Making a Difference by Making Connections
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MAKING A DIFFERENCE BY MAKING CONNECTIONS
A CURRICULUM TO ADDRESS CO-OCCURRING DOMESTIC VIOLENCE, MENTAL HEALTH AND SUBSTANCE USE PROBLEMS
Robin Mason PhD and Susan O’Rinn
THE CONNECTIONS
• Worldwide, nearly one third (30%) of all women who have been in a relationship have experienced intimate partner violence (Garcia-Moreno & Pallitto, 2013)
• >50% women who experienced IPV developed a mental health problem (Junior & Janson, 2008)
• 2/3 of those who experienced ‘severe’ IPV had 1 or more diagnosed mental health disorder (Roberts et al 1998)
THE CONNECTIONS
THE CONNECTIONS
• Substance use is associated with increased risk of IPV (Timko et al 2008; Martino et al 2005; El-Bassel et al 2005)
- 25-57% of women in substance treatment programs experienced DV
• IPV associated with increased risk of substance use (Ackerman et al, 2007; Greaves et al, 2011; Wingood et al, 2000)
• 67% of women with substance use problems have a co-occurring mental health problem (e.g. PTSD, depression, anxiety) (Sullivan & Holt 2008)
CURRICULUM OBJECTIVE
To improve the knowledge, skills and influence the behaviour of frontline providers who care
for women who experience co-occurring domestic violence, mental health and/or
substance use problems.
STEPS IN CURRICULUM DEVELOPMENT• 14 Regional Round Tables (taped, transcribed,
analyzed for common themes)
• Literature Review (Academic & grey literature reviewed for training/education, existing curricula, best practices, treatment modalities)
• Advisory Committee (experts from each sector including women with “lived experience”)
EVIDENCE INTO COMPETENCIES
Learning
DOING
Practicing
CollaboratingKnowingManaging
Understanding
Referring
Communicating
CURRICULUM LAUNCH SPRING 2012
CURRICULAR ELEMENTSText Manual (six chapters)Six Interactive Online Modules (& videos)Online Discussion ForumFull Day, Cross-Sectoral WorkshopNewly Added: Module on Organizational Change Management
DATA COLLECTION
Demographic Pre-TestWorkshop EvaluationPost-Test (~ 3 months)
WORKSHOP/PARTICIPANT INFO (SEPT 2012 – APR 2014)
34 Workshops781 Participants
~ 23 participants/workshop Data from the first 24 workshops
PARTICIPANT DEMOGRAPHICS (n=492)
VAW Shel-ter
VAW Counselling
Mental Health
Susb-tance Use
Dual Roles
Other
Profession
VAW ShelterVAW CounsellingMental HealthSusbtance UseDual RolesOther
PARTICIPANT DEMOGRAPHICS (n=492)
Years of Experience
< 56-1516+
Age
20-3940-5960+Missing
PARTICIPANT DEMOGRAPHICS (n=492)
Prior Education
YesNo
Confer
ence
Work
place
Schoo
l
Self S
tudy
Other
Missing
0
50
100
150
200
Type of Training
PARTICIPANT DEMOGRAPHICS (n=492)
Policy or Protocol?
YesNoMissing
Treat;Refer;Combination
PRE & POST (n=253)
PRE POST
KNOWLEDGE dfP
ValueWhich of the following is generally not considered a determinant of health? 147 63 197 48 1 0.00* **
Legal substances, specifically alcohol and tobacco, cause more harm to women than do illegal substances 201 49 230 22 1 0.00* **
What % of Canadian women over age 16 have experienced at least one incident of physical or sexual violence? 131 121 168 81 1 0.00* **
According to Ontario's DVDRC, which of the following is not a common risk factor for lethal violence? 91 135 167 75 1 0.00* **The most social criticism and stigma is directed at: 150 82 197 44 1 0.00* *** sig < 0.05; ** sig < 0.001
PRE & POST (n=253)
PRE POST
KNOWLEDGE dfP
Value
Pregnant women who are heavy substance users should be encouraged to immediately stop using 211 34 237 15 1 0.00* **
Which of the following is not a good strategy to use when helping a women manage signs of dissociation? 206 34 233 15 1 0.00* **
Working with women who have experienced DV, mental health and/or substance use problems can result in: 60 190 97 156 1 0.00* **Which of the following is not part of the Stage of Change Model? 223 18 240 11 1 0.02*How many Canadians will personally experience a mental health problem at some point during their life? 216 33 231 22 1 0.01*
* sig < 0.05; ** sig < 0.001
PRE & POST (n=253)
PRE POST
KNOWLEDGE dfP
ValueDomestic violence always precedes mental health or substance use problems 237 15 232 20 1 0.24
Mental health or substance use problems may increase the risk of domestic violence 244 9 245 5 1 0.07
In the context of mental health, a 'trigger' refers to: 99 149 107 145 1 0.40
Which of the following is not a factor in considering the immediate safety of a woman experiencing DV? 203 31 219 30 1 0.27
* sig < 0.05; ** sig < 0.001
PRE & POST (n=253)
PRE POST
COMPETENCE dfP
ValueI understand the ways in which DV, mental health & substance use problems are interconnected 176 71 246 6 1 0.00* **
I can initiate a conversation, ask questions about, and appropriately refer a woman who has experienced DV, mental health and/or substance use problems 201 47 247 4 1 0.00* **
I can respond to crises related to DV, mental health and/or substance use 197 50 242 9 1 0.00* **
* sig < 0.05; ** sig < 0.001
PRE & POST (n=253)
PRE POST
COMPETENCE dfP
ValueI can help a woman manage her distress even if she begins to dissociate while talking to me 151 96 229 21 1 0.00* **
I can outline the steps to building useful organizational partnerships 134 112 224 27 1 0.00* **
I can recognize the signs of burnout or compassion fatigue and have strategies for self-care 212 36 248 4 1 0.00* **
* sig < 0.05; ** sig < 0.001
PRE & POST (n=253)
AS A RESULT OF THIS TRAINING:
93% of participants are "better equipped to identify DV, mental health and/or substance us problems“
94% of participants are "better equipped to provide appropriate supports to women who experience DV, mental health and/or substance use problems"
95% of participants have "increased knowledge about DV, mental health and/or substance use problems"
PRE & POST (n=253)
AS A RESULT OF THIS TRAINING:94% of participants have "increased knowledge about the ways in which DV, mental health and/or substance use problems co-occur"
91% of participants have "greater familiarity with local referral networks, resources and services for women who experience co-occurring DV, mental health and/or substance use problems“
88% of participants have "made linkages among individuals across different sectors/professions"
ACKNOWLEDGEMENTS
We gratefully acknowledge the contributions of :Advisory Committee memberFacilitators and co-facilitators of the workshopsWorkshop participantsMeaghan Morris for data support
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