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Building Bridges: Exploring Women


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Title: Building Bridges: Exploring Women

Building Bridges Exploring Womens Experiences
of Violence, Mental Health, and Substance Use
BC Womens Hospital and Health Centre
  • Woman Abuse Response Program
  • Alexxa Abi-Jaoude Louise Godard
  • 604-875-3717

What we do
  • Focus on the health impacts of violence
  • Program activities include
  • training and support
  • research
  • consultation¬†
  • development of resource materials related to
    practices, policy, and guidelines
  • Have led a number of community and province wide
    projects/consultations including Building
    Bridges, Making Connections and currently Girls
    Speak Out

Addressing the links between violence, substance
use and mental health concerns is important
The Issue
  • Research shows that woman abuse often precedes
    the development of mental health concerns and
    substance use
  • This emerging evidence is not yet reflected in
    practice and policy
  • In response, the Woman Abuse Response Program at
    BC Womens initiated a research and practice
    programme Building Bridges and Making

Project Methodology
  • BC Province-wide workshop/consultation with N460
    service providers representing mental health,
    substance use and anti-violence sectors from 82
  • 15 Focus groups with N102 women affected by
    woman abuse, substance use and mental health

Hearing from women
  • Through consultations and focus groups we have
    heard from women and providers about
  • The impact abuse has on womens health and
    wellness, and on their ability to access services
    and support,
  • How services unintentionally create barriers to
  • How womens interactions with services can echo
    their experiences of abuse, and
  • Recommendations for how to improve access and
    support to this population of women

Building Bridges Framework
Doubly Victimized
  • Many women who access the health care system
    experience their contact with the helping
    professions and systems as another form of abuse.
    These women are doubly victimized, first by
    violent partners and then by practices and
    procedures that are insensitive to their needs
  • (Health Canada)

Violence Against Women
What is Woman Abuse?
  • Violence against women in relationships is
    defined as a pattern of intentionally coercive
    and violent behaviour with whom there is or has
    been a relationship. These behaviours can be
    used to establish control of an individual and
    can include physical and sexual abuse
    psychological abuse with verbal intimidation,
    progressive social isolation, or deprivation and
    economic control
  • the abusive use of power by which an individual
    in a position of force aims to control another
    person by using different strategies to keep this
    person in a position of inferiority or to compel
    this person to adopt behaviors in compliance with
    the individuals own desires. Because violence
    can be exerted in larger systems, this definition
    is not limited to individual conduct but also
    includes violence imposed by social and
    structural systems.

Violence against women
  • 50 of Canadian Women have experienced sexual or
    physical violence.
  • 1 in 3 women experience abuse in their
    relationship at some point in their lives
  • Women constitute 87 of the victims of violence
    in relationships
  • 80 of the accused perpetrators are men1
  • From 1999 to 2004, 4 out of 10 women reported
    that their children witnessed the abuse.

What is Violence against Women
  • A lot of it was just verbal, but I wished he
    would have hit me instead of said what he said.
    The words were just as bad as, they hurt more
    than probably any beating could have. And they
    did more damage for the long term. DJ

Who is Most Vulnerable to Abuse?
  • Aboriginal Women are almost 3.5 times more likely
    to report violent victimization, and more than 8
    times more likely to be killed by their spouses
    than non-Aboriginal women.
  • More than half of children taken into custody in
    BC are Aboriginal, with Aboriginal children being
    apprehended more than 6 times as often as
    non-Aboriginal children
  • Abuse for racialized women can be compounded when
    disclosure triggers assumptions that certain
    cultures are inherently violent or results in
    culturally inappropriate responses

Who is Most Vulnerable to Abuse?
  • Young women aged 25-34 years old were 3 times
    more likely than those aged 45 or older to state
    they had been physically or sexually assaulted by
    a male intimate partner.
  • Girls between the ages of 13-15 are at the
    highest risk of being sexually assaulted. More
    than half of all women who are sexually assaulted
    are under 18.
  • Women working in the sex trade are at enormous
    risk of sexual and physical assault, ongoing
    abuse, and murder. Often when they do report
    abuse (from partners or johns), their stories are
    discredited or minimized

Who is Most Vulnerable to Abuse?
  • Women with disabilities are 40 more likely than
    non-disabled women to be abused by their male
  • Senior women are vulnerable to abuse from their
    spouse as well as their adult children and care
  • Pregnant women are more likely to experience
  • Low-income women may be more often trapped in
    abusive relationships because of a lack of
    financial resources for housing and income

