Thanks, Mary Kay, and thanks for being here with us and helping us today. And also, I'd like to thank everyone that's attending the webinars today. Today's webinar is Diving into the Reality of Safety Planning for Survivors. This webinar is being brought to you through IFN's Safety Technical Assistance Project, and we're grateful to be able to have Lacey, Tanya, and Mildred with us for today's webinar. So a few things to start out housekeeping-wise. Of course, I have to acknowledge our federal funders. This presentation is being supported through a federal grant. In addition, I also want to make sure that you all understand that if you have multiple people watching with you today, that that is fine, but we do ask that you send a list of any attendees that may not have actually registered to us at safetya.forensicnursing.org so that we'll be able to share the evaluation link with them, and we can also keep an accurate count of how many people are actually attending our educational sessions. As a benefit of membership for IAFN, IAFN members are eligible to receive 1.5 contact hours for continuing education activity. IAFN is accredited as a provider of continuing nursing professional development by the American Nurses Credentialing Center's Commission on Accreditation. For IAFN members to obtain a CE for this activity, they're asked to attend the webinar in full and complete the post-webinar activity evaluation to obtain your certificate. For non-IAFN members, with the completion of the post-activity webinar evaluation, you will receive a certificate of attendance. Today's webinar is being recorded. Once the recording is available, up on safetya.org website, and we will send out an announcement to all participants that have registered for today's webinar. If you have any questions or concerns, feel free to reach out to us, but you will receive a notification once it's available. I'll turn it over to Tanya to introduce herself as one of our presenters for today. Tanya Moultrie-Paste Thank you. Hello, everybody. It is great to meet you and to be in this space with you today to talk about safety planning. My name is Tanya Moultrie-Paste. I have had the pleasure of working in the domestic violence field for 20 years now. I started out in Ohio at the Ohio Domestic Violence Network and then worked for a period of time at the National Network to End Domestic Violence, and I currently own my own consulting business where I work with domestic violence programs, coalitions, as well as other non-profits on diversity, equity, and inclusion, as well as organizational development. So, great to be here. I look forward to a wonderful discussion. I'll turn it back to you. Thank you so much, and again, thank you for being here. I'm excited to have you here today. And I will turn it over to Lacey to introduce Mildred. Lacey Wright I'm going to introduce one of our presenters, Mildred D. Muhammad. Mildred Muhammad is a recognized global keynote speaker, best-selling author, and certified domestic violence advocate. She is known for her harrowing personal story as the ex-wife of John Allen Muhammad, the convicted Washington, D.C., sniper. After surviving her own ordeal of abuse and violence, she has dedicated her life to raising awareness about domestic violence. Mildred travels extensively, sharing her experiences and insights to educate and support victims. She also works with various organizations to provide resources and advocate for policies to protect those affected by domestic abuse. Through her books and public speaking engagements, she continues to be a powerful voice for change and empowerment in the fight against domestic violence. So thank you, Mildred, for being here with us today. Mildred D. Muhammad Thank you. It's my honor to be here. Lacey Wright And I'm Lacey Smith. I'm a forensic nursing specialist here at IAFN. Angelita Oluwu And I'm Angelita Oluwu. I'm one of the forensic nursing directors here with IAFN. Ironically, although my first time working with Tanya here is here in this space, I too am from Ohio, born and raised in Ohio. I've been working in this field since, hmm, 14 years now. I've been in nursing for 16 years. But this is my first time being able to actually work with Tanya. So great to have you here. So let's move forward on into the presentation. We can start out with just kind of filling you guys in on what we hope that you learned today. We want to make sure that you guys have some additional knowledge on trauma-informed patient-centered approaches to safety planning with individuals experiencing IPV. We want you all to be able to identify barriers to effective safety planning and to develop strategies for overcoming these barriers. So before we dive in, we wanted to just take a few minutes to talk about the different disciplines that are represented here. We have lots of different disciplines, but specifically victim service providers like advocates. And we have clinicians here that may be forensic nurses or nurses in other fields, physicians, advanced practice providers. And we kind of thought it was really important for you all to understand the language that we use when we talk about the individuals that we are serving in the victim service provider realm with advocacy and different roles there. You will hear these individuals that we're going to talk about be referred to as survivors. And then with the clinician realm, you'll hear us refer to these individuals as patients. And while it is so important to talk with the individual that you're taking care of to find out how they identify, whether they want to be called a survivor or a victim or however they want to be referred to is, of course, how we want to refer to them. But you will typically hear us refer to them in a