Violence, Drugs and Health: Implica8ons for a Trauma-Informed Approach in a Healthcare Se>ng

Transcription

1 Violence, Drugs and Health: Implica8ons for a Trauma-Informed Approach in a Healthcare Se>ng Terri L. Weaver, Ph.D. Saint Louis University Department of Psychology Saint Louis, Missouri Trauma'c Stress New Mechanisms and Effec've Treatment March 9 10, 2016 Clayton Plaza Hotel 7750 Carondelet Ave. Clayton, Missouri 63105

2 In'mate Partner Violence Screening: The Mandate and the Challenge 2010 Affordable Care Act (ACA), sec'on 2713, delineates preven've services for women with private health insurance, including screening for in'mate partner violence (IPV); IPV-related comorbidi'es complicate screening/ interven'ons; Substance use and/or disorders are one such complica'ng comorbidity (Weaver, Gilbert, El-Bassel, Resnick & Noursi, 2015). Meta-analy'c findings document consistent paxerns of bidirec'onal risk between alcohol use/disorder and exposure to physical or sexual IPV (Devries, Child, Bacchus et al., 2014). Meta-analy'c studies have also iden'fied drug use as a risk factor for perpetra'on of IPV by male partners who used drugs (SFth, Smith, Penn, Ward & TriJ, 2004).

3 Substance Abuse and Associated Comorbidi'es Challenge IPV Screening and Referral Capaci'es Substance abusing vic'ms of IPV experience: Some of the most severe and intractable forms of violence; Complex childhood trauma histories; Significant mental and physical health comorbidi'es; Limited individual, social and community-based resources; Synergis'c biases (about IPV and substance abuse) engage healthcare providers values and expecta'ons for change.

4 Substance Abuse is Associated with Severe and Intractable Forms of Violence The Topography of the In'mate Partner Violence Reciprocal Violence and reciprocal substance use/abuse Substance use may be maintained as it is perceived by vic'ms as reducing risk of violence (Macy, Renz & Molino, 2013) Substance use may be coerced (Macy, Renz & Molino, 2013) Previous trauma exposure Childhood trauma history may play a significant role in substance ini'a'on and advancement (GuFerres & Van Puymbroeck, 2006) Increased Poten'al for Lethality (Campbell, Webster & Glass, 2009) Substance facilitated or incapacitated sexual assaults (Kelly & Stermac, 2012; Kilpatrick, Resnick, Ruggiero, ConoscenF & McCauley, 2007)

5 Substance Abuse is Associated with Significant Mental Health and Physical Comorbidi'es Reduced Decision/Judgment and Resources Impairment in memory, cogni've func'oning, problem solving and access to (eroded) social supports Alcohol/drug use can influence the woman s personal safety assessment Social/environmental risk factors including poverty, violence subcultures, increased access to weapons (Testa, 2004) PosXrauma'c Stress Disorder(Sullivan & Holt, 2008) Depression (Lipsky, Caetano, Field, & Bazargan, 2005) Comorbid Medical Issues Injury (Thompson & Kingree, 2006) Pregnancy (Ogbonnaya, Macy, Kupper, MarFn & Bledsoe-Mansori, 2013) Behavioral Health Risk factors (Plichta, 2004) Interac'ons with medica'ons (Weathermon & Crabb, 1999) Issues with managing chronic health condi'ons (Plichta, 2004)

6 Trauma-Informed Care: Sedng the Stage for a Tailored Approach to SUDs/IPV A strengths based approach; Understands and is responsive to (all the ) impacts of trauma while emphasizing the physical, psychological and emo'onal safety for providers and survivors; The healthcare experience should provide an opportunity for survivors of trauma to rebuild their sense of control and empowerment and avoid ins'tu'onal processes and prac'ces that may retrauma'ze individuals (Hopper, Bassuk, & Olivet, 2010).

7 Professionals barriers to enquiry of domestic violence. Diana Rose et al. BJP 2011;198: by The Royal College of Psychiatrists

8 Service users barriers to disclosure of domestic violence. Diana Rose et al. BJP 2011;198: by The Royal College of Psychiatrists

9 Substance Abuse Requires Tailored Screening/Interven'on Considera'ons: Trauma Informed Considera'ons Stages of Change for Screening/Safety Planning (Zink, Elder, Jacobson & Klostermann, 2004) Evaluate readiness for change in substance abuse and explore in conjunc'on with readiness for change in improving safety Consider how readiness for change may influence engagement in forms of treatment Consider stage of change for determining the nature of the discussion of IPV/substance abuse

10 Screening/Interven'on for Comorbid IPV/ SUDs: Trauma-Informed Considera'ons Fear of perceived blame or actual blame by healthcare provider Altered percep'ons of healthcare provider mo'ves Woman s percep'on of the role that her partner s substance use in IPV (Macy, Renz & Molino, 2013) Concern regarding forensic/legal implica'ons of her substance use and barriers to pursuing IPV-related civil and criminal op'ons Coerced/substance facilitated involvement in criminal ac'vi'es Limited access to resources depending on restric'ons regarding sobriety

11 IPV: Brief Interven'ons in Healthcare Sedngs Brief Interven'ons for IPV, generally, have been conducted within Healthcare Sedngs (Eckhardt, 2013) A recent review of 6 brief IPV interven'ons delivered in health care sedngs iden'fied several common components: Safety planning; Increasing mo'va'on and sedng goals to reduce IPV and improve safety; Linking women to IPV-related services and social support. Findings were mixed with most consistently posi've results for increased use of safety behaviors (4/6 studies) To date no such interven'ons have been found to be effec've in addressing IPV among women presen'ng with SUDs in healthcare and other sedngs.

12 Poten'al Evidence-Based Integrated Interven'ons for SUDs and IPV If drugs/alcohol are being used as a way of coping with the pain of IPV or as the result of PTSD associated with IPV, trauma informed interven'ons may need to include self-regula'on and coping skills to deal with nega've affect (Gilbert, El- Bassel, Chang, Wu & Roy, 2013). If partners are experiencing withdrawal or engaging in conflict over drug supply, interven'on approaches may need to incorporate couple s communica'on, problem solving and nego'a'on skills (El-Bassel, Gilbert, WiJe, Wu, Hunt, Remien R, 2010).

13 Conclusions SUDs significantly complicate the presenta'on, experience, outcomes and trajectories for female vic'ms of IPV; Healthcare sedngs may provide opportuni'es for screening/ interven'on with IPV and are now federally mandated sedngs for screening; Trauma-Informed approaches must consider all the rela'onal, emo'onal, psychological and physical comorbidi'es associated with IPV/SUD in their quest to develop effec've preven'on and interven'on strategies. PorFons of this talk were presented the U S Department of Health and Human Services InFmate Partner Violence Screening and Counseling: Research Symposium Friday October 4, 2013 Natcher Building, NIH Campus