Developing Organizational Capacity to Reduce the Intersection of IPV and HIV/AIDS through Referral Services: A Local Par

1. Developing Organizational Capacity to Reduce the Intersection of IPV and HIV/AIDS through Referral Services: A Local Partnership Approach Amelia J. Cobb, MPH The Wright Group, LLC National HIV/AIDS and VIOLENCE CONFERENCE AUGUST 22, 2009 ATLANTA, GA

2. What is Capacity Building for HIV/IPV? • Capacity building for HIV/IPV can be defined as the skills, infrastructure, and resources of organizations and communities that are necessary to effect and maintain behavior change, thus reducing the level of HIV risk and violence among women.

3. What is Capacity Building for HIV/IPV? • Rarely can a single facility, agency or community group deliver all of the services to meet the needs of the HIV/IPV intersection therefore referral networks and local partners are key for HIV testing in IPV CBO’s and after IPV screening in HIV CBOs. • Capacity building and programming for IPV/HIV integrated approaches must be tailored to the specific community, city, county, or state context • Many Community-Based Organizations (CBOs) represent the only accessible service point for integration at the community level, and they need support in their efforts to deliver integrated services.

4. Levels of Capacity Building for IPV/HIV • Organizational Level- Primary • Map out current resources within reach • Establish or developing a referral system/network • IPV or HIV agency, Police Department, Hospitals, Churches • Local Level (City, County)- Secondary • Developing HIV testing or IPV screening recommendations • Partner with city or county working to address IPV/HIV locally • State Level • National Level

5. Steps to Start Capacity Building

6. Referral System Definitions • Referral is the process by which immediate client needs for comprehensive HIV/IPV supportive services are assessed and clients are helped to gain access to services, such as setting up appointments or giving directions to facilities for services.

7. Referral System Definitions • Referring organization: organization that first makes the referral; it is also sometimes called the coordinating organization. • Receiving organization: the organization to which the client is referred for services; it is also sometimes called the organization that fulfilled the referral.

8. Partnership Overview • What is the Partnership to Reduce Intimate Partner Violence (IPV) and HIV? • Began as a pilot program formed in October of 2006, as a growing national effort to educate intimate partner violence (IPV) and HIV/AIDS services providers on the relationship between IPV and HIV in female survivors.

9. Geographical Reach for 2009 # Primary # Secondary 1 1 1 1 1; 49 1 1; 26

10. Primary CBO Partners Trained • California Partnership to End Domestic Violence • Center Against Domestic Violence  • Delta Region AIDS Education and Training Center • Family Crisis Center of Prince George’s County • Giving Chance • House of Ruth Maryland • My Sister’s Place • New Age Services Corporation • Ramona’s Way • Women Alive Coalition • Women of Freedom Foundation • Turnaround Inc. • YWCA Annapolis and Anne Arundel County • YWCA Northwest Georgia

11. Secondary CBO’s Trained in 2009 Office of Public Health HIV/AIDS Program ONE LOVE African American HIV/AIDS Prevention Project Option House Outta the Box Peace & Joy Care Center Peace Over Violence Prototypes- Women's Care Center Rainbow Services SFVCMHC Sojourn Services for Battered Women and Their Children South Asian Network Su Casa~Ending Domestic Violence Tulane University HSC UCLA Medical Center Valley Family Center/ Jewish Family Services Watts Healthcare Corporation WB Community Learning Center West Angeles Community Development Corporation Woman's Hospital East Los Angeles Women's Center EIC/EKLMC EMS Prison Medical Services Haven Hills HOP Clinic House of Uhuru J.W.C.H. L.A. Gay & Lesbian Center LA Office of Public Health LA State Univ. Health Science Center LAC/USC Maternal Child Clinic LACDC LADA - Victim-Witness Assistance Program Legal Aid Foundation of Los Angeles Los Angeles County Housing Authority Los Angeles Family Housing LSU Heath Sciences MidCity Clinic N.O.W. New Age Services NO AIDS Task Force NORAPC N'R PEACE • 1736 Family Crisis Center • Adolescent Trials Network • AGAPE Foundation Against Domestic Violence • AIDS Healthcare Foundation • Alcoholism Center for Women • Altamed Health Services • Belle Reve • Bernie's Lil Women Center • Black AIDS Institute • BLWC • CA Black Women's Health Project • Center for Domestic Violence • Children's Hospital-FACES • Charles Drew University • Chicana Service Action Center • Child & Family Center • Coalition of Mental Health Prof. • Common Ground • Cornerstone Counseling • Delta Region AIDS Education & Training Center • Downtown Women's Center • Drew University • East Los Angeles Women's Center

12. The Partnership Focus • The Partnership focuses on: • Training HIV/IPV providers on the intersection to strengthen prevention messages to foster rapid HIV testing and IPV screening in CBOs. • Increase capacity building among HIV/IPV agencies • Access and awareness of testing, screening ,utilization of local state and regional services, referrals and strategic partnerships. • Builds HIV/AIDS capacity in IPV agencies for institutional and systems change. • Infrastructure development in IPV/HIV agencies for HIV prevention, testing and IPV screening. • Organizational leadership development in IPV agency staff with respect to HIV/AIDS.

