NASW Social Work Talks - EP 109: Partnering with White Ribbon VA to end sexual harassment, sexual assault and domestic violence

Episode Date: November 28, 2023

White Ribbon VA is a national call to action to eliminate sexual harassment, sexual assault, and domestic violence across the Department of Veterans Affairs by promoting a positive change in culture so that the actions outlined in the pledge become the organizational norm. NASW and other mental health organizations have partnered with White Ribbon. In this episode we talk about the importance of White Ribbon VA with  Dr. Bridget Truman, associate director of the Prevention and Management of Disruptive Behavior at the Veterans Central Office, Office of Mental Health and Suicide Prevention in Asheville, NC;  Doctor Angela Lamson is a professor at East Carolina University and a representative of the American Association for Marriage and Family Therapy; and Doctor Carole Warshaw, MD, director of the National Center on Domestic Violence, Trauma and Mental Health and a representative of the American Psychiatric Association.

Welcome to Social Work Talks. I'm Greg Wright. Today we are here talking about domestic violence and White Ribbon VA, an initiative to eliminate sexual harassment, sexual assault, and domestic violence across the Department of Veterans Affairs. Domestic violence continues to be a serious problem in the United States. According to the National Coalition Against Domestic Violence, one in 20 people in our nation are physically abused by an intimate partner every minute. That adds up to 10 million men and women each year. We have some of the leading experts on domestic violence here today. They also represent organizations that are partnering with White Ribbon VA. Let me introduce. The first is Dr. Bridget Truman. Dr. Truman is

Associate Director of the Prevention and Management of Disruptive Behavior at the Veterans Central Office, Office of Mental Health and Suicide Prevention in Asheville, North Carolina. Our second guest is Dr. Angela Lampson. She is a professor at East Carolina University and a representative of the American Association for Marriage and Family Therapy. Dr. Carol Warshaw, MD, is director of the National Center on Domestic Violence, Trauma, and Mental Health. We may also have another guest, social worker Dr. Tricia Bentley with us later on. She actually has a client now who is having a crisis and may join us in a few. She is a National Association of Social Workers expert and also an author on this subject.

Welcome to Social Work Talks, all. Thank you. Thank you. Yes. So our first question is, this is a very complicated and emotional topic. And I wanted to ask you, how were you drawn into this? How did you end up addressing the issue of domestic violence? I'll ask Ms. Lampson first, and then after that, Ms. Truman. it. Sure. Thank you, Greg. So as a part of my role at East Carolina University, I have been a part of a medical family therapy doctoral program. And medical family therapy, we see

health as a part of illness, loss, trauma, death, and in the context of families and how those families interface with their healthcare systems, their school systems, their justice systems, military systems. And so for me, I am drawn to begin thinking about how relationships matter and being able to think about facets of domestic violence as we also consider how to intervene, both through trauma-informed treatments and also focusing on resilience in relationships. Thank you. Bridget, or should I say Dr. Truman? Oh, feel free to call me Bridget. Happy for you to do that. Yeah, so I became interested in this as just a lifelong career in looking at working with

individuals who have experienced different forms of trauma. I started my career in crisis intervention and have continued with that with the VA. Currently, I serve as the associate director, as you mentioned, for an employee education program that's within VA that really helps to target any types of workplace violence. And so certainly domestic violence can spill over into our workplace settings. And so I've just continued my interest in making sure that we equip our employees with the tools to be able to navigate these challenging situations. Thank you. Dr. Warshaw, our question is, what actually drew you into a career that addresses the issue of domestic violence? Oh, that's a long question. Thank you.