specific way. You'll hear it used interchangeably throughout this presentation. So know that when we're talking about survivors or patients, we are referring to individuals who have experienced intimate partner violence or violence of other forms. We have some poll questions that we would like to ask of you all. First, here we go. Do you have a community response team or multidisciplinary team that addresses the response to intimate partner violence within your community? Still got a couple of people answering, but looks like a lot of yeses. And a couple of no's. Okay. So it looks like we have about 73% yes and 27% no. Did not give the option to choose unsure. Sorry about that. Okay. And our next question, for those who responded yes, the last question, is there representation from healthcare on the response team? Thank you very much. Looks like we've still got a couple of people answering here. Okay, so we have a couple of yeses, mostly yeses, some no's, and some I'm sure. I'm going to turn it over to Mildred and Mildred is going to talk with us for just a few minutes. Thank you for having me on this webinar regarding safety planning for survivors of domestic abuse. As we know, domestic violence, IPV, domestic abuse, is consistently growing worldwide. And the pandemic, it became an epidemic within a pandemic. And although we try our best to get the resources out there, there are still many people that are falling in the tracks. So John and I were married for 12 years, we have three children. He was an 84th combat engineer, he was an expert shot, he was like a MacGyver, he can make a weapon out of anything. When he was in the military, we decided to get out of a long story, I'm trying to make it really short. And when he got out of the military, we were at Fort Lewis, we started our own company, express car truck mechanic, where we would repair cars right on the spot or come to you for that. In that company, we had a lot of female customers who had children and he felt he needed to be the surrogate father for these children. And so I asked him for a divorce because he was doing more than just fixing the cars, so to speak. And he said, why do you want a divorce? I said, well, you know, you're acting free, you may as well be free. You know, you're going here and there, you're not where you say you are. And this would eliminate you having to lie to me. And shortly thereafter, he moved out. Well, when he moved out, he still had a key to the house. So he would come in in the middle of the night. I would hear the key going in the door. I would hear him walking down the hallway. He would come in, walk from one end of the bed to the other, lean over to listen to me, breathe, stand up and leave. He did that three times. Our baby girl woke up and she said, Daddy. He picked her up and gave it to me like he's supposed to be there. I decided to get the locks changed. When you're in an abusive relationship, it's important to inform your children of a little bit of what's happening, but please use age appropriate language so that they will understand what is happening in the home. He came over and he asked our son, so what's going on? He said, Daddy, Mommy's going to get the locks changed. So he said, you're going to get the locks changed? I said, yeah, something wrong with the door. He said, well, come on, let me go to the door because my key doesn't work either. So he tried to put his key in the lock, but it wouldn't go in. Then he said, give me your key. Let me show you. He took my key and tried to put it in, but it wouldn't go in as well. He said, I'm going to take it off. And when I come back, I have another lock. Well, when he took off the lock, he turned it and a straight pin fell out. So he sabotaged the lock. He said, I'll be right back, but he didn't come right back. So I took a chair, propped it up under the door in order to secure me, my children, and my mom while the locksmith came a couple of days later to secure the lock. So once you get one thing fixed, you notice something else was wrong. I picked up the dial tone and the phone and the dial tone wasn't on. And so as soon as I hung up the phone, it rang and it was a friend of ours. And she said, I'm just calling to check on you to see how you and the children are. I said, well, what number did you call? She said, John changed your number. I said, well, can you give me my number? She said, no, I'm not giving you a number because I'm just calling to see how you are and to report back to him. Click. So I called the phone company, got my number changed. As soon as it hung up, I hung up the phone. It rang again. And it was John. He said, who told you to change this number? I said, I don't need your permission to change my number. I can change it at will. He said, don't, don't change it again. So I called the phone company. They gave me a new number. As soon as I hung it up, he called back, didn't I tell you how to change this number? I said, I don't need your permission to change this number. I got the phone. This time I asked for a supervisor. And I asked him. supervisor isn't it against the law for you to change the number on a resident when their name is not on the bill and he said yes it is so let's go ahead and change your number we apologize for the inconvenience so they put a code on my phone and so as he was doing that john was calling back he said he's calling right back right now so we need to hurry up and do this come to find out that he befriended a woman at the phone company that every time i changed my number then he she would call him and give him my new number so we got all of that straight so then we had to i i decided he became angry because i had a restraining order i was going to get one he came over to the house and he said