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Taking Flight NEWS FROM THE CENTER FOR VIOLENCE AND INJURY PREVENTION AT WASHINGTON UNIVERSITY’S BROWN SCHOOL I S S U E

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Director’s

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Behind the

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Development No More Silos 5 IPV PhD

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Affiliates 7

Domestic

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Violence Conference

Building healthy relationships and other social supports are important factors in the prevention of Intimate Partner Violence (IPV), according to research here and in China. What exactly are social supports? Social supports include emotional support such as having someone to talk to or tangible support, such as having friends or family who can help with childcare, housing, or bills. Access to local social services is considered an important form of support as well. And all of these supports are vital to individuals affected by IPV. The Research

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Healthy Relationships: Social Support & Intimate Partner Violence

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Social support has been shown to work as a protective factor in the prevention of child maltreatment, the reduction of suicide risk, and can work to mediate the effects of mental health risks related to IPV and/ or sexual violence exposure. For women who possess higher education, income and social connections there is a lower risk of IPV1. In 2002, the research of Coker et al. found an association between higher levels of social support and “reduced risk of

poor perceived mental health”2. In another study, social support was found to have direct and indirect buffering effects for victims of IPV, but these effects were strongest among those with less severe experiences3. A qualitative review of turning points in battering behavior found that building relationships was one of the key factors reported in successful change4. Researchers in China have looked at the attitudes regarding IPV, social support, and negative life experiences of perpetrators of IPV5. Results suggest that, in China, both abusers and victims of IPV lack strong social support. While further research is needed to understand if this is true across multiple cultures, it indicates the need to give more attention to how we prepare both men and women to build positive relationships with friends as well as partners. The Centers for Disease Control and Prevention (CDC) treats IPV as a public health threat. In an effort to counter IPV, the CDC promotes building healthy relationships and relationship habits as a means of preventing future Intimate Partner Violence6.

For victims, researchers suggest that healthcare providers could serve a more supportive role by not only doing more to identify IPV, but also helping those affected to “develop skills, resources, and support networks to address IPV”. Some are calling for providers that work with victims of IPV to refocus their efforts on working with informal support networks rather than just focusing on the victim alone7. Coker et al. also recommend a daily consciousness to the role of IPV in our society and suggest that because of the prevalence of IPV, “it is likely that most persons will have contact with someone who has experienced IPV, whether they know it or not”. So, while agencies and healthcare systems can provide tremendous support to individuals affected by IPV, so too, might each of us simply through our daily interactions and compassion. Prevention A recent randomized trial study in rural South Africa used a combination of microfinance and empowerment interventions for women and was able (Continued on page 2)


Director’s Note

Melissa Jonson-Reid Professor, Brown School

I want to thank everyone for their dedicated efforts to prevent violence and injury. Last year we welcomed renewed attention to the issue of domestic violence in the state legislature with the passage of SB320 sponsored by Senator Lamping. But, as you know, we need more attention on prevention. We must remain dedicated to ensuring adequate protection and support for victims and families, while working to make sure that

the incidence of victimization declines. One interesting example is the New York City Healthy Relationship Training Academy , part of a larger coordinated effort of government, foundations and local agencies.

Factors for Intimate Partner Violence or Sexual Violence Perpetration” (see grants.gov). We look forward to continuing to work with all of you on this important issue for individuals and families in Missouri and around the world.

For our research partners, we hope everyone is . aware of the funding opportunity available from the Centers for Disease Control “Identifying Director, Center for Violence Modifiable Protective and Injury Prevention

Director, Center for Violence and Injury Prevention

Citations (Healthy Relationships: Social Support & IPV) 1

Jewkes, R. (2002). Intimate partner violence: causes and prevention. The Lancet, 359(9315) 1423 - 1429. 2

Coker, A. L., Smith, P. H., Thompson, M.P., Mckeown, R. E., Bethea, L., Davis, K. E. (2002) Journal of Women's Health & Gender-Based Medicine, 11(5) 465476 DOI: 10.1089/15246090260137644

Social Support to demonstrate a significant drop in IPV8.

