Meeting the Clinical Service Needs of NYC’s Sexual Violence Survivors The Critical Importance of a Resource Guide

1. Meeting the Clinical Service Needs of NYC’s Sexual Violence SurvivorsThe Critical Importance of a Resource Guide Debi Fry, MA MPH, Research Director Tamara Pollak, RN MPH, Training and Ed Director NYC Alliance Against Sexual Assault

2. The Alliance: Who We Are & What We Do • The Alliance was founded in 1999 as a coordinating agency to facilitate a network of support and share knowledge on behalf of the professionals who care for victims of sexual assault throughout New York City.

3. The Alliance: Who We Are & What We Do • The Alliance was founded in 1998 as a coordinating agency to facilitate a network of support and share knowledge on behalf of the professionals who care for victims of sexual assault throughout New York City. • DETECTION • INTERVENTION • & • PREVENTION • throughout lifespan • RESEARCH • TRAINING & ED • ADVOCACY

4. The Alliance Resource Guide • Published in Fall, 2000 • At that time goal was to provide a complete and comprehensive listing of specialized programs within the city. • Criteria for inclusion • Specialized funding to provide direct service to New Yorkers affected by sexual violence OR • Ongoing agency commitment to training & supervision in sexual violence issues.

5. Successes & Shortcomings of Resource Guide • Successes • Widely distributed to and utilized by hotlines and allied multi-sector service providers • Accessed frequently by web audience • Shortcomings • Criteria for inclusion vs. definition of services • Are you really a rape crisis program? • Ignores services at community based mental health centers • Important access point?

6. You’ll hear more About this in the next presentation We suspect it is… & that we should consider this when updating guide… More on this now. Successes & Shortcomings of Resource Guide • Shortcomings • Criteria for inclusion vs. definition of services • Are you really a rape crisis program? • Ignores services at community based mental health centers • Important access point?

7. What is the role of Community Based Mental Health Services? • Consider the capacity of rape crisis centers • Consider the perceived function of rape crisis centers by the public • Consider the mental health outcomes that accompany a history of sexual violence or partner violence • Consider the capacity of CBMHS both in terms of numbers & in terms of where survivors access services & why …

8. Capacity of Rape Crisis Services • Number of active cases seen by NYSDOH-funded Rape Crisis Programs in NYC on a given day • 1,918 active cases • (on 6-30-05 snapshot data; NYSDOH Bureau of Women’s Health) • Number of people thought to experience sexual violence in NYC in a given year • 22,000 women and nearly 7,000 men will experience attempted or completed rape • Tjaden, P. & Thoennes, N. (2006). Extent, nature, and consequences of rape victimization: Findings from the National Violence Against Women Survey. National Institute of Justice.

9. Perceived function of rape crisis centers by the public • Not well studied • Few studies ask survivors what services they need or where they want to get services. • Misperceptions of RCP services? • “Urban participants indicated that even if women are aware of specific services, they often have misperceptions about what these services offer. For example, one participant suggested that organizations with names that include the words trauma or crisis conveyed the message that only women with an urgent need immediately following a rape should use those services.” • Logan TK et. al. Barriers to Services for Rural and Urban Survivors of Rape JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 5, May 2005591-616

10. Consider mental health outcomes of sexual violence / IPV • MENTAL HEALTH OUTCOMES • Peri-traumatic stress response • Post-traumatic stress • Depression • Anxiety • Phobias/panic disorder • Eating disorder • Sexual dysfunction • Low self-esteem • Substance abuse Assumption: Many survivors access CBMHS, but not explicitly for services related to the violence they have experienced … And if these pts are never asked explicitly about a history of violence, it may never be addressed. Fact Sheet of the Program on Women, Health & Development, Pan American Health Organization, accessed September, 2004 from http://www.paho.org/English/DPM/GPP/GH/VAW2003.pdf

11. Consider mental health comorbities HEIGHTENED RISK OF SEXUAL / IPV AMONGST MENTALLY ILL • “Goodman et al. published a review of studies of victimization of women with “serious mental illness.: • “A large proportion of women with a serious mental disorder are victimized repeatedly in the course of their lives.” .. • Hiday et. Al: 331 individuals with severe psychiatric disorders were questioned about victimization in the 4-month period immediately preceding their psychiatric hospitalization. • 8.2 % experienced assault, rape, or mugging a rate 2.7 times higher than the annual rate of violent criminal victimization in the United States. Goodman LA, Rosenberg SD, Mueser KT, Drake RE. Physical and sexual assault history in women with serious mental illness: prevalence, correlates, treatment, and future research directions. Schizophrenia Bulletin 23:685–696, 1997. Hiday VA, Swartz MS, Swanson JW, Borum R, Wagner HR. Criminal victimization of persons with severe mental illness. Psychiatric Services 50:62–68, 1999.

12. And capacity of community based mental health centers … • NYS Office of Mental Health Licensed Outpatient programs, (removing child-only services) • About 400 adult / adolescent serving programs in NYC • ? ? Capacity to address sexual violence / intimate partner violence?? • Training needs?

13. Goals for updated resource guide: To comprehensively map the mental health resources available in NYC for survivors of sexual violence / IPV Update what we know about specialized programs Determine what services exist at community based programs Determine gaps in services Determine training needs of professionals at community based programs Which brings us back to our resource guide …

14. 1) Mapping the mental health resources available in NYC for survivors of sexual violence / IPV New School piloted survey tool that Alliance hopes to use to achieve this goal Tonight’s presentations 2) Universal Screening … resources and beyond • Panel Discussion: NYC is in a unique position to initiate groundbreaking services and create and evidence base for the efficacy of universal screening for SV/IPV which is critically important because …

15. Remember these numbers? • Number of active cases seen by NYSDOH-funded Rape Crisis Programs in NYC on a given day • 1,918 active cases • (on 6-30-05 snapshot data; NYSDOH Bureau of Women’s Health) • Number of people thought to experience sexual violence in NYC in a given year • 22,000 women and nearly 7,000 men will experience attempted or completed rape & many will interface with health services • (Tjaden, P. & Thoennes, N. (2006). Extent, nature, and consequences of rape victimization: Findings from the National Violence Against Women Survey. National Institute of Justice.)

16. Impetus behind universal screening • If we screen and treat effectively, we can help mitigate negative health outcomes for thousands of undetected survivors • Benefits: • save lives • save money • contribute to prevention (ultimate public health goal) • Tonight’s panel will consider questions about how NYC can build a screening initiative on a citywide level in the context of our discussion of resource mapping and beyond.