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