So I started working on domestic violence in 1980 when I was an ER physician at Cook County Hospital, and we did a journal club when there were only a few articles on, I was already thinking about issues of violence against women and women's health, on people coming to emergency rooms who experienced domestic violence and nobody was addressing them, particularly Evan Stark and Ann Flick-Krantz, really important article on patriarchal violence and looking at how people would come to the ER and nobody would figure out what's going on and they'd come back with all the complicated problems related to domestic violence ongoing where no one's intervening and then, you know, all of the tragic consequences that are potentially

there if nobody pays attention. So it was really about the healthcare system not responding that was part of the problem. So we did a study that was published in 1989 looking at ER records where nobody was looking at what was really going on. it was like hit by fist or jackhammer nobody was attached to the fist nobody was so a lot of my work has been what is it about the medical system that mitigates against people actually recognizing what's happening and being able to be present and traffic and take in and respond appropriately so i was doing this work in the healthcare field for many years and then and went back and did a

residency in psychiatry and was doing um really looking at all of the complex layers of what goes for people's experiences and the system's responses or lack of system responses. So in 1993, we started one of the first hospital-based domestic violence advocacy projects at the Chesapeake Hospital and in 1999, we started doing work on the instance of mental health and domestic violence. And again, we're working with all the DV programs

in the Chicago area and the publicly funded mental health system and people just didn't understand. They were beginning to understand trauma but not about ongoing risk and coercive control. So a lot of our work, and then we became a national, federally funded national center in 2005. And so our work is to really support the DV field

in responding to mental health and substance use and trauma related needs of survivors and their families, and to help their organizations be accessible and to try to improve the responses of the mental health and substance use systems. And as well as other systems where mental health are used against survivors, like child welfare, family court, and the criminal legal system. So it's like, I'll talk a little bit more about this complex intersection, but part

of our work is looking at what happens at the individual level, but what happens at the societal level, and what happens at the political level that creates structures that really help perpetuate abuse and violence. Thank you. Sorry. Oh, no, no, no. Not at all. Now, one thing that I've learned, I work with social workers, is that this is an issue.

It cuts across, like, class, race, like, faith. It's, like, everywhere, even though it's, like, hidden a lot. Dr. Warshaw, I wanted you to, like, give us an overview about how widespread this issue is and also, like, why isn't it that open? Like, why is it so, like, hidden in our society? Well, first of all, you know, I don't know how many of you are familiar with the CDC's Innocence Study, National Intimate and Sexual, Intimate Partner and Sexual Violence Study that they do. And the most recent data is from 2016, 2017, and their latest publication was from October

of 22. So they, you know, the statistics keep getting updated. But more than half of women, 54.3%, nearly one-third of men, 31% in the U.S., reported some form of sexual victimization involving physical contact or sexual violence at some point in their lifetime. And almost one in two women and more than two in five men report experiencing contact, sexual violence, physical violence, and or stalking by an intimate partner at some point in their life. That's a lot of people. And about two in five women and one in four men in the U.S. received some form of intimate partner violence that had a major impact on them. For example,

injury or defense or safety or need for housing or legal services or helping law enforcement. And one of the things that's important to understand, and they're also very high rates among LGBTQ individuals, high rates of partner violence against gendered people, particularly blackness that's been the women disproportionate impact on many communities that are that have been marginalized and part of that is due to structural violence and the you know the lack of resources and ways that society responds to probably being very you'll have to take that off i just say it's also important to address the impact of intersectional discrimination and bias on the basis of gender, race, and other factors, including sex orientation,

ethnicity, immigration, religion, disability, age, ethnicity, and economic status. So partly part of what people who abuse their partners do is leverage anything that they can that creates vulnerability or risk for someone. So they know that someone that they can view as a legitimate target, or they know that certain forms of abuse are going to make it much harder for them because of discrimination in societies. Thank you. Thank you. Dr. Truman, so all of your organizations are partners with a white ribbon VA.

And I was wondering if you could explain exactly what that is. I work for the National Association of Social Workers. I mean, we've been a partner for a few years. How long has your organization? Well, you're part of the VA, so explain it, and I want, like, others to, like, answer why are you, like, now a partner with them? Thank you, Dr. Truman. Yeah, Greg, thanks so much. That's a great question.

So the White Ribbon VA campaign was launched initially in 2020 by the VA in an effort to help veterans and employees feel welcome and physically and emotionally safe at all VAs. It really was linked to our mission to provide excellent health care for our veterans and resources for their families. So as you mentioned, we partnered with the White Ribbon USA and the National Association of Social Workers to really have this shared goal of taking an active stand and ending sexual harassment, sexual assault, and domestic violence. What we really want to emphasize is that the White Ribbon VA campaign really is the department's national call to action to eliminate sexual harassment, sexual assault, and domestic violence across VA and really attempting to promote a positive change in culture so that the actions outlined in the pledge become the organizational norm. What's really exciting is to date we have more than 300,000 VA employees, veterans, congressional members, and our partners in inter-agencies and communities have all taken the White Ribbon VA Pledge. At this point, we have 100% of our VA medical facilities who have a White Ribbon VA champion.

