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BCIFV home > Newsletter > 2002 Archives > Winter 2002 articles

Womenís Health Planning Project
Implementation Task Force
Continuum of Violence Services
Working Group Recommendations

by Penny Bain, LLM

 

Introduction

The Vancouver Richmond Health Board (V/RHB) adopted the Womenís Health Planning Project Report on February 24, 2000. The Womenís Health Planning Project report concludes that the current Vancouver-Richmond health system does not respond well to the needs of women and their children who experience violence, particularly in diverse populations.

The Board hired the BC Institute Against Family Violence to conduct a literature review, develop an inventory of violence services and develop recommendations for implementation of a continuum of violence services proposed by the report.

The Institute created a Working Group of community representatives to advise on current service quality and to develop recommendations for improved services in the region to abused women and their children.

The purpose of the Report of the Continuum of Violence Services for Women and Children Working Group is to recommend an operational plan to the Vancouver Richmond Health Board Womenís Health Plan Implementation Task Force to address those needs.

The Working Group met for six months to discuss their experience, review the literature, develop guiding principles and identify implementation recommendations.

In adopting the Womenís Health Planning Project Report recommendations in 2000, the V/RHB specifically requested that the implementation plan include all services in the continuum of responses to women and their children who experience violence.

 

Principles and Values

The principles and values on which the implementation plan of the Working Group on Continuum of Violence Services for Women and Children is based include:

  • Violence is a health care issue. Victims of violence have a right to health care that acknowledges the root causes of their health issues.
  • Women and children have the right to live free of violence.
  • All forms of violence have a significant impact, sometimes acute and sometimes long-term, on womenís health.
  • Women are experts on their own lives. Women have a right to autonomy in making decisions about their health care.
  • Women who experience violence have a right to appropriate and accessible services that respect sthe diverse contexts of their lives.

The following are recommendations made by the Working Group in the Report of the Continuum of Violence Services for Women and Children Working Group.

 

Recommendations

The Working Group recommends that the Vancouver Richmond Health Board must do the following in order to prevent and reduce the health impact of violence against women :

(1) provide adequate funding to support and expand existing services;

(2) develop and implement policies, protocols, training and evaluation;

(3) increase co-ordination of existing services; and

(4) advocate for improvements in policies and services.

health impact of violence against women in Vancouver and Richmond. "Women" includes women throughout their life- span and in diverse circumstances, for example, girls, young women, single women, women with children, older women, women with disabilities, women with mental health issues, women with addictions, women with HIV/AIDS, sex trade workers, First Nations women, women of colour, women from diverse cultures, lesbians, transgendered women, etc.

The Working Group recognizes that the V/RHB is constrained by limited resources. However, the Working Group strongly urges the V/RHB to provide leadership and to more effectively direct current and new resources first to the services priorities as described below. The Working Group, as support by the Womenís Health Planning Report, concludes that the need for services far exceeds the capacity of existing programs. We strongly urge action to address the gaps in services to women who experience violence as follows:

 

First Service Priority

The Working Group concludes that because the availability of V/RHB funded mental health services is limited to "chronic and persistent" conditions, abused women, and their children, are unable to access services to address the range of mental health impacts described in the definition of "mental and emotional health services" above. Those counselling services that do exist have waiting lists that create significant barriers to obtaining appropriate services. The V/RHB must act decisively to address the gaps in mental and emotional health services for women who experience violence.

The Working Group recommends that V/RHB expand access to crisis, early intervention and longer term mental and emotional health counselling services for survivors of emotional, physical and/or sexual abuse. Specific service requirements include trauma counselling for women who experienced childhood trauma, including sexual abuse; counselling for women who experience severe trauma from adult sexual assault or relationship violence; counselling for abused women with multiple issues such as trauma and mental health concerns or trauma and drug or alcohol abuse; trauma counselling for children who have experienced physical or sexual abuse; counselling for children exposed to relationship violence (wait lists are particularly long for children from diverse cultures and for young children aged 3 to 5); culturally appropriate counselling services (including diversity in the languages in which counselling services are provided); and counselling services accessible to women with disabilities.

