>> Hi, everyone, welcome. Thanks for joining us today. >> Good morning, everyone. Feel free to type in the chat where you're joining us from, the name of your location, program. We'd love to see who's on. You ready, Anisa? Ready to start? >> Yeah, just one second. Yeah, if you're ready. >> All right. Thanks, everyone, for joining us for increasing staff capacity to respond to intimate partner violence and human trafficking during COVID-19, and on this day, today, many of you are probably coming from the inauguration. So we appreciate you joining us for this session today. Next slide, please. My name is Anna Marjavi, program director at Futures Without Violence and I work with HRSA, it supports community health centers, patients and staff and promotes partnerships with community-based domestic violence advocacy organizations and others. So let me also start by saying welcome again to our healing-centered learning collaborative participants. This is our third meeting. We'll meet again in just a couple of days. On the screen you might recognize several of my colleagues who have been here for this series with us. You'll hear from all of them today. And all of the speakers on today's webinar use she/her pronouns. First to the right on the slide, you can see her on camera, Rebecca Levenson is a senior policy analyst and consultant for many years with us, a nationally recognized researcher, advocate and speaker who's worked in the areas of primary care, adolescent health, reproductive and perinatal health, community clinics, home visitation programs for more than 20 years. To her right and also on video is Kiricka Yarbough Smith, an expert in human trafficking, sensitivity collaborative and rapid response teams, worked with the North Carolina coalition against sexual assault, cochaired the Pitt county task force and the coalition against human trafficking, an expert in that area. We're pleased to have her join us as well. Just below on the slide on the photo is Anisa Ali running our tech today, senior program specialist at futures and provides technical assistance for project catalyst and leads our campus leadership program. Schist a fellow with the women's policy institute through the women's foundation of California. On the bottom right of the slide and on video you'll see Abby Larson, a second-year MSU student on the strengthening organizations and communities track at UC Berkeley. She's been involved with the anti-violence movement since 2011 primarily specializing on sexual assault and domestic violence counselor training and sexual assault education. She joined as an MSW intern this past fall, September 2020. Next slide, please. Just a few notes about our technology today. I think many of you are familiar with Zoom but a few reminders. You can listen either through the phone or through the computer, and you can switch mid-webinar if you want through the lower left where the microphone is, there's a pop-up menu. You can switch if it's not sounding as clear for you. All of the participants are muted so if you want to chime in, ask any questions or share comments or stories please use the chat box. Just make sure you select "all participants" and panelists so we can see what you're saying. You can also send a private message to the panelists if you'd like only us to see what you have to say. This webinar's being recorded, and it will be emailed to all participants attending the event. And you will also receive the slides after the recording. Next slide, please. So the national health network on intimate partner violence and human trafficking is funding through the HRSA bureau and run by our organization to work with community health centers to support those at risk of or surviving intimate partner violence, human trafficking and exploitation and bolster our efforts. We offer a range of technical assistance including on topics you're hearing on today as well as assessment and universal assessment strategies and the UDS measures on intimate partner violence and trafficking and a range of tools which you'll find online at IPChealthpartners.org. Don't hesitate to reach out if we can support you in your work. Next slide, please. So I'm going to tell you a little bit about our goal for building local partnerships and why they're so meaningful. And it's really the heart of our model. In doing this work is not for health centers to do it in isolation but to do it in partnership with it domestic violence programs and to really promote the way you all are referring your clients or patients over to one another with those supportive services. So on the domestic violence advocacy side we know that many survivors of violence have a lower access to primary care because of control and other things they've been experiencing. They may not have been to a doctor in quite some time and might have acute health needs. As patients are coming into the program or shelter we want to increase the opportunity and information they have to be seen by a health center smile during -- especially now during COVID-19 when there's opportunities for testing and down the line, vaccinations, both for adults and children. On the community health center side we know that providers and health staff are supporting patients going through these issues in an ongoing way. And it can really reduce the isolation that they're facing by increasing their understanding and information about what local domestic violence programs offer to them. How to reach them. They're 24/7 and they have hotlines. And that's going to improve both their safety outcomes as well as their health status. So this is a little bit about why we really believe in this partnership. We have a sample MOU for those of you who would like to initiate an agreement between your local program. You can download it on the URL on the slide, IPChealthpartners.org/partner. Next slide, please. So we have three key learning objectives for today's webinar. The first is to learn two ways that vicarious trauma impacts healthcare providers and also advocates working at the