Welcome

PAHO JAM & PAHO WDC

 1. Demonstrate general knowledge
of violence against women as a
public health issue
2. Demonstrate clinical skills
appropriate to one’s profession and
Objective specialty including the ability to
s identify, and respond to violence
against women

3. Communicate empathetically with

the patient/survivor
4. Practice self-care

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4
Violence against Women
in the Caribbean

Type of Violence Prevalence

Intimate Partner Violence 27.09%

Non-partner Sexual 10.32%

Violence

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Definitions
Intimate partner violence
• Ongoing or past violence and abuse by an intimate partner or ex-partner, defined as a
husband, boyfriend or lover, either current or past
• Types of violence can include: physical violence, emotional/psychological abuse, controlling
behaviors, and sexual violence
Sexual assault
• Forced sex or rape; can be perpetrated by a stranger or by a known individual including
• partner (also known as marital rape)
• other family member, friend or acquaintance

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Forms of violence
Physical violence
• Includes causing injury or harm
to the body by, for example,
hitting, kicking or beating,
pushing, hurting with a weapon
Emotional/psychological abuse
Can include many types of behaviors
such as:
• criticizing her repeatedly
• calling her names or telling her she
is ugly or stupid
• threatening to hurt her or her
children
• threatening to destroy things she
cares about
• belittling or humiliating her in public
Controlling Behaviors
Includes, for example:
• not allowing a woman to go out of the
home, or to see family or friends
• insisting on knowing where she is at all
times
• often being suspicious that she is
unfaithful
• not allowing her to seek health care
without permission
• leaving her without money to run the
home
Sexual violence
Includes:
• forcing her to have sex or perform sexual
acts when she doesn’t want to
• harming her during sex
• forcing her to have sex without
protection from pregnancy or infection
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A note on sexual violence
• Sexual violence can occur within and outside relationships
• Women may be particularly reluctant to share sexual violence perpetrated by
partners due to…
• Added shame
• Normative beliefs that, in relationships, partners are entitled to sex
with or without consent

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Health Impact of IPV

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 Pathways and health effects of IPV

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García-Moreno, C., Pallitto, C., Devries, K., Stöckl, H., Watts, C., & Abrahams, N. Global and regional estimates of violence against women: prevalence and health effects
of intimate partner violence and non-partner sexual violence. WHO, 2013.
What conditions can be caused or
complicated by VAW?

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Violence against women: Strengthening
the health system response

https://www.youtube.com/watch?v=Qc_GHITvTmI
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 • Women identify health care providers
as professionals they trust with personal
topics including abuse

Why the • VAW is linked with poor health

outcomes
VAW • Health settings can be a confidential
setting to provide VAW support
response? • Addressing VAW in the health sector
shows patients that VAW and healthy
relationships matter for their health and
mental well-being .

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 Responding to survivors of
violence can be simple, and is
important for health
Role of
health Provider role:
care Provide competent, compassionate
and confidential assessment, care,
providers treatment and referral to all
survivors
in VAW
response Providers are not responsible for:
“solving” violence for the survivor or
determining the legal aspects of the
violence
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 • Support, not diagnosis, is your most
Why is the important role
• She may have various emotional needs that
VAW require attention

response
• She may be frightened and need
reassurance

different • She may or may not need physical health

care

from most • Her safety may be an ongoing concern

• She may need referrals or other resources
other for needs that the health system cannot
meet

care? • She may need help to feel more in control

and able to make her own decisions

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 Immediate emotional/psychological
health needs
The 4
needs Immediate physical health needs
When providing first-
line support to
violence survivors, 4
kinds of needs Ongoing safety needs
deserve attention:

Ongoing support and mental health

needs

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WHO Clinical and Policy
Guidelines on VAW assessment
• VAW assessment is recommended when assessing
conditions that are caused or complicated by VAW

• “Universal screening” or “routine inquiry” (i.e. asking

women in all health-care encounters) is not
recommended

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 Minimum requirements for VAW
assessment and response
What • Protocol/standard operating
procedure
needs to • Training on how to ask, minimum
response
be in • Private setting

place? • Confidentiality ensured

• System for minimum response in
place, including and referrals

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What conditions can be caused or
complicated by VAW?