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Beeble, Marisa L.;Bybee, Deborah; Sullivan, Cris M.; Adams, Adrienne E. (2009). Main, mediating, and moderating effects of social support on the wellbeing of survivors of intimate partner violence across 2 years. Journal of Consulting and Clinical Psychology, 77(4), 718-729. 4

Sheehan, K., Thakor, S.,, Stewart, D. (2012). Turning Points for Perpetrators of Intimate Partner Violence. Trauma Violence Abuse, 13(1), 30-40. 5

Huang, G., Cao, Y., Momartin, S., & Wei, M. (2010) Relationship between recent life events, social supports, and attitudes to domestic violence: Predictive roles in behaviors. Journal of Interpersonal Violence, 25 (5), 863876. 6

Centers for Disease Control and Prevention (2010) Preventing intimate partner & sexual violence. Retrieved from http://www.cdc.gov/ violenceprevention/intimatepartnerviolence/ 7

Goodman, L. A., Smyth, K. F. (2011) A call for a social network-oriented approach to services for survivors of intimate partner violence. Psychology of Violence 1(2), 79-92. 8

Pronyk, P., Hargreaves, J., Kim, J.C., Morison, L., Phetla, G., Watts, C., Busza, J., Porter, J. (2006). Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. The Lancet, 368, (9551), 1973–1983. 9

About Challenge Day. Retrieved from http://www.challengeday.org/

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Legiardi-Laura, R., Sultan, A., Shaffer, D. (Producers) & Legiardi-Laura, R., Sultan, A., Shaffer, D. , Martinez, E. *Directors+ To be heard *Motion Picture+ United States: To Be Heard Productions. Retrieved from http:// www.tobeheard.org/

The CDC supports several program efforts to prevent teen -dating violence and educate youth on healthy relationships. It is hoped that these efforts will help youth continue to cultivate healthy relationships into adulthood. Many other efforts to curtail violence through healthy relationships exist. Some school health courses utilize the knowledge and experience of community agencies focused on violence prevention.

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“Challenge Day” is another example of a school based prevention program9. Challenge Day promotes healthy relationships through professionally facilitated sessions in high schools. Students are challenged to listen to one another’s stories, find commonalities with one another, and develop compassion for others. In November, New York City educator, poet, film producer and director, Roland Legiardi-Laura, facilitated a workshop for youth workers in the St. Louis area. The workshop focused on

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an empowerment technique called power-writing. Before the workshop, a screening of his most recent film “To Be Heard” was aired for participants10. In discussion following the film, viewers were struck by the power of the friendships and relationships made in the “power-writing” course, by the teens who were center to the film. LegiardiLaura suggested that schools concentrate more on building and nurturing student relationships at their schools.

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AWARE: Model for social supports The AWARE program, founded in 1994, promotes the health, safety, and wellbeing of Barnes-Jewish Hospital (BJH) patients and team members affected by Intimate Partner Violence (IPV). According to AWARE staff members, Zoila Rendon-Ochoa, MSW and Sue Dersch, RN, AWARE provides individualized, culturally competent services to clients with the goal of helping to reduce or remedy the impact of IPV through advocacy, resources and education. AWARE is remarkable for several reasons; the passion and devotion of its staff, the comprehensive services it provides to the BJH community, but, perhaps, especially because of the fact that AWARE is the only hospital-based Domestic Violence program in the state of Missouri. Rendon-Ochoa explains that AWARE has made contact over the years with other hospital-based DV programs in other states in order to exchange information on funding resources and program development. “This is one way that helps us to evaluate our process, and strengthens what we already do or gives us new ideas to incorporate into our program” says Rendon-Ochoa. AWARE serves an average of 400 patients/clients each year; 98% are women. AWARE staff uses the term “patient” for someone who is seen for the first time during admission or at an outpatient clinic visit. The term “client” is used once an individual has agreed to AWARE services. When AWARE was founded, the intention was to provide a link between BJH patients in need and the community resources available for those affected by IPV. However, Sue Dersch points out, “early on it became evident the community services available were designed primarily to serve women who wanted to leave their partners and were not meeting the needs of the majority of patients who were referred to AWARE”.