 

Second Service Priority

The Working Group recommends that V/RHB increase access to existing sexual assault and relationship violence services, particularly for marginalized women. Urgently required service improvements include appropriate assessment, care and follow-up for all women who experience relationship violence; appropriate staff training, referral and follow-up services at Richmond Hospital for women who experience sexual assault; adequate counselling services for women who experience sexual assault in Richmond; services to assess, care for and follow-up on victims of elder abuse using St.Vincentís Hospital staff and facilities; improved outreach crisis services for women with special needs such as young women/girls, sex trade workers, First Nations women, women with HIV/AIDS, older women etc.; improved access to the "morning after" pill; and date rape drug testing protocols for date rape victims.

 

Third Service Priority

The V/RHB Strategic Plan for Housing Services (April, 2000) recognizes the significant role of adequate and affordable housing as a health promotion strategy. The Working Group recommends that the V/RHB take a leadership role to improve the access of abused women to both crisis and second stage housing, particularly for those women with mental health issues, addictions problems or other special needs such as older women, young women, First Nations women, women from diverse cultures, women who speak English as a second language, women with disabilities, women in lesbian relationships, and transgendered women.

 

Fourth Service Priority

The Working Group recommends that V/RHB ensure that all women have options in accessing health care services, including multidisciplinary teams with access to female physicians, for example, medical clinics staffed by women that offer 24-hour drop-in spaces for women and/or women-only hours.

 

Fifth Service Priority

The Working Group recognizes that in order to stop the intergenerational use of violence and to assist mothers who experience violence, the V/RHB must increase its parent support services. We recommend that V/RHB increase funding for education and support programs for parents or parents to be, for example: teen parents; grandparents parenting their grandchildren; parents who were abused as children, parents who lack parenting skills, who are addicted or have mental health issues, or who are otherwise at risk of abusing their spouse and/or children; parenting services and programs specifically designed for people with FAS and NAS; parenting programs in transition houses and second stage housing; and web-based parenting support information resources.

 

Sixth Service Priority

The Working Group recommends that V/RHB work with community agencies to ensure that immigrants/refugee women are informed in their first language about their rights to live free of violence and about access to health and legal services, and that the V/RHB fund the provision of interpretation services in all health care settings and in all support and counselling services.

 

Seventh Service Priority

Finally, the Working Group recommends that V/RHB implement women-centred health promotion strategies to prevent woman abuse, for example: education services on the health risks of violence; date rape prevention resources; programs in schools that promote building healthy relationships, parenting skills programs; public education on abuse of older women (particularly for recent immigrants), etc.

 

2. Recommendations Concerning Policies, Protocols, Training and Evaluation

As a second but concurrent priority, the Working Group recommends that the Vancouver Richmond Health Board allocate further resources to developing and implementing appropriate policies, protocols, training, and evaluation based on the Framework of Women Centred Health. As a minimum standard, the V/RHB should ensure that all health care providers have the resources and training to provide adequate health care responses to women who experience violence, including access to interpreters and legal advice. In particular, the implementation plan should include the following steps:

1. Develop and adopt a regional health policy statement on violence against women that includes a statement regarding diversity and inclusiveness based on an understanding of gender, of the power dynamics of violence, and of the barriers women face, and the impact of violence on womenís health.

2. Develop goals of practice (in terms of locally researched outcomes for women) and best practices based protocols and guidelines, and assign authority and responsibility for the implementation of violence against women "best practices" to health care providers in the region.

3. Establish baseline statistics in the region for such outcomes as the number of women turned away from emergency housing per year, the number of police calls that result in charges being laid and the utilization rates of services such as woman assault and sexual assault centres. In this effort, be sure to include fields related to the abuse of older women.

4. Using these baselines, set realistic goals for reducing violence in the region and assign responsibility for dealing with violence against women at all service levels, including a requirement that all managers support staff to implement goals and evaluate outcomes.

5. Provide support for ongoing training, including staff release time, to sustain protocols and ensure that all health care providers achieve agreed-upon knowledge and skills to intervene effectively in cases of violence against women, particularly in cases where women are further marginalized. Two priorities are 1) training for anti-violence and mental health workers on abuse of older persons and 2) learning more about each otherís services in order to work more effectively together.

