2. Domestic Violence It is Everyone’s Business
Leah Rosenthal, PhD
Jennifer Brown, MFT
Claudia Kruse, MFT
Kaiser Permanente Employee Assistance Program

3. It Can Happen to Anyone…
KP physician and employees victims of domestic homicide
Stephanie Zalot Quality Outcomes
Cassandra Floyd, MD OB/GYN
Lisa Munoz Optical Services
“An Equal Opportunity Destroyer” 3

4. Overview Establishing DV as a Critical Workplace Issue
Prevalence, health effects and costs
Why employers are getting involved
The important role of EAPs
Building an Effective Workplace Program
Education - training staff and managers
Partnership - raising awareness
Prevention - promoting materials
Responding to DV at the Workplace
Partnerships
Policies
EAP role

5. Kaiser Permanente by the Numbers
A healthy workforce requires
a healthy workplace.
8.7 million members
156,000 employees
13,729 physicians
416 medical offices
32 medical centers
80% female workforce

6. Kaiser Permanente by the Numbers
KP Employee Assistance Program is a division of
KP Healthy Workforce and a National Shared Service.
External:
Colorado
Georgia
Mid-Atlantic States
Ohio
Internal / Onsite:
Northern California
Southern California
Oregon / Washington
Hawaii

7. DV is Common New cases of breast cancer: 211,000
Number of women dying from cardiovascular disease:
484,000
Number of women who are victimized by DV each year:
1,500,000
Victims of physical DV during their lifetime (USA):
1 in 4 women
1 in 14 men
Breast Cancer Facts & Figures , American Cancer Society: Atlanta, GA.
Heart Disease and Stroke Statistics. 2006, American Heart Association.
Tjaden, P. and N. Thoennes, Prevalence, Incidence, and Consequences of Violence Against Women: Findings from the National Violence Against Women survey. National Institute of Justice Centers for disease Control and prevention (NIJCDC), 1998.
Domestic violence is the leading cause of injury to women aged 15 to 44. Can Fam Physician, : p. 2317, 2322. 7 7

8. A Look at National Statistics: DV Leads to High Morbidity & Mortality
1 in 4 women, 1 in 14 men are the victims of DV at some point in their lives.
DV is the leading cause of injury to American women ages
DV is a leading cause of pregnancy-associated mortality.
Thompson, R., et al., Intimate Partner Violence: Prevalence, Types, and Chronicity in Adult Women.
Am J Prev Med, (6): p

9. Prevalence of DV has been Significantly Under-Estimated
Group Health Cooperative assessing physical, sexual and emotional abuse (2006 data):
Among 3,429 Seattle women years:
8% are currently experiencing DV
15% experienced DV in last 5 years
44% lifetime prevalence
Highest prevalence occurs in working age and parenting women
Associated with 4 times higher risk of severe depression+
+Thompson, R., et al., Intimate Partner Violence: Prevalence, Types, and Chronicity in Adult Women.
Am J Prev Med, (6): p
Thompson, R., et al., Intimate Partner Violence: Prevalence, Types, and Chronicity in Adult Women. Am J Prev Med, (6): p
2006 Bonomi, A. E., Thompson, R. S., Anderson, M., Reid, R. J., Carrell, D., Dimer, J. A. and Rivara, F. P. Intimate partner violence and women's physical, mental, and social functioning. Am J Prev Med, (6)p 9

10. A Look at National Costs
$5.8 billion per year.
$4.1 billion in direct medical and mental health expenses.
$900 million in lost productivity.
$900 million in lost earnings by victims of homicide.
$18 billion per year for costs associated with law enforcementand criminal justice system.

11. Contributes to Future Health Care Costs
Witnessing physical abuse of mother is strongly associated with health risk factors and conditions.
Unintended pregnancy
Sexually transmitted disease
Smoking as an adolescent
Becoming victims or perpetrators of DV as adults
Poorer health outcomes as adults:
cardiovascular disease
emphysema
depression
Based on CDC/Adverse Childhood Experiences studies conducted at KP San Diego