Who is Most Vulnerable to Abuse?
  • Immigrant refugee women may face barriers to
    escaping due to isolation (language or culture),
    dependent status on their partners (immigration
    legislation), or their marginalized place in the
    workforce .
  • Women in rural and remote communities can face
    barriers to escaping abuse due to isolation and
    confidentiality concerns
  • Lesbian, bisexual, queer, transsexual and
    transgendered women can face barriers in
    obtaining support in the social context of
    homophobia and heterosexism

Intersectional Lens
  • Women have a number of different roles and
    identities, and experience various forms of
    oppression that can intersect
  • Geography - rural, urban, reserve
  • Ethnicity
  • Race
  • Class
  • Sexual orientation
  • Disability
  • Mothering
  • Financial insecurity and Poverty
  • Homelessness

Violence and Homelessness
  • Womens incomes from employment and social
    assistance are often too low to afford safe,
    stable housing
  • exposes women to the risk of further abuse and
    sexual exploitation
  • Single mothers entering the shelter system at
    twice the rate of couples with children
  • Women will often do everything they can to avoid
    losing housing for themselves and/or their
  • We see all choices as survival strategies
    choices made between crappy options i.e. trading
    sex for shelter, couch surfing, entering into an
    unsafe relationship for shelter or continuing to
    stay in an abusive relationship because they have
    nowhere else to go.

Violence and Homelessness
  • And the bottom line is if women dont have safe
    housing, how are they supposed to be productive
    members of society. Really? When we are sitting
    in a transition home for 30 days, moving from one
    into another. Going to a hostel. Sleeping on
    our parents couch or our sisters couch. How are
    we supposed to be productive if we dont have
    consistency in our lives? Were not. Were going
    to stay stuck - Dawn

Dominant Discourse of Violence Against Women
  • Commonly held societal beliefs, perceptions and
    commonly used language can be just as damaging as
    formal practices and laws.
  • 40 of men (n1000) in recent Alberta study
    believe that if a woman wears provocative
    clothing, shes putting herself at risk for rape
  • How many times do women get told oh you
    shouldnt have been wearing that short skirt,
    its been going on for generations. Its always
    thrown back at you." - Kris

Dominant Discourse of Violence Against Women
  • Many do not see it as a systemic issue, but
    instead issue of violence against women is
    becoming privatized
  • Instead, stories of abuse are told as individual
    stories, disconnected from each other, and rooted
    in personal characteristics and behaviours.

Dominant Discourse of Violence Against Women
  • Language is relevant in all of our work. We use
    it every day to talk to colleagues about the
    clients that we serve .
  • The language and words we use to write up a
    womans files and how that gets documented
    impacts how the woman may see and understand her
    own experiences.
  • The kinds of questions we ask, when we ask the
    questions and in what tone may impact a womans
    ability to share her experiences of violence with

The Language of Violence and Abuse
  • WE USE woman abuse, violence against women and
    girls, gender-based violence, women with
    experiences of abuse
  • Instead of intimate partner violence (IPV),
    domestic violence, family violence

The myth of mutual battering
  • Research tells us that 88 to 95 of victims of
    abuse are women
  • Women rarely initiate violence against men
  • Women's aggression is mostly retaliatory or
  • Violence experienced by women, as well as its
    impacts, is far more severe than that experienced
    by men

What about men?
  • Any kind of violence is wrong, be it against men,
    women or children.
  • The idea is not to paint men as villains, or
    group ALL men with the group of men who choose to
    perpetrate violence. We recognize that this is a
    small subsection of males.
  • We need to look at the clear gender relationship
    in violence, and what it tells us about the issue
    and potential solutions, so we can avoid
    perpetuating the problem for generations to come.
  • Need for relevant and effective ways to support
    men who are abusive as well ways to engage boys
    and men to work towards
  • ending VAW

Cycles of Violence and Abuse
  • I was in a very abusive violent relationship
    for too long. I was so worn down because his
    moods would change just like that. One minute he
    would be telling me how much he loves me and the
    next minute hed be hitting me or screaming at
    me. And I never knew when he would switch. -

Cycles of Violence and Abuse
  • Abusive men target vulnerable women, portraying
    themselves as someone who can protect her and
    care for her, making false promises to attract
    her to him.
  • Girls fleeing abusive families often become
    involved in abusive relationships - He tells her
    he can protect her or meet some of her needs.
  • The process of leaving is hard. For some women,
    they leave immediately and never look back. But
    most return hoping for a different outcome, that
    promises will be kept.