look we need to talk i said okay we go into the garage my brother is in the kitchen so i'm i feel like i'm safe i can talk to him while he's there so he said you know you're not going to raise my children by yourself you have become my enemy and that's my enemy i will kill you say well you know i've been sleeping with the enemy all this time what else you're going to do he charged at me i ran to my brother john left i told my brother and i was crying i said john's going to kill me he's going to kill me he said girl john i can't kill you just playing i never went to my brother again because when a victim is in that type of distress the last thing they want to hear is that you have taken the side of the abuser because that's exactly what he did in that split second when he said john's not going to kill you he automatically took his side so i didn't go back to him i called the police the police asked me what's his name on the lease i said yes it is they said well i'm sorry there's nothing we can do but do you have a restraining order he gave me the paperwork to go to court to file the restraining order there was 10 questions and i cried the whole time because how did i get here married for 12 years have a business three children and our mom is living my mom is living with us and i'm filling out paperwork for restraining order i filled out the paperwork i went back to court the judge said after reading my petition you really need to get away from this guy i said your honor i am really trying to get through that he gave me a lifetime restraining order of which i don't know if they give those out anymore so we had to have someone to go back and forth with our children because in the restraining order it was still visitation for the children and him so the first weekend went fine we had someone to pick him up from me and then they take them back to him the second weekend was my mom's birthday she wanted to go to country buffet i said you got to have them back by five o'clock on sunday he picked him up on friday sunday came no children the guy the person who brought took them from me came back with a note that said happy birthday grandma that was from my baby girl so i say where are my children he said you need to call john so i'm blowing up his pager because back then we didn't have cell phones like we do now we have pagers so blowing up his pager at 4 30 he calls and he says uh i said my son was on the phone i said where are you he said mom we're at walmart getting close i said actually dad what time you coming home say dad said we'll be home at 7 30 7 30 comes no children i'm blowing up his pager he calls anybody 11 o'clock he says we're in from seattle we'll be there shortly well seattle to tacoma is 45 minutes one way and he was only five minutes away at walmart a Sunday. So Monday, I went over to the school, I called the school and asked them, are my children there? And she said, Ms. Muhammad, I'm sorry, your children are not here. I called every day that week. Friday, I went over there. They weren't there. She said, go home and call the police. I was coming around the corner. My mom was standing in the doorway. And she let out a scream. I had not heard my mother scream before because she saw I didn't have my children. I ran to her before she could hit the ground. And she said, he took our babies. I said, I know, Mom. She said, what are we going to do? I said, I don't know, but we're going to do something. So I called the police. I told them what happened. They said, sorry, do you have a parenting plan? I said, no, sir. We were getting ready to go to court. It's not that we can do. He has just as much a right to the children as you do. I said, but does he have a right to keep them from me? That's the window of opportunity when you get, when victims are trying to get a restraining order. There is no plan in that from scheduling a court date to actually having it done. And that is the time when children are taken. So I didn't know where they were. Nobody would help me. I tried to go to our friends, whom I thought were friends. And the first thing they said, yeah, John told us that you was going to come talking about him. So, you know, snap out of it. Get back to work. At least your children are with their father, you know, cut everybody off. So I'm trying to sign for a package for mother's day for my mom in the interim. I wasn't eating anymore because I didn't know if my children were eating. So I was eating a half a slice of bread and crushed ice, just enough to sustain me. I was signing for a package from my mom and I passed out. They took me to the hospital. My body shut down on because my cycle would not go off. So they ended up giving me three units. They ended up giving me a blood transfusion because I was losing three units of blood. At the hospital, two people knew I was at the hospital, my mom and my neighbor across the street and my phone rang and it was John. He said, how are you doing? I said, good. I said, why won't you let the children call me? He said, we don't always get what we want, do we? I had two choices. He said to me already, you have become my enemy. And as my enemy, I will kill you. So my choices were, I could go back to him and die, or I could hang up the phone and never see my children again. And I hung up the phone. I let out a scream. The nurses came running in the room. I said, can you trace the call? They traced the call to a woman who called the hospital for John to find out if I was there or not. Shortly thereafter, my mother called the hospital and said, John just called her and said he was on his way to kill her daughter. So they took me out of one room, placed me in another, took my name off of the register. Anyone that wanted to see me had to send up their