1. National Health Collaborative on Violence and Abuse | Briefing Violence Against Women, Children and Families: New Health Policy Responses and Opportunities Transforming the Health Care Response to Domestic Violence Brigid McCaw, MD, MPH, MS, FACP Medical Director, Family Violence Prevention Program, Kaiser Permanente

2. My sister Beth is a new mom In 1981, I start medical school We were both trying to learn how to save lives…

3. Why is IPV important in health care? IPV is extremely common The health effects are devastating The health care costs are substantial IPV impacts future generations Health care interventions make a difference

4. Comparison to Other Life-Threatening Conditions Affecting Women New cases of breast cancer [2] 211,000 Number of women dying from cardiovascular disease [3] 484,000 Women who are injured from IPV [4] 2,000,000 In the US, each year

5. Health Effects of IPV: Injuries & Death Most common cause of injury in women aged 18-44 A leading cause of pregnancy associated mortality Rape Homicide Suicide

6. 6 Abused women experience a Abused Women Experience a Campbell et al, 2002 in gynecological, neurological, and stress-related problems. 50% to 70% increase

7. Higher Utilization of Health Care Services 14 - 21% higher for primary care and specialty care 50% higher for emergency department 2 times higher for mental health 6 times higher for chemical dependency services Source: Group Health Cooperative, Seattle BURNING PLATFORM

8. IPV and Chronic Health Problems 60% more likely to have asthma 70% more likely to have heart disease 80% more likely to have a stroke 2x as likely to be a current smoker Source: Centers for Disease Control (CDC) February 2008

9. US medical costs for IPV in the year after victimization 9 Brown et al, 2008

10. Annual Additional Health Care Costs For Kaiser Permanente Northern California $212 Million Every Year $19.3 Million /100,000 women enrollees (age 18-65) For Kaiser Permanente $580 Million Every Year

11. Another Cost: Impact on Children of Witnessing IPV

12. Intervention Makes a Difference! Women who talked to their health care provider about the abuse were nearly 4 times more likely to use an intervention

13. Healing and Recovery Happens The majority of women eventually end their relationship with violent partners (On average, after 3-5 attempts and about 7 years) The majority of women do not have recurrent abusive relationships Health care costs go down after abuse ends

14. IPV screening and counseling should be core part of women’s health services Women’s Preventive Health Care Services Committee Universal screening for childbearing-age women recommended

15. …to include prevention of Intimate Partner Violence as part of routine health care services for women? Is it possible … …to include prevention of Intimate Partner Violence as part of routine health care services for women? YES

16. Kaiser Permanente’s Innovative Model http://www.youtube.com/watch?v=uocoMbCg9N8

17. The KP Systems-Model Approach Inquiry and Referral Supportive Environment Leadership and Oversight On-site Services Community Linkages “Making the right thing easier to do”

18. Using Technology to Improve Care Engaging patients: – Online information for patients – Secure messaging – Call Centers Supporting clinicians: – Tools in electronic medical record – Online clinician training – Point-of-care online resources

19. New Online Resource on Health and IPV  Supported by DHHS Family Violence Prevention and Services Program Supported by DHHS Family Violence Prevention and Services Program  Offers patient and provider educational tools and resources Offers patient and provider educational tools and resources www.healthcaresaboutipv.org

20. KP Northern California: Seven-fold Increase in IPV Identification Members Diagnosed with Intimate Partner Violence, 2000-2011 1022 7106 { { Emergency Dept. & Urgent Care Mental Health Primary Care

21. Implementation of IPV Services Underway in Every KP Region Group Health Northern California Northwest Southern California Colorado Ohio Mid-Atlantic Georgia Hawaii

22. Dr. Robert Pearl at CEO Breakfast sponsored by Fortune Magazine Robert Pearl,MD The Permanente Medical Group 2007 “Domestic violence prevention is part of a strategic approach to both quality and affordability. By doing the right thing, we can improve quality, increase service and satisfaction, while also decreasing costs to employers and patients.”

23. Looking toward the next decade… We can transform the health care response to Domestic Violence

24. Brigid McCaw, MD, MS, MPH, FACP Medical Director Family Violence Prevention Program The Permanente Medical Group Brigid.McCaw@kp.org 510-987-2035 kp.org/domesticviolence Contact Information

25. Resources  "Using a Systems-Model Model approach to Improving IPV Services in a Large Health Care Organization". Institute of Medicine. 2011 http://www.iom.edu/Reports/2011/Preventing-Violence-Against-Women- and-Children-Workshop-Summary.aspx  AHRQ Tool for Assessment of Health System Response http://www.ahrq.gov/research/domesticviol http://www.ahrq.gov/research/domesticviol  AHRQ Innovations Solution : “Family Violence Prevention Program significantly improves ability to identify and facilitate treatment for patients affected by domestic violence,” http://www.innovations.ahrq.gov/content.aspx?id=2343 http://www.innovations.ahrq.gov/content.aspx?id=2343  Health Resource Center on Domestic Violence, Futures Without Violence http://www.futureswithoutviolence.org/content/features/detail/790/ http://www.futureswithoutviolence.org/content/features/detail/790/  Kaiser Permanente Domestic Violence website kp.org/domesticviolence

26. END

27. Stories of courage, survival, and hope www.kp.org/domestic violence Supportive Environment Workplace Awareness

28. Cultural Competence Women’s Health Culturally Competent Care INQUIRY AND REFERRAL IPV Chapter includes:  Age (teens, elders)  Ethnicity  Life experiences  Adverse Childhood Experiences (ACE)