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

Substance use is associated with increased risk of IPV (Timko et al 2008; Martino et al 2005; El-Bassel et al 2005) % 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

CURRICULUM LAUNCH SPRING 2012

CURRICULAR ELEMENTS Text Manual (six chapters) Six Interactive Online Modules (& videos) Online Discussion Forum Full Day, Cross-Sectoral Workshop Newly Added: Module on Organizational Change Management

DATA COLLECTION Demographic Pre-Test Workshop Evaluation Post-Test (~ 3 months)

WORKSHOP/PARTICIPANT INFO (SEPT 2012 – APR 2014) 34 Workshops 781Participants ~ 23 participants/workshop Data from the first 24 workshops

PARTICIPANT DEMOGRAPHICS (n=492)

Treat; Refer; Combination

PRE & POST (n=253) PREPOST KNOWLEDGE   df P Value Which of the following is generally not considered a determinant of health? * ** Legal substances, specifically alcohol and tobacco, cause more harm to women than do illegal substances * ** What % of Canadian women over age 16 have experienced at least one incident of physical or sexual violence? * ** According to Ontario's DVDRC, which of the following is not a common risk factor for lethal violence? * ** The most social criticism and stigma is directed at: * ** * sig < 0.05; ** sig < 0.001

PRE & POST (n=253) PREPOST KNOWLEDGE   df P Value Pregnant women who are heavy substance users should be encouraged to immediately stop using * ** Which of the following is not a good strategy to use when helping a women manage signs of dissociation? * ** Working with women who have experienced DV, mental health and/or substance use problems can result in: * ** Which of the following is not part of the Stage of Change Model? * How many Canadians will personally experience a mental health problem at some point during their life? * * sig < 0.05; ** sig < 0.001

PRE & POST (n=253) PREPOST KNOWLEDGE   df P Value Domestic violence always precedes mental health or substance use problems Mental health or substance use problems may increase the risk of domestic violence In the context of mental health, a 'trigger' refers to: Which of the following is not a factor in considering the immediate safety of a woman experiencing DV? * sig < 0.05; ** sig < 0.001

PRE & POST (n=253) PREPOST COMPETENCE   df P Value I understand the ways in which DV, mental health & substance use problems are interconnected * ** I can initiate a conversation, ask questions about, and appropriately refer a woman who has experienced DV, mental health and/or substance use problems * ** I can respond to crises related to DV, mental health and/or substance use * ** * sig < 0.05; ** sig < 0.001

PRE & POST (n=253) PREPOST COMPETENCE   df P Value I can help a woman manage her distress even if she begins to dissociate while talking to me * ** I can outline the steps to building useful organizational partnerships * ** I can recognize the signs of burnout or compassion fatigue and have strategies for self- care * ** * 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 member Facilitators and co-facilitators of the workshops Workshop participants Meaghan Morris for data support