ID so that I could identify if it was John or not. A social worker came in and told me that I couldn't go home. I said, what do you mean I can't go home? I have to take care of my mom. She said, no, we'll take care of your mom, but I need you to do three things. One, we need you to change your name. Change it to a name that when someone calls you, you will respond. So my safe name is Millie. Number two, we're going to bring you different clothes because you can't walk around and he recognizes who you are. And three, the most difficult of all, you have to disconnect from everybody that you know. We have to put you in hiding and nobody can know where you are. So they waited until it got dark. We went to, I was at Tacoma General Hospital. We went out of the back door. There was a car waiting. They told me to slouch down in the front seat. And as they were driving, they drove all over the city when the shelter was actually right across the street. But I was looking for every open window and every rooftop because John's motto was one shot, one kill to the head, never leave an enemy behind. When I got to the shelter, the staff person walked in and said, hey, Millie, you're in luck. You got your own room. Like I want to be in the shelter. So I got to the shelter, woke up the next morning, it's 18 different women in the room. So I was sitting there watching this commercial and the commercial said, Professional Career Development Institute. I need to learn the law. So at that time, online courses were $5. So I signed up for paralegal courses. I'm making straight A's in the shelter. The executive director found out that I was a business owner. She asked me to be the executive secretary. I also became staff at the shelter at night. So getting all of my paperwork straight, the YWCA contacts me and asks me, can I come and help them in their organization in the legal department. So they have to pick me up at three o'clock in the morning in a disguise. I go there, I'm in the legal department. I'm helping other victims of domestic violence to get restraining orders in court. And the judge that gave me my lifetime restraining order was very happy that I was doing the work to help other people. So I'm going back and forth to court. I'm like, I'm coming in this court, I need to get my own paperwork straight. So I got my divorce October 6, 2000. Washington State had just passed a law stating that if you are a victim of domestic violence, and you leave the state, you will not be charged with kidnapping and you do not have to let your abuser know where you're going. I had all of my paperwork notarized. So I was set to go. My sister called me from Maryland and said, mama's sick, can you come and help? But have you found your children? I say, no, I haven't, but I can wait over there. So I came over here to Maryland. I filed my restraining order on the full faith and credit in Washington, D.C. and in Maryland. I contacted the FBI because my children were no longer in the country and that is a federal offense. So the agent came over, he said, Ms. Muhammad, how do you know your children are no longer in the country? I said, well, my cousin is a private investigator. He said, when your children, when people you're looking for are no longer in the country, the trail runs cold, that's how you know they're no longer here. He said, okay, Ms. Muhammad, what paperwork you have? I said, I gave him my divorce decree, writ of habeas corpus, meant that anywhere they found my children, they need to bring them back to me. I gave him pictures of John and our children. He took all of my paperwork. Two weeks later, I got it back with a letter that said, I'm sorry, there's nothing we can do to help you. This is an ongoing case. We're going to refer you back to Seattle. He gave me the agent's number to call. I called that agent. I said, I am looking for my children. I am Ms. Muhammad. He is looking for me. It's going to be a headshot. He's going to, he's going to kill me and I need to find my children. He said, well, Ms. Muhammad, since we know he's looking for you, what we want to do is put you in the middle of a parking lot and use you as a decoy. This way we can lure him out. I said, excuse me, it's going to be a headshot. You're not going to know which way the bullet is coming from. I said, well, you know, we're just trying to help you out. So I hung up the phone. The executive director of the shelter I was in called me and said, Millie, I think we found your children. You need to fax all your paperwork to detective McCarthy in Bellingham, Washington, follow up with the phone call. And I did that. He said, well, Ms. Muhammad, you know, we're right on the border of Canada. And if he gets across that border, there'll be nothing we can do. I said, I appreciate that information, but if you could please just go get my children, I would appreciate that too. August the 31st at 4.35 PM, he called and said, Ms. Muhammad, we got your children. I had to fly back to Tacoma for an emergency custody hearing. We got to the court. John, the YWCA gave me an attorney and an advocate. We went to court. The judge said, we're here today to decide who gets custody of the children. John said, your honor, she already knew what those children were. I don't even know why we're here. He said, again, we're here to decide who gets custody of the children. And since she did her paperwork pro se, which meant I did it myself, and it is in perfect order, she will get custody of her children. He said, your honor, you're telling me I'll never see my children again? He said, you have to go through the same process that she went through, case dismissed. So we waited until John left the courtroom. My attorney, my advocate, and I went in the hallway. My attorney