6. Support development of a core curriculum for undergraduate and post-graduate education for all professionals who might come in contact with abused women.

7. Ensure that workplaces have policies and procedures in place that:

  • create a safe and supportive work environment, including responsiveness to employees who are abused;

  • encourage the hiring of women from diverse cultures in order to provide culturally appropriate services, and

  • ensure employee assistance programs are responsive to women who experience violence.

 

3. Recommendations Concerning Coordination of Services

Third, the Working Group recommends that the V/RHB allocate resources to improving the efficiency and effectiveness of current violence against women services by enhancing three levels of co-ordination:

l Bring together and coordinate direct and contracted V/RHB service providers to exchange information and develop protocols; e.g., increase co-operation between the Seniorsí Health Advisory Committee and the Womenís Health Advisory Committee

l Co-ordination with external community servicesm (e.g., assign staff to participate in community meetings and co-ordination processes such as the Community Response Networks and Violence Against Women in Relationships Co-ordinating Committees)

l Co-ordination at the intra-ministerial and inter-governmental level (e.g., advocate for the re-establishment of the intra-ministerial committee on violence against women; eg advocate for co-ordination between the Office of the Public Guardian and Trustee and V/RHB services for abused older adults).

The V/RHB co-ordination plan should include:

  • an annual, one day forum or venue where the V/RHB, the community, nurses, physicians and other health/mental health service providers set priorities and plan initiatives on womenís health/violence against women

  • representation on community co-ordination committees by nurses, physicians, community or public health service providers, hospitals, mental and emotional health service providers from both private and public sectors.

  • co-ordination between health/mental health services and violence against women service providers, particularly women who work with diverse groups of women in the region (e.g., women with disabilities, First Nations women, women from all ethnic communities, women with mental health challenges, women with HIV/AIDS, older women, young women/girls, drug and alcohol addicted women, LBT women).

 

4. Recommendations Concerning Board Advocacy

Finally, the Working Group recommends that the V/RHB take a leadership role to advocate for improved response to women who experience violence, including:

  • That V/RHB work with the Medical Services Plan to ensure that doctors can bill MSP, using appropriate billing codes, for the health care services that they provide to women who experience violence

  • That V/RHB advocate for an increase in the number of psychiatrists with training and expertise in responding to the mental health needs of women who experience violence and for an increase in the number of female general practitioners with similar expertise

  • That V/RHB work with the Legal Services Society to increase access to legal services for abused women, with particular attention to be paid to young women, older women, women with disabilities, recent immigrants, women who speak English as a second language, First Nations women and lesbians

  • That V/RHB support Vancouver City Police to create a mandate for the Domestic Violence Unity to work with abused older women irrespective of whether the abuse is perpetrated by a partner (i.e., expand the mandate of the Unit to include abuse of older women by relatives or caregivers).

  • That V/RHB support the proclamation of the Care Facilities Admissions section of the Health Care and Care Facilities Act, Part 2 of the Adult Guardianship Act, and Section 54(c ) of the Adult Guardianship Act in order to assist older abused women and their advocates (i.e. proclaim the provisions requiring facilities to provide care plans and requiring that patients are served with court documents and given legal assistance.)

  • That V/RHB advocate for more support, advocacy and counselling services for abused women involved in custody and access proceedings.

  • That V/RHB support the requirement that psychologists and other counsellors who prepare court ordered child custody assessment reports have training in the dynamics of family violence, and support increased availability of child custody assessment reports and of supervised access services in the region.

  • That V/RHB advocate for increased funding for employment programs for women who have experienced violence, including bridging programs, to make them available at all times (i.e., to eliminate wait lists).

  • That V/RHB support the implementation of guidelines for child protection workers responding to violence against women cases and advocate for more training of MCFD staff, particularly in relation to First Nations women, women from diverse cultures, recent immigrants, and young parents who experience violence

  • That V/RHB advocate that training programs for interpreters include information about violence against women related health and legal issues.

 

Conclusion

The above recommendations are currently being considered by the V/RHB Womenís Health Planning Project Implementation Task Force.

Check for updates on this project in 2002 at the Health Boardís website, located at

http://www.vcn.bc.ca/vrhb/