1. Policy

1.1 Best practice protocols and policies on domestic and sexual violence screening and intervention are promoted/adopted/implemented on the statewide organizational level and on the local institutional level

1.1.1. Statewide organizations recommend guidelines esp. on routine screening

Action Steps:

• Make a list of health care organizations to approach. Include substance abuse service providers, emergency medical technicians, dental health professionals, alternative health care providers, School Nurses  and other groups that might be forgotten.
• Recruit small groups to discuss their protocol and policy needs and make recommendations
• Encourage appropriate organizations to disseminate/promote the guidelines among their constituencies. Include DOH, VPQ, CMS in this effort

1.1.2        Screening and intervention protocols are widely implemented

• Intake forms include appropriate screening questions.
• Training, protocols and resources are available to health care providers enabling them to effectively assist clients who screen positive.

Action Steps

• Approach AHS about general intake process: include a general screening question on intimate partner violence that allows for clients’ self-identification and quick referral to IPV services.  In progress.
• Work with AHS sub programs (WIC, ADAP etc) to review or draft screening tools for more in-depth screening and needs assessment.
• Work with AHS on training for all appropriate staff
• Offer resources to AHS staff and other health care providers
• Choose other key institutions to support in implementing screening and intervention protocols (hospitals?) Working with Gifford, VT Child Health Improvement Project.

1.2       VT Legislation is conducive to an effective health care response to intimate partner violence.

Action Steps:

• Existing VT legislation is reviewed and compared to national recommendations/model legislation regarding health care response to intimate partner violence. (e.g. reporting laws, funding/reimbursement, licensing requirements. privacy etc)
• If necessary, advocacy efforts regarding appropriate legislation is supported

2. Education

2.1       Health Systems: Health Care providers and administrators are educated and engaged.

2.1.1    Health Professional and Allied Health Students

Curricula at all health professional and allied health schools and programs in Vermont include intimate partner violence education that is consistent with curricula and clinical guidelines recommended by national organizations.

Action Steps:

• Make an inventory of institutions/programs.

• Make an inventory of which regular education/curricular elements on IPV are already in place in those programs

• Offer support to institutions and programs who are interested in reviewing and
  enhancing, or creating their curricula on IPV. Met with director of Norwich Nursing Program

• Also find, contact and engage the statewide groups that have an influence on the education of health care students, e.g. VT Organization of Nurse Leaders and Colleges

2.1.2    Practicing Health Care Providers

Health Care providers at all levels have access to intimate partner violence education and are trained in appropriate health care responses to intimate partner violence relevant to their role and practice setting (including effective ways to collaborate with DV/SV and other community services)

• Information materials and tools are made available to health care providers.

• Distribution of written materials
• VT Resource website on the health care response to DV/SV (contains easy-to-use clinical and resource/referral tools that can be downloaded.)

Action Steps:

• Support upcoming BCBS provider education campaign. A newly updated provider info and resource kit will be sent to all providers in the BCBS network. DONE Oct 2004

• Inventory of what IPV and HC info is already available in VT and national websites – do we need more than that? Or is a collection of links enough? (Done, see website)

• Find host for VT website. (DOH? VMS? VT Network?) Who will maintain the website in an ongoing way? Do we need funding for that? DONE Oct 2004. Website was written by VT Network, designed and hosted by VT Medical Society. www.vtmd.org

• Create website (funding needed?). Add links to already existing good web-based information. DONE, see above

• Find out where different types of HC providers go for their clinical information – try to get links to our website into all VT and some national places

• Educational events are organized regularly by local, regional and statewide organizations..

• Train-the-trainer initiatives build capacity for regular education offerings throughout the state
• CMEs and CEUs are granted at most educational events.

Action Steps:

• Explore with AHECs whether they can offer regional workshops Southeastern AHEC put Domestic Violence Lecture on their website. North Eastern Ahec invited Dr David Little to do IPV workshop at regional symposium (spring 2004)

• Make calendar of statewide or regional health care conferences, contact the organizers and encourage them to include IPV presentations

• Contact hospitals and encourage them to include IPV topics in Grand Rounds. Done grand rounds Spring 2004 Springfield Hospital (Dr David Little, general audience), Oct 2004 at Gifford (Wynona Ward and Antje Ricken, general) and Dartmouth Hitchcock (Antje Ricken, OB/GYN)

• Pilot new VT Curriculum on IPV for HC Providers Announcements are going out October 2004

• Find out how else each hospital educates new and established staff. Get contacts, ask about IPV education. Offer to help establish routine IPV education. Met with VT Inservice and Continuing Education group Oct 2004– nursing educators from VT hospitals, training materials and guidelines passed on.

