VULNERABLE POPULATION PRESENTATION: EDUCATING ADULT WOMEN, VICTIMS OF

INTIMATE PARTNER VIOLENCE

Tammy Virginia Selleck

Summer 2014 – Nursing 551

Clinical Prevention and Population Health

Ferris State University

INTRODUCTION

• Presentation: A synthesis of knowledge of educational program designed for adult women who are victims of intimate partner violence (IPV).

• HAVEN (HAVEN.org, 2014)

• Women’s and children’s shelter in Bingham Farms, MI• Provides shelter, counseling, advocacy and educational programming to victims

• Education to be created per HAVEN and research on aggregate:• Domestic assault/IPV and dating violence pamphlets and presentation on self-esteem

INTRODUCTION (CONT.)

• PICO: • Increasing educational materials decrease the rates of IPV in young adult women (18-35

years)/teenagers who are victims of IPV/dating violence?

• Class objectives for presentation:• Understand IPV demographics, how affects adult women, and why adult women considered a

vulnerable population;• Analyze how logic care delivery model plays role as framework for educational program created

specifically for aggregate;• Identify risk assessment of abused sub-population to understand the gap in the aggregate

learning needs;• Establish educational and evaluation methods used to educate aggregates; and• Apply what information was learned from presentation to answer raised PICO question

POPULATION DEMOGRAPHICS

• Approximately 1.5 million women annually, or 1 in 4, are raped and/or physically assaulted by an intimate partner (Black et al., 2011; CDC, 2012, OWH, 2011)

• Linked with serious health problems for women:• Chronic pain, reproductive disorders, depression, post-traumatic stress disorder, frequent headaches,

difficulty sleeping asthma, irritable bowel syndrome, diabetes and poor mental health (CDC, 2012; 2011)

• Women at risk have increased use of healthcare services (Black et al., 2011; CDC, 2012; OWH, 2011)

• Incidences of IPV, or numbers of separate victimizations or incidents, have exceeded the prevalence, or number of victims themselves (Black et al., 2011; CDC, 2012; OWH, 2011)

DEMOGRAPHICS (CONT.)

• Physical violence most common: rape and stalking being most prevalent types (Biag et al., 2012)

• Homicides a concern with IPV:• 1,589 women, approximately 13% of murder victims, are killed by an intimate partner in 2010 reports

(Black et al., 2011; CDC, 2012, OWH, 2011)

• 440 men, approximately 4% of murder victims, are killed • Women predominately are the victims of IPV

• Psychological IPV accompanies physical practice (Black et al., 2011; Sprague, et al., 2013)

• Low-self esteem = first negative consequence from IPV (CDC 2013; 2012)

• Costs exceeded $8.3 billion annually (Black et al., 2011)

• Divided into $460 million for rape, $6.2 billion for physical assault, $461 million for stalking, and $1.2 billion in the value of lost lives

THEORETICAL CARE MODEL

• Logic models (AHRQ, 2013; Curley & Vitale, 2011; Hayes et al., 2011):• Organizing/planning goals • Advantageous for educational programs due to multiple and interdependent components used in

interventions, activities, outcomes, and external influences

CARE MODEL (CONT.)

• Strategies created are cohesive and applicable in the program (AHRQ, 2013; Curley & Vitale, 2011; Hayes et al., 2011)

• Can lead to comprehensive IPV interventions

• Logic model:• Increase the quality, availability, and effectiveness of educational and community-based programs (AHRQ,

2013)

• To prevent disease and injury, improve health, and enhance quality of life• Similar to a map or a graphic display• Establish what resources, staff and leaders available (Jost et al., 2010)

• Assists in the formation and utilization of strategies/interventions in the program (AHRQ, 2013; Curley & Vitale, 2011; Hayes et al., 2011)

RISK ASSESSMENT

• Criteria for high-risk IPV victims:• Female, young adults, around 16-24 years old, separated or divorced, possess low academic achievement

due to less than high school education, unemployed, and low income (CDC, 2011; Sprague et al., 2013)

• Exhibit a combination of socio-economic and psychological risk factors:• Ex. Lack confidence, have low self-esteem, depressed, and engage in high-risk sexual behavior (CDC, 2011;

Sprague et al., 2013)

RISK (CONT.)