13. Partnership Capacity Building • Organizational Level Examples: • HIV CBOs • Established draft protocols for IPV screenings and referral forms in all HIV primarypartnering agencies in 2009. • IPV CBOs • Established HIV prevention and testing referral recommendation procedures into the in-take process (resident and non-resident) in all primary IPV partnering agencies in 2009 • Established HIV Confidentially Policies Recommendations for clients (which was previously not instituted). • Protocols for Occupational Exposures in Shelter/Housing

14. Partnership Capacity Building • City/ County Level Examples: • Los Angeles County Office of HIV/AIDS • As of 2009 HIV/AIDS Prevention Guidelines include Violence Against Women (VAW) • Established partnership for joint local agenda for Fall 2009 • DC Partnership Working Group • Ninecommunity based organizations (CBOs) developed gender-specific prevention and intervention service recommendations for the District of Columbia HIV/AIDS Administration. • Recommendations provided to: • Mayor of the District of Columbia • The DC HIV Prevention Community Planning Group (CPG) • Office for Women’s Policy • Over 40 nonprofit health and social service organizations servicing women in the District of Columbia

15. Lessons Learned • The intersection of HIV/IPV not seen as public health issue by IPV CBO’s; particularly in southern states. • Changing practice to incorporate IPV screenings in HIV agencies takes time, even when accompanied by substantial support as has been provided. • HIV provider agency’s in states that do not require IPV screening after HIV testing didn’t screen for IPV 100% of the time. • Documenting client HIV testing accurately and consistently • Staff turnover in IPV and HIV CBO’s is high, in 2009 primarily due to layoffs and funding cuts • Impact of local government in relation to CBO participation • CBOs fear of local government • IPV Partners not allowing direct access to clients if leadership changes • To ensure validity of self-reporting and evaluation

16. The Challenges • Lack of supervised practices and follow-up after training by CBO managers or clinical directors • Inadequate resources, facilities and organizational management for need of the population • Poor selection of provider trainees amongst CBO • Burnout (emotional exhaustion among providers) • Weak referral system • The existence of good support for providers to lessen burnout is directly related to a good referral system.

17. Successful Referral System • There are varying degrees of formalization however, a successful referral system entails a process of coordinating service delivery to ensure that: • Access to needed services is expedited. • Confidentiality is maintained. • Referrals between the organizations in the network can be tracked. • Referrals and their outcomes are documented. • A feedback loop informs the organization initiating the referring organization that the requested service has been delivered and has met the needs of the client. • Gaps in services can be identified and steps taken by organizations in the network to bridge them.

18. Recommendations for Referrals • An HIV or IPV provider can perform the following referral functions: • Identify and conduct outreach to clients. • Assess the comprehensive needs of the client. • Discussion of HIV risk, testing services or • IPV screening with IPV agency follow-up • Develop an individual plan with the client: • Sexual Safety Plan • Sexual Health Assessment Check-Up Plan • Implement the plan by linking with the respective IPV/HIV service delivery system partners or receiving organization. • Monitor service delivery and advocate for clients when possible • Continue evaluation of client needs

19. Recommendations for Referrals • Work with clients to decide what their immediate referral needs are for themselves and their children. • Outline the health and social service options available and help the client choose the most suitable in terms of distance, cost, culture, language, gender, sexual orientation and age. • In consultation with the client, assess which factors may make it difficult for the client to complete the HIV/IPV referral (e.g., location, lack of transportation or child care, work schedule, cost, stigma) and try to address them based on your resources.

20. Tools to Facilitate the Referral Process • Directory of services • HIV providers do you know where the nearest IPV agency or domestic violence shelter is in your community? • DV providers do you know where your nearest FREE HIV testing center is in your community? • Give clients a list of other available services with addresses, telephone numbers and hours of operation- KEEP IT UPDATED! • Ask the client to give feedback on the quality of services to which she is referred. • Develop referral form and client tracking method • Maintain a referral register or log

21. Outcomes of the Referral Process • Total number of referrals made • Number of follow-up referrals made • Number of referrals made to which services (i.e., re-connected with care, housing, legal, child-welfare system) Number or percent of referral services completed • Number or percent of clients who report their needs were met • Number or percent of clients who report satisfaction with referral process • If possible, number of clients who did not follow-up with referral process

22. Potential Policy and Program Actions • Key integration of gender-specific HIV/IPV policy and program actions are need and must build on the following principles: • Address structural determinants • Focus on human rights and gender-based violence • Promotion of a coordinated and coherent response to IPV/HIV in the U.S., specifically and exclusively • Involvement of survivors of IPV and women living with HIV • Foster community participation • Reduce stigma and discrimination among providers and also local community leaders

23. Where & How Can Your Start? • Provides conduct internal organizational assessment • IPV Providers (recruitment, interventions) – incorporate assessments HIV risk , referral linkages and additional program development for prevention • HIV Providers (clinical, testing) – implement IPV screening tools and safety planning; referrals and linkages • Local, County and State Health Departments – Implement Integrating Domestic Violence Screening into HIV Counseling, Testing, Referral & Partner Notification; Ex. New York State http://www.health.state.ny.us/nysdoh/rfa/hiv/guide.htm • Researchers – develop local gender-specific research agenda; additional studies on women, violence and substance use; specific to the United States • Funders – fund comprehensive strategy for services and community change as it related to HIV, women and violence • Policy makers – prioritize HIV risk among women and violence as public health priorities to improve community health.

24. Thank You! Contact Information: Amelia J. Cobb, MPH Principal The Wright Group, LLC.1701 Pennsylvania Avenue, NW- Suite 300 Washington, DC 20006phone: (202) 904-6824 fax: (800) 886-9698 email: acobb@twgstrategies.com; acobb@reduceipvandhiv.org