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Dersch explains that, “Perhaps due to being identified much earlier in the process of dealing with the abuse, women referred to AWARE were also needing resources and support to assist them while they were in a relationship along with support and information as they were trying to sort things out”. With this realization, AWARE began providing the comprehensive services they offer today. Services provided to AWARE patients and clients include initial screening and contact with an AWARE advocate. Advocacy and support services are offered to those affected by IPV and the AWARE advocate coordinates confidential protocol for making contact with the client outside of the hospital. Once the client is discharged they enter the stage of services that Rendon-Ochoa calls, the “heart and soul” of AWARE services. During this time the client and advocate work toward identifying and addressing the underlying barriers interfering with the client having healthy options and in carrying out those options safely. Client advocacy and support services include: risk assessment, safety planning, economic advocacy and literacy, linkage to community resources, financial assistance through AWARE funds, court advocacy, emotional support, and housing/employment assistance. Throughout every step of AWARE services, clients are offered a tremendous amount of social support in a safe environment. “This is done by providing advocacy and support rooted in respect, selfdetermination, and non-controlling beliefs that respond to the unique perspectives and resources of each patient/client and builds a partnership between the advocate and the patient/ client,” says Rendon-Ochoa. RendonOchoa feels that the way in which AWARE advocates treat clients can shape

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their relationship into an effective client social support. Advocates are trained to keep client’s perspective in mind, to practice self-awareness, respect the client’s authentic beliefs and judgments, and to practice humility, honesty and respect. AWARE advocates also work with clients to identify and build up their own interpersonal social supports. RendonOchoa asserts that “For some clients we are their only social support because the abusive partner has isolated them so much”. However, Rendon-Ochoa offers hope, stating that while it is a long process in building back their support networks, clients have done it with the assistance of AWARE advocates. The AWARE program also provides specialized training to BJH staff. Staff are trained to ask screening questions and respond appropriately to patient disclosure of abuse, and to connect those patients with an AWARE advocate. AWARE advocates are also available for consultation of hospital staff for coaching or if they are struggling with their own feelings, worries, or concerns regarding a patient’s choices. AWARE services are not limited to BJH patients, though. The founders of the program were aware of the prevalence of IPV and, therefore, also offer AWARE services, at no cost, to any BJH team member who is facing IPV. Services are confidential and privacy is of upmost importance to AWARE staff. The AWARE program is truly doing groundbreaking work in the field of IPV and serves as a great model for building and enriching social support for clients.

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Behind the Scenes Dr. Kristin Carbone-Lopez When she was younger, Professor Kristin CarboneLopez says her dream-job changed frequently. She wanted to be an astronaut, a theater producer, an engineer; all highly specialized fields. Since her childhood Carbone-Lopez has chosen a dramatically different field, finding research and teaching to be a much better fit and a specialist nonetheless.

“One of the most important ideas that I try to convey in my work and to my students is that women do leave violent relationships.”

An assistant professor in the Department of Criminology and Criminal Justice at the University of Missouri–St. Louis, Carbone-Lopez’s research focuses on the overlap between gender, crime, and victimization. Carbone-Lopez has authored or co-authored more than 14 peer-reviewed articles, procured national, and university grants and is often sought as an expert presenter and commentator on the subject of Intimate Partner Violence (IPV), amongst her other specializations. Her three main research goals include an interest in victimization across the life course (particularly IPV and the etiology and

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consequences for future violence and relationship development), gender and criminal offending, and finally, the social control of women. Through her research Carbone-Lopez hopes to provide education to create change and awareness about the consequences and patterns of violence. She offers fresh perspectives and analysis of the intricacies of violence in our society today. In a recent publication (Gender Differences in Risk Factors for Violent Victimization: An Examination of Individual, Family, and Community-level Predictors) Carbone-Lopez and colleague Janet Lauritsen (CVIP Natl. Research Advisory Board) advocate for further research and attention to how IPV is conceptualized, measured, and screened for. Specifically, the authors suggest that “while women have greater exposure to IPV”, the prevalence of men who are affected as victims should not be ignored through research and advocacy. Carbone-Lopez says that she is often asked why she

continues to do the work she does, by the women she has interviewed. Her answer illustrates her dedication to education through research, as she explains that while she has not personally experienced violence, people who are very close to her have. “They are the reason why I keep doing this workalong with all the other women I’ve talked to over the years who have shared horrific stories of violence”, Carbone-Lopez explains. In spite of the misery intrinsic to a study of IPV, CarboneLopez holds hope and motivation that the conditions surrounding IPV are not as bleak as they often seem. Carbone-Lopez says, “One of the most important ideas that I try to convey in my work and to my students is that women do leave violent relationships. This is, in my opinion, good news”. Carbone-Lopez explains that when looking at lifetime prevalence of IPV, most experiences occurred within previous or dissolved relationships.