So this is someone at the facility who's going to lead the way in getting the word out about the campaign and the pledge. And we've interwoven it into a lot of our VA programming system-wide, including the swearing-in that we have with the senior executives, with the secretary of the VA, so they take this pledge as part of their swearing-in ceremony. We've also included it in our prevention and management of disruptive behavior training program, as well as new employee orientation. And we're really excited to share that on December 1st, there'll be a White Ribbon Day

in Congress. And this is an opportunity for us to recognize survivors of domestic violence. We have a whole host of speakers, one of which will be Veronica Mudra, who's the founder of the White Ribbon USA program. Excellent. Dr. Lamson, why is your organization involved? What actually prompted that? Well, we're so excited with AAMFT to be a part of the White Ribbon program. And I feel like our missions are very much aligned. And so that to me is such a call, not only to the organization, but to our providers to engage and to be reminded of the importance of this mission as we provide training and education to our next generation of learners, to be proactive as clinicians. And that means a lot of things because our clinicians in marriage and family

therapy are situated across the lifespan, thank goodness, because of different forms of insurance and also being able to provide for uninsured, we're able to be able to see people in medical contexts, in spiritual contexts, in private practices and agencies. And so I think a lot of what is important for us at AMFT is that we are not going to stay silent. We are going to be committed to addressing issues of sexual harassment and sexual assault and domestic violence. And so I'm grateful for our code of ethics as well. It's challenging. It's challenging work. Even though we are marriage and family therapists, a lot of who we see are individuals and we see those individuals systemically. We see them within their relationships and we also see

their biological, psychological, social, and spiritual health. And so it's important for us at AAMFT to honor our relationship and our contributions with White Ribbon. We will be a part of the December 1 event, and so we're excited about that. We are also going to be featuring some articles on the aamft.org website that may be helpful for others to be able to see as well in relation to family, couple and family therapy and domestic violence. Dr. Warshaw, your organization has been around a long time, but what actually drew you into a partnership with a white ribbon VA at this point? You know, the APA has, you know, there have been people in the APA who have been very

committed to addressing issues of intimate partner violence in the context of mental health treatment and substance use disorder treatment. One of the things that the APA did, there was an online guide for psychiatrists on intimate partner violence that a number of us were involved in. That's there. We recently developed telepsychiatry guidance

so that people who are providing telehealth or tele-mental health or telepsychiatry can recognize the potential safety risks for someone whose abusive partner was trying to monitor their calls or put spyware on their technology or who is trying to interfere with their treatment or access their medical records through an .

So we've been doing work on that. We've done lots of trainings at annual meetings. And the Committee on Women's Mental Health that I'm a member of is becoming a council, which gives it more influence within the APA. The APA used to have committees on family violence and childhood trauma. And I think this will be another way

to raise that to another level within the APA. The APA also supports federal policies that really impact the lives of people who experience intimate partner violence and gender-based violence in general, including the National Act on Gender-Based Violence. Thank you. So all three of you, like doctors, come from professions that are kind of related because you're all about mental well-being. So I wanted to ask, how does each of the professions address this issue? Is it different or is it similar, how you approach and treat a client? Anybody who wants to answer, answer that, please.

How about I'll take a go and then my friends can join in. Honestly, I think that all of our mental health professions are needed. And the ways in which clients, patients, customers, residents, however you want to consider the individuals that come to us, if they find us, we are grateful. And I think when we are in these roles, if we feel as though the needs that they bring to our attention are not in our wheelhouse, we are going to be collaborators to work with one another to ensure that that individual's needs or that couple's needs or that family's needs are met. So for me, I do think that we need to spend a lot of time in our joining process with those that come to see us. We recognize that when there's domestic violence, that's a part of someone's life. It is difficult to know how to trust a provider. It is difficult to know how to open up and address what's happening in their life.