  • Leaving dominant normative ideal of services
    and supports designed to help women with
    experiences of violence
  • based upon the basic unexamined assumption of
    'leaving' as the most rational choice, much like
    abstinence-based approaches to substance use.
  • also based on the notion that if a relationship
    is abusive, a woman will exercise agency and
    choose to leave
  • tension between discourses of free will and
  • I heard people say that you make your own
    choice you can do whatever you want. And to an
    extent I agree, but when you make that choice,
    you and your children could be killed if you do
    it, so you choose not to. To an extent that
    choice is made for you. - Nicola

Cycles of Violence and Abuse Why doesnt she
  • If women fail to successfully leave and cease
    contact with the abuser, the truth surrounding
    their experiences of violence and their mental
    capacity is questioned
  • reducing questions of complex social and
    structural inequities to issues of self-esteem
    and co-dependence
  • Increased lethality/Fear of retaliation
  • Wants to keep her family intact/ avoid a custody
    battle/fear of losing kids
  • Fear of disapproval by her cultural community
  • Negative consequences of such actions on her
    immigration status
  • Economic and language barriers
  • Fear of dealing with unfamiliar legal systems
  • Lack of long-term stable, affordable housing

  • It is important that you do not see womens
    return to abusive relationships as a failure on
    your part.
  • Women leave and return to their abusers several
    times before finally leaving (current average 8
  • Important that she feels like she can come back
    and that you will do the same for her the next
    time she walks into your organization.

Power and Control
  • Power and control is central to dynamics of abuse
  • Perpetrators are 100 responsible for their use
    of abusive strategies
  • Perpetrators use abusive strategies intentionally
    they are not out-of-control
  • Abuse is not equivalent to mismanaging anger

Power and Control Wheel
Intersectional Power and Control Wheel
What are some of the Impacts of Abuse?
(No Transcript)
Linking Violence against Women and Mental Health
Linking Woman Abuse and Mental Ill Health
  • There is evidence that many mental health
    problems post-date experiences of abuse
  • 70 of women in psychiatric in-patients and 80
    in secure settings have histories of physical or
    sexual abuse (Phillips, 2000)
  • Between 35 73 of abused women experience
    depression or anxiety (Golding, 1999, Fikree
    Bhatti, 1999)
  • More than 70 of those diagnosed with
    post-traumatic stress disorder (PTSD) are women
    (Kessler, 95).

like the first counselingwas totally
uncomfortable because shes like right off the
bat, not even five minutes into the session,
and shes like oh, so youre depressed. No, Im
just tired of being hit all the time. - Kate
Mistaken Assessments
  • Research identified women being pejoratively
    characterized and labeled as neurotic,
    hysterical, hypochondriacal, having personality
    disorders, or as a well-known patient with
    multiple vague complaints
  • These outcomes may be effects of abuse or signs
    of coping
  • Going to my doctor, I used to break down and cry
    in his office and hed say, Youre depressed.
    No Im just sad. Im just going through a really
    sad time. He said, Theres a name for that.
    Its depression. Finally he convinced me I
    should go on an anti-depressant. Like that was
    going to stop me from being beat up.- Gillian

Symptoms of Abuse
  • What is interpreted in a womans presentation as
    non-compliance, aggression, an inability to make
    a decision or follow through with a decision,
    dependency, dysfunction, poor mothering, etc. may
    be the demeanour of a woman impacted by abuse
  • I dont call it mental health, I call it
    symptoms of abuse, because to me that is what it
    is. - Gail

Abusers may exploit a womans vulnerability
  • Keep medications from her, give her too much
    medication, demand she takes medication
  • Take advantage of changes in her symptoms and
    moods (eg. encouraging suicidal feelings)
  • Threaten to take her children away and tell child
    protection authorities or the court of her
  • Claim that she is an unfit mother because of her
    mental health problem
  • Minimize her credibility

Abusers may exploit a womans vulnerability
  • Mine was happy that I was getting mental health
    care. Because I was in an extremely low
    depressive state. But I had to sneak around to
    get the type of help that I really need in order
    to be able to climb out of that hole. He wanted
    mental health and addictions to fix me so that I
    would be his mold. And that I could go back to
    living in the bedroom of the RV and not coming
    out and bugging him and just doing what he told
    me to do when he told me to do it. That would be
    his idea of fixing me.
  • - Emma

