Violence

1) Pre-class reading

  • Raja, S.  Trauma Informed Care In Medicine: Current Knowledge and Future Research Directions.  Family and Community Health 38(3):216-26. July 2015
    • Context: Exposure to trauma is nearly universal, and yet differential incidence and impact of trauma are a large source of health disparities.  Trauma informed care uses an understanding of the prevalence and impact of trauma to provide care that is responsive, safe and empowering for providers and survivors.  Through universal and trauma specific practices, this approach serves to reduce health disparities.
    • Goal: Describe the components of a trauma informed clinical practice.
    • Reflect: Which of these practices have you seen implemented in your primary care practicum?  Have you participated in patient encounters that, in retrospect, may have benefitted from this approach?  How do you think implementation of trauma informed practices benefits providers?

2) Pre-class Module

  • Aquifer Trauma-Informed Care Course, Module 1: Understand the Nature and Prevalence of Trauma: Understand how simple and complex trauma may present in a diverse patient population, Cases 1-4  https://owhtic-re.meduapp.com
    • Instructions: Students will create an account using their UW email address.  After completing each case, click on “case summary download.”  This will provide you with a pdf of the instructional content.  Keep these completed pdfs for your own use and reference.
    • Context: These four clinical cases demonstrate a range of ways in which trauma may affect health and the clinical encounter.  Through the cases the concepts of trauma, the epidemiology of IPV and child abuse, and screening are reviewed.  Trauma informed care is introduced including universal trauma precautions and trauma specific interventions.  
    • Goal: Appreciate the prevalence and impact of trauma on patients’ health and interaction with the healthcare system.  Acquire skills for applying trauma informed care principles to the clinical encounter.
    • Reflect: Which patients from PCP do these cases remind you of?  What is one patient you might approach differently after working through these cases?
    • Further reading: interested students may complete other modules from this Aquifer course.

Optional Reading

  • Amnesty International Maze of Injustice: Sexual Violence Against Indigenous Women in the USA.(chapters 1,2,4)
    • 4 in 5 American Indian and Alaska Native women have experienced violence.  1 in 2 have experienced sexual violence.  Alaska Native women have 10 x risk of IPV compared to the general US population.  On some reservations indigenous women are murdered at more than 10x national average, many by non-indigenous men.  This report explores the complex etiologies and impact of this violence.
    • Goal: Explore the ways historical, political and sociocultural issues intersect with social determinants to affect the incidence and impact of violence.
    • Reflect: Why does violence disproportionally affect marginalized individuals and communities.  How does this knowledge improve our ability to serve patients responsively?
  • Violence Is a Public Health Problem, American Public Health Association Policy Statement Nov 2018
    • This 2018 policy statement looks at the rationale for viewing violence as a public health problem.  Risk factors for and differential impacts of violence are reviewed.  Successful public-health based intervention programs are discussed, and recommendations for physician practice, collaboration and advocacy are made.
    • This statement by the American Public Health Association reviews the epidemiology of violence, the differential impact on traditionally marginalized communities, the similarities to other types of epidemics and chronic health problems, the evidence available for physicians’ role in primary and secondary prevention and a call for further action in approaching violence through a public health lens.
    • Goal: Describe the scope of interpersonal violence and its impact on health.     Recognize structural factors that contribute to disparities in frequency and impact of violence in different populations.  Describe the potential role of physicians in responding to and preventing violence.  Understand the role of interprofessional and community partnerships in preventing and responding to violence.
    • Reflect:  What factors contribute to the resistance of the political and medical community to viewing violence through a public health lens?  What is one idea from this reading that you hope to take with you into your clinical work as a medical student?
  • Seattle: King County Violence Prevention Resources
    • Hosted by King County Public Health, this website has excellent general information on prevention of and resources for domestic violence, gun violence, trafficking and suicide.  Most resources are general or national, although some are King County specific.

Optional Videos

  • Futures without Violence video resource library: universal screening, education and referral
    • https://www.futureswithoutviolence.org/health-training-vignettes/
  • Violence Against American Indian and Alaska Native Women and Men, National Indigenous Women’s Resource Center.
    • http://www.niwrc.org/resource-topic/videos
    • This video describes the findings of a National Institute of Justice (NIJ) supported study on the prevalence of violence against American Indian and Alaska Native women and men, and briefly examines the impact of violence int that community.
    • Interested students can read about the some of the complex factors involved in the optional reading below, “Maze of Injustice, an Amnesty International report.”
    • Goal: Explore the ways historical, political and sociocultural issues intersect with social determinants to affect the incidence and impact of violence.
    • Reflect: Why does violence disproportionally affect marginalized individuals and communities.  How does this knowledge improve our ability to serve patients responsively

Additional Resources

  1. PEARR tool: Dignity Health Tool universal education and screening approach https://www.dignityhealth.org/hello-humankindness/human-trafficking/victim-centered-and-trauma-informed/using-the-pearr-tool
  2. Excellent Education and Safety Planning worksheets in multiple languages. (some of the worksheets include California specific resources, but all include general resources as well.   https://www.leapsf.org/html/safety_plan.shtml
  3. Futures without Violence training videos on implementing universal education using wallet cards –  https://www.futureswithoutviolence.org/health-training-vignettes/
  4. Futures without violence wallet card pdfs (link to wordpress IPV site resource)“Is Your Relationship Affecting Your Health” safety card
  5. Link to MyPlanApp website https://www.myplanapp.org/home
  6. State-by-State reporting requirements for violence towards adults Information on rules/requirements for mandatory reporting by state
  7. Hotlines: If it is safe for you to do so, consider programming these hotlines into your own phone.