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What do women say about violence
discussion in the health care setting?
Research shows that abused and non-abused women
alike feel that violence-related discussion in health
settings…
• can help abused women get help
• makes women glad that someone took an interest
• is not insulting to women who are not being
abused

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WHO Clinical Handbook
• Implementation guide
• Awareness about violence against
women
• First-line support for intimate
partner violence and sexual violence
• Additional care for physical health
after sexual violence
• Additional care for mental health
• Job aids

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In Her Shoes
In Her Shoes
• This activity allows us to spend time walking “in the shoes” of a
woman who has experienced violence
• Objectives
• Increase awareness of and empathy for the difficulties
women who experience violence face when seeking support.
• Highlight how gender norms can affect women’s ability to
seek help and access care.
• Encourage participants to think about what they can do as
health care providers to provide an empathetic response to
survivors of violence.
• We will make the kind of decisions that she is faced with and
discuss those decisions

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In Her Shoes
Break into groups of 3-5 participants

Each group will be assigned one woman’s story

• read the story card
• follow the instructions at the bottom of the card
• visit the appropriate station and choose the next card for
your character
• repeat until the story is finished

• Decisions and challenges will be discussed in the full group after the activity
is complete.

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 Discussion
• How did it feel to walk through the story
of the woman? Were you able to put
yourself in her shoes?
• How did you feel about the woman’s
options for help?
• How did you feel about the choices that
were available?
• What made it difficult for the woman to
escape or leave violent situations?
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 Discussion (cont.)
• How did the actions of family, friends, neighbors,
institutions, and others depicted in these stories actually
put the woman at risk for further violence? What happens
when we do not believe women who seek support when
they are experiencing violence?
• How could family, friends, neighbors, institutions and others
depicted in the story have better supported survivors?
• Did anything in this exercise make you think differently
about violence against women? If so, what was it and how
did it change your thinking?

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Why don’t women leave abusive
relationships?
Leaving can be Believe abuse is
more complicated Fear  Shame 
normal 
than it seems

Love/hope for Cultural/religious

Low self-esteem  Children 
change  reasons 

Lack of
Disability  Isolation
money/resources 

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Barriers to VAW care seeking
• The violence was normal or not serious
• She was afraid of consequences/threats/more violence
• She was embarrassed or afraid of being blamed or not believed
• She was afraid of bringing shame on her family
• She may fear economic hardship or manipulation
• She was afraid it would result in separating children and father

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Why/when do women seek
VAW care?
Most commonly mentioned reasons for seeking help:
• She could not endure more
• She was badly injured
• Partner had threatened or hit her children
• She had been encouraged by friends or family

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Distinguishing Myths &
Facts
Myth or Fact?

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Vote with Your Feet
Vote with Your Feet
After each statement is read out loud, position
yourself at either the Agree or Disagree station,
or somewhere in between.

Be prepared to discuss your position.

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 Discussion
• How did it feel to confront values
that you do not share
• What did you learn from this
experience?
• Did you change your opinion about
any of the issues?

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Vicarious Trauma
& Self-Care

Amber Clough, MSW

 Listening to stories of pain and trauma can
impact us both physically and emotionally.

What is When we open our hearts to hear

someone’s story of devastation, our
Vicarious beliefs are challenged, and we are
changed
Trauma?
Over time, we can experience trauma
symptoms similar to the original trauma
survivor, this is known as Vicarious
Trauma.
 “Hearing stories day after day about the

horrible things that humans inflict on others

fills me with rage—not only toward the abuser

but also against our systems for repeatedly

failing to support women.”

 “I have found that while working with survivors, I am
constantly having to take the time to remind myself that
not everyone is abusive. I do this by enjoying time with
friends, watching kids play in the park, and take
vacations. Without this balance, I think it would be very
easy to develop a general attitude that the world was
full of abusers and that I had to hide away in order to
protect myself.”
 Common
Symptoms
of VT
 Know the early warning
signs in your life that let

What can
you know that you are
moving into the stress
zone
I do to
address
VT? Develop self care
strategies that you
incorporate into your life
Pay attention to your body

rapid heartbeat ?
Is it giving you stomach pains ?
warning signs? tightness in the chest?
feeling tired all the time?
headaches and other pain?
Pay attention to your mind

difficulty concentrating?
difficulty remembering?
Is it giving you finding that you are more
warning signs? “disorganized” than usual?
feeling overwhelmed, fearful, or
worried?
Pay attention to your personal life and emotions

arguing more with

Are they friends or co-workers or
giving you family members?
warning
signs? constantly feeling angry,
sad, fearful or hopeless?
Pay attention to your work

impatience when patients tell their story?