And so I think the joining process is incredibly invaluable. and hoping then that we can discern how to best assess what's happening because domestic violence can influence our life physically. It can influence our life psychologically. It can influence our life socially. It can influence our life spiritually. And the questions that we ask can go in a variety of directions. That also means as providers, we have to be very aware of what we're hearing, we may need to listen for cues differently. And I know Dr. Warshaw mentioned a lot of different intersectionalities. When I'm working with Hispanic women, I may be listening for different kinds of experiences, for example. So I think having then doing our

engaging in our joining, engaging in our assessment helps us with our interventions to make sure they're indicated. And that can be really complex for a marriage and family therapist, but I have some incredible colleagues who are working very hard to provide us with indicated and evidence-based treatments that can help individuals as well as couples and families. And I don't want to dismiss the importance of focusing on children who witness domestic violence. And so adverse childhood experiences is essential to the work that I do. And too frequently, we're asking questions in healthcare context, but we're not necessarily clinically following up with what happens with those questions. And so I just think that we need to be mindful of those aspects. But

turning to my colleagues in social work and counseling, in psychology, psychiatry, those are incredibly important partners, as are the pediatricians and primary care providers and oftentimes spiritual leaders as well. Thank you. Yeah, thank you. Dr. Warshaw, did you want to like weigh in on how your profession addresses this that like might be um a related way or like different from how the others do well you know it's hard to generalize because in psychiatry people do so many different things some people provide their more psychopharmacologists and other people do therapy and some do a combination some work in private practice some and other you know larger settings so there's a there's quite a range um so there's all of the things that are

kind of standard for doing, you know, culturally responsive trauma-informed work and how, you know, one of the things, you know, there's all this stuff around screening and assessment and really how do you create a safe space for someone to talk about what's happening in their lives in ways that they feel safe and comfortable doing that. And as you said, Angela, building trust when trust has really been betrayed, whether it's childhood trauma or from an intimate partner violence or a system that can be challenging and recognizing that is really critical. part of what we focus on is both the what are the unique risks that someone

who's experiencing intimate partner violence experience and you know I was going to talk about earlier you know they're very high rates of mental health effects of high rates of people experiencing intimate partner violence and mental health and substance use disorder treatment settings and it researchers consistently documenting the mental health and substance use related effects of IPV and of course abuse and violence across the lifespan so but one Some of the things that's less well recognized is forms of abuse that are specifically targeted towards a partner's mental health or substance use that we've coined mental health and substance

use coercion. And we did two national surveys in 2012, and we've just repeated one that we're analyzing the data. But there are a very high percentage of people who said that their partners deliberately did things to undermine their sanity, gaslight them, interfere with their treatment, control their meds, try to prevent them from accessing services. In substance use, there were 27% said they were forced to use by an abusive partner, and of the 15% who sought treatment, 60% said their partners tried to prevent them from

access treatment or diverting meds. And then they would turn around and use it against them to undermine their credibility with potential sources of protection and support. So if for mental health and substance use disorder treatment providers not to recognize what's going on, for example, someone's buprenorphine level is too low, someone thinks they're not complying when their partner is diverting their meds or they're using something else, they're going to get drug tested and lose their kids because their partner's forcing them to use. So lots of things that people need to be aware of. So we have a whole layer of how to intervene

that people usually don't think about. And even things like open notes where the default is that your information is going to be available online when your abusive partner may try to access that and all the things you have to put in place to block that if that's going to be dangerous for people even to talk about that or if you have a psychiatric advanced directive who's the attorney in fact who's making decisions for you there's lots of layers of things that need to get integrated in addition to the trauma treatment um or adding that layer into any kind of treatment that really looks is someone that's still at risk and how do you heal when you're still under siege so there's a lot of layers but i'll stop oh yeah yeah definitely dr truman so you um are working in

a military-like setting. I was wondering, is it a culture that differs? For instance, Dr. Lanson said she has a client who is a woman who is Hispanic. So there are things to listen for. Working with a military-like client, are there things that are specific there that you might want to tell us about? Sure, Greg. I think that's a great question. So when we think about our veterans, in this particular population, there can be higher prevalence of PTSD and traumatic brain injury, which can then in turn increase the potential for the prevalence of domestic violence to occur. And certainly, when we think about higher rates of violence in a veteran population, more so than a civilian, there has more potential for that cause of significant injury. I think it's important to recognize how veterans may feel, especially when they come from a military culture where they may have not gotten a lot of support seeking mental health services or addressing substance abuse issues, which, as Dr. Warshaw mentioned, could be a risk factor for domestic violence. So that fear and that concern can travel with them when they're out of the military and now they're in the veteran population.