• Aggregate barriers that prevent obtaining education or assistance (Baig et al., 2012; Sprague et al., 2013)

• Barriers interrelated with these women:• Include psychological issues, education, and economic status, which are caused by the effects of IPV• Lack of freedom and resources, low income, gap and lack in education, financial stability, and employment

(Black et al., 2011; CDC, 2012, OWH, 2011)

• Only19.9% of aggregate reported making use of resources available (Black et al., 2011; CDC, 2012, OWH, 2011)

• Educational materials need to be developed and distributed to emergency departments, clinics, shelters and health departments

BEHAVIORAL OBJECTIVES

• Objectives for aggregate are goals incorporated in program, • Expected outcomes of the program to bring positive change to the population

OBJECTIVES (CONT.)

• Objectives for aggregates:• Relate how educational program addresses needs of HAVEN and aggregate to improve their lifestyle and

physical/social/psychological health;• Understand IPV and dating violence are forms of abuse/domestic violence and lead to negative personnel

and familial health consequences and intervention might be required to improve outcome;• Compare causal relationship between IPV and self-esteem, and explain decreased self-esteem directly

effecting physical/social/psychological life; • Recognize/identify ways for young adult women to improve their self-esteem after being victims of IPV;• Distinguish signs of abuse/IPV and apply topics and strategies learned from both the brochures and

presentation to improve health and well-being, so can contribute as members in their communities; and • Evaluate strategies in program to determine how can be applied to life to decrease prevalence of dating

violence and IPV.

EDUCATIONAL INTERVENTION

• Centers for Disease Control and Prevention (CDC) recognizes IPV as major public health threat (CDC, 2011)

• Created the Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA) program • Collect data and developing/improving education on IPV

• Educational interventions can be created by criteria and information retrieved from DELTA and reviewing literature

• Issues with this aggregate: • Substance abuse is highly correlated with incidences of IPV and young women (Black et al., 2011; CDC, 2012, OWH, 2011)

• Engage in dangerous, life-risking behaviors, such as drug abuse, alcoholism, personality disorders, depression, and suicide attempts (Baig et al., 2012; Chu & Kim, 2012; Sprague et al., 2013)

INTERVENTION (CONT.)

• Other aggregate issues:• Poverty, low socioeconomic class, lack of employment, young age (Black et al., 2011; CDC, 2012, OWH, 2011)

• Psychological issues are prevalent, with low self-esteem as largest barrier (OWH, 2011)

• Intervention:• Making pamphlets/presentations based on prevention and intervention information (Baig et al., 2012; Chu &

Kim, 2012; Sprague et al., 2013)

• Relevant and accessible abuse prevention information to assist in improving health of young adult women and teenagers (Baig et al., 2012; Sprague et al., 2013)

• Information distributed in shelters, health clinics and health departments• Goal: To promote safety and health of IPV/abuse victims and increase self-esteem to empower them

EDUCATIONAL PROGRAM

• Brochures placed in HAVEN lobby and presentation given at educational meeting • Presentation and brochure for young adult women

• HAVEN = more need for educating aggregate due higher prevalence of abuse with this sub-population • Presentation (CDC, 2013):

• Relationship between IPV and decreased self-esteem • Negative implications of low self-esteem and how to increase• How to better cope with past IPV abuse

• Brochure (CDC, 2013):• Emphasized IPV is form of abuse, signs of an abusive partner, and how to seek assistance

• Brochure for teenagers (14-17 years old):• Explained teen dating violence and how to seek assistance

PROGRAM (CONT.)

• Nursing leader worked with HAVEN interdisciplinary team• Social work, administrators, and nursing/medical staff • Concurred on the type of education and way to provide

• Young adult women more likely to experience IPV abuse (Cho & Kim, 2012; Golden et al., 2013; Saftlas et al., 2010; Stuart et

al., 2014): • Between ages 18-35, lower socioeconomic status, unemployed, and less than a high school education (finish

ninth grade or below)

• Teenagers are more likely to experience teen dating violence abuse (Cho & Kim, 2012; Golden et al., 2013; Saftlas et al.,

2010; Stuart et al., 2014):• Females between 14-17 years old = dating violence/abuse most prevalent

• By improving psychological well-being, both aggregates can positively contribute to their communities (Black et al., 2011)

PROGRAM EVALUATION

• Twelve young adult IPV female victims attended, over two educational sessions

• Surveys evaluated on the effectiveness and applicability of presentation • Ranged from one to five, one = strongly disagreeing and five = strongly agreeing

• Results: • 67% of participants strongly agreed presentation helped in coping with stress and improving self-esteem• 92% strongly agreed presentation helped in understanding causative relationship between IPV and

lower self-esteem, presentation/PowerPoint format was effective method, and presenter appeared to be very interested in subject and audience

• Area for improvement: 58% strongly agreed all questions and concerns were addressed during presentation

• Presentation success: Self-esteem is significantly improved!