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Dr. Anne Glowinski: No More Silos Dr. Anne Glowinski, associate professor of psychiatry at Washington University School of Medicine in St. Louis, believes that medical education should not be practiced in silos. Her work to integrate IPV into medical education hits home this point. As a medical educator, Dr. Glowinski noticed that IVP or domestic violence was not being addressed throughout the many (average of 7) years of medical training. She says IPV “doesn't have a lot of ‘airtime’” in medical school. So she ventured to fill this gap in the curriculum. Three years ago Glowinski partnered with Washington University professors, Dr. Robert Rothbaum (Pediatrics), Dr. Megan Wren (Internal Medicine), as well as Center for Violence and Injury Prevention (CVIP) Director Melissa Jonson-Reid and Co -Director of the center’s Education Team, Brett Drake, to develop a training program on IPV for medical students at Washington University School of Medicine. Before implementing the training program, Glowinski wanted to see how correct her assumption regarding “airtime” was. In a survey of medical

students and professors, Glowinski found that less than 25% felt prepared to ask patients questions regarding IPV experiences, less than 12 % felt prepared to assess an IPV victim’s readiness for change, and less than 3 % felt they knew how to get an IPV victim to create a safety plan. Her assumptions were confirmed. The team’s initial research found that only lecture-format trainings were available to medical schools. Glowinski wanted training with a more experiential element. So the team developed its own training. Today, a session on IPV is built into “Practice in Medicine”, a four-year long, required course for all medical students. The training is designed to: 

Increase physician comfort with the topic of IPV

Increase student understanding of IPV and its prevalence

Dispel myths

Help students develop a nonjudgmental attitude which promotes people getting help

Increase students’ knowledge of resources for IPV victims.

Students participate in interactive roleplaying scenarios with simulated patients (actors trained to portray clinical scenarios) in order to allow for exposure to the topic and increase comfort in discussing IPV with potential patients. The hope is that through this training, medical practitioners will become even stronger social supports for victims and potential victims of IPV in their community. The team would like to see the training expanded at the School of Medicine and perhaps serve as a model to other medical schools across the country.

Professional Development Opportunity Selecting Adult Suicide Prevention Assessment Measures Washington University in St. Louis, Danforth University Center, Room 276 April 20th, 8:30-11:30 am

Monica Matthieu, PhD, LCSW Research Assistant Professor, the Brown School Research Social Worker, St. Louis VA Medical Center This workshop provides an overview of suicide prevention measures for use with adult clients. Resources to locate psychometrically-sound suicide prevention assessment measures will be discussed. There is a fee for this workshop. Registration is required. For more info: http://brownschool.wustl.edu/profdev

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PHD Affiliates in IPV Annah Bender

Rachel Voth Schrag Rachel Voth Schrag, first year doctoral student at the Brown School, researches the intersection of IPV and poverty. She is interested in the impact of economic abuse (the use of economic tactics like destroying credit to establish power and control) on the long-term safety and economic security of IPV survivors, as well as the potential role of economic interventions, supports, and government policies in protecting survivors from repeated victimization and supporting women in establishing economic independence. Rachel is also interested in woman-defined advocacy, the empowerment model, poverty prevention and social welfare research.

Annah Bender got her start in the social services field as shelter advocate for battered women in the Ozarks. Since then she feels fortunate to have worked with survivors in Missouri, New York, Michigan and Guatemala. It was her desire to learn and apply IPV research in rural areas that led her to pursue a PhD in social work. Annah is interested in women's health, particularly access to the types of services that cross-cut so many survivors' stories: the need for substance abuse treatment, mental health services, and health care in the wake of partner violence. Annah is a pro-choice feminist committed to working with survivors and fellow practitioners for social justice. In her ever-decreasing spare time, she volunteers for NARAL, rides her bike, and blogs about music for 88.1 KDHX.

Megan Petra A PhD student at the Brown School, Megan Petra investigates harm reduction (effective coping) for women experiencing the often co-occurring family problems of addictions and intimate partner violence. She has over 20 years of practice and research experience, including positions at a shelter and a transitional housing program. She has provided college IPV prevention and awareness programs and served as a support group facilitator, and crisis line volunteer. She has conducted research into prevention of IPV and addictions, coordinated community response to IPV, and therapeutic interventions for people with addictions as well as survivors and perpetrators of IPV. She was named a CVIP PhD Affiliate with Distinction in 2011, an award providing dissertation support. She is also a National Institute of Drug Abuse Pre-Doctoral Fellow.

