OPPORTUNITY TO DO THESE QUALITATIVE INTERVIEWS, BOTH WITH PROVIDERS AND WITH CLIENTS. AND HERE'S WHAT ONE PROVIDER SAID ABOUT USING THE CARDS. "THE CARD MADE ME FEEL EMPOWERED BECAUSE YOU CAN REALLY HELP SOMEBODY. SOMEBODY THAT MIGHT HAVE BEEN AFRAID TO SAY ANYTHING OR DIDN'T KNOW HOW TO APPROACH THE TOPIC. THIS IS A DOOR FOR THEM TO OPEN SO THEY CAN FEEL MORE RELAXED ABOUT TALKING ABOUT IT." I ACTUALLY ALSO THINK IT HELPS THE PROVIDER, HELPS YOU AS HOME VISITORS, CASE MANAGERS, FEEL MORE RELAXED, BECAUSE IT FEELS MORE LIKE THAT TURKEY SANDWICH AND GLASS OF SWEET TEA. IT FEELS AUTHENTIC. IT FEELS REAL. AS OPPOSED TO DOING THAT CHECKLIST APPROACH OF HAVE YOU BEEN HIT, KICKED. HERE'S SOME THOUGHTS FROM CLIENTS. THEY WOULD BRING OUT THE CARD AND BASICALLY WALK IN WITH IT AND SHE WOULD OPEN IT AND ASK ME HI EVER SEEN IT BEFORE. IT WAS AWESOME. SHE WOULD TOUCH ON, NO MATTER WHAT THE SITUATION YOU'RE IN, THERE'S SOME THING OR SOME PLACE THAT CAN HELP YOU. YOU DON'T HAVE TO BE ALONE IN IT. THAT WAS REALLY HUGE FOR ME BECAUSE I WAS ALONE MOST OF THE TIME FOR THE WORST PART. " AND HERE ANOTHER CLIENT USING YOUR WORDS, ACTUALLY FROM THE WEBINAR EARLIER, WHEN I ASKED YOU ABOUT WHAT HAPPENS WITH THAT MAGIC BOX PORTION, GIVING TWO CARDS, GETTING THE CARD MAKES ME FEEL LIKE I HAVE A LOT OF POWER TO HELP SOMEBODY. AND THAT MAKES -- THAT HELPS BUILD A RELATIONSHIP. SO PART OF WHAT WE'RE TRYING TO DO IS DEEPEN THE RAPPORT AND RELATIONSHIP THAT YOU HAVE WITH THE CLIENT AND THIS IS THE STRATEGY TO DO THAT. AND I THINK SOMETIMES THE LONG PAPERWORK SCREENING TOOLS CAN MAKE IT FEEL MUCH MORE DISCONNECTED FROM THE CLIENT THAN YOU'D WANT TO BE. SO I THINK IT HAS LOTS OF LAYERS OF HOW THIS CAN BE REALLY HELPFUL TO YOUR WORK. I DON'T WANT TO SAY YOU CAN'T EVER ASK A DIRECT QUESTION, BECAUSE OF COURSE YOU CAN. AND JUST AS I SAID YOU CAN USE THE SAFETY CARD INTO A SEGUE FOR YOUR SCREENING TOOL FOR DOMESTIC VIOLENCE OR IPV. YOU CAN ALSO USE IT AS A FOLLOW-UP FOR ANOTHER CORRECT QUESTION. SO, FOR EXAMPLE, SOMETIMES WHEN I HEAR ABOUT ONE OF MY MOMS NEEDING A PREGNANCY TEST, IT MAKES ME WONDER IF HE'S FORBIDDING YOU FROM USING BIRTH CONTROL OR NOT USING CONDOMS, OR MAKING YOU DO SPECIAL THINGS YOU DON'T WANT TO DO. IS ANYTHING LIKE THIS GOING ON FOR YOU? OR IF YOU'VE GOT A CLIENT WHO IS STRUGGLING WITH ANXIETY, AND -- OR DEPRESSION, SOMETIMES WHEN I HEAR ABOUT ANXIETY IT MAKES ME