Making connections across silos: intimate partner violence, mental health, and substance use

Abstract

BackgroundUntold numbers of women worldwide are survivors of intimate partner violence (IPV) with a substantial number of these experiencing co-occurring mental health and substance use problems. Despite the complex interconnections among these problems, funding mechanisms and organizational structures and mandates have been designed to address just a single, focal problem. One of the challenges for frontline providers is the lack of effective, evidence-informed inter-professional education or training to help them identify and appropriately respond to co-occurring problems. We developed an evidence-informed, competency-based curriculum to address this gap. In this paper we report on its effectiveness in increasing knowledge, changing beliefs and enhancing skills of frontline workers from all three sectors.MethodsThe curriculum consists of multiple elements: a text manual; an interactive, online series of modules; and, an in-person workshop. Frontline workers (n = 1111) in the violence against women (VAW) (n = 499), mental health (n = 229), addiction treatment (n = 167), and associated sectors (n = 149) were recruited to attend the workshop and instructed to read the manual or complete the online modules before attending. Some failed to respond (n = 67). Online pre- and post-tests were used to assess changes in knowledge, beliefs and skills; evaluations of the workshop were also collected.ResultsMatched pre- and post-tests were available for over half of the participants (n = 624). Results show statistically significant improvements across all six competency domains from pre to post-test (p <0.0001). Significant changes in participants’ knowledge and stigmatizing beliefs were achieved. There was no correlation among differences in sector, age, size of organization, years of experience or prior training. Participant feedback made evident prior misconceptions about women experiencing co-occurring problems, improved understanding about the need to bridge silos, as well as the need for enhanced self-care.ConclusionsAn educational intervention designed to sensitize frontline workers to the realities of women’s experiences of co-occurring problems, educate about the challenges of accessing help when there are co-occurring problems, and bridge discipline and practice-based silos, can effectively challenge and alter providers’ negative attitudes and stigmatizing beliefs. Decreasing stigmatizing beliefs and increasing knowledge has the potential to help survivors access needed help.Electronic supplementary materialThe online version of this article (doi:10.1186/s12905-017-0372-4) contains supplementary material, which is available to authorized users.

Advancing our knowledge of the complexity and management of intimate partner violence and co-occurring mental health and substance abuse problems in women

“…However, there was promising preliminary evidence that reductions in episodes of IPV and substance use followed women's participation in parallel or integrated treatment programs. Unfortunately, it was also noted that few shelters offered any onsite substance abuse treatment programs, although this may not be surprising given that many shelters have rules against the provision of services to substance-using abused women [ 31 ].…”

Women and Barriers to Harm Reduction Services: A Literature Review and Initial Findings From a Qualitative Study in Barcelona, Spain

“…Women who experience gender based violence are sent from one service to another to address different issues and this lack of integrated service delivery is another deterrent for women accessing any services. [42,43,55] Drug use and intimate partner violence are de ned by power relations based on gender, race and class. [56] As such, it is vital that services providing health and harm reduction services to women who use drugs are able to respond to the needs of those who have experienced intimate partner violence.…”

“…A study among staff in Canada found that when accessing health and harm reduction services, people with experience of intimate partner violence encounter stigmatizing or victim-blaming attitudes. [55] Under-resourced staff, both in terms of training and high caseloads, reduces the likelihood that intimate partner violence will be addressed. [58] The lack of services for people with experience of intimate partner violence is an unmet need in harm reduction services.…”

Correction

“…PTSD and substance use disorder commonly occur together leading to impairment of functioning (Mason, Wolf, O'Rinn, & Ene, 2017). Individual-based trauma-focused cognitive behavioral therapy plus concurrent adjunctive substance use disorder intervention reduce levels of distress (Roberts, Roberts, Jones, & Bisson, 2016).…”

“…Individual-based trauma-focused cognitive behavioral therapy plus concurrent adjunctive substance use disorder intervention reduce levels of distress (Roberts, Roberts, Jones, & Bisson, 2016). Coordinated treatment between mental health providers, therapists to treat substance abuse and primary care doctors is essential (Mason et al, 2017). The team of providers must be cognizant that the stress of abuse may result in depression, anxiety, overeating, hypertension, and headaches.…”