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Medical outreach helps domestic abuse victims

Domestic violence victims who had an intervention from a health care provider saw a 71 percent reduction in coerced pregnancies versus a control group, a study found.

The same study found women who received interventions were 60 percent more likely to end relationships they felt were unhealthy or unsafe.

The local domestic violence prevention organization, HAVEN, hopes to get more local care providers to participate in a low-key intervention that reaches out to patients about how their lives are going.

It’s a “two-minute intervention,” said Tara Koch, HAVEN director. The unobtrusive approach involves broaching the subject and handing a patient a credit-card sized pamphlet, which folds out to provide information on what healthy and unhealthy relationships look like. It also has the HAVEN hotline number on it.

It can be handed to a patient with a non-specific comment, such as saying it’s being offered for “you or maybe someone you know.”

But it’s a delicate balance that care providers must strike.

Becky Ruby, clinical operations manager at One Community Health in The Dalles, attended a conference in June sponsored by HAVEN that was aimed at local care providers.

Clinicians “are mandatory reporters, so if a person were to tell them about abuse, they have to report that,” Ruby said.

So, what happens is that oftentimes, if clinicians ask the question, the answer will be no, “because they know that their spouse or whoever will end up in jail.”

A nice workaround, then, could be handing out the wallet-sized cards. “If we as clinicians were to hand those out to patients then they’d have that information and be able to hook up with someone and talk with them,” she said.

She didn’t know if One Community Health would be adopting the program. Staff will look over material, meet with HAVEN again, “and decide if and when and how to pursue,” she said.

“I think this is a great program, I really do. It’s super new. I think it will take some time and education and hoping that the Gorge adopts it,” Ruby said. “There’s nothing wrong with being straightforward with patients.”

The North Central Public Health District already does the program. Its clinicians hand out the wallet-sized brochure to each woman who sees a practitioner.

If a woman visiting the health district does ask to speak to someone from HAVEN, they are available to help “within minutes,” Koch said. Several cards are available, covering different topics. One card asks questions like: “does my partner shame or humiliate me? Does my partner mess with my birth control or try to get me pregnant when I don’t want to be? Does my partner make me have sex when I don’t want to?”

It also states: “A partner may see pregnancy as a way to keep you in their life and stay connected to you through a child – even if that is not what you want. Your health care provider can offer birth control that your partner won’t know about.”

The cards even suggest that if a patient’s partner checks their cell phone or texts, “talk to your health care provider about using their phone to call the hotlines on this card – so your partner can’t see it on your call log.”

Rebecca Levenson, a San Francisco-based consultant, spoke at the conference in June. She said her work involved guiding health care providers “away from yes/no questions of survivors.”

It is more universal education about what healthy relationships look like, she said, since some patients might not know. The new thinking is moving away from a disclosure-driven method, “because a lot of people can’t say yes,” Levenson said.

She said just telling victims they have intrinsic value is important, since they are told by their abusers that they’re worthless.

She said victims can worry about losing their kids if they disclose abuse. “There’s a lot of good reasons not to tell something to your health care provider,” Levenson said.

Levenson said HAVEN was a national leader in this area. “They’re kind of rock stars,” she said.

A doctor’s visit may be the only time the victim has an opportunity to connect to help, away from their abuser, said Becca Simons, the bilingual community engagement coordinator for HAVEN.

Teri Thalhofer, director of the health district, said it is district policy that patients meet alone with the health are provider.

Domestic violence “underlies so much of these other social determinants of health, but it’s often silenced,” Thalhofer said.

Domestic violence is linked to a number of chronic health issues, including hypertension, diabetes, sexually transmitted infections, unintended pregnancies and chronic pain, said conference presenter Ana Marjavi, program director, health, with Futures Without Violence.

Sometimes the disclosure of violence can shed light on the root cause of a problem, such as that a patient has bad asthma because their partner won’t let them have an inhaler.

Children who experience the trauma of living with domestic violence in the home can also have poor health outcomes, including pregnancies and sexually transmitted infections.

Marjavi said even when health care providers understand the implications of abuse, “they still are a little nervous or reticent about opening that conversation, because they feel they need to be the expert.” But the real role they can play is as a bridge to the experts at HAVEN. “This is a huge relief to health care providers because they’re used to fixing everything,” Marjavi said.


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