Rachel received her MSW from the Brown School, and is a Licensed Clinical Social Worker. Her work experience includes advocacy and supervision at Redevelopment Opportunities for Women, Inc.

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Publications Below is a partial list of publications by our Center affiliates (bolded) from the past 12 months. The featured publications all relate to Intimate Partner Violence.

Lauritsen, J. L., & Carbone-Lopez, K. (2011). Gender differences in risk factors for violent victimization: An examination of individual-, family-, and community-level predictors. Journal of Research in Crime and Delinquency, , 1-28.

Carbone-Lopez, Kristin, Ross Macmillan and Callie Rennison. (Forthcoming). The transcendence of violence across relationships: New methods for understanding men’s and women’s experiences of intimate partner violence across the life course. Journal of Quantitative Criminology.

Appell, A. R. (2011). The myth of separation. Northwestern Journal of Law and Social Policy, 6 (Spring 2011), 291.

Bagley, S. L., Weaver, T. L., & Buchanan, T. W. (2011). Sex differences in physiological and affective responses to stress in remitted depression. Physiology & Behavior, 104(2), 180.

Bright, C. L., Raghavan, R., Kliethermes, M. D., Juedemann, D., & Dunn, J. (2010). Collaborative implementation of a sequenced trauma-focused intervention for youth in residential care. Residential Treatment for Children & Youth, 27, 69-79. doi:10.1080/08865711003712485

Bright, C. L., & Jonson-Reid, M. (2010). Young adult outcomes of juvenile court-involved girls. Journal of Social Service Research, 36(2), 94-106. doi:10.1080/01488370903577993

Aron, S. B., McCrowell, J., Moon, A., Yamano, R., Roark, D. A., Simmons, M., Tatanashvili,Z.; Drake,B. (2010). Analyzing the relationship between poverty and child maltreatment: Investigating the relative performance of four levels of geographic aggregation. Social Work Research, 34(3), 169-179.

National Conference on Health and Domestic Violence San Francisco March 29-31, 2012 The 6th Biennial National Conference on Health and Domestic Violence aims to advance the health care system's response to domestic violence. For more information about the National Conference on Health & Domestic Violence, call Futures Without Violence (415) 678-5500 and ask to speak to Anna or Vedalyn Or, go to: http://www.nchdv.org/

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Next Issue Our May issue will focus on: Sexual Violence

The Brown School’s Center for Violence and Injury Prevention was

Our butterfly icon represents transformation and symbolizes the

founded in 2009 with a grant from the Centers for Disease Control

developmental aspect of our mission to advance evidence-based

and Prevention. The Center conducts research, training, and

primary prevention of violence and injury among young families,

outreach to prevent and ameliorate harm related to:

and intervention for childhood victims of violence to prevent potential later perpetration of violence toward themselves or

child maltreatment (CM)

others as they transition to adulthood. Our colors represent

intimate partner violence (IPV)

those typically used by community organizations working in

sexual violence (SV)

these four areas.

suicide attempts (SA)

Director Melissa Jonson-Reid, PhD

The Center is an open and dynamic collaboration with researchers from multiple disciplines and multiple universities.

Co-Director John N. Constantino, MD

While it is not possible to acknowledge all our individual colleagues, we want to recognize our other university partners

Administrative Assistant Diane Wittling

outside of Washington University who have had a particularly

Research Assistant Michelle Wiegand

instrumental role in the CVIP. These include the Saint Louis

Special thanks to Taking Flight contributors.

University of Missouri at St. Louis Schools of Criminology and

University Schools of Social Work and Public Health; the

Criminal Justice and Social Work; and the University of Missouri at Columbia Schools of Nursing and Social Work. Visit us online at http://cvip.wustl.edu Opinions or views expressed in this newsletter do not necessarily reflect those of the funding agency.

700 Rosedale Campus Box 1007 | St. Louis, MO 63112| Ph: 314-935-8129 | Fax: 314-935-3051 | E-mail: bcvip@wustl.edu TAKING FLIGHT — ISSUE SIX

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Taking Flight: Winter 2012