THINK ABOUT RELATIONSHIPS AND STRESS, OR SOMETIMES I THINK ABOUT DEPRESSION, IT MAKES ME THINK ABOUT RELATIONSHIPS AND STRESS, IS ANYTHING LIKE THIS DOING ON FOR YOU? SO YOU CAN SEE HOW YOU CAN USE IT AS A BUILDING BLOCK TO -- AS YOU COME DOWN THIS UNIVERSAL EDUCATION, TALK ABOUT THE REALITY OF THIS, TALK ABOUT DOING IT WITH EVERYBODY, BECAUSE YOU ALSO NORMALIZE IT'S GIVEN MORE SPACE TO TALK ABOUT IT THAT TAKES AWAY SOME OF THE SHAME AND FEAR, IT LENDS ITSELF TO BEING ABLE TO HAVE A BIGGER CONVERSATION ABOUT OTHER THINGS. SO THIS COPING WITH PAIN PANEL, I KNOW THAT MANY OF YOU HAVE A SCREENING TOOL FOR DEPRESSION. AND FOR SUBSTANCE ABUSE. SO YOU CAN SEE BECAUSE WE SHOWED YOU THE DATA EARLIER, ABOUT HOW CONNECTED SUBSTANCE ABUSE AND MENTAL HEALTH ISSUES CAN BE FOR SOMEONE WHO IS EXPERIENCING DOMESTIC VIOLENCE, THAT THIS IS A GREAT PANEL -- CARD TO USE PERHAPS IN CONJUNCTION WITH ONE OF THOSE SCREENING TOOLS. HOW IS YOUR HEALTH GOING, HOW ARE YOU COPING, ARE YOU SMOKING MORE TO TRY TO CALM YOURSELF, YOU CAN HIGHLIGHT IT. SOMETIMES IN THE HEART OF RELATIONSHIPS WE SEE PEOPLE WHO ARE SMOKING MORE TO TRY TO CALM THEMSELVES, OR THEY'RE USING DRUGS OR DRINKING MORE, OR IT'S REALLY HARD TO STOP BECAUSE THEY'RE -- THAT'S THE ONLY WAY THEY CAN TAKE CARE OF THEMSELVES. OR SOMETIMES IT CAN BE SO STRESSFUL IN A RELATIONSHIP THAT PEOPLE HAVE THOUGHTS OF GOING AWAY, HURTING THEM SELFS OR SUICIDE. SO YOU CAN SEE HOW YOU CAN USE THIS AS A SPIN ON HAVING THOSE MORE AUTHENTIC CONVERSATIONS ABOUT ALL OF THESE THINGS WITHOUT HAVING TO ASK DIRECT QUESTIONS. AND THEN YOU'VE ALREADY DONE THAT UNIVERSAL EDUCATION, SO IF THIS IS EVER AN ISSUE FOR ONE OF YOUR FRIENDS, HERE'S THE SUICIDE HOTLINE, BECAUSE YOU ALWAYS HAVE TO TAKE THAT -- WHEN ANYONE TELLS YOU THEY'RE THINKING ABOUT SUICIDE, YOU HAVE TO TAKE IT SERIOUSLY. YOU CREATED THIS PLACE TO HAVE A BIGGER CONVERSATION, AND YOU CAN USE THIS -- NOW I'M GOING TO ASK YOU POINTED QUESTIONS ABOUT HOW YOU'RE FEELING ABOUT DEPRESSION, OR WHAT HAVE YOU. S, SUPPORT. DISCLOSURE IS NOT THE GOAL. SO WE RECOMMEND A LOT OF PEOPLE AREN'T GOING TO BE ABLE TO TELL US THEIR STORIES, BUT -- AND THEY DO HAPPEN. AND I WANT YOU TO KNOW HOW TO -- I WANT TO SUPPORT YOU IN HAVING THE BEST CONVERSATIONS WITH YOUR CLIENTS WHEN DISCLOSURE DOES HAPPEN. WHAT THE LITERATURE TELLS US WHICH I THINK EVERYBODY ON THIS CALL KNOWS, FOLKS WANT YOU TO LISTEN. AND THEY