Trauma Resources in San Francisco

Trauma Resources in San Francisco Dr. Leigh Kimberg // ARISE Melissa Murphy // Trauma Recovery Center Kenneth Epstein // SF Dept. of Public Health Rebecca Schwartz // HIVE Jia Min Cheng // Bay Area Legal Aid Melissa Bergson // La Casa de las Madres Moderator: Karishma Oza

ARISE: Aspire to Realize Improved Safety and Empowerment Leigh.Kimberg@ucsf.edu

ARISE: Aspire to Realize Improved Safety and Empowerment Funding: Office of Women s Health (OWH), Health and Human Services annually for 3 years Impetus: Affordable Care Act requirement that all health plans must offer interpersonal violence (IPV) education, screening, brief counseling and referral as free preventive health services to all women and girls Grantee: UCSF Division of General Internal Medicine at ZSFGH (Co-PI s: L. Kimberg, D. Schillinger, Co-Investigators: E. Bakken, E. Machtinger) 5/2/016

In a survey of Californians, the most trusted sources of assistance with domestic abuse were DV shelter advocates and healthcare providers yet, most respondents did not know how to reach a DV shelter advocate and had never been screened for IPV by a healthcare provider. This will change with ARISE. Tulchin Research, Blue Shield Foundation, 2013 4 5/2/16

ARISE: Partnerships Partnerships to Improve Safety and Empowerment UCSF lead agency San Francisco Department of Public Health s Primary Care clinics La Casa de las Madres Bay Area Legal Aid Trauma Recovery Center Futures without Violence California Healthcare Safety Net Institute Instituto Familiar de la Raza Child Trauma Research Program (invited) Women s HIV Program 5 5/2/16

ARISE: Rationale Partnerships to Improve Safety and Empowerment Our Hypothesis: Highly vulnerable patients who suffer from a high burden of trauma, social and economic disadvantage and health disparities will achieve greater safety and empowerment through: Support of co-located community partnerships Panel management and outreach Multi-disciplinary team care coordination 6

ARISE: Setting San Francisco Department of Public Health SFDPH Initiatives Trauma-informed Systems Cultural Humility Primary care clinics 17 clinics Integrated behavioral health model *Photo from San Francisco Health Network 7 / 5/2/2106

ARISE: Model Three layered tiers of increasing support Tier 1: Universal IPV education, screening, brief counseling, and referral;; behavioral health safety and empowerment counseling Tier 2: Universal IPV education, screening, brief counseling, and referral;; behavioral health safety and empowerment counseling AND IPV advocate Tier 3: Universal IPV education, screening, brief counseling, and referral;; behavioral health safety and empowerment counseling AND IPV advocate AND Medical-legal partnership AND Panel Management AND Multidisciplinary team meeting 8

ARISE: Model IPV survivors with high lifetime burden of trauma The Trauma Recovery Center: Advisors to ARISE Multi-disciplinary team meeting members Expedited referral to longer term trauma treatment 9 2/17/16

ARISE: Quasi-experimental research study Compare outcomes for IPV survivors in 3 tiers Primary Outcome: Safety behaviors Secondary Outcomes: HITS + sexual abuse* (IPV) Empowerment scale** Quality of Life*** Social Support**** Satisfaction with services *Sherin, K.;; **Rogers, ES.;; ***WHO QOL-Bref;; ****Gielen, AC. 10 5/2/2016

ARISE: Partnerships to Prevent Violence 11 Photos from La Casa de las Madres, Trauma Recovery Center, Futures without Violence 5/2/2016

Trauma Resources in San Francisco Dr. Leigh Kimberg // ARISE Melissa Murphy // Trauma Recovery Center Kenneth Epstein // SF Dept. of Public Health Rebecca Schwartz // HIVE Jia Min Cheng // Bay Area Legal Aid Melissa Bergson // La Casa de las Madres

Trauma Recovery Center Our vision is a community that heals the wounds of trauma and embraces hope for a non-violent, compassionate world. Goals: To offer early intervention for adult victims of interpersonal violence To engage victims who might have difficulty accessing more traditional mental health services To investigate which treatment models are most helpful to victims of crime To provide training to medical and mental health providers around treating trauma

