Assessment. Key health assessment questions should be standardized across Partner Agencies.
PROMISING MEDICAL MODELS The following chart reviews the final list of viable medical models the Alliance recommends for development in FJC sites. These models were chosen based on evidence from the literature, our data findings, and feasibility within the FJC or a multi-disciplinary service agency model. The benefits, challenges, and evidence supporting each on- and off-site model are detailed. ON-SITE MODEL
BENEFITS
CHALLENGES
+Build link to personal physician +Cross-training HEALTH opportunities PARTNERSHIPS +Extra use of forensic (E.G. medical units COMMUNITY HEALTH CLINICS, +Can link to ongoing advocacy/casework RESIDENCY +Sustainable funding PROGRAMS) (CHC partner can bill services) +Potential for multiple partners, based on community resources (e.g. health provider from CHCs, residency programs, private practice, etc) +FJCs have navigators/caseworkers that can be trained +Cross-training HEALTH opportunities between NAVIGATORS +Hospital/clinic and FJC navigator programs +Can link to ongoing advocacy/casework +Health insurance enrollment +Medical professionals already trained/sensitive to issues of violence +Can link to ongoing advocacy/casework FORENSIC +Many FJCs and/or MEDICAL UNITS community clinics have forensic units available
EVIDENCE
- Undocumented immigrants do not qualify for coverage - Building relationship with overburdened CHCs or Medical Schools - Need to guarantee patient flow
CHCs provide primary care to >9 million disadvantaged Americans (Stargield & Shi, 2004). Patient-centered medical home model has a team/coordination emphasis in line with FJCs (Health Affairs, 2010). Having a Primary Care Provider (PCP) is the only factor related to receiving regular healthcare (Stargield & Shi, 2004).
- Still need to make referral and link to health care site - Building relationships with health partners - No direct medical/health services on-site
Nurse Coordinators/Navigators have decreased readmission rates, improved patient adherence, and strengthened patient-provider relations in hospital settings (Health Affairs, 2013). Pilot studies have shown that advocates (“IPV interventionists”) increased screening and disclosure rates in clinics (Rhodes et al., 2013)
- SART/SANE nurses not necessarily connected to broader health system - Need to train and engage advocates in health issues - Need to engage nurses in ongoing advocacy - Only reimbursed for SA, not DV - Not all are capable of evaluating children
Documenting DV in medical health records may assist in DV cases (Isaac & Enos, 2001). Training for providers on trauma and forensics remains limited (Barefoot & Galvan, 2003). Forensic units and documentation for DV (similar to SA) is expanding in Coalition/Hospital partnerships (MNADV, 2012). New York State (Bill S1593-2013) passed laws to expand use of forensic medical units.
ADDRESSING HEALTH NEEDS OF IPV SURVIVORS
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