>> 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.