12. DV is a Costly Workplace Issue
Hidden costs:
Abuse related absenteeism: 54% missed an average of 3 days or more per month.*
Decreased productivity: 37% report job performance affected.+
Increased cost of DV + employees
$2,200/yr direct health care costs+
$990/yr in productivity (CDC estimate)+
Workplace security and liability
In a survey of EAP programs, 83% had employees with restraining orders.
*Laurence, L. and R.Spalter-Roth, Measuring the Costs of Domestic Violence Against Women and the Cost-Effectiveness of Interventions. 1996, Institute for Women’s Policy Research.
+Cost of Intimate Partner Violence Against Women in the United States , National Center for Injury Prevention and Control, CDCP
*Laurence, L. and R.Spalter-Roth, Measuring the Costs of Domestic Violence Against Women and the Cost-Effectiveness of Interventions. 1996, Institute for Women’s Policy Research.
+Cost of Intimate Partner Violence Against Women in the United States , National Center for Injury Prevention and Control, CDCP

13. Health Effects More than physical injuries… Headaches
Insomnia, fatigue
Chest pain, palpitations
Chronic pain syndromes
Substance abuse or relapse

14. Mental Health Effects Major depressive disorder
Occurs in 63-81% of abused women compared to 7% in controls.
Generalized anxiety
Occurs in 38-47% of abused women compared to 6% of controls.

15. DV is Closely Associated with Other Health Risks
Smoking
Sexually transmitted infections
Not obtaining preventive care (breast and cervical cancer screening, immunizations)
Sub-optimal control of chronic health conditions (diabetes, asthma, hypertension)
Unintended pregnancy, complications during pregnancy
Other chronic health problems
Centers for Disease Control (CDC), Feb 2008

16. Aiding Recovery The majority of women end abusive relationships.
On average, it takes about 5 years.
On average, leave 3-5 times.
Most do not have another abusive relationship.
Financial resources and economic stability are extremely important.
Focus on safety.

17. “The Systems Model” Health Care Approach to DV Prevention
“Kaiser Model”
Inquiry and Referral
On-site
Resources
Leadership
and
Quality Improvement I
Supportive
Environment
Community
Linkages 17

18. Engaging Leadership How to engage leadership: Identify a “Champion.”
Begin a DV Prevention Task Force.
Build the business case for prevention by:
- examining prevalence.
- presenting financial and human costs.

19. KP Domestic Violence Champions
Brigid McCaw, MD, MS, MPH
Medical Director for Domestic Violence Services
Kaiser Permanente Northern California
Tammy Jones
Senior Vice President
Healthy Workforce, National Human Resources
Jerry O’Keefe, MFT, CEAP
Director, Kaiser Permanente National EAP Services

20. Why are Employers Getting Involved?
A healthy workforce:
contributes to organizational prosperity.
fosters workplace safety (OSHA).
reduces risk of legal and liability issues.
enhances community improvement and positive business identity.
decreases expenses associated with health care.

21. Building a Workplace Program
Raising awareness at work…
Where to focus?
- Prevention
How to prevent?
- Education, partnership and promotion
Tjaden, P. and N. Thoennes, Extent, Nature, and Consequences of Intimate Partner Violence. 2000, U.S. Department of Justice: Washington, DC.
Adult Female Victims of Intimate Partner Physical Domestic Violence, in Data Points. 2001, California Women's Health Survey, Office of Women's Health, California Department of Health Services: Sacramento, CA.
41.Felitti, V.J., et al., Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med, (4): p
Dube, S.R., et al., Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: implications for health and social services. Violence Vict, (1): p
Anda, R., et al., Childhood abuse, household dysfunction and indicators of impaired worker performance in adulthood. The Permanente Journal, : p
Rivara, F. P., Anderson, M. L., Fishman, P., Bonomi, A. E., Reid, R. J., Carrell, D. and Thompson, R. S. Intimate partner violence and health care costs and utilization for children living in the home. Pediatrics, (6):1270 21

22. When to Promote Health at Work?
Healthy and
Productive
Risk Factors
Develop
Early Clinical
Disease
Prevention and
Health Promotion
Raising Awareness at Work
Raising awareness at work…
Full Blown
Clinical Disease
Chronic Care
Management
Severe Disease and Disability 22 22

23. Domestic Violence at Work… Who is Affected?
Victims
12 months, affects 8% of female and 3% of male employees.
Frequently associated with other conditions that reduce work performance.
Co-workers
Increased workload.
Concern about safety.
Perpetrators
20% of employees report they have known co-worker who perpetrated DV on work time.

24. EAP and Employers Education, Partnership, Prevention
Religious
Leaders
Advocates
Police
Health Professionals
Employers
Friends
Judges &
Legal Professionals
Policy Makers
Educators

25. Thank You!