Sometimes that can make them even more anxious. to talk about these issues, to talk about these concerns, and to seek treatment. So I think we really have to pay attention to, as Dr. Lampson mentioned, some of those more subtle cues that this type of experience is happening for them so that we can really do what we can to support them in getting the services that they need and the support that they need. We've got a really great, in 2014, we had established the Intermittent Partner Violence Prevention Assistance Coordinator. And so this is a person that is at VHA facilities that really is able to provide services for veterans, for family members, and even for employees who've experienced intimate partner violence to get them to the therapy and resources and treatment that will help them along that

healing journey. Excellent. Excellent. So a few more questions. One is, oh, absolutely. Absolutely. One of the things that's really important is being able to build partnerships with domestic violence programs and to be able to have those not just like a send someone off but a really

warm referral people being able to make calls while they're in your office and also being able to do cross consultation until you know for providers who aren't champions to get more someplace where they're more comfortable and have those relationships so there's lots of ways to do that but it's really a critical piece yes so um is there like more of that like happening now where where there's more um cross like partnerships with like all of the local resources i mean is it more like open now than it's like been um whoever wants to like answer that i would love to know i know i know there are a lot of places that have um on-site domestic violence programs or gender-based violence you know human trafficking trafficking sexual assault dv programs some that

have partnerships with local programs some that have their own experts on site who can then make referral if somebody needs shelter or needs other kinds of things that aren't available so or who need legal assistance so there's lots of ways to figure out what what the best mix is but depending on the resources in your community and in your setting i was just going to add to that but i do think that there is a beautiful growth in integrative care and that is the concept of having different kinds of providers to work together sometimes simultaneously on behalf of patients and or clients. And so I think being able to have physical health and mental health or substance use treatments happening simultaneously with one another helps in so many ways. I think

too, it provides a teamwork with the client or patient and not on the client or patient, if you will. It really helps them to have a voice and agency in what they feel is going to be needed for themselves and for their families. And I think that in and of itself can help to build trust. It's like being able to say, Dr. Warshaw and I, we work together oftentimes, right? So being able to build that teamwork with the client or the patient helps to provide that safer environment for future care. Thank you. Thank you. Another question is, if I'm a person who is experiencing thing like this, I was wondering if each of you could, like, offer

some resources for help. And we also have our resources that we'll, like, post up under this episode. So even if you, like, say it, like, fast, we'll be able to record it and, like, share it with our audiences. So

whoever wants to go first, it's up to you. I could do the hotline. You know, there's a national domestic violence hotline that's 1-800-799-SAFE. And they also have a TTY and a text. So then there's a national teen dating abuse hotline. That's 866-331-9474. And the text is 22522. And then there's the Strong Hearts Native Helpline. That's 844-762-8483. There's also a national sexual

Assault Hotline and the DOD Self-Help Line for Sexual Assault and Human Trafficking Hotline. Thank you. Thank you. Any others? Doctors, doctor and doctor. I've never been on an episode with three like doctors at the same time. We would have had like four. So I'm impressed. That's a major accomplishment. Dr. Lanson, any other other resources that you can think of? I will say one that I do share. Obviously, I think it's important for us to be thinking about our more local resources as well. And so being able to think about for our children, knowing that the school oftentimes is that resource where you may be able to have a protected conversation. Our primary care offices are really an entrance point as well, oftentimes for mental health and