Linking Violence Against Women and Substance Use
Connections Between Substance Use and Violence
  • Alcohol dependency is 15 times more prevalent
    among women impacted by abuse than the general
  • Between 60-80 of women in treatment have
    experienced sexual or physical abuse at some
    point in their lives. This increases to 90 100
    when emotional/verbal abuse is included.
  • I went from a mentally abusive household to a
    husband who physically abused me and did drugs.
    And my home was so full of drugs, I had no
    control over what he was selling in the house,
    what he was doing in the house or doing to me. -

Connections Between Substance Use and Violence
  • In a BC study of 512 young Aboriginal people who
    smoke or inject drugs, a large majority (68) of
    the 262 participating girls and young women had
    experienced early childhood sexual abuse, with a
    mean age of 7 years old
  • growing up in foster homes and group homes.
    And, the neglect and the abuse that goes on in
    there, like I dont wanna remember that or
    participate in whats really going on, so I check
    out from life, and I bang heroine all day so I
    can numb myself, right? Jessica (GSO)

Girls who experience physical sexual abuse by dating partners are more likely to engage in risky behaviors. (Note Odds of 2.0 mean a girl is twice as likely to engage in the behavior as one who was not abused.) Girls who experience physical sexual abuse by dating partners are more likely to engage in risky behaviors. (Note Odds of 2.0 mean a girl is twice as likely to engage in the behavior as one who was not abused.)
Behavior Odds
Heavy smoking (within 30 days) 2.5
Binge drinking (within 30 days) 1.7
Cocaine use (ever) 3.4
Diet pill use (within 30 days) 3.7
Laxative use / or vomiting (within 30 days) 3.7
More than three sex partners (within 90 days) 3.3
Pregnancy (ever) 3.9
Considered suicide (within 1 year) 5.7
Attempted suicide (within 1 year) 8.6
Silverman, J. G., Raj, A., Mucci, L. A., Hathaway, J. (2001). Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behaviour, pregnancy, and suicidality. The Journal of the American Medical Association, 286, 572-579 Silverman, J. G., Raj, A., Mucci, L. A., Hathaway, J. (2001). Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behaviour, pregnancy, and suicidality. The Journal of the American Medical Association, 286, 572-579
Medicating Impacts of Abuse My doctor was
my drug dealer
  • Women in abusive relationships may be addicted to
    medications prescribed by health care providers
    for health concerns related to abuse. For
  • chronic headaches
  • abdominal pain
  • joint and muscle pain
  • anxiety and depression
  • sleep disorders

My addiction was the solution, my problem is
abusive relationships- Stella
Connections Between Substance Use and Violence
  • Substance use may begin or escalate as a response
    to victimization/ woman abuse
  • Some women drink alcohol or use other substances
    to numb or escape the emotional and physical
    trauma of violence/abuse
  • Substance use can placate her abusive partner and
    create temporary safety for her.
  • One starts with one- the abuse and then you
    have the abuse and then you start with alcohol
    and then a bit of coke and carry on from there
    and keep going. Just trying to be numb...

Connections Between Substance Use and Violence
  • An abuser may introduce his partner to alcohol or
    drug use to increase her dependence on him and to
    control her behaviour
  • Efforts to stop using substances may precipitate
    abusive partners' use of increased violence or
    other control tactics.
  • It went from mental abuse to physical to
    emotional. The way I dealt with it was by
    drinking all the time. Thats the only way I
    could cope. Naomi

Connecting Abuse, Substance Use, Mental Ill
Health and FASD
  • Study of Birth Mothers of 160 children with FAS
  • Of the 80 interviewed
  • 100 were sexually, physically or emotionally
  • 80 met the diagnostic criteria for a serious
    mental illness
  • 80 lived with men who did not want them to quit
    drinking when they were pregnant

Astley, S. J., Bailey, D., Talbot, C., Clarren,
S. K. (2000). Fetal Alcohol Syndrome (FAS)
Primary Prevention through FASD Diagnosis II A
comprehensive profile of 80 birth mothers of
children with FAS. Alcohol and Alcoholism, 35(5),
  • I think it needs to be everybodys
    responsibility. I dont think it should just be
    put on the mothers. I think it should be the
    fathers job. I mean, his dad made me drink a
    couple of times when I was pregnant with him,
    because he was I mean, to try and make us not to
    fight, he would try to get me to drink, when I
    was angry, and that kind of stuff.- Shannon

