Orange County Women's Health Project (OCWHP), the Domestic Violence & Health Collective – Orange County (DVHC-OC), is wrapping up its five-year $2.15 million initiative to strengthen the local healthcare sector’s response to domestic violence (DV) and improve connections between the healthcare sector and the shelter, social and legal services that support DV survivors and their families in Orange County. 

“At least one in four adult women in Orange County has experienced physical or sexual violence by an intimate partner – yet most of them struggle with the stigma of domestic violence. By developing this innovative and cross-disciplinary initiative, we have equipped Orange County with simpler resources, increased access, and better connections between healthcare and social, legal and shelter service providers,” said Allyson Sonenshine, founding director of the Orange County Women’s Health Project. 

Funded by Blue Shield of California Foundation, the Domestic Violence & Health Collective-Orange County shared a press release outlining how the initiative brought together local healthcare, shelter, social and legal services to: 

  1. Better train local healthcare providers to recognize those at risk of DV, thus improving these potential victims’ access to services;

  2. Create a central clearinghouse educating at-risk women in OC to call 2-1-1 or visit 211OC.org/dv for information and service referrals; and

  3. Develop and unveil a public health campaign reducing the stigma associated with DV so that local victims are more willing to seek help.

Launched in 2015 after 18 months of exhaustive research and planning, the DVHC-OC is an innovative countywide effort to elevate awareness of DV as a women’s health priority and pursue the elimination of this public health threat through collaborative action among local health \care, shelter, social, legal and other service providers. Led by the OCWHP, the Collective gained strategic and operational support from participating Orange County organizations including Human Options, Laura’s House, UC Irvine, Waymakers, Women’s Transitional Living Center and 2-1-1 Orange County.

Through its Cross-Disciplinary Trainings (CDT), the DVHC-OC trained 699 healthcare and social service providers and 16 trainers (for a total of 715 trainees) about the health impacts of DV and how to screen, counsel and refer for DV, with the intention of impacting their screening practices. Notably, 99% of the 699 said the CDT increased their knowledge about DV and health; 92% said the CDT helped them feel more prepared to screen/counsel for DV, and 96% said the CDT improved their understanding of how to refer victims to DV resources in the community. Three to six months after training, the percentage of trainees who said they know the DV mandatory reporting law and how it applies to them increased from 57% to 78%, a statistically significant improvement. Furthermore, the percentage of trainees who screened patients/clients for DV at every appointment also increased significantly.

Trainees shared positive reviews of the CDT:

  • “Great presentation and information on prevalence, screening, counseling, legal issues, and resources/referrals. Applicable to our practice.” – a medical professional

  • The DV training completely changed the way I view DV and my role as someone who can help.” – a social service professional

  • “I now feel more comfortable asking about DV and less scared of offending the patient, given what I now know about how important it is to screen.” – unidentified professional

The campaign encouraged individuals to call 2-1-1 or visit 211OC.org/dv, a dedicated portal (website) that includes a comprehensive online database for DV services, DV-related content (safety plan, articles, videos, etc.), and a guided search function for DV resources. 2-1-1 also operates a 24/7 Multilingual Helpline (dial 2-1-1) that offers “warm transfers,” which is when 2-1-1 offers to stay on the line and connect the caller with a DV shelter hotline. 

Prior to the launch of the CC, 2-1-1 offered a warm transfer only to DV callers facing imminent risk of being harmed due to DV; however, as part of the DVHC, 2-1-1 expanded this protocol to also offer a warm transfer to DV callers at imminent risk of becoming homeless or displaced due to DV. As a result of this change, from February 2016 to October 2018, the CC received 2,978 DV related calls, of which (64%) were offered a warm transfer. When compared with the quarter before the new warm transfer protocol was implemented, the number of warm transfer offers more than tripled and the number of completions more than quintupled.

From the provider perspective, nearly 85% of respondents to the Health and DV Provider Survey felt that deportation concerns are “very important” in terms of their impact on stigma and/or influence on whether DV survivors feel encouraged to seek support. The second most important factor identified was training healthcare providers to screen for DV and to make referrals.

Moving Forward to Address Domestic Violence, Find Solutions and Replicate the Model

Key recommendations that emerged from the DVHC-OC evaluation findings included continuing training and support for DV screening and referrals; accounting for differences in trainees’ knowledge, attitudes and beliefs about screenings; disseminating consistent messaging about DV in order to destigmatize the issue; incorporating direct linkages to services and resources; reducing barriers to services, such as deportation fears and other concerns, and funding for the coordinating entity as well as for administrative staff at each organization that participates in a coordinated, multi-strategy and multi-year initiative such as this.

In addition to the information and direct resources made available in Orange County, 2-1-1 Orange County is also taking the lessons learned from the CC and sharing it with other 2-1-1s throughout California. These results will help 2-1-1 to make the case for funding to support shared learnings, as well as to sustain and continue making broader impact by replicating the model. 

In addition, the OCWHP recently adapted the CDT for a behavioral health audience and delivered it to approximately 85 substance abuse and mental health providers throughout the county. To request a free training at your site, please contact dratch@ocwomenshealth.org.

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