Health Resources and Services Administration & Social Solutions International, Inc. August 2012

1. The State & Community Intimate Partner Violence & Perinatal Depression Resource Development Project: Policy and Legislation & Standards of Care Health Resources and Services Administration & Social Solutions International, Inc. August 2012 IPV/PD: A Comprehensive Approach

2. Webinar Moderators Moderators: KeisherHighsmith, DrPH Director of Special Initiatives and Program Planning and Evaluation HRSA/Maternal and Child Health Bureau Kristen Stier, MAResearchand Logistics Associate Social Solutions International, Inc. Gloria Aponte Clarke, MPH Senior Policy Associate Altarum Institute IPV/PD: A Comprehensive Approach

3. Webinar Speakers Speakers: Jeanette Valentine, PhD Director, Business Development Pathways LA Lisa L. Derrick, M.Ed. BAM Project Director South Phoenix Healthy Start, Maricopa County Department of Health Kim Dartez Executive Director FamilyTree Health Care Women of Color-Chair, The AZ Coalition Against Domestic Violence IPV/PD: A Comprehensive Approach

4. Objectives Provide examples of existing Standards of Care for Intimate Partner Violence and Perinatal Depression Describe the process of implementing Standards of Care in your organization Describe the role policy and legislation play in addressing IPV/PD Provide examples of strategies/tactics used to advance policy and legislative initiatives concerning IPV/PD IPV/PD: A Comprehensive Approach

5. Toolkit Goals – Policy and Legislation Provide an overview of the policy process and why it is important in addressing IPV/PD Highlight select federal and state policies related to IPV/PD IPV/PD: A Comprehensive Approach

6. Toolkit Goals – Standards of Care Provide an overview of the importance of having IPV/PD Standards of Care Guidelines Provide an overview of national resources and IPV/PD Standards of Care Guidelines Provide an overview of training materials and resources available to help address IPV/PD IPV/PD: A Comprehensive Approach

7. Grassroots to Treetops:How Local Programs Can Impact Policy & Legislation onIntimate Partner Violence & Perinatal Depression Jeanette Valentine, Ph.D. LA County Perinatal Mental Health Task Force Los Angeles CA August 2012 IPV/PD: A Comprehensive Approach

8. Learning Objectives • To understand how to have an impact at different levels of policy processes • To appreciate the breadth and depth of influence that local programs have IPV/PD: A Comprehensive Approach

9. Key Principles 1. Know your audiences 2. Appreciate your power 3. Apply advocacy tools IPV/PD: A Comprehensive Approach

10. Audience Elected and Appointed Officials Community Leaders Business Leaders Thought Leaders IPV/PD: A Comprehensive Approach

11. Power Knowledge Passion Access IPV/PD: A Comprehensive Approach

12. Tools & Tactics Inform & Educate Collaborate Mobilize Lead IPV/PD: A Comprehensive Approach

13. Know Your Audience THERE ARE MULTIPLE AUDIENCES IN THE POLICY PROCESS One Bright Idea: Define your community – GEOGRAPHY OR DEMOGRAPHICS – & determine who has a stake in it IPV/PD: A Comprehensive Approach

14. Audience, cont. LEGISLATIVE & BUDGETARY: For Elected Officials – Geography Counts IPV/PD: A Comprehensive Approach

15. Audience - Officials ELECTED AND APPOINTED OFFICIALS • Legislative Bodies • Legislative Committees • Administrative Agency Heads • Special Commissions • Staffers • Appointed Officials IPV/PD: A Comprehensive Approach

16. Civic Leaders Community Leaders Thought Leaders Business Leaders IPV/PD: A Comprehensive Approach

17. Power - Knowledge • Problems • Solutions • Costs of doing nothing • Costs of doing something IPV/PD: A Comprehensive Approach

18. Power – Sources of Knowledge • Experts Speak: Evidence-based & Best Practices • Experience Speaks: Personal Stories • Wisdom Speaks: Community-defined Evidence IPV/PD: A Comprehensive Approach

19. Power - Passion • Authentic Voice • Urgent Need • Actionable Solutions IPV/PD: A Comprehensive Approach

20. Power - Access • Voters • Civic Leaders • Media • Clients & Other Community Residents • Agency Partners & Collaborators IPV/PD: A Comprehensive Approach

21. Tools & Tactics INFORM & EDUCATE • Testimony • Briefings • Cost & Outcomes Data • Survivor Stories • Model Legislation, Regulations, Policies • Community News & Media Outlets IPV/PD: A Comprehensive Approach

22. Tools & Tactics, cont. COLLABORATE • Strategic Partnerships • Coalitions • Task Forces IPV/PD: A Comprehensive Approach

23. Raise a Crowd! MOBILIZE • Strategic Partnerships • Coalitions • Task Forces • Clients • Community Residents IPV/PD: A Comprehensive Approach

24. Tools & Tactics - Lead • Identify Champions • Draft Legislation and Policy Language • Develop grass roots leadership & advocacy skills IPV/PD: A Comprehensive Approach