CONCLUSION

• IPV causes:• Negative financial, physical, and mental health consequences (CDC, 2013)

• Have devastating effects on adult women

• Nurse leaders can identify, intervene, and reduce rates of IPV by developing strategies• Result: Assists women with understanding effects of IPV and improve their health and life outcomes

REFERENCES

• Agency for Healthcare Quality and Research [AHRQ]. U.S. Department of Health and Human Services. (2013). The logic model: The foundation to implement, study, and refine patient-centered medical home models. Retrieved from http://pcmh.ahrq.gov/sites/default/files/attachments/ LogicModel_032513comp.pdf

• Baig, A., Ryan, G., & Rodriguez, M. (2012). Providing barriers and facilitators to screening for intermediate partner violence. Healthcare Women International, 33(3), 250-261.

• Black, M., Basile, K., Breiding, M., Smith, S., Walters, M., & Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

• Centers for Disease Control and Prevention [CDC]. Department of Health and Human Services (2013). Intimate partner violence. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CC0QFjAA&url=http%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Fintimatepartnerviolence%2Fconsequences.html&ei=GCd_U6rgJIiUyAT-3YJg&usg=AFQjCNFgqBs5djVo4N2VM5lDJTWscS9kwA&bvm=bv.67720277,d.aWw

• Centers for Disease Control and Prevention [CDC]. Department of Health and Human Services (2012). Intimate partner violence. Retrieved from http://www.cdc.gov/violenceprevention/intimatepartnerviolence/definitions.html

• Centers for Disease Control and Prevention [CDC]. Department of Health and Human Services (2011). The DELTA program. Retrieved from http://www.cdc.gov/violenceprevention/delta/index.html

• Chu, H., & Kim, W. (2012). Intimate partner violence among Asian Americans and their mental health services: Comparisons with White, Black, and Latino victims. Journal of Immigrant Minority Health, 14(5), 805-815.

• Curley, A.L. & Vitale, P.A. (Eds.) (2011). Population-based nursing: Concepts and competencies for advanced practice. New York, NY: Springer Publishing Company.    

REFERENCES (CONT.)

• Golden, S., Perreira, K., & Durrance, C. (2013). Troubled times, troubled relationships: How economic resources, gender beliefs, and neighborhood disadvantage influence intimate partner violence. Journal of Interpersonal Violence, 28(10), 2124-2153.

• HAVEN.org. (2014). About HAVEN. Retrieved from https://www.haven-oakland.org/about

• Hayes, H., Parchman, R., & Howard, M. (2011). A logic model framework for evaluation and planning in a primary care practice-based research network. Journal of the American Board of Family Medicine, 24(5), 526-539.

• Jost, S., Bonnell, M., Chacko, S., & Parkinson, D. (2010). Integrated primary nursing: A care delivery model for the 21 st century knowledge worker. Nursing Administration and Quality, 34(3), 208-216.

• Office on Women’s Health [OWH]. Department of Health and Human Services. (2011). Violence against women. Retrieved from http://www.womenshealth.gov/violence-against-women/types-of-violence/domestic-intimate-partner-violence.html

• Saftlas, A., Wallis, A., Sochet, T., Harland, K., Dickey, P., & Peek-Asa, J. (2010). Prevalence of intimate partner violence among the abortion clinic population. Journal of Public Health, 100(8), 1412-1416.

• Sprague, S., Swinton, M., Madden, K., Swaleh, R., Goslings, C., & Bhandri, M. (2013). Barriers to and facilitators for intimate partner violence in surgical fracture clinics: A qualitative descriptive approach. BMC Musculoskeletal Disorders, 14(122), 1-10.

• Stuart, G., McGeary , J., Shorey, R., Knopik, V., & Temple, J. (2014). Genetics associations with intimate partner violence in a sample of hazardous drinking men in batterer intervention programs. Violence Against Women, 20(4), 385-399.