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Multidimensional AdvocacyWorking at the Intersections of Domestic Violence and Behavioral Health2017 DOMESTIC VIOLENCE SYMPOSIUM
Today’s Panel
Alicia Glenwell• Trauma and Behavioral Health Systems Coordinator, Coalition Ending
Gender-Based Violence
Kellie Rogers• Program Manager - Community Advocacy Program, Domestic Abuse
Women’s Network (DAWN)
Maria Williams• Services Director, LifeWire
Theresa Epstein• Behavioral Health Consultant, Refugee Women’s Alliance (ReWA)
Tigist Negash• Program Manager, Refugee Women’s Alliance (ReWA)
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 1 of 15
Key Background Information
Behavioral health concerns used as a system of power and control (abusive partners and systems)
Behavioral health treatment separated from DV advocacy
DV advocacy and behavioral health services changed, adopting a trauma informed perspective of service
Now, addressing intersection of behavioral health and DV is most often essential in helping survivors heal from trauma
Trauma and Behavioral Health Systems Coordination
ALICIA GLENWELL
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 2 of 15
Systems Coordination
Policy and Practice Review Relationship Building Consultation Training, training, training!
Key Lessons
Have a willingness to initiate and participate in relationship-building across professions
Not just about training – policies and practices must reflect intersections of DV/BH
Build the policies, relationships, knowledge etc. before you need them!
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 3 of 15
Therapy Services Co-Located at Community-Based DV Agencies
ALICIA GLENWELL
KELLIE ROGERS
MIDD-Funded Mental Health Services
Mental health therapists who are employees of and located at domestic violence agencies
Free of charge No diagnosis/careful documentation
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 4 of 15
Why This Model?
Looking at all service provision through the lens of safety
Ease of access Increases skills and cross training for
both advocates and therapists. People untrained in DV or in BH issues can unintentionally cause harm (ex: documentation , not recognizing signs); working together increases appropriate support for survivors
MIDD-Funded Mental Health Services
Culturally and linguistically appropriate Trained in criminal/civil law issues and how that
can impact a survivor Connection to holistic services provided by DV
agencies (from 24 hour DV crisis line, shelter, legal, housing, etc.)
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 5 of 15
MIDD-Funded Mental Health Services – The ReWA Model
TIGIST NEGASH
THERESA EPSTEIN
What’s Different?
Based on the unique cultural & linguistic needs of the clients
Advocates/para professionals are the BH Counselors
Provide – Brief mental health treatment• Individual and group support
• Referrals to community mental health & other resources as needed
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 6 of 15
How Does this Work?
MH Consultant provides individual and group consultation• Mandatory bi-monthly education/training
meetings with the advocates/counselors.• Individual consultation with advocates
providing counseling to new and ongoing clients to discuss:
o Risks and safety concerns
o Client’s primary MH issue
o Possible treatment modalities
Core Values & Beliefs
Different cultures have different ways of perceiving and understanding DV, power, control and counseling. A western model does not fit all.
Using non- threatening and non- labeling language to describe and explain BH services. • How many ways can you talk about
“counseling” without using the word?
Survivors are having normal reactions to abnormal experiences. Their mental health issues are a result of trauma and dislocation.
Institutional support for advocate/counselors essential for good outcomes and retention.
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 7 of 15
Challenges & Successes
Wearing 2 hats – advocate and counselor
Clients have multiple traumas Confidentiality / small
communities Clients fear of being seen as
“crazy” MH viewed differently in
different cultures. Refugee and immigrant
women who are victims of DV/SA also face complex issues regarding their immigration states.
Increased trust with advocates who are trained as counselors and are bilingual and bicultural.