community level. Second is to understand how healing centered engagement builds on trauma-informed care as a framework for system change to support staff. And finally, to understand how our CUES intervention, an evidence-based intervention for patients or clients also supports staff. We're not going to go into full detail today but we will tell you about an initial resource and another webinar archive where you can learn more thoroughly about the CUES intervention and how to change your clinical practice. Today we're going to focus on increasing your band width and capacity to begin this work or expand on your current efforts. I'm going to turn it over to Kiricka for more on domestic violence programs. >> Great. Good morning, good afternoon everybody depending on where you are. So, yeah, I wanted to take a few minutes and talk about domestic violence and sexual assault programs. I'm noticing in the chat who's on the call. I see we have quite a few of those programs on the call. But we just wanted to kind of give you a little information for those who are not from those local programs to just kind of understand when we're looking at our domestic violence and sexual assault programs they have a vast experience when working with survivors of violence and finding ways to assist them in increasing personal safety while also helping assess the risk. So it's important as we're thinking about increasing staff capacity especially for our healthcare centers to kind of support your patients around IPV is to really know your community based partners and advocates because they're really going to serve as an excellent resource for you. And it seems like a lot of you already have some great partnerships but we just really encourage you to keep expanding those partnerships if you already have them or are connecting. Some of the things that they connect patients to when we're thinking about additional services is crisis safety planning. Most advocates will have the 24-hour hotline. Also, housing. So emergency and transitional housing is something we're also seeing, that they do a lot of. And also legal advocacy, things like family court, immigration. They also provide support groups and counseling services for survivors. Then when we're thinking about children they also provide different services that children specifically may need including finding ways to support survivors with employment as well. So it's something to really think about because our capacity is already limited right now. It's always been limited but it's even more limited with COVID-19 right now. And so you want to connect to these resources as much as possible. Next slide, please. All right. So one of the other things we wanted to cover really quickly is hopefully you guys have heard of either all or most of these different hotlines. And, you know, these are all funded from the -- I'm sorry, the administration for children, youth and families under Department of Health and Human Services. So with these hotlines there are several of them, and you'll have these slides to kind of go through and kind of look at the different things that all of them do but I wanted to highlight two in particular, one the National Domestic Violence Hotline. We're thinking about the National Domestic Violence Hotline, it's there to respond -- they respond to calls 24/7. They provide confidential and anonymous one on one support to the callers and looking at things like crisis intervention, next step, hoping make direct connections for immediate safety for survivors. Those are some of the things you want to make sure that you connect to that hotline for. Also I wanted to invite stronghearts, another program that particularly works with native survivors and provides those same resources but specifically for native survivors of domestic violence and dating violence. And so they are really there to help advocates and they're usually Monday through Friday 9 a.m. to 5:30 p.m. So I am going to turn it over to Rebecca. >> Thanks so much, Kiricka. I always appreciate your wisdom and the work that you do, so thank you so much for giving us that wonderful overview of all the amazing things that can happen to help survivors and the ways in which advocates can help with trafficking survivors and victims or survivors, rather, of intimate partner violence. Today was a big day. And it's a big day on a lot of levels, right? And I -- we as a team -- decided we wanted to create some spaciousness for truth, for feeling, for grief, and for hope. So I'd love us all, however you worship, however you think about spirituality, however you hold space for yourself and others in the world, we're just going to take a minute and think about the 400,000 people we've lost to COVID. And just take a second as a community. Thank you. Next slide, please. And I, again, we're here on inauguration day as Anna mentioned, and we're also here in the face of enormous loss and grief for many of us. Maybe your partner or, you know, others in your family have lost their jobs. This is a hard time. And I also know that this is a time of growth, possibility. We're here together because we are interested in creating partnerships. So, yes, please tell me where you are, and I see Linda, you said hopeful. Thank you for sharing that. Thank you for hope. Grateful. Beautiful. Humble. Delores, thank you. Others. Anybody else? Proud. Grief. Hope. Relieved. Happy. Joyful. Relieved. Overwhelmed. Blessed, hopeful. Content. Oh, that's a beautiful word. Blessed. Thank you, Megan. Overthinking. You're not alone in that. Hopeful. Well, thank you for sharing your thoughts. And patience. Yeah. I mean, I think the range of feelings is huge, and I'd love to have us next, please. Nervous but excited. Hopeful. And I -- you know, again, you're -- you represent the voice of every other American, right? You represent the voice of where folks are. And, you know, we are in a moment where we're going to be thinking about the public health challenges for rolling out the vaccine. I mentioned to you earlier COVID