The CDC has identified domestic violence as a public health epidemic with associated direct health care costs of $4.1 billion. 1

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2 The CDC has identified domestic violence as a public health epidemic with associated direct health care costs of $4.1 billion. 1 One in four women will experience domestic violence in their lifetime. 2 Approximately 73,000 hospitalizations and 1,500 deaths among women are attributed to domestic violence annually. 3 In a study of nearly 5,000 women, only 7% said a health care professional had ever asked them about domestic violence. 4 Conversely, in four different studies of survivors of abuse, 70% to 81% of patients studied reported they would like their health care providers to ask them about intimate partner violence. 5

3 Dr. Kevin Sherin, Director of the Orange County Health Department in Orlando, Fla., developed a short tool called the HITS Assessment to screen potential victims of violence. The HITS Assessment is a four-question survey that asks respondents how often their partners physically Hurt, Insulted, Threaten, and Scream at them. The HITS Assessment is a proven, evaluated method of identifying victims of domestic violence. It is at least 91% effective in identifying an abusive relationship. 6 A study funded by the Center for Disease Control showed the HITS Assessment to be one of the most effective domestic violence screening tools in the world for medical professionals. 7

4 National statistics show only 10% of physicians regularly screen for domestic violence. 8 In two years of health care professional trainings conducted in Central Florida by Harbor House, we found that 71% of physicians did not routinely screen for domestic violence. Those that did screen did not have appropriate protocols or referral systems in place to help identified survivors. As part of our Project Courage initiative, Harbor House engaged Dr. Kevin Sherin and began recommending in all of its trainings to medical professionals that HITS be utilized as the standard domestic violence screening tool in Central Florida.

5 Background The R3 App was designed to meet the needs and concerns identified by local physicians and health care professionals voiced during those trainings: 1. Lack of an evidence-based screening tool 2. Lack of knowledge regarding what to do if someone in need is identified 3. Fear of liability 4. Lack of access to best practice protocols

6 The R3 App was created by Harbor House of Central Florida in partnership with Florida Hospital, Dr. Sherin and Echo Interaction Group to assist users in how to Recognize, Respond and Refer (R3) those in need of domestic abuse services.

7 The R3 App is an evidence-based screening tool utilizing the HITS Assessment methodology, which correctly identifies a minimum of 91% of individuals in abusive relationships. The R3 App s self-scoring HITS Assessment tool automatically links to recommendations based on the score of the individual being screened. A resource locator identifies by zip code the local provider of domestic abuse services using the geolocation feature of the mobile device. Additional references and information including videos, links and screen/refer protocols feature industry best practices from nationallyrecognized sources. The R3 App provides a one-stop mobile application for users to recognize domestic violence, respond to it effectively and refer survivors to resources that can help them.

8 The R3 App - Version 2.0 Planned for Fall 2012 release. Will incorporate research-based R3 online training, which shows 60% of those completing the training correctly identify and refer a survivor within six months. Medical, mental health and basic training will be available on both web and mobile platforms.

9 Design & Usability See The R3 App in use at

10 The R3 App design is simple, sleek and easy to navigate. The R3 App is available on itunes and Google Play platforms, encompassing the Apple and Droid markets. Videos are incorporated in the R3 App to teach and empower all parties how to use the app in a safe, secure way. Most importantly, the R3 App contains the only mobile listing of all domestic abuse service providers by zip code in the United States. The R3 App provides quick and easy access to screening protocols and reporting laws. The R3 App can be used for female and male survivors as well as those in same sex relationships.

11 While the R3 App was designed for medical settings, Harbor House recognizes that those in abusive relationships will also utilize the tool. Because of this, and due to the inherent danger involved in abusive relationships, special precautions were built into the design to ensure the safety of survivors: An icon that does not mention domestic violence Warning notices on the download page Video rather than print disclaimers that must be viewed prior to usage for both professionals and survivors Multiple reinforcements to seek further assistance either locally or through the national hotline

12 The HITS Assessment is validated in English, Spanish and Mandarin Chinese. The HITS Assessment is validated among female and male populations. The R3 App s scalable design enables: Ongoing updates from providers across the country Listings of services available worldwide Integration of additional languages (currently offered in both English and Spanish)

13 More than 1,500 downloads since its launch in early In use in 25 countries and counting Spain Australia Ireland Canada China Saudi Arabia Austria Singapore Netherlands Germany Italy Brazil UK New Zealand Venezuela Denmark Mexico Israel Russia Philippines Taiwan Belgium Thailand Ukraine

14 1. Costs of Intimate Partner Violence Against Women in the United States, Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. March Tjaden, Patricia & Thoennes, Nancy. National Institute of Justice and the Centers of Disease Control and Prevention, Extent, Nature and Consequences of Intimate Partner Violence: Findings from the National Violence Against Women Survey, (2000). 3. Crowell NA, Burgess AW, editors. Understanding violence against women: panel on research on violence against women, National Research Council. Washington, DC: National Academy Press; 1996; Tjaden P and Thoennes N. Full report of the prevalence, incidence, and consequences of violence against women. Washington DC: National Institute of Justice and the Centers for Disease Control and Prevention; November Screening for Abuse May Be Key to Ending It, Erin N. Marcus, M.D., New York Times, May 20, Caralis P, Musialowski R. Women s Experiences with Domestic Violence and Their Attitudes and Expectations Regarding Medical Care of Abuse Victims. South Medical Journal, 90: , 1997; McCauley J, Yurk R, Jenckes M, Ford D. Inside Pandora s Box : Abused Women s Experiences with Clinicians and Health Services. Archives of Internal Medicine, 13: , 1998; Friedman L, Samet J, Roberts M, Hudlin M, Hans P. Inquiry About Victimization Experiences: A Survey of Patient Preferences and Physician Practices. Archives of Internal Medicine, 152: , 1992; Rodriguez M, Quiroga SS, Bauer H. Breaking the Silence: Battered Women s Perspectives on Medical Care. Archives of Family Medicine, 5: , Ramsay J, Richardson J, Carter YH et al. Should healthcare professionals screen for domestic violence? Systemic review. Br Med J 2002;325(7359): ; American College of Obstetricians and Gynecologists. Special issues in women's health: Intimate partner violence and domestic violence. Washington DC: American College of Obstetricians and Gynecologists; HITS: a short domestic violence screening tool for use in a family practice setting. Sherin KM, Sinacore JM, Li XQ, Zitter RE, Shakil A. Family Medicine Jul-Aug;30(7): Basile KC, Hertz MF, Back SE. Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings: Version 1. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2007.

15 Available on itunes and Google Play Search R3 App