25. Illustrations: LA County Perinatal Mental Health Task Force http://maternalmentalhealthla.org Assembly Concurrent Resolution 105 Designating May as Perinatal Depression Awareness Month Proclaimed the month of May of each year to be Perinatal Depression Awareness month across the state of California and requested that a number of stakeholders work together to explore ways to improve women's access to mental health care at the local and state level, facilitate increased awareness about perinatal depression, explore and encourage the use of prenatal screening tools and improve the availability of effective treatment and community support services.  IPV/PD: A Comprehensive Approach

26. Illustrations http://maternalmentalhealthla.org/ Assembly Concurrent Resolution 53 Kelly Abraham Martinez Act  Urges hospital providers, mental health care providers, health plans, and insurers to invest resources to educate women about perinatal depression risk factors and triggers. IPV/PD: A Comprehensive Approach

27. Illustrations, cont. http://maternalmentalhealthla.org Perinatal Depression Awareness Month Proclamation: A proclamation issued by the County of Los Angeles declaring May of every year to be Perinatal Depression Awareness Month IPV/PD: A Comprehensive Approach

28. Illustrations – National Legislation http://maternalmentalhealthla.org California Assembly Bill 159/2009 Healthy Mothers Act Established and convened a statewide perinatal mood and anxiety disorders task force to develop recommendations and educational materials for the State Department of Public Health's perinatal health programs. IPV/PD: A Comprehensive Approach

29. Some Concluding Thoughts CHALLENGES & OPPORTUNITIES • Time, talent and treasure to conduct policy work are limited in local programs, but … • Policy and systems change is embedded in the Healthy Start mission • Individuals at every level of the policy-making process want to hear from you, but … • The message has to be policy-relevant and actionable IPV/PD: A Comprehensive Approach

30. Contact Us Jeanette Valentine, PhD Director, Business Development Pathways LA 3550 W. 6th Street-Ste 500 Los Angeles CA 90020 Ph: 213-427-1651 Email: jvalentine@pathwaysla.org IPV/PD: A Comprehensive Approach

31. A Comprehensive Approach for Community-Based Programs to Address the Intersection of Intimate Partner Violence & Perinatal Depression: Policy and Legislation Kristen Stier, MA Social Solutions International, Inc. August 2012 IPV/PD: A Comprehensive Approach

32. Policy and Legislation Understanding the process for creating policy and legislation is an important part of addressing Intimate Partner Violence (IPV) and Perinatal Depression (PD), whether it is at the local, state or federal level IPV/PD: A Comprehensive Approach

33. Public Policy Making • Citizens Being Heard • Writing the Bill • Formulating the Policy • Policy Implementation • Policy Evaluation IPV/PD: A Comprehensive Approach

34. Federal Policies • Violence Against Women Act • Affordable Care Act IPV/PD: A Comprehensive Approach

35. State Policies • Massachusetts legislated the creation of a commission to strengthen PPD support programs in the state, including treatment, screening and public-awareness efforts • New Jersey law requires health care providers to screen women who recently have given birth for postpartum depression, and provides funding to do so. IPV/PD: A Comprehensive Approach

36. State Strategies • Mandated Screening of IPV. • Mandated Reporting of IPV. • Home Visiting Programs • New Parent Programs • Workgroups/Consortia for Perinatal Health • Health Care Providers’ Trainings • Awareness Campaigns IPV/PD: A Comprehensive Approach

37. Policy Brainstorming Tool • What are the key issues and challenges around IPV/PD in your community? Consider awareness of the issues, stigma, rates of IPV/PD, and resources available for screening, referral and treatment. • Are there policies that would help your organization be able to screen, refer and treat women for IPV/PD? • What are some policy ideas for how to address IPV/PD in your community? IPV/PD: A Comprehensive Approach

38. Healthy RelationshipsIntegrating IPV/PPMD Standards of Care and Service into Healthy Start Practice Lisa L. Derrick Program Director South Phoenix Healthy Start, Phoenix ArizonaKim Dartez Executive Director Family Tree Health Care, Tempe Arizonaand Women of Color-Chair, The AZ Coalition Against Domestic Violence August 23, 2012 IPV/PD: A Comprehensive Approach

39. Outline of Presentation Introduce SPHS method of integrating IPV screening with PPMD screening Present key components of Standards of Care and Service Overview of SPHS IPV/PPMD strategies Tools, techniques and training for SPHS staff Community involvement in migration and sustainability IPV/PD: A Comprehensive Approach

40. Screening Tools and Methods Intimate Partner Violence Perinatal Mood Disorders • Edinburgh Depression Scale • Self administered or facilitated by CHW • Pregnant and post partum participants • 10 questions • Focus on feelings in past week • Scores of 10 or above receive referral and plan for follow up • Crisis intervention on Q10 • Re administer within 2 weeks, if no follow up • Supervised by RN and MSW • Modified Abuse Assessment Screen (AAS) • Administered by CHW • All female participants • 4 questions • Focus on real acts of violence and strong fear over the past year or since last visit • Yes answers receive referral and plan for follow up • Crisis intervention for injuries • Re administer within 2 weeks, if no follow up • Supervised by RN and MSW IPV/PD: A Comprehensive Approach