losses. Certainly we understand that we are in the midst of having to reconcile in a very important and public way something we have historically not necessarily brought fully to light, and that is the issues of institutional and systemic racism and what are we within our programs going to do. And as many of you wrote in the chat, this is about hope and where we want to go for the future. So thank you for taking time today to be a part of the change we all want to be able to make for ourselves, our communities and the people we serve. Next slide. I wanted to -- we wanted to sort of open it up, let you all feel, think, grieve together, hope together. And we wanted to leave you with something that brought us back into the floor, grounded us all together. And I think Maya Angelou is the perfect person, her words are the perfect words to do that for us. So here on the pulse of this new day, may you have the grace to look up and out and into your sister's eyes, into your brother's face, your country and say simply, very simply, with hope, good morning. Next slide. And with this, I am going to -- next slide? With this I'm going to turn it over to my wonderful colleague Kiricka who's going to take us along a journey looking at trauma-informed care and healing-centered engagement. >> Thanks, Rebecca. It's always so good to have you first because you're so soothing. And I'm, like, so calm now. It's been such a day, so I appreciate it. So, yeah, when we're thinking about trauma-informed care we know that most of the people on the call, you definitely understand the definition, and you know what that is. So it's not really, you know, us giving you specifically a definition. But really reminding you of what we're talking about when thinking about trauma-informed care, which is moving away from what's wrong with you and thinking more and focusing more on what happened to you. And so we're really trying to take into account a person's sort of personal experiences when we're talking about trauma-informed care. So we want to think about those six guiding principles. So the number one guiding principle when we're talking about trauma-informed care is really looking at safety. So not just the physical safety but you also want to think about psychological safety and really thinking about interactions and their interpersonal relationships and really how do you help them promote safety and encourage safety in their lives. You know, as a whole person. Then also we want to look at another principle, being trustworthiness, and when we're thinking about that, really thinking about transparency. I don't know how many of you think about this all the time but for me to trust people, I need that air of transparency. So I don't know what's happening. Just like when your patients are in front of you if you're not giving them the next steps, what's going to happen next it's harder for people to trust you because they don't have that transparency. So that's a huge part when we're talking about decision making and people really trusting you. Next when we're talking about guiding principles for trauma-informed care is thinking about really sort of establishing safety and building trust around how do we support people's recovery, their healing. But a part of that is making sure that they have peer support. I always say that we need to make sure that we are engaging with our clients but ensuring that they have people in their lives that are there to support them that are not just paid to be there. Because sometimes that non-paid support is what they need. So we want to think about that and help them identify those non-paid sort of peer support people. Then also when we're thinking about the principles we want to think about collaboration and just, you know, really making sure that we're leveling or minimizing any sort of power differences within an organization. And this is particularly important when we're thinking about healthcare for survivors. We know there is a lot of disparities looking at healthcare for marginalized groups, for disconnected youth. So we want to think about how do we collaborate to as much as possible, you know, really minimize those sort of power differences and really share in decision making so that these things don't happen. Also, we want to make sure that we're empowering our survivors and encouraging them to use their voice and also encouraging them to be a part of or make their own choices so their self efficacy. Also finally when thinking about trauma-informed care, just focusing more on the individual's culture, you know, their history. Then any issues that are related to or surrounding gender. Next slide, please. So another thing that we want to talk about is vicarious trauma. And so when we're thinking about vicarious trauma it's an accumulation of stories, things that a person has not just been through but hearing through the stories of some of the survivors they're helping or patients that they're caring for. So sometimes we forget that vicarious trauma is really a way that a person's thinking is changing, their world view changes, and it's specifically due to exposure to other people's traumatic stories. This might include images, certain sounds. Also things that we've heard, which then kind of come into play when we're informing our world view. And some of the things we've kind of been dealing with, whether it's the pandemic or some of the other very specific things that have happened just even in 2020, just thinking about how some of those can impact a person's level of trauma or their response to treatment, even. So, yeah, next slide. So this is just, you know, a quote that we wanted to share with you. Really just looking at how when we're thinking about our trauma-informed principles, and how do we sort of begin recognizing that. This is just an example. So this was shared by someone from the direct -- she was the director of or is the director of the behavioral health center in woodland California. She said "at the beginning of our intimate partner violence work we