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IHSACF Domestic Violence Demonstration Project IHS Intentional Injuries Course Albuquerque, NM April


Funded by DHHS to operate National Health Resource Center on Domestic Violence ... Policy & Procedure. Feather River Tribal Health Inc. ... – PowerPoint PPT presentation

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Title: IHSACF Domestic Violence Demonstration Project IHS Intentional Injuries Course Albuquerque, NM April

IHS/ACF Domestic Violence Demonstration
Project IHS Intentional Injuries
Course Albuquerque, NM April 5, 2005 Anna
Marjavi Family Violence Prevention
Fund anna_at_endabuse.org
Family Violence Prevention Fund
  • National non-profit working to end domestic
  • Based in San Francisco with offices in Boston and
    Washington, DC
  • Public education, judicial/legal, immigrant
    communities, workplace, healthcare, children, and
  • Funded by DHHS to operate National Health
    Resource Center on Domestic Violence

(No Transcript)
Why Native Communities?
  • A recent report from the U.S. Bureau of Justice
    Statistics found that Native women
  • five times more likely to be a domestic violence
    homicide victim
  • highest rates of DV
  • twice as likely to be victims of violent crimes
    committed by an intimate partner
  • three times as likely to be victims of sexual

Health Implications
  • A review of the medical charts of 100 female
    patients between the ages of 15 and 99 with
    visits to Warm Springs Health and Wellness Center
    over the past 10 years revealed that
  • 58 (58) had medical documentation of domestic
    violence at some point in their lives.
  • the incidence of depression, alcohol abuse, drug
    abuse, chronic pain syndrome, and suicide
    attempts were higher in women with a history of
    domestic violence, than those without.

In the Beginning
  • Partners Indian Health Service, Administration
    for Children and Families, Sacred Circle, and
    Mending the Sacred Hoop
  • September 2002, FVPF piloted new project working
    with 9 Indian/Tribal/Urban healthcare sites on
    institutional reform for DV

Nine Participants
  • Rosebud IHS, Rosebud, SD
  • Gerald L. Ignace Indian Health Cnt., Milwaukee,
  • Ketchikan Indian Corp., Ketchikan, AK
  • Mississippi Band of Choctaw Indians, Choctaw
    Health Center, Choctaw, MS
  • Houlton Band of Maliseet Indians Health Clinic,
    Houlton, ME
  • Feather River Tribal Health, Inc., Oroville, CA
  • Partially funded projects
  • Zuni Comprehensive Community Health Center, Zuni,
  • Warm Springs Indian Health Center, Warm Springs,
  • Crownpoint Healthcare Facility/Family Harmony
    Project, Crownpoint, NM

What did we want to accomplish?
  • develop and strengthen the clinical practice,
    public education and outreach efforts around DV
  • build the domestic violence training capacity and
    leadership within these facilities
  • develop culturally appropriate tools
  • raise visibility that DV is a public health issue
    in AI/AN communities
  • disseminate model and tools nationally

Getting Started
  • multi-disciplinary Leadership Teams at every
    participating site
  • partnerships between healthcare staff and local
    domestic violence advocacy organizations

Getting Started
  • Two training were held in San Francisco and
    Albuquerque addressing
  • Dynamics of domestic violence and sexual assault
  • Health effects of domestic violence including
    issues specific to the OB/Gyn setting
  • Routine assessment for domestic violence,
    intervention, and follow-up
  • Domestic violence reporting requirements and
    legal issues
  • Connection to HIV/AIDS, pediatric-setting
  • IHS data collection, documentation and coding

Policy Procedure
  • Feather River Tribal Health Inc. developed a
    domestic violence protocol for medical, dental
    and behavioral health departments.
  • Houlton Band of Maliseet Indians sought
    achieved Tribal Council approval for medical and
    workplace PP.
  • Warm Springs Health Wellness posted theirs to
    the IHS womens health website.

  • Ketchikan conducted a Domestic Violence in the
    Workplace training to all staff (130 FTE) as
    part of annual safety fair.
  • Instituting ongoing training such as Warm Springs
    mandate that staff complete an online PowerPoint
    training by a set deadline.
  • Feather River created a domestic violence
    training module for medical and dental.
  • All day all-staff mandatory training at Houlton.
  • Crownpoint/Family Harmony provided 5 trainings
    throughout course of Phase I.
  • Zuni trained all staff in 6 months.

Inquiry and Assessment
  • Feather River screens all women 12-80 yo.
  • Choctaw created a screening tool for use in
    Womens Wellness Center
  • Crownpoint/Family Harmony conducts universal
    screening of all females 18 and older.
  • Gerald Ignace created a written form with
    multiple questions social worker follow-up
  • Zuni PHS screens outpatient, inpatient
    medical/surgical, OB and home health visits,
    females 13 and up.