DON'T WANT YOU TO JUDGE THEM. SO HOW YOU RESPOND WHEN YOU HEAR MATTERS A LOT. AND WE'RE GOING TO GIVE YOU SOME SAMPLES OF HOW AND WHAT TO DO AFTER WE TALK ABOUT A SIMPLE SAFETY PLAN. NOW, ONE OF THE LINKS THAT WE'RE GOING TO SEND TO YOU, IT'S COOL BECAUSE IT WAS DONE BY A FRIEND OF OURS IN SAN FRANCISCO, SHE'S A WISE WOMAN WHO CREATES THINGS THAT ARE FOR MUCH BROADER AUDIENCE THAN SAN FRANCISCO, AND THIS TOOL HAS BEEN TRANSLATED INTO MULTIPLE LANGUAGES. SO I THINK IT'S ARABIC AND SPANISH, AND MANDARIN, AND -- WHEN YOU GO TO THE WEBSITE YOU'LL BE ABLE TO SEE THERE'S SAFETY PLANS THAT ARE SPECIFIC TO SAN FRANCISCO, AND ONES THAT ARE SORT OF GENERIC THAT YOU CAN TURN AND USE, YOU CAN PRINT THESE OUT AND HAVE THEM PART OF YOUR PROGRAM. NOW, I DON'T WANT -- I DON'T WANT YOU ALL TO WALK AWAY THINKING OH, MY GOSH, NOW SHE'S ASKING ME TO DO A SAFETY PLAN WITH MY CLIENT? I'M NOT NECESSARILY ASKING YOU TO DO THAT AT ALL. I'M HOPING YOU END UP HAVING A GOOD WITH WITH A DOMESTIC VIOLENCE ADVOCATE WHO CAN DO THIS, IN A FAR MORE ROBUST VERSION OF THE SAFETY PLAN, BUT I CAN TELL YOU AS A GIRL WHO GREW UP IN RURAL COLORADO, AND THE PUBLIC HEALTH NURSE WHO CAME AROUND EVERY ONCE IN A WHILE WAS THE ONLY CONTACT WITH THE OUTSIDE WORLD, SOMETIMES YOU'RE GOING TO BE IT. YOU'RE GOING TO BE THE ONLY AND THE ONE AND ONLY AND THEY'RE NOT GOING TO BE INTERESTED IN A REFERRAL, OR THERE'S NOT GOING TO BE A PROGRAM NECESSARILY NEAR YOU. I DO WANT TO MENTION THAT THE NATIONAL DOMESTIC VIOLENCE HOTLINE AND ALSO YOUR LOCAL ADVOCACY PROGRAM WOULD BE HAPPY TO DO THIS OVER THE PHONE. SO THEY HAVE OTHER TOOLS, MAYBE YOU COULD USE THIS AS PART OF THAT, SO JUST KNOW THAT THIS IS A BACKUP FOR YOU AS A HOME VISITOR AND I THINK IT HAS A REALLY GOOD QUESTION FOR THE CLIENT TO REFLECT ON AND FOR YOU AS A HOME VISITOR TO THINK, WHAT DOES A SAFETY PLAN REALLY MEAN? WHAT WE'RE REALLY TRYING TO DO IS GIVE YOU AND THE CLIENT IDEAS ABOUT HOW TO PREP IN THE EVENT THAT YOU NEED TO LEAVE QUICKLY, OR THE IMPORTANT THING TO TAKE WITH YOU, BECAUSE WHAT CAN HAPPEN WHEN WE'RE REALLY AFRAID OR UPSET IS WE -- OUR MIND GOES BLANK. SO THIS IS TO REALLY HELP SUPPORT SOMEONE WHO IS NEEDING TO LEAVE OR WANTING TO PLAN, HAVE A PLAN FOR IF THEY DO NEED TO LEAVE. WE ALSO BELIEVE IN PROVIDING ACTIVE RUSSELLS. WHEN I SAY "ACTIVE REFERRAL" I THINK SOMETIMES IT CAN BE A REALLY OVERWHELMING TO THINK ABOUT PICKING UP YOUR