first offered information and resources for employees on vicarious trauma. This including developing a support group just for staff. And because of that we were able to build staff resiliency for addressing IPV with patients." And it's so important. She said she started with the employees. So having a support group just for the employees to deal with the traumatic that they're actually experiencing before they can then assist and help patients. It's sort of like the flight attendant mantra you have to take care of yourself before you can take care of others. So I'm going to now hand it back over to Rebecca. >> Thank you so much, Kiricka. And I think I always love that -- the facemask, right? The oxygen. We have to put it on ourselves before we can help other people. And I actually think that, you know, this sort of shift from trauma-informed, and many of you have had training on this in the past, trauma-informed care to sort of the next level of what do we want to see. Because I don't know about the rest of you but I'm kind of tired of trauma soup. And I think that one of the things that we've been thinking about is what does wholeness look like? So we wanted to share a new concept with you called healing-centered engagement, and I wanted to give you an example of the differences between the two and where we think that the field really could blossom and grow for all of you within your own institutions, whether it be advocacy or healthcare but also just for the clients in the world that we're a part of. So this is for all of us. You know, I think the deal with trauma-informed care is it's important but incomplete because it doesn't acknowledge that trauma is experienced collectively. We know that just by being in a pandemic together. So it's experienced collectively not just individually. It fails to address the root causes of trauma that exist in the environment, not the individual. And this really, again, lends itself back to the conversation about systemic and institutional racism, for example, other kinds of inequities, poverty, et cetera. It focuses on coping with symptoms rather than healing from them, and I believe this is the next phase of all of our work. It's not enough to be able to cope. We need to heal. Next slide. I'm always trying to advance my own slides, forgive me. I'm going to read out the definition. A healing-centered approach is holistic, and it involves culture, spirituality, civic action and collective healing. A healing-centered approach views trauma not simply, again, as an individual isolated experience, but it highlights the ways in which we are healing collectively. It supports providers or advocates with their own healing. It asks systems to build in structures that address the realities of facing health like CommuniCare. It supports providers and helps staff better support patients or in advocacy-land support clients and healing is a process every single one of us deserves. We're all feeling a need for it given everything in COVID. Let's talk about the world before COVID. We certainly know that half of the is it physicians in the United States were experiencing substantial symptoms of burnout. In a study of 10,000 nurses 43% had a high degree of emotional exhaustion. With that comes less room, capacity to take care of others. Let's talk about now. What happened in COVID? There was a large study done at the University of California San Francisco, and I think this is so important because it looks at whether or not you're in a hospital that's dealing with heavy duty COVID caseloads or not. Here is the universal experience. Amid the COVID-19 chaos in many hospitals, emergency medicine physicians in seven cities around the country experienced rising levels of emotional anxiety and exhaustion regardless of the intensity of the surge. So just the anticipation, just being a healthcare provider in this moment in time had a ripple effect. Next slide. It's estimated that 68% of healthcare workforce experienced at least one episode of violence. When I think about folks who care about folks, a lot of times folks who care about folks are caring about those folks because they came from hard places themselves. Maybe they came from a family with a history of trauma. Maybe they've experienced themselves. So certainly that's not the case for all providers or all advocates but many. What this slide is looking at is the fact that healthcare providers as compared to other occupations have higher exposure to histories of personal traumas. They're also more likely to experience workplace violence, working with the public, some of whom are mentally ill. Then we know healthcare professionals develop responses Kiricka talked about earlier relative to the stories that they heard, secondary and vicarious trauma. Next slide, please. So one of the things that we are really wanting to hold for folks in this moment in time and moving forward is we want to dispel the sort of idea of self-care because it's not about a massage, it's not about, you know, shopping or any other kind of thing that you think about necessarily when you do a throw-away thought about self-care, and I think Audre Lorde did a beautiful job of making it soul, making it a part of our well-being. She says at its core it's about rituals meant to calm the nervous system which is what we all need to take care of others. She writes in a poem, I think this is poignant, caring for myself is not an act of self indulgence, it is self-preservation. That is an act of political warfare. It is so hard in the midst of chaos to really carve out time to calm our own nervous system. Next slide. So one of the things that -- CommuniCare and Kiricka's example of CommuniCare was really important. They talked about how important it was to build a space for providers before they started doing this important work of taking care of clients. One example of something we are hearing about and what we're hoping to see systems make changes about, this is both on the advocacy side as well as the healthcare provider side is practice groups