Public Education
  • Creation of public education materials such as
    the Mississippi Band of Choctaws poster
    featuring a child with the headline Domestic
    Violence and Children Witnessing violence always
    has an impact on children! for display in
    waiting areas and patient rooms.
  • Development of a series of domestic violence
    educational screen savers to run on computers in
    exam rooms (Warm Springs Health Wellness
  • Hospital displays.

Community Involvement
  • Gerald Ignace Indian Health Service staffs
    distribution of domestic violence materials at
    local pow wows.
  • Use of radio and local television to raise
    awareness such as Warm Springs Health Wellness
    Centers public service announcements on domestic
    violence through a local radio station.
  • Media newspaper articles, cable-access shows,
    hospital newsletter/web.

  • Choctaws chart review of 87 patients who were
    screened in the Womens Wellness Center. Twenty
    five had a past/present history of DV 60 were
    negative for lifetime DV and 2 patients did not
  • Crownpoint/Family Harmony review of 124 medical
    records revealed screening increased from 31 to
    51. Referrals from the Crownpoint hospital to
    the Family Harmony Project during 2003 were 69.
  • Ketchikan conducted a medical chart review of all
    women seen for annual exam, prenatal or
    traumaevaluated screening, ID and referral and
    provided follow-up training to nursing/medical.

Other Efforts
  • Coloring contests with children in elementary
    schools banner making at summer camp engaging
    kids through quizzes teen dating violence
  • Button making contests
  • Candlelight vigil community walks
  • Banners displayed in courthouse and around town
  • Including DV flyers and stickers with all Tribal
    employee checks
  • Ketchikan presented project results at Rural
    Physicians Conference
  • Warm Springs created domestic violence intra-net

Phase II
  • A year and a half marked end of Phase I (spring
  • IHS and ACF offered refunding for second phase
  • Phase II will last seventeen months
  • October 1, 2004- March 1, 2006.

  • All 9 sites invited to reapply at 1 of 2 levels
  • 15k to continue with institutional reform
  • 30k to continue with institutional reform and
    provide training to outlying I/T/U facilities,
    and provide training to newly selected sites.
  • Eight of nine original sites reapplied
  • 4 were selected under each category
  • Seven new sites joined (30-35k each)

Continuing Sites
  • Feather River Tribal Health, Inc. (Oroville, CA)
  • Rosebud IHS Hospital (Rosebud, SD)
  • Zuni Comprehensive Community Health Service
    (Zuni, NM)
  • Mississippi Band of Choctaw IndiansChoctaw
    Health Center (Choctaw, MS)
  • MENTOR SITES (30k)
  • Ketchikan Indian Corporation Tribal Health
    Clinic (Ketchikan, Alaska)
  • Warm Springs Health Wellness Center (Warm
    Springs, OR)
  • Houlton Band of Maliseet Indians (Houlton, ME)
  • Crownpoint Healthcare Facility/Family Harmony
    Project (Crownpoint, NM)

New Sites
  • Cherokee Indian Hospital (Cherokee, NC)
  • Chinle Comprehensive Healthcare Facility (Chinle,
  • Crow/Northern Cheyenne Hospital (Crow Agency, MT)
  • Kaw NationKanza Health Clinic (Kaw City, OK)
  • The N.A.T.I.V.E. Project Inc. (Spokane, WA)
  • United American Indian Involvement, Inc. (Los
    Angeles, CA)
  • Utah Navajo Health System (Montezuma Creek, UT)

Phase II Meetings
  • October, 2004 Kick-off meeting in Boston, MA
    followed by National Conference on Health Care
    Domestic Violence
  • Second project meeting will be held April 26-27,
    2005 in Portland, OR
  • Third final meeting will likely be held in
    winter, 2005

Project Goals
  • Work with new sites to conduct institutional
    reform as piloted in Phase I
  • Work with continuing sites to increase
    leadership, conduct outlying training, national
    conference presentations, and solidify model for
  • Secure funding to continue work beyond Phase II.

Project Goals
  • Development of
  • new AI/AN specific educational manual
  • model policy procedure
  • assessment tools
  • Exploring dental response
  • Reporting requirements of Tribes, IHS

Recent Success
  • Feather Rivers lead article in IHS The Provider
    highlighting chart review results
  • Choctaw recently completed 30 min. Community
    Video to highlight local DV resources as
    orientation for all new healthcare employees.

  • Chinle will work with the local DV group ADABI
    to lead a community involvement and education
    project to create a mural on the hospital walls
    promoting family wellness, harmony, safety and
    healing. Artists include students from a local
    school art program, the boys and girls club, and
    the 21 Century Program (youth after school
    development program).

  • Anna Marjavi
  • Family Violence Prevention Fund
  • anna_at_endabuse.org
  • 415-252-8900 x22
  • www.endabuse.org/health
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