• Find out who trains nurses aides, substance abuse providers, MH service providers, EMTs and other groups. Offer to establish routine IPV education.

2.1.3    Health System Leaders and Administrators

Leaders in Public health, health insurance, health administration etc are engaged in promoting intimate partner violence as a public health issue and the importance of a health care response.

• Administrators are provided with relevant information.
• Recommendations for institutional change are made. (see policy section I.1. Best practice protocols and policies)

Action Steps:

• Ask Jill Olsen from VAHHS to include list of DV/SV programs in the contact lists for the community health assessment that each hospital needs to do DONE Aug 2004

• Use the business case by FVPF or, better, create one based on VT data to get administrator’s interested

• Explore whether we can use internal hospital QA departments Targeted mailing to QA depts. and HR depts.of all VT hospitals through VAHHS Sept 2004

• Use JCAHO recommendations on IPV response to get administrators interested (then maybe offer them to help review their policies/protocols and support them in meeting those recommendations even better?).

• Include resources for administrators on the website. Done, see website

2.2  Main Collaborators and Referral Resources for Health Care Professionals Responding to Intimate Partner Violence are informed about intimate partner violence as a health issue and about effective collaboration with health care systems.

2.2.1        Domestic/Sexual Violence Service Providers

Domestic/Sexual Violence Service providers and advocates are engaged in exploring intimate partner violence as a health issue and are educated about effective ways of collaborating with and accessing health systems/health care providers.

Action Steps:

• Antje Ricken will bring this to the VT Network. A group from the NW can work on 2.2.1. Will need input from HC providers regarding what DV/SV providers need to know about HC providers/systems..Done at new All Advocate Training Oct 04, ongoing improvement

2.2.2 Other Community Resources as identified.

2.3       The VT Public.

The VT public is educated about intimate partner violence as a public health issue.

Action Steps:

• Identify already existing intimate partner violence awareness campaigns or appropriate public health campaigns and try to coordinate public education efforts with them. – for example use national Health Cares About Domestic Violence Day (October) to highlight the issue for health care consumers in VT Mailing to all hospitals, AHECs and DOH district offices Oct 2004

• Write periodic press releases on the topic and get it in the VT press. AP press release.about statewide plan Aug 2004.

• Organize a press conference on the completed action plan or other topics.

• Identify VT publications that could carry articles on IPV and HC. Submit articles to them Submitted to Hospital newsletters, CV AHEC newsletter Oct 2004

• Identify websites used by the public to obtain information on either health issues or intimate partner violence issues and ask that information be added about intimate partner violence as a public health issue

3. Program Development

Existing programs and services are altered as needed to enhance the health care response to intimate partner violence. New programs or services are developed if needed.

Comments:

Program development will likely be an outgrowth of policy/education work (not one of the first steps)

5.  Data Collection and Research

Meaningful Vermont data and information on intimate partner violence as a health (care) issue are regularly collected, analyzed and disseminated

5. 1.     Periodic or continuous feedback processes provide information about needs of survivors, advocates and health care providers regarding intimate partner violence as a health issue.

5.1.1    Existing data collection tools and mechanisms are expanded to include questions on intimate partner violence (e.g. BRFSS). Existing data collection that already includes intimate partner violence is identified and used by the team (e.g. data from the Fatality Review Commission)

5.1.2    The leadership team participates in the planning stage of new health care studies in Vermont, e.g. women’s health studies, women’s reproductive health studies, mental health/trauma studies etc) that could be expanded to collect information on intimate partner violence and its impact on health.

5.1.3    The health care costs of domestic and sexual violence are estimated based on data collected.

5.1.4    Health care providers and domestic/sexual violence advocates are asked about their resource, training and other needs regarding implementing an effective health care response to intimate partner violence survivors in Vermont.

Action Steps:

• Work with DOH Surveillance to implement DV/SV module of BRFFS in 2005 (see also Funding Development)..Done. Data will be gathered at next BRFFS

• Explore HIV data collection in VT for opportunities to get IPV data...

• Find a way to make the business case for HC response to IPV – we need data to document IPV health care costs in VT (see business case made by FVPF)

• Support BCBS New England Regional IPV initiative in obtaining a grant to study insurance IPV data...

5. 2      The progress of Vermont’s Health Care system toward improving the health care response to intimate partner violence is tracked and monitored

• Training efforts are tracked and evaluated.
• The action plan implementation is tracked and evaluated in an ongoing way.