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Domestic Violence It is Everyone’s Business

Domestic Violence It is Everyone’s Business. Leah Rosenthal, PhD Jennifer Brown, MFT Claudia Kruse, MFT Kaiser Permanente Employee Assistance Program. It Can Happen to Anyone…. KP physician and employees victims of domestic homicide. Cassandra Floyd, MD 1966-2001 OB/GYN .

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Domestic Violence It is Everyone’s Business

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

  2. It Can Happen to Anyone… KP physician and employees victimsof domestic homicide Cassandra Floyd, MD1966-2001OB/GYN Stephanie Zalot1966-2003Quality Outcomes Lisa Munoz1976-1999Optical Services “An Equal Opportunity Destroyer”

  3. 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

  4. 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

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

  6. DV is Common

  7. 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 15-44. • 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, 2006. 30(6): p. 447-457.

  8. Prevalence of DV has been Significantly Under-Estimated • Among 3,429 Seattle women 18-65 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, 2006. 30(6): p. 447-457 Group Health Cooperative assessing physical, sexual and emotional abuse (2006 data):

  9. 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.

  10. 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 Contributes to Future Health Care Costs Witnessing physical abuse of mother is strongly associated with health risk factors and conditions. • Based on CDC/Adverse Childhood Experiences studies conducted at KP San Diego • http://www.cdc.gov/NCCDPHP/ACE

  11. 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. 2003, National Center for Injury Prevention and Control, CDCP

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

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

  14. 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

  15. 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.

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

  17. 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.

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

  19. 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.

  20. Building a Workplace Program • Raising awareness at work… • Where to focus? • -Prevention • How to prevent? • - Education, partnership and promotion

  21. 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. 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.

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

  24. Thank You!

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