41. Key Components of Standards of Care and Service All women are screened for PPMD and IPV upon initial intake and routinely Affirmative screening = referrals to programmatic and community resources Affirmative results = Level 1 Risk with at least 4 contacts per month; at least 1 face to face Readiness for change is assessed and documented Barriers to follow through on referrals are identified Plans for overcoming barriers and follow up care are created and documented In person support provided to first visits or group All HS staff are initially trained and receive annual training and regular in-services Critical incident briefings conducted within 2 working days IPV/PD: A Comprehensive Approach

42. Strategies and Interventions • Crisis Support Referrals • Mental Health Crisis Line • Crisis Housing & Nursery for Respite • Medical Care • Center for Healthcare Against Domestic Violence • Legal Services • Pro bono therapeutic counseling • Peer led support groups • Teen specific • Adult specific • Language/Culturally Specific • Community-based support groups IPV/PD: A Comprehensive Approach

43. Tools, Techniques and Training • Staff Training • IPV and PPMD 101 • Motivational interviewing • Crisis Intervention resources • Standards of Care/Protocols • Legal processes • Infant Mental Health • In-services • Data on IPV and PPMD • Teen Dating Violence vs. Bullying • Female to male and same sex IPV • CDC Guide to IPV during pregnancy • Community and Consortia Awareness • IPV and PPMD 101 • Power and Control Dynamics • Roots of Violence • International Trafficking • Male Support Services • Fathers Mentoring Fathers • Court and Custody • Financial Stability “Violence is a problem for many women. Because it affects health and well-being. I ask all my participants about it.” IPV/PD: A Comprehensive Approach

44. IPV Referral Referral card recommends screening all patients for domestic violence. The card lists screening questions to ask on one side. The other side lists hotlines and helpful phone numbers. Card is in both Spanish and English. IPV/PD: A Comprehensive Approach

45. IPV PPMD Referral Card • The Referral for Services Card has a space to include: • The reason for the referral • Date/Time • Signatures • And emergency number for help IPV/PD: A Comprehensive Approach

46. Family Tree Healthcare Peer Led Support Groups Meeting Topics for Discussion 1. Introduction – Our story (confidentiality and safety) 2. Definition of Intimate partner/dating violence awareness, prevention and warning signs of abusive relationships and prevention. 3. Healthy relationships; tools needed for a healthy relationship, qualities of a healthy partner. 4. Health disparities and healthy choices 5. Identifying internalized racism, mainstream privilege and overcoming institutionalized racism and oppression. 6. Character Counts (resources for character education- best practices) 7. Youth conflict resolution (National youth violence prevention resource center) 8. Goal setting; how to create and achieve short and long term goals 9. Provide resources, referrals and community linkages, safety planning IPV/PD: A Comprehensive Approach

47. FTHC Peer Led Support Groups Steps to get your group started 1. Decide frequency of meetings. Be sure to remember this is best if it is for the long haul so do not commit to an unreasonable schedule. Choices may include weekly, monthly or quarterly. 2. Meetings should have a maximum of 8 participants. ( When having maximum number try to have an assistant in case someone may need one on one attention.) We want to keep the meeting flowing if possible. WE ARE NOT THERAPISTS and this is a community support group. If someone is in need of a professional, we can offer referrals from the resources supplied by FTHC. 3. The average group should be 90 minutes. You can however include an extra 15 minutes at the beginning for introductions when your group is first beginning. 4. Groups can be conducted in ten series cycles. The above meeting topics are a general guide, the last week is for any follow-up or extra discussion. IPV/PD: A Comprehensive Approach

48. Peer Led Support Groups, cont. 5. You can design your group to either allow the same participants to continue or have new participants every ten groups meetings. 6. Secure location, (best places are neutral and non-threatening such as nail or hair salon, school, community centers and libraries) have signed confidentiality agreement with owners and/or management of business or property. 7. Think of innovative ways get participation. Some ways participants are invited are: a) word of mouth, b) social media (can call the group by another name), d) contacting the local Jr. and high schools. Particularly the counselors and the nurses of the school would be familiar with who would benefit from the support group. Be sure and share the ways you recruit with other facilitators. IPV/PD: A Comprehensive Approach

49. Tools for Peer Led Support Groups 1. DV 101, include power and control wheel 2. Multicultural perspectives 3. Confidentiality 4. Safety 5. Communication and facilitation skills 6. Meeting structure and navigating the meetings 7. Develop a plan 8. Contingency planning and resources IPV/PD: A Comprehensive Approach

50. Community Involvement Train the Facilitator Workshops Business, Civic and Faith based Groups Annual Conference IPV/PD: A Comprehensive Approach