It should come as no surprise that victims and survivors of domestic violence often do not have access to quality health information. This could be because the abuser keeps the victim isolated and restricts access to medical professionals or it could be because even with access to a physician, the victim is too fearful to speak honestly with their provider out of fear they will be reported to authorities or that their abuser would find out.
To bridge this gap, Next Door Solutions partnered with Stanford University’s Medical School to develop two initiatives designed to not only increase victims and survivors access to quality medical information and health education, but to also help train the next generation of physicians to be both sensitive to the nature of domestic violence and developing a trauma informed approach to their practice.
Health Access and Education Program
Home Safe is NDS’s transitional housing program, built and operated in partnership with Charities Housing and LifeMoves. Among the many programs offered to residents of Home Safe is the Health Access and Education program. In 2013 NDS was approached by students of Stanford’s Community Engagement Program, these medical students spent a year with community organizations identifying challenges faced by the clients of that organization and propose possible solutions. Using community based participatory research (CBPR), the students shadowed staff, spent time at the program sites and conducted focus groups with program participants. They quickly identified the lack of access to quality medical information and education and proposed that they develop a series of health oriented workshops to be presented at the transitional housing program. The workshops covered 13 topics, identified by NDS staff and clients as being areas of interest and were initially facilitated by experts in that field (coming either from academia or from another community based organization), topics ranged from how to partner with your healthcare provider, recognizing signs of stress in children and parent-teen communication.
This program was the first of its kind–being both designed and evaluated by domestic violence survivors. The students piloted the workshops for a year and then conduced follow up interviews and focus groups to determine their effectiveness. The workshops were well received by both clients living at the Home Safe facility as well as the staff. Students learned that survivors preferred the continuity and trust that comes with having the same facilitators each week, and they preferred having a familiar face over expertise. Out of this suggestion came the idea to train volunteers on the curriculum so they could facilitate the groups. Volunteer facilitators continue to run these workshops at Home Safe, they are students from the Stanford Community Health Advocacy Fellowship. Each student is placed with an organization where they learn about resources in the community, challenges faced by patients and the social determinants of health while helping their host organization build their own capacity to serve. The students placed with NDS continue to implement the curriculum while working with NDS staff to identify where changes to the curriculum are needed to reflect the changing needs of clients.
Ask a Pediatrician
In July 2016, NDS launched a second health education program, Ask a Pediatrician, at their emergency shelter, The Shelter Next Door. In partnership with Stanford Medicine’s Community Pediatrics and Child Advocacy Rotation. This program was facilitated by first year pediatricians-in-training and served to not only introduce future physicians to local resources, help them reflect on social, economic and environmental issues that impact health and learn how pediatricians can be advocates in the community. For residents at the shelter, it meant they had access to critical child health information.
This workshop series proved to be uniquely challenging because the children of domestic violence victims are often at high risk of abuse themselves. Pediatricians-in-training needed a delicate balance of wanting parents to trust them enough to share their concerns about their children while also maintain their role as mandated reporters and honoring their obligation to report suspected child abuse. NDS staff worked with the pediatric residents to create a policy based on the principles of trauma informed care that helped create a culture of transparency and honesty so clients would know what circumstances may result in a report and what information may be shared.
Both the Health Access Program and the Ask a Pediatrician Program have been well received and although and are seeing steady growth. For victims of domestic violence to have easy access to medical information in a safe and transparent environment empower them and helps in the healing process. For future physicians and pediatricians, having the opportunity to work with survivors of domestic violence early on in their career helps them develop the tools to serve their patients in a holistic and trauma informed manner.