Perpetrators and Substance Use
  • Research shows
  • Men use substance use as an excuse for violence
  • Even if assaults occur when using, non-physical
    abuse occurs when sober
  • No evidence that working with perpetrators
    substance use will reduce violence, and some
    evidence that violence increases with addictions

Barriers Exercise
Abusive partners can prevent access to services
  • Prevent women from getting support
  • Dominate or control encounters with service
  • Interfere with womans treatment regimens
  • Describe his partner as mentally ill and a danger
    as a strategy to discredit her
  • Groom providers hes such a nice guy hell
    make such a great dad youre so lucky.
  • Be given guardianship of womens care

Access to Care Is it really a choice?
  • There has been several times especially in
    hometown . My hip was broken. My partner had
    broken my hip and I chose not to go until I was
    out of the situation. He had refused to take me.
    He had basically stopped me from going. I heard
    people say that you make your own choices you can
    do whatever you want. And to an extent I agree
    but when you make that choice, you and your
    children could be killed if you do it, so you
    choose not to. To an extent that choice is made
    for you.
  • - Natalie

The Reality of Accessing Services
  • Only 11 of women survivors had accessed a
    shelter or transition house, 11.2 a women's
    center and 15.4 a community or family center
  • For women who did not seek help, only 6.4
    reported that they did not know of any services,
    or that services were unavailable
  • Insufficient knowledge and training on violence
    against women can lead to
  • Ignoring or minimizing womens experiences of
  • concerns that addressing abuse is
  • fear that talking to women about abuse will open
    'Pandoras Box' "to which they feel they are
    ill-equipped or not responsible

Routine PracticesAdverse Effects
  • The dynamics of power and control women
    experience in their abusive relationships can
    also be central to their experiences in services
  • Services can retraumatize women by replicating
    the dynamics of women's primary trauma (Markoff
    et al., 2005 Elliot et al., 2005).
  • I had an ectopic pregnancy And then, they
    used me as a guinea pig for the medical students.
    So I've got all these medical students shoving
    their fingers up my vagina, and that's when I
    just died that day. Courtney

Provider Attitudes and Mistreatment can be a
Barriers to Access
  • Not respecting womens decisions
  • Judgments about help seeking behaviours
  • Prejudicial attitudes
  • Women may not seek services for fear that service
    providers will alert the police or MCFD
  • Pressuring women to do things they are unable or
    unwilling to do
  • Not obtaining consent
  • Not believing women
  • Women made to feel responsible for their own
    suffering and undeserving of help

Service Encounters Can cause Further Harm
  • theres nothing thats going to hurt me more
    than taking my kids away. Theres nothing. Like
    theres no like, give me a fucking death
    sentence, theres nothing. And that little
    fucking shadow on your shoulder, that youre
    always scared cause things get manipulated, and
    they dont need any good reason to take your
    childrenAll they need is some fucking person
    thats making a big enough accusation that
    theyre going to fucking do it, and then you have
    to prove yourself later. Thats like- for me,
    honestly now that I have my daughter, I look over
    my shoulder the whole time Annabelle (GSO)

Family Centred Care?
  • Because he always participated. This is
    another barrier. He always participated in my
    sessions with my mental health worker. He had
    them believe, for the little while, that he was
    Mr. Support. Hugely. He couldnt do that with
    the Stopping the Violence Program. My partner
    insisted and MH worker allowed him to. So I
    could never speak completely freely or anywhere
    freely about the relationship. All that was
    being dealt with was the mental health issue.
    But the mental health issue had so much to do
    with the relationship issues - Vivian

Attitudes of Professionals
  • Im always seeing judging eyes. Judging ears.
    It feels like they dont want to hear your story.
    Or maybe, youre fabricating some of your story?
    This is how it was. This is how I present it,
    because its the only way I know how to. Its
    judging eyes. Thats the barrier I face every day
    when I leave the door. Which people are going to
    have those judging eyes? - Hanna

Service Encounters Can cause Further Harm -
Attitudes of Professionals
  • I dont feel comfortable if its a certain
    person. Theres somebody there that makes you
    feel like youre a burden. And Ive been a burden
    all my life. I dont need to feel that. You need
    people to love you when you cant love yourself..
    Not feel like they are just there for a pay
    cheque. - Wendy