not listening to patients?
Are you
excessive worry for people’s safety?
noticing
feeling sad with yourself for not being
warning more helpful?
signs? frustrated with coworkers?
not wanting to go to work?
Let’s do an exercise to
help recognize when
stress is increasing in
your own life
 Avoid avoidance

Avoid adding other trauma into your life (tv,

news)

Maintain a regular schedule

Managing
Vicarious Keep up support network inside and outside
work

Trauma Find meaning in your work, remind yourself of

it

Use relaxation, meditation, prayer etc.

Practice regular self-care

Examples of Common Self Care Strategies

Physical
exercise, eating Spiritual
healthy foods, Meditating,
dancing praying, faith
community being
Social/Recreational in nature
spending time with
friends, doing Verbal
activities you enjoy express feelings or
stress by talking
In the Workplace about it or writing
take breaks, have a in a journal  
balanced case load
Mindfulness Exercise

Focused Breathing
Technique

Links:
Animation
Guided breathing audio
 Supervision and support
within your organization

Regular meetings for

debriefing
Organizational
Support
Clear job duties

Training
Mindfulness Exercise

Body Scan Relaxation

Technique

Links:
Animation
Guided breathing audio
Approaches to
Effective Training

Amber Clough
 Know how to plan and
prepare to conduct this
training when you
return to your setting

Objective Understand
effective facilitation
s skills

Demonstrate your
skills - Conduct Your
Own Training Session
on Friday!
 For frontline
healthcare
providers

This
Uses participant-
training centered learning
is….

Is a competency-
based training
Preparing Training Prep Checklist
for
Training Planning for Training in
your own setting
 Choose facilitators with:
• Experience in providing health care
to survivors of violence
• Familiarity with local laws/policies
governing health response to VAW
Facilitato • Experience training/leading
r Roles interactive discussions

Two facilitators

Alternate Lead and Support

roles
 Things you have liked What have you disliked?
about previous trainings
you have participated in?
 Prepare

Plan for the size of your group

Tips for Communicate clear instructions and

guidelines
Effective
Trainings Stay on time

Follow the facilitators guide

Keep the clinical handbook handy

 Create a good
learning
environment

Trainer
Facilitatio Read your audience
n Skills

Manage the
audience
More
Training Tips
Repeat important concepts
Don’t assume because you said it they got it.
Don’t assume because you said it 5 minutes ago,
they remember it!

Be enthusiastic!
If you are not passionate, don’t expect
energy from your learners
 Responding to
? Questions
 1. Break into groups of 4
2. 1 person is the facilitator, 3 are
the participants
3. The facilitator chooses a section
Lets practice! of the clinic handbook to present.
4. The 3 participants each ask a
question that the facilitator
responds to using the techniques
learned:
• Refer to audience
• Refer to written materials
• Will be answered in a future session
• I don’t know
• Referring to core principles
5. Switch roles so everyone has a
chance to be the facilitator
 Thank presenters for their courage
presenting in front of the group

Providing Emphasize positive feedback

Feedback
Invite other participants to provide

During
feedback

Role Areas that need adjustment are

Plays “opportunities for improvement”

Directly correct anything that may be

harmful to patients such as victim-
blaming
 1. Break into groups of 4
2. 1 person is the facilitator, 3
people are the learners
Lets practice! 3. Facilitators: give your learners
instructions on a short role play
you want them to perform
4. Learners: Perform role play (no
more than 5 minutes).
5. Facilitators: Give the learners
feedback on the role play using
the skills
6. Switch roles so everyone has has
the opportunity to be the
facilitator
Applying What
We Have Learned
Amber Clough
 Break into groups of 5
Assignment Prepare a 35-minute training
for Friday session
Mini Training
Skills Practice • Welcome remarks and
communicate learning objectives
of the mini-training (2 min)
• Choose 1 topic to present ( 8
minutes, 2-5 slides)
• Choose 1 activity from the
curriculum (role play, discussion,
etc.(25 min)
• Wrap up (1 min)
* You will have a projector on Friday
if needed