for providers. Reflection means stepping back from the immediate intense experiences of hands on work and taking time to wonder about what that experience really means. What does that mean for all of us? I would say to any administrator on this call, federal program officer funding programs, this is an incredibly important thing to think about, investing and supporting change around. Because this is where we help those providers who are so burnt out even before COVID. It's a cost-effective way to help staff with work-related stressors, it's creating spaces that are safe and nonjudgmental, exactly what we want them to do, creates positive regard and caring, what you need to heal, provides space for reflection. Next slide. Please. So there's a new concept that we've also been excited about in addition to healing-centered engagement, vicarious resilience. It's a process of us as the provider, the caregiver in the moment. It's a process of tapping into our own feelings, extending our thinking to how others may be feeling, which of course when you are overwhelmed, flooded, experiencing this sense of anxiety and overwhelmed, it's hard to do this. It's hard to tap into how others may be feeling when we're emotionally tapped out ourselves. It builds empathy, helping us to make more aware of -- helps us be more aware of our own biases and the ways in which different identities influence our perceptions of others. So again, this is what we want to do to create a more equitable environment for -- or a more -- yeah, more equitable environment in the places that we serve. And this, in turn, helps us -- helps to position us to recognize power dynamics, our privileges, helps guide how we engage in our work. This is that next wave. This is how we move from trauma-informed to healing engaged sort of practice because we're creating and looking at power differentials, looking at systems of care that are built on power differentials, and we're taking it back. As we develop these reflective skills we become more attuned to contexts in which inequities exist and allows us to unpack bias which is what we want to do. Next slide. So I'm going to give you just a minute because I just gave you a little journey, right? We talked about a lot of different new terms and concepts but at the end of the day, going back to Audre Lorde, this is how we take a moment in this second together. I want you to take out a piece of paper and a pen or you can use your phone or a Post-it or whatever you want but I want you to take a second and reflect. What are you like inside yourself when you're feeling balanced and regulated? And you can use adjectives. What is it like in your body? What is it like in your feelings? Your thoughts and behavior? Just take a second and jot those things down. Body, feelings, thoughts and behaviors. Then on a different piece of paper, I would like you to write down what are you like when you're disregulated and not in balance in your body, feelings, thoughts and behaviors. Again, writing down adjectives. I'll give you just a second to finish up those lists. What are you like? Can anyone guess why I asked you to do this exercise? Why did I ask you to do this? Because I think we often don't take time to stop and take self-inventory. We don't have spaciousness to do that. If you better understand what you're like when you're disregulated you're better aware of that and able to take steps back into where you are in your body, thoughts, behaviors when you're at a better place. It allows you to take a self-inventory, going back to Audre Lorde, thinking, whoa, my heart's racing, my foot's stamping, I have a headache, stomach ache, my shoulders are like this, feeling really crabby, I'm sure your list is longer than that when you're disregulated. And noticing that sooner rather than later, you have an opportunity to get grounded. I'm going to give you four examples of how you get grounded, that's the next slide, please, Anisa. Mindful self regulation, there's a body of knowledge, lots of research relative to this, and I'm just going to give you four strategies. One is breathing. Many of you do this regularly. Some of you are expert at it, even teach it. So you want to think about how you can use your breath to ground yourself. So one strategy is you can take your fingers on your shoulders, take a deep breath in. Hold it for a count of four. Blow it out. One more time. Deep breath in. Hold it for a count of four. And blow it out. While you can do this in the privacy of your home or turn off your camera on Zoom, I'm not going to suggest you do this in front of your patient or client when you're stressed out, sorry, I need to do this but I can show you a technique in real time on Zoom or in person. For all of you who have your legs crossed, sit forward in your chair, if you're shorter, put your feet on the floor such that you can feel your heels and balls of feet on the floor. Take your palms and rub them on your knees, and push your feet into the floor. Take a little breath. Nobody knew you did that, and that is a grounding technique, and there are many more where that came from. Self-talk. Some of you do this. Mine happens to be "you got this, you got this, you got this" even when I don't. Because it's supposed to be a bridge between my anxiety and my hope. Right? Some folks say a prayer. Some folks have a different mantra. Others use imagery. Maybe it's a picture in your brain of your child or a beautiful, peaceful place that you go to to relax. I love the example of a field of wheat, a nurse in Oregon talked to me about this. She said when I feel stress coming on or have a wave of feeling stirred up I think about the field of wheat and wind plastering the wheat down but then the wind passes, and the wheat comes back up, and it's okay. On the other slide where you talked about dysregulation, I want you to write at the bottom of that exactly which one of these four things is going to be your go-to in the moment. Because the more you have tools in your back pocket the easier it is to access