OWN PHONE AND CALLING A DOMESTIC VIOLENCE AGENCY OR THE NATIONAL HOTLINE. SO WHEN YOU CONNECT A PATIENT OR CLIENT TO A LOCAL PROGRAM, IT CAN MAKE ALL THE DIFFERENCE, AND IT TAKES THE BURDEN OFF THE CLIENT DO MAKE THE CALL. ALSO IT'S A SAFETY ISSUE POTENTIALLY. SO IF YOU HAVE A CLIENT WHO IS IN A CONTROLLING RELATIONSHIP, HER PARTNER IS PROBABLY MONITORING HER TEXTS OR PHONE CALLS, SO BY USING YOUR PHONE THAT MIGHT BE A WAY TO HELP KEEP THEM SAFER SO YOU DON'T HAVE TO WORRY ABOUT -- THEY DON'T HAVE TO WORRY ABOUT THEIR PHONE NUMBER BEING CONNECTED TO THE PARTNER TO SEE. IF YOU'D LIKE I CAN PUT YOU ON THE PHONE RIGHT NOW WITH, YOU KNOW, SOMEONE FROM THE HOTLINE, OR YOUR LOCAL ADVOCATE SO THEY CAN COME UP WITH A PLAN TO HELP YOU BE SAFE EVERY. THAT'S HOW YOU DO THAT SORT OF ACTIVE REFERRAL. ON THE BACK OF THE SAFETY CARD IS OUR NATIONAL DOMESTIC VIOLENCE HOTLINE NUMBER. THERE ARE -- THEY ARE STAFFED 24/7, THEY HAVE ACCESS TO LANGUAGES, 179 LANGUAGES SPOKEN, I BELIEVE. THERE'S ALSO THE SECOND REFERRAL THERE, TREATMENT REFERRAL, IS ACTUALLY FOR -- THAT IS FOR REFERRAL FOR SUBSTANCE USE OR MENTAL HEALTH USE AND THEY ALSO HAVE ENGLISH AND SPANISH AND I BELIEVE ACCESS -- IF SOMEONE IS WANTING TO GET HELP FOR SUBSTANCE ABUSE OR MENTAL HEALTH ISSUES, THAT'S THE NUMBER WHERE THEY CAN FIND OUT ABOUT LOCAL RESOURCES. THE OTHER THING I WANT TO SAY TO YOU IS THAT THE NATIONAL DOMESTIC VIOLENCE HOTLINE CAN CONNECT YOUR CLIENTS BASED ON ZIP CODE. YOU DON'T EVEN HAVE TO -- THE CLIENT DOESN'T EVEN HAVE TO HANG UP THE PHONE. IF YOU'RE IN BISMARCK -- THAT CAN BE A HELPFUL THING FOR YOU AS A HOME VISITOR TO KNOW, BUT SOME PEOPLE CHOOSE TO PUT STICKERS ON THE BACK OF THE CARD THAT HAVE THEIR LOCAL HOT LANES ON IT, AND WE'RE RECOMMENDING THAT IF YOU ARE WANTING TO DO A STATEWIDE CARD OR EVEN A LOCAL CARD, WE CAN CHANGE THE NUMBERS TO FIT WITH WHAT YOUR COMMUNITY NEEDS ARE. SO AGAIN, ASK FOR SUPPORT. WE REALLY THINK DOMESTIC VIOLENCE ADVOCATES ARE THE EXPERTS, AND I'M SO GLAD THERE'S SO MANY OF YOU ON THE PHONE, BECAUSE AGAIN, THAT ALSO TINY SAFETY PLAN IS NOTHING TO WHAT I KNOW YOUR RESOURCES CAN DO. I WANT TO MENTION THAT SOME OF THE REALLY COOL PARTNERSHIPS THAT ARE HAPPENING IS THAT FOR MOMMIES WHO ARE COMING IN TO DOMESTIC VIOLENCE AGENCIES WHO ARE PREGNANT OR HAVE LITTLE ONES WERE LOOKING TO CREATE PARTNERSHIPS AND MOUs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