TRC/RTC Mental Health Services Comprehensive psychosocial evaluation Intensive case management Trauma-focused psychotherapy Some group and family work Psychiatric medication evaluation Short-term treatment Voluntary Services/Client-Centered Philosophy Available to consult for other agencies 14

How to Reach Us 2727 Mariposa Street Suite 100 (x Bryant & Florida) San Francisco, CA 94110 415/437-3000 (front desk) 415/437-3050 (fax)

Trauma- Informed Systems Initiative Kenneth Epstein, Ph.D., LCSW Director Community Behavioral Services San Francisco Department of Public Health

GOAL To align and embed trauma informed principles into practice Trauma Understanding LEADERSHIP POLICY & PROCEDURES PRACTICE Resilience & Recovery 18

Trauma Organized Trauma Informed Healing Organization ü Reactive ü Reliving/Retelling ü Avoiding/Numbing ü Fragmentation ü Shared Language ü Foundational Understanding of Trauma ü Understanding of the nature and impact of trauma ü Reflective ü Collaborative ü Culture of learning ü Making meaning out of the past ü Growth and Prevention Oriented Trauma Inducing to Trauma Reducing

Teach Study Workforce Training Evaluation Train the Trainer PRACTICE Support Alignment Champions Sustain Leadership

HIVE A Hub of Positive Reproductive & Sexual Health Founded in 1989 at San Francisco General Hospital; formerly Bay Area Perinatal AIDS Center (BAPAC). Our Mission Advancing reproductive and sexual wellness for individuals, families and communities affected by HIV in San Francisco and beyond. Our Vision A world where people affected by HIV have safe pregnancies, reproductive autonomy, access to state-of-the-art health care, and enjoyable sex lives.

HIVE Clinic Provides multidisciplinary preconception, prenatal, gynecologic and sexual health care to women living with HIV as well as HIV-affected couples: v Clinical care: Outpatient/inpatient high-risk obstetrics, obstetric-specific psychiatric care, genetic counseling/testing, prenatal nutrition & health education, inpatient nursery care, HIV testing & linkage to care for partners, children and other family members. v Social services: Intensive medical case management, counseling, and social services for clients and their families.

HIVE Education Website: www.hiveonline.org v Rapidly diffuse ideas & engage larger SRH community and those living with and affected by HIV. Tools & Resources v Videos & resources for clinicians to provide highest quality care & support consumers in achieving fulfilling sexual and reproductive lives. v HIVE blog highlights stories and voices of people living with HIV, women who conceived using PrEP, trans people, and innovative collaborators.

Melissa Bergson, MFTi melissa@lacasa.org Business Line: 415-503-0500 24 Hour Crisis Line: 1-877-503-1850

What is domestic violence? Domestic violence is an escalating pattern of abusive and violent behavior, that a person uses to exert and maintain power and control over another person, within an intimate relationship.

Connecting with La Casa de las Madres 24 Hour Crisis Lines - Always answered by a person. Crisis lines for consultation, guidance, counseling, shelter intakes, and referrals. 1-877- 503-1850 Shelter Program - Location is confidential, private single person rooms & family rooms, up to 8 week stay with supportive services. Drop In Center Provides ongoing support for individuals who don t need emergency shelter or for those exiting shelter. One on one therapy, family therapy, support groups, legal services, and more. Teen Program - All services tailored to people under the age of 24; includes individual counseling, young women s support groups, educational workshops. Bayview HRT- Advocate working at the Bayview YMCA to reach out to victims referred by SFPD. Community Education Workshops and presentations on a variety of topics that intersect with DV at any place of business, community group, high schools and colleges, etc... Domestic Violence Response Team 2 advocates working at the Hall of Justice alongside the police department to reach out to victims and provide support. Permanent Housing Resident Support Onsite emotional and practical support at two permanent housing sites for formerly homeless women. Safe Housing Site Program Education and training provided for property management and community education; workshops and support groups for tenants on site. ARISE @ SFGH Case management at ZSFG to connect with women through the emergency department who are victims of DV