them when feeling flooded or overwhelmed. So go ahead and take a second to write that down. And now I am going to pass it on to the wonderful Anisa who's going to give us an example of something inspiring. Thank you, Anisa. >> Thanks so much, Rebecca. Definitely feeling a little more grounded right now. So I appreciate having that exercise right in the middle of our webinar. So we wanted to give an example of a clinic example of self-care. So we wanted to share this example from CommuniCare, which is the same health center that we shared that quote from earlier from the director of behavioral health Sarah Gavin who talked about meeting some staff self-care as they were beginning to address IPV in their health center. CommuniCare is just outside of Sacramento, it's a federally funded, qualified health center. We wanted to share some of the benefits of health centers. So we talked earlier about advocacy programs and what they offer. Anna shared earlier that we are the national health network on intimate partner violence and human trafficking, so essentially we are a training and technical assistance center for community health centers nationally to address IPV and human trafficking. We've been working with community health centers for a number of years now, even before we were awarded this grant. And we just feel really strongly that community health centers and DV programs are natural partners because of their goals. Community health centers see patients on a sliding fee scale. They don't turn away patients regardless of their ability to pay, regardless of their immigration status. They're located in medically under-served areas, they're patient-directed. So we really feel strongly that community health centers are a wonderful partner for DV programs and vice versa. You're remember the warm referral graphic we had on the screen earlier and support bidirectional warm referrals one to the other. In this example of CommuniCare we worked with them as they were building their partnership with a local DV program near where they are. As they were beginning this work they were really great with thinking about the needs of their staff and how to really take on this sort of organizational self-care in order to be really effective at doing the work. And so a few examples of what they did was they had these monthly brown bag lunch meetings where staff and providers were able to just connect. And just really have a space for kind of peer support. They also, in their clinic, they had a dedicated space to meet. They had this couch where staff and providers could just sort of hang out and relax and just have a little down time together and additional opportunities to connect with one another. And another thing that we really love that they did was they had this focus on self-care and celebration. And rather than being focused on the problems or any issues that were arising. So they're really great in having that really positive focus on growth. And so this approach they found just really helped build resiliency and helped providers really, like, see and understand other providers being intentional about taking a break. So it was really just important for that to be sort of the culture that they had. And it also just really demonstrated how taking care of themselves really meant joining in a celebration of the resiliency and sharing that out loud. So these were just some really great examples of the great work that CommuniCare did. So we want to shift gears and start talking a little bit about our clinical intervention to address IPV and human trafficking and get into a little bit of some of the -- why it differs from traditional screening practices. So I want to just take a minute, and you can just type in the chat box and think about some reasons why patients may be not willing to disclose certain things to their healthcare provider. If you can just note in the chat box how many of you have or know someone who has intentionally left something out of their medical history or intentionally misrepresented to their healthcare provider. Type in the chat box and I'll open it up. Yeah, so it looks like a lot of you are answering the second question, why. Why we think it might be. Maintain family honor, embarrassment, fear, fear, shame, embarrassment is coming up a lot. Mistrust, fear of being judged. Definitely. So we just want to highlight that a lot of people don't share information to their healthcare providers because of all of these reasons. And for fear of judgment, fear that it's going to be used against them in some way. Then we can also think about why this might be the case for specific populations, for example, someone who's worried about their immigration status. So thanks for thinking about that with us. And thinking about why it's -- just could be difficult for folks to disclose some information to healthcare providers. So keeping in mind all of those reasons why patients may be reluctant to share information with providers and keep things from the medical records, in our work we've been thinking about how to make health more equitable for all. I'm going to read the definition on the screen of health equity. It means that everyone has a fair and just opportunity to be as healthy as possible. To achieve this, we must remove obstacles to health such as poverty, discrimination and deep power imbalances and their consequences, including lack of access to good jobs with fair pay, quality education, and house, safe environments, and healthcare. So in the next slide we're going to apply this thinking to domestic violence and the real fears that folks have about reporting and thinking about all those reasons that came up earlier. So this is why we feel an obligation to stop screening and, rather, push for universal education. And I'm going to turn it back to Rebecca who is going to tell us a little bit more about that. >> Thank you. So one of the things that we think about, right, relative to that list that you all generated that Anisa went through is when folks can't tell us their