All women are served regardless of immigration status
No interpreter needed Non-western approach Increased safety working
with 1 person
Behavioral Health-Focused Advocacy at LifeWire
MARIA WILLIAMS
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 8 of 15
LifeWire – My Friend’s Place
Up to 24 months of transitional housing for survivors with children
Offers on site DV advocacy, access to individual substance abuse treatment and groups, access to individual mental health, trauma focused therapy and groups
Key service offering in an array of behavior health supports at LifeWire (MIDD funded therapy, family trauma healing groups, connection with substance abuse treatment providers, CDVRT)
Services and program model based in survivor driven, trauma informed advocacy and from a social justice framework
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 9 of 15
Trauma-Informed Services
NCDVTMH Definition of Trauma-Informed: The term trauma-informed is used to describe organizations and practices that incorporate an understanding of the pervasiveness and impact of trauma and that are designed to reduce re-traumatization, support healing and resiliency, and address the root causes of abuse and violence (NCDVTMH 2013, adapted from Harris and Fallot 2001)
Survivor-Driven, Trauma-Informed services
Survivors have choice
Services are strengths based
Services are flexible
Services are physically accessible
Services are culturally accessible
Services are voluntary
Advocates bear witness
Organization itself is trauma informed
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 10 of 15
Harm Reduction Philosophy, Social Justice Framework
Housing is a human right
Healthcare and healing from trauma is a human right
Systems of oppression lead to depression, anxiety and trauma
The most marginalized of survivors should be given the most options
Sobriety is not required
Treatment is not required
Danger in a survivor’s relationship has direct correlation to danger of using – so what does she/he identify as safe?
Opportunity to learn new coping mechanisms is presented
Children’s Domestic Violence Response Team (CDVRT)
KELLIE ROGERS
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 11 of 15
The Children’s Domestic Violence Response Team (CDVRT)
Collaborative program in partnership with Sound Mental Health, DAWN, LifeWire, and New Beginnings
Partners survivors with therapists trained in DV and advocates (community, legal, and children’s)
Wrap-around model; Survivor lead On-going consulting and coming
together
CDVRT, cont.
No parameters on length of time Therapeutic practice focuses on
trauma informed modalities : TF-CBT, PCIT, and others
Advocacy-intent to allow easy access to all programs (the CDVRT advocate is conduit)
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 12 of 15
Lessons Learned
Agency policies can be a barrier/need a champion
Team building is very important to nurture trust Trust fosters learning and growth “Advocacy” looks different dependent on
which field one is coming from
Key Concepts
Practice beliefs that Inform this work:
1. Everything needs to be looked at through the lens of safety
Is therapy safe? (Parenting Plans, abuser’s use of therapy, etc.)
Is the meeting space safe?
What about some of the “homework” asked in therapy, what about mandated reporting, etc.?
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 13 of 15
Key Concepts, cont.
2. Understanding that behavioral health issues do not necessarily affect parenting.
Are the concerning behaviors actually a strategy for coping with the coercive control/abuse (ex: disassociation, lack of assertiveness, lack of boundary setting)
Living with fear and abuse changes family dynamics and often leads professionals to see the victim as the problem (the children don’t behave that way when their father is around.)
Understanding that the abuser undermines her parenting at every opportunity and doesn’t allow her to parent in ways that make sense to her. (Not allowed to pick up a crying baby)
Key Concepts, cont.
3. Advocacy (empowerment model) may look different for someone affected by behavioral health issues.
Harm reduction
There are reasons that our “interventions” may not work
Really listening to the survivor. (Ex: woman who has a plan that allows her to become homeless.)
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 14 of 15
Key Concepts, cont.
4. Willingness to consult/listen and learn from professionals
Agency policies may get in the way
Learn and understand processes and what guides those in other disciplines; the more you know, then better able you are to navigate on behalf of clients
Avoid making decisions in a vacuum …..consult, consult, consult
Thank you!
Alicia Glenwell, Coalition Ending Gender-Based Violence• 206-568-5454, [email protected]
Kellie Rogers, Domestic Abuse Women’s Network (DAWN)• 253-893-1617, [email protected]
Maria Williams, LifeWire• 425-562-8840, [email protected]
Theresa Epstein, Refugee Women’s Alliance (ReWA)• 206-789-8732, [email protected]
Tigist Negash• 206-721-3846, Ext 27, [email protected]
9th Annual Domestic Violence Symposium The Bigger Picture
Session 4C - Multidimensional Advocacy Panel Presentation
September 7 & 8, 2017 Page 15 of 15