Services dont reflect womens reality
  • Treatment length and lack of options for
    non-residential support
  • Mandates that dont support women staying in
    treatment mixed gender, male dominated and male
    oriented services
  • Services without childcare
  • Lack of focus on safety during and after
    completion of treatment

Key Principles
Trauma and Violence-Informed
  • Based on understanding violence against girls and
  • Reflects the prevalence and impacts of violence
  • Understand the social, economic, psychological
    and legal ramifications
  • Understand its long-term nature, and hence the
    difficulty in a quick resolution
  • Explicitly naming violence and using the term
    violence-and trauma- informed, helps to recognize
    and account for the gendered and ongoing context
    of coercion and control of womens experiences of

  • Given pervasiveness of abuse and challenges of
    differentiating abused / non-abused women - treat
    all women with assumption that they may be
    experiencing abuse
  • Women will not have to disclose to receive trauma
    and violence-informed services.
  • Focus on changing our practices and settings to
    take the burden off women to disclose and
    instead create services that all women can feel
    comfortable in.
  • Providing services counter to the dynamics of
  • Designing services based on needs of women, e.g.
    support groups, women only spaces, practical
    support, peer support
  • Making links and avoiding misdiagnosis and

What does a violence and trauma informed approach
look like in practice?
  • Supporting womens involvement
  • Enhancing control, choice and autonomy
  • Control remains in the hands of the woman (i.e.
    explicit consent for everything)
  • Interrogates practices that make assumptions
    about womens autonomy and choice
  • sharing power
  • integrating care
  • promoting healing and recovery
  • Promoting Safety
  • Recognizes womens safety strategies and honours
    and supports her (i.e. recognizes substance use
    as a safety/ coping strategy)
  • Ensure women are safe (Before women leave the
    program develop a plan with the woman to support
    her safety)

Women-Centred Approach
  • Women know their own reality best
  • Women are best served by a system of care that
    acknowledges womens differences from men
  • Providing women-centred services is fundamental
    to womens empowerment and safety
  • Recognizes womens safety
  • is an important factor in the
  • safety and protection of
  • their children

Gender-Informed Practice
  • Focus on womens health and safety needs in the
    context of gender identity
  • Gender-based Analysis
  • used to determine the differences in experiences
    between men and women (i.e. how they may
    experience violence, poverty, homelessness, etc.
  • challenges the assumption that women and men are
    affected in the same way by research, policies
    and programs, or that health and social issues
    such as causes, effects and service delivery are
    unaffected by sex and or gender.

What does a Women-Centered Gender-Informed
Approach look like in practice?
  • Treat women as the experts of their own lives
  • Support women to set their own goals and support
    womans choices
  • Recognizing and supporting women discover their
    strength, resources and resistance to all forms
    of oppression, including violence.
  • Honour diversity
  • Acknowledge the social realities and various
    forms of oppression that impact women, rather
    than focusing on individual characteristics
  • Shift perspective from What is wrong with this
    woman to What has happened to this woman?

Harm Reduction
  • A spectrum of strategies to reduce harm around
    substance use.
  • Abstinence not viewed as the final goal or even
    the ideal goal
  • Work to reduce risks to women who are using as
    well as others in the community
  • Since the majority of women who use substances
    have histories of abuse, need to expand the
    approach to encompass womens safety concerns.
  • We use the drugs to try and mask the abuse. And
    once you stop using them flashbacks come. Its
    just a constant. We just self-medicate. Trying to
    push those memories out. Sherri

Harm Reduction
  • Recognizes the intrinsic value and dignity of
    human beings
  • does not divide women into binaries of survivors
    who are deserving of support vs. drug users who
    are undeserving of support
  • Does not judge licit and illicit drug use as good
    or bad, rather it looks at people's relationship
    to drugs
  • The focus is on how a woman feels about her
    substance use, whats working or not working,
    what could be working better.

What does Harm Reduction look like in
  • Expand definition from focusing on use of
    substances to promoting health, safety and
  • Primary concern is her safety and providing
    helpful support.
  • She may decide to reduce her use of substances
    but she may not.
  • She may decide to quit working in survival sex
    work but she may not.