stories, what have we done as a system when we predicate the ability to access services based on their yeses, right? So this is about challenging the limits of disclosure driven practice. If I say have you been hit, slapped or choked, you say no, that's the end of our conversation. So we want to say we are leaving the most marginalized behind us. If we want a more equitable world we have to make room for the fact that your beautiful long list that may reflect your own experiences, right, hasn't been addressed by the system that's supposed to be taking care of it. And we have an opportunity to rethink it together. That's why this is so exciting. Next slide. Please. So really universal education is about equity in health. It gives us an opportunity to not set up our clients to be forced to tell us their story in order for us to help them. But, rather, it creates this universal space so that nobody is left behind. Next slide, please. How do we do this? Well, we've done a lot of research on this little brochure based intervention. These are cards the size of a business card with multiple panels in them. And next slide, please. And inside of the card it has key information. These are really developed for two-fold, right? One was for the client. But the other was for the provider because we know that it can be hard to have a conversation about complicated relationships, about healthy relationships, about trafficking, about vulnerabilities, all of these things can be difficult. So we wanted to give you a jumping off point to have those conversations as we support you in rethinking screening for violence. So here, this is a card for adolescence, hanging out and hooking up card. It talks about what about respect, right? If you're a kid who comes from a home where there wasn't any respect for you or others, this is really important. Anyone you're hanging out with should make you feel safe and listened to, never pressure you, try to get you drunk or high especially if they use that to hook up with you. These are words that may never have been heard. Next slide, please. Here, this panel of the card was informed by formally trafficked women who were teenagers, and in some cases very young teenagers when they were trafficked, and so this helps providers have complicated relationships and actually brings up some of these pieces that I think can be, again, really helpful because I think it can be a stumbling place for some adolescent providers. Next slide, please. Some people say we have an app for that. At futures we say we have a card for that. You are looking at one particular tool developed for adolescents but we have been thinking with you. Everything we do at the national health resource center is about the stories of the clients, the patients, the stories of the healthcare providers and the stories of the advocates. How do we bring all of this together to create tools meaningful for you in your day-to-day world? This is an example of the things you can get from us. Next slide, please. So CUES, those cards are tied to a very simple intervention, and CUES stands for confidentiality, universal education and empowerment and support. Confidentiality, we want to see our clients alone first, nobody in earshot or in the room such that this could be a safety concern for them or would set them up to get in trouble. Universal education empowerment, let me tell you how this works. Pretty simple. Here are the words for providers. I started giving two of these cards out to all of my patients in case it's an issue for you, because relationships can change, and also so you can help a friend or a family member if that's an issue for them. Hold that. You unfold the card. It talks about healthy and safe relationships, ones that aren't and how they can affect your health, situations where youth are made to do things they don't want to and tips so you don't feel alone. On the back are national text and support lines, things to help folks who may not know where to get help otherwise, and you can share that with others. Next slide, please. So a case example. And I'm now going to stop and I -- that was a very quick overview. But the one thing I want to say about the CUES intervention is the magic sauce is that piece around friends and family because altruism is a part of who we are, it's a universal. We all want to help each other. Kiricka's going to give you an example of the ways in which cards have been used in the context of some of her work. Thank you, Kiricka. >> No, thank you. I just think it's important to give practical examples. Because one of the things that we did, we actually have a youth program that we do called lead for 13 to 17-year-olds. And we also provide trainings to a lot of programs like, for instance, healthy living coordinators have a youth program that they work with youth leaders across the state. And so one of the things that we have done is provided some training. And we have used the cards, you know, one on healthy relationships but we really love the hanging out and hooking up card with the youth that we work with. We always do exactly what Rebecca said, give them two, one for you and one for a friend. We had someone within one of those trainings, a youth leader that came up to us and talked about how that card helped a friend. So as we talked to the person it was very obvious, you know, this is like -- and we do this training for them yearly. So we -- it was obvious that it was something that the person was experiencing. So we were able to talk through some of the things that were -- was happening with the friend and some of the connections they could make for that friend. But it just opened up dialogue and gave them something to start that conversation; whereas, I think if we wouldn't have had those cards they wouldn't have health comfortable coming forward to have that discussion. >> Yeah and I'm going to turn it back over to Rebecca. Just wanted to give a practical example. It's helped us with some of the teens that we work with. >> Thank you, Kiricka, that was perfect. I