Over the years both Next Door Solutions and MayView have engaged in ongoing reflection on the work of serving victims and survivors. Throughout this process there have been great successes, challenges and of course, surprises.
“It was a wonderful experience for staff to not just learn the content and patient need but to have additional exposure to the social determinants of health, and how our patient’s health needs expand far beyond the four walls of our exam room”- Kelvin Quan, CEO, MayView Community Clinic
When the project launched Next Door Solutions and Mayview anticipated screening 800 patients. Sonia Padula, Director of Care Management with MayView noted, “It was intimidating but within the first six weeks, we had already passed our screening goal”. MayView staff embraced the project and volunteered to attend the 40-hour Domestic Violence Counselor training through Next Door Solutions and their sister organizations and in the end four MayView employees completed the training. Thanks to the decision to screen both men and women, staff were able to identify at least one male victim of female perpetrated violence.
Far from becoming “just one more thing” on provider’s already full plates, domestic violence trained MayView staff saw their role as instrumental to the holistic health and well-being of their patients and a culture of advocacy developed. One trained MayView staff even went above and beyond the required services outlined in MayView’s protocol and accompanied a victim to file a police report.
Although both organizations have long histories of client centered services and strong commitments to their communities, the two organizations have very different ways of approaching the work. This led to challenges along the way as Next Door Solutions maintains much of its grass roots activist work culture, where MayView has a hierarchical structure frequently found in health care organizations. This meant that MayView had additional steps to approve new processes and communication issues were noted by both partners.
Staff turnover was a challenge for both organizations. During the course of the project MayView had three executive transitions. All executives voiced support for the project, but the ongoing changes led to minor slow downs while the new CEOs were brought up to speed.
Patient participation, both in the needs assessment and the screening itself was a challenge. The needs assessment was long and difficult to complete while they were waiting for their appointment. The survey itself was only printed in English and Spanish while MayView has growing Asian and Middle Eastern patient populations. Limited literacy also became a factor, it is common for MayView patients to have limited or no literacy and without staff availability to review the survey with them verbally, there was virtually no way to solicit feedback from them.
Balancing the needs of the clinic, staff work flow and best practices in the field was a challenge. “We spent so much time training staff to understand why it was important to screen patients verbally and to equip them with the tools to do so”, noted Erica Villa, Next Door Solution’s Project Coordinator. However in developing programs with the intent that the clinic would take ownership of the program, it is only fair to expect that they might make changes along the way to best meet their own needs. There are at least four basic screenings that take place during a routine clinic visit and appointments are scheduled every 20 minutes. Providers must balance the need to meet these screening mandates and respond appropriately while also addressing the patient complaint that brought them into the clinic.
Perhaps the biggest surprise was the number of MayView staff who came forward as having experienced domestic violence and/or child abuse. This created two issues: first it put Next Door Solutions in the position of providing direct service to MayView staff and second, it brought to light the lack of formal in-house policies at MayView to support staff who may be victims. Currently MayView has drafted a policy that is awaiting formal review and adoption.
Looking ahead both organizations are planning to continue their partnership, expanding their capacity for training and increasing their advocacy for victims and survivors.
In February 2017 the work that MayView and Next Door Solutions had engaged in suddenly hit close to home when a beloved physician was murdered in an alleged domestic violence homicide. The loss was devastating–for providers and patients alike and out of this tragedy came a renewed commitment to educating not only patients but each other about domestic violence as well as self care. MayView wrote and adopted a policy on dealing with domestic violence in the workplace so that going forward all MayView employees know their rights and know their employer will support them. For more information about developing domestic violence policies in the workplace please visit Workplaces Respond from the National Resource Center.