substance use as well. For me, I always want to make sure that people know the 988 number. And while that is most commonly aligned with suicide, it is important we screen every single individual for suicide because we know how desperate situations can become with regard to domestic violence as well. And if they are not able to seek help in one way, we're going to hope that they seek it in another. Thank you. And Dr. Truman, you are at the VA. you have already mentioned that you have like help at a VA center. Could you kind of run like through that once more, please? Sure. Happy, happy to do so. And just want to tag into what Dr. Lannison was saying that be sure with our veterans, really do you want to make sure that they have that 988 number and then veterans will press one to reach the veterans crisis line. So

that's another tool that they can have. As I mentioned before, we have had since 2014 the intimate partner violence assistance program coordinator. We also in recent times have added harassment prevention coordinator at VHA sites that will manage any kind of reports and get folks access to care. I think the main thing that we really try to do at the VA is remind our veterans of all these points of access

to get to appropriate medical and mental health resources. So they can talk to the VA police, they can talk with our patient experience officers, they can even talk with their primary care physician they will get them connected to the proper resources. We've also had, for many years now, the Military Sexual Trauma Coordinator. So this is someone who's especially designed to make sure that veterans get access to care and get access to therapy when they've had those types of experiences in the military. Thank you. Thank you. I also want to chime in that the National

Association of Social Workers has a website called healthstartshere.org, and it has a lot of resources there, including many of the lines already mentioned by Dr. Warshaw and Dr. Lampson. So it's been a wonderful conversation. The folks in our audience don't know, this is probably our biggest panel on a podcast ever. Usually we only have a single guest or two guests. Today I have like three and I could have had like four. These are all accomplished and busy, busy people. So I thank you for having a little time for us. I know that it was a big deal to get us all together in one place at one time. So a final question is, how can all these different professions and organizations work with each other better? If you could offer that, then I'll let you go and so that you can get ready for the holiday coming up. Yeah, Greg, I think that's a great question.

And I think, you know, just to reiterate with the White Ribbon VA initiative, our partnership with the National Association of Social Workers and the White Ribbon USA program really demonstrates a great example of a shared goal to eradicating sexual violence of any kind and domestic violence. And we really recognize and see that resources and supportive services are available to anyone who's experienced sexual violence. We're really excited, as Dr. Lamson had mentioned, that the American Association of Marriage and Family Therapy is joining us on December 1st. We're really excited that the American Psychiatric Association has joined our efforts as well. We really do believe that we can stand together and help to eradicate these types of violence from occurring.

Thank you. Dr. Lamson or Dr. Warshaw, whoever wants to go. I'm so grateful for Dr. Truman's comments. And I would say that one of the things that would be helpful for all of us is to continue to collaborate clinically, to continue to collaborate on policy. And that's something that I've really been keeping an eye on recently as we think about prevention, as we think about protective factors and the influence on children to end domestic violence, to end intimate partner violence. And so to me, being able to think about our work clinically, being able to think about

our work through policy, through research, et cetera, together, I know that we can do better together. Thank you. And Dr. Warshaw. I think I have to echo what both of you have said, but I think it's really making sure there's more formal opportunities for pooling resources and thinking about where we're doing things that are similar, where our work amplifies each other, particularly on the policy front. And the other is on how do you, even when you have things that are in kind of federal

policy, implementation on the ground requires a lot of resources and a lot of support, and we know from what it means to do trauma-informed work that staff really need support, and trying to really think about what does it take to have that happen on the ground is going to be really important. So I welcome the opportunity of all of our organizations working together more. Thank you. Thank you. more. If I could add one more. Absolutely. Absolutely. Together, we have been, we have

unified through COVID. We have unified through many social injustices. And I think we've got a lot of providers who have also experienced or are currently experiencing domestic violence. And so together, I think too, to be able to care for one another, to look out for one another, as we care for those who are experiencing domestic violence. Thank you. Thank you. Well, I want to thank Dr. Lamson, Dr. Warshaw, and Dr. Truman for being our guests today on Social Work Talks. Thank you very much, ma'am. You have been listening to NASW Social Work Talks, a production of the National Association of Social Workers. We encourage you to visit NASW's website for more information about our efforts to enhance the professional growth and development

of our members, to create and maintain professional standards, and to advance sound social policies. You can learn more at www.socialworkers.org. And don't forget to subscribe to NASW Social Work Talks wherever you get your podcasts. Thanks again for joining us. We look forward to seeing you next episode.