think what we've seen in Kiricka's stories is that card builds relationships. It's strength based, healing focused, talking about the healing centered engagement approach. There's altruism, improves access to advocacy. I don't have to tell you my story to know that Kiricka exists, and she can help me. You've said I'm giving it to you and to everybody so nobody's so alone. It empowers clients and shares power between the provider and client. This issue of building equity and systems that feel safer and more collective is a part. CUES is just one little part of a little stepping-stone toward this ultimate goal of building a more equitable system. Next slide, please. I -- I also want to say, my provider friends, and I was a clinic director for Planned Parenthood, we did full spectrum primary care prior to coming to futures as staff and then a consultant so I know very well, I've lived the experience of provider burnout, and trying to think deeply about what helps. One of the things that I think is also kind of beautiful about CUES is it's not just another thing we're asking you to do for your patients, it feeds you, too. That's what we've learned from our research, right? It addresses provider burnout, helps you identify -- this is one of the things you can control at work. The more things you can control, the buffer, that's a buffer for burnout. The issue of not having enough time with patients, I think when you see folks happily take those two cards, and you're watching their wheels turn, all of a sudden it's not about you being the only person who can hold space. Rather you've shared your power. Now that client can go on to help someone else or themselves. That feels good to providers, right? I think CUES' scripts and tools ease those conversations, promotes meaningful connection in a brief time, we're talking 30 seconds or less, promotes meaning and centers the client's needs above the system's requirements going back to screening versus universal education and where do we want to be in 2021. Again, the script helps providers address conversations that might have historically been difficult for them. And it really brings us back to vicarious resilience which bolsters staff capacity, screening reproduces systems of oppression and universal education. Takes us to the places we want to go. Next slide. Up here -- stop here, and I am going to hand it over to Abby who's going to talk about what's next. >> Thanks, Rebecca. Hi, everyone. First I'm going to post the link to our webinar evaluation into the chat for you all so you can be prepared to fill that out when we close out for the day in just a few minutes. Next I wanted to highlight this webinar recording that we have available to you as a resource. It goes over the CUES intervention that Rebecca covered today as well as some of the UDS measures for capturing intimate partner violence and human trafficking, outlines considerations for privacy, safety and equity working in virtual platforms and strategies for health information technology to support quality clinical care and data collection around intimate partner violence and human trafficking. Next slide, please. And so one week from today we also have another live webinar. This was done in partnership with the migrant clinicians network. If you want more information about registering, follow the link or visit the national health network website. This webinar is going to offer a combination of self-care and organizational practice strategies to help prevent burnout and trauma-informed practices. Check that out if you're available. Next slide, please. We also just want to highlight IPV health partners for you all again. There's more about CUES there as well with an online toolkit. There's information about enhancing patient privacy, limits of confidentiality, some scripts that you can use, ways that you can reach out to friends and family. Information about supportive messages that you can provide for patients and ways that health centers can partner with local DV programs, how to get connected with DV program advocates and where they're located and how to safely share those resources. Next slide, please. All right. So finally we have a few upcoming learning collaboratives as well. The next one is in March, this one's covering health centers and DV programs for a national protocol on IPV and human trafficking, next is strengthening patient and provider responses to intimate partner violence and human trafficking, then crafting a new national version for health centers working with IPV programs and supporting inclusive recovery, addressing the intersection of gender, behavioral health services, IPV and homelessness, adapting a gender justice lens and self-care for provider burnout, mental health and IPV and human trafficking patient support. Now I'm going to hand it over to Anna to close us out for the day. >> Thank you. And just wanted to share this photo. It's on the National Mall. Some you may have seen over the last couple of days these 400 lights in remembrance of the 400,000 lives lost to COVID. So just as we opened, we want to close by giving our thoughts to those not only who have lost their lives but many of you here on the webinar who are doing so much to prevent the loss of life. And to support those in terms of preventing COVID, helping people access healthcare, helping people access domestic violence services. The and just want to continue that light on this day and moving forward. So just want to thank you all for joining us. We will send you a recording of today's webinar. Really appreciate all of you and all the work you're doing. And hope to connect with you soon through some of our other offerings. Don't hesitate to reach out. Our email's on the slide. Just one more reminder to please complete the evaluation. We'll put it in the chat one more time. Abby just put it there. Let us know if there are other to that itics or ideas and you had -- topics or ideas you'd like to hear about. Thank you so much. Enjoy your day and your week. >> Thank you, everyone.