  • When substance use is viewed as a safety or
    coping strategy, violence in a womans life may
    need to be addressed before the symptom or
    coping mechanism can be reduced/ withdrawn.
  • Acknowledge the effort of reaching out and
    getting the support she so deserves.
  • Recognizing that women may not be able to choose
    to stop using substances reflects the complexity
    and risks involved in womens substance use.
  • Avoid language praising sobriety or being clean
  • if a woman is still substance using are they
    unclean or dirty?

What does Harm Reduction look like in
  • Provide realistic options and services to women.
  • Focus on reducing harms now (i.e keeping women
    safer) while helping achieve longer term goals.
  • Focus on reducing harmful effects of behaviours
    that still supports personal choice, strengths
    and motivation to change (w/o imposing moral
  • Supplying food, housing, safety, fostering
    trusting relationships, all serve to reduce harms.

Relational Approach
  • Even more important than access to care is the
    nature of the relationships the women experience
    with providers or counsellors they encounter in
    the helping system. (Spencer 2000)
  • The support of a caring, respectful, authentic,
    accepting, patient, non-judgmental, encouraging,
    empowering, hopeful and empathetic service
    provider is crucial

Relationship Building
  • Focus on building relationships based on respect
    and trust
  • Get to know the women, who they are, what their
    story is
  • Women say the most effective approaches for them
    is a supportive, non-stigmatizing relationship
    with a service provider
  • On the other hand, one of the main barriers to
    seeking help and support is the fear of being
    judged and treated prejudicially.
  • It takes time to build these relationships

What does Relationship Building look like in
  • Respectful, nonjudgmental services will reaffirm
    a womans decision to seek support and to do so
    again if she needs it
  • Being engaged and there for each woman who enters
  • Focusing on what she wants support for, rather
    than identifying areas of support for her
  • Give lots of personal space.
  • Using respectful tone and language Being attune
    to your body language and how it is impacting the
  • Actively listen to what the woman has to say.
  • Be authentic, open and honest
  • Inform women of their rights, rules and grievance

What does Relationship Building look like in
  • Requires flexibility
  • Every woman we support is different and has
    unique needs and goals.
  • Flexibility is important to meet womens varying
  • Constantly think about and ask women how best we
    can support them
  • Consistency and transparency is important so that
    policies procedures do not feel arbitrary.

Promising Practices
Promising Practices
  • Integrated Services
  • Girls and Womens Support Groups
  • Peer Support
  • Outreach Services
  • Help Navigating the System
  • On-going Support/Follow-up
  • Mothering Support
  • Culturally Safe, Inclusive Services
  • Support for Men and Boys

Making Connections Support Groups
  • Low barrier integrated support groups for women
    impacted by violence, substance use and mental
    health concerns
  • 16 week women only support groups
  • Women can self refer do not have to prove abuse
    or have a clinical diagnosis
  • No intake process
  • Women are not required to abstain from using
    substances to participate in the group
  • Women can arrive late, leave early or miss weeks
    without consequence

Making Connections Support Groups
  • Co-facilitated by a provider from the
    anti-violence sector and a provider from mental
    health and addictions
  • Shared ownership of the group
  • The first group session allows women to build
    rapport and set up guidelines
  • Many facilitators set a precedent by disclosing
    some of their own experiences
  • Facilitators check-in also

Guiding principles for groups
  • There is no agenda to have women leave their
  • Women sharing their experiences is central to the
    healing process
  • It is the facilitators role to earn womens
  • The importance of having relationships with
    supportive professionals that are free from power
    dynamics, judgments or punitive consequences so
    that women may experience relationships of trust,
    mutuality and respect.

Making Connections Support Groups Improved
  • Im not crazy Im not alone Its not my fault
  • Decrease in isolation/increased connection
  • Increased empowerment
  • Reduction in depression and anxiety
  • For some women a reduction in use of substances

Making Connections Support Groups Improved
  • But that was so exciting to come here and meet
    all these beautiful women that have had these
    same experiences. We think no one else in the
    world would live like this. But for me it does
    take away that crazy-making, like Im insane? Did
    this really happen? And its very valuable -

Alexxa Abi-Jaoude aajaoude_at_cw.bc.caLouise
Godard lgodard_at_cw.bc.cahttp//
Thank you!
Action Planning
  • Where is the potential for replicating the
    dynamics of power and control (within your
    personal practice and/or within your
  • How can we shift these practices/policies to
    mitigate the potential for harm?
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