was calling the CPS to find out where my children were. As she's calling them, she's standing in front of me. I feel a presence behind me. I turn around, and it's John. I take off down the hallway. Shoes go everywhere. My attorney and my advocate looked at me. They looked at John, and they ran, too. We all ran around the corner, peeked back at him. He put his hand on the courtroom door, looked at me, and said, gotcha. My attorney said, oh, hell no. We got to get out of here. So we go downstairs to the police substation and tell them what happened and ask, could we please go out of their back door? They say, no, you have to go out the same door everybody else go out of. And they were stressing how dangerous the situation was. Nope, same door. So we had to walk in a triangle watching each other's back. We went over to the Department of Health and Human Resources where my children were. And when they came down, I was crying so much I couldn't see them. And my attorney said, look, the man trying to kill you, we need to leave. So we got in the car. We went to the YWCA. While we were there, we had to wait until it got dark. There was a car waiting for us outside the facility. So we had to go in the basement of the Y, around the swimming pool, through the clothing closet, open the red door. That was the car. Got in the car, drove 45 minutes one way. Security picked us up at the car, took us to their office, waited for the pilot to radio them to bring us to the plane. We got to the plane. We landed at BWI, September 5th, 2001. Fast forward to the shootings. They told us to look for two Caucasians in a white box truck. So we were looking for that. And I was looking for John. Everyone was looking for two people. I was looking for three. October 11th, my co-worker was picking me up for work. And she said, you know, there's a dark colored car outside your cul-de-sac. I mean, it's getting kind of leery about that car. I said, girl, don't worry about it. We'll just go to work. So we passed by the car. The driver looked at us, but the passenger had a newspaper and he held it up to hide himself. I said, did you see that? She said, yeah. I said, give me your phone. I called the police. I told them it was a dark colored car outside of my cul-de-sac. She said, well, can you describe the car? I said, it's a dark colored Capri Sun palette, New Jersey plates, two African-American males seated in the car. They said, okay, we will get somebody over there. So October 23rd, the FBI and ATF knock on my door, asked me to come down to the police station. And I do. At first I said, I'm not going because John is there. And I've been trying to tell y'all that this man is trying to kill me. They said, Ms. Muhammad, he's not there. We just want to ask you some questions. So I get down to the police station. The agent that I called earlier, he was there. I said, well, why are you here? He said, well, I'm just here to investigate some homicides. I get into the interrogation room. Two officers are in front of me. The one that took me there was next to me. And they said, so when was the last time you saw John Allen Muhammad? I said, an emergency custody hearing, September 2001 in Tacoma, Washington. They said, well, have you heard about any shootings anywhere? I said, no, sir, I haven't. So we want you to look at this letter. It was the note that was posted to the tree. Do you know, or do you recognize this handwriting? I said, no, sir, I don't. So, okay, well, why don't you listen to this CD? It was the voice, the voice on the CD had an accent. So do you recognize this voice? I say, no, sir, I don't. They say, look, Miss Muhammad, we're just going to have to tell you. We're going to name your ex-husband as a sniper. I said, what? My head hit the table. They said, well, do you think he would do something like that? I raised my head. I looked up in the corner and I said, yeah. They said, well, why would you think that? I said, because he said, and I don't, we were watching a movie and he said, I could take a small city, terrorize it, and they would think it would be a group of people and it would only be me. I asked him, why would he do something like that? And he changed the subject. They said, well, Miss Muhammad, didn't you know you were the target? I said, well, no, why would I think that? Say, well, there was a man shot right down the street from you six times. It took $6,000 and a laptop. There was another man shot a couple of miles from you, Miss Muhammad, at a convenience store in the abdomen. You were the target. Would you like to go into protective custody? I said, you have to ask me that. They said, yes, ma'am, because some people don't want to go. I said, okay, do you know where he is? No, ma'am. Have you caught him yet? No, ma'am. And you still have to ask me. Yes, ma'am. Okay. Yes, I want to go into protective custody. So we left there, went home and got my family. And as soon as we left, the media was coming in. They took us to a hotel. I still don't know where the hotel is. And I turned on the TV and it was the first time I saw his face. I walked over to the TV, put my hand on and say, what happened to you? And my son was crying on one bed. My daughters were crying on the other. I pulled them together and they cracked themselves asleep. I got a pillow, went in the bathroom, turned on the water in the tub and in the sink, closed the door, sat on the floor and screamed in a pillow because I didn't know what to do. And I didn't know who to call. The next day is when they caught him. My sister came in the room and said, ABC was on the phone. I said, well, how do you get your numbers? She said, I don't even know. So they said, Ms. Muhammad, we're so sorry for the danger that your children have been in. And we want to put you up at the Mayflower for six months, as long as you give us exclusivity to your story. I said, ma'am, I don't even know what exclusivity means. I just know that I need to humbly decline your offer because I need to take care of my children. And so after that, we tried to get counseling. Unfortunately, I must have run into every unethical counselor here because the one that was referred to me, he wanted my son to contact Malvo to ask him what did he think of the case because his intentions were to help us to write a book because he knew we needed money. I said, you know, you're lucky I'm not a cursing woman. So I went to the library. I got a book on counseling and I learned how to counsel me and my children myself. I told them that what we're going to do is we're going to respect each other's emotions. My baby girl was taking it the hardest, but the older two were kind of back and forth. I said, and we're not going to debate with anybody about what has happened. So the trial came, they wanted to talk to him before the execution. He was guilty, of course. They wanted to talk to him. I just remembered all of the work that I had done to get them to this point. If they just had a conversation with him, he would unravel everything that I had done to get them to this point. But I felt like if I didn't allow that, then they would hate me for the rest of their lives. So I tried to get them to talk to him, but he would not cooperate with the foreman. And even on the day of execution, my son was angry because they were announcing who was there with him. And he had his family there and his attorney said he wanted, he only wanted to be with family who knew him before the shootings. So once they announced that the execution had taken place, my children were in three different directions. My son went in the room by himself. My daughter, Selena, she just sat on the sofa. My baby girl, she just hit the floor crying. So I picked her up first and I said, she looked at me in my eyes and I knew what she was looking for. She was looking for some type of emotion that I would have because her dad had just been executed, but I had nothing because he said, you have become my enemy. And as my enemy, I will kill you. I severed every emotional tie to him so that I would be able to think about myself and trying to get away from him. Then wondering what he would think because I was trying to get away from him. So she saw I had nothing in mind. She stopped crying just like that. I went to my son. I say, honey, you okay? He said, mom, I'm good. I'm good. So I go to my daughter, Selena, on the sofa. She's whimpering. My son, I say, honey, are you okay? She said, mom, you know, dad tried to kill you, right? I said, yeah, I do know that. She said, well, but he's gone, Selena. She said, but mom, he didn't love me. How can he love me? And he wanted to kill you. I said, well, that is true. However, he's gone and I need you to let it go. You have to grieve your dad. So the next day, my daughter, Taliba, who is the youngest and still is the speaker for the group, came and said, mom, can we go to the funeral? I said, well, why do I need to go to the funeral? Well, we need closure. Okay. So I took them to the funeral. They went in. I did not have stayed in the parking lot. And when we left, they, I could see that this cloud had been lifted over them. So my son, John, he's 34. He's married. He's a salesman at Sunglass Hut, a platinum store. I have to be sure to say platinum store. My daughter, Selena and Taliba, they are vocal performers and they also work at NASA. And I've become dedicated in my life to helping other people who find themselves in abusive relationships and just trying to find the best way that they can leave, helping them with restraining order. I've helped over 200 plus women gain restraining orders because the way to get them is so much different now. And it's very complex. They've taken advocates out of the court or they can't help them to write the restraining orders anymore. And it's just really gotten more complex for victims than what it was 20 years ago. So thank you for listening to my story. If you have other questions, whether it's now or after the presentation on the webinar, I'm still here. Thank you. Madre, thank you so much for being willing to come on and tell your story and also present the rest of the webinar with us today. Just wanted to say that before we actually moved on with the webinar. Thank you. Welcome. Sorry, I have a really heavy hand apparently with these slides. So yes, thank you so much for sharing your story and really helping to really set the basis for why this webinar is so incredibly important to understand the needs that survivors have and the importance of safety planning. And so in being there, being that person that doesn't say like, oh, I just can't help or it doesn't fit into a particular thing, but really looking at how can we best help and support survivors at each and every step. And so thinking about what is safety planning, this really is a very personalized plan that we create that is based on the needs of that particular survivor. There is no such thing as a cookie cutter safety plan. It just doesn't exist, right? Because each survivor's needs change. And this is really based upon what dangers are being presented, what's going on with their partner, right? And they know that person better than we do. We are always looking to figure out how to help increase that safety of that survivor and their children based upon wherever they are at in their journey. And it's done at any point in the journey. So if someone is talking about, I think I need to leave, I'm not sure, let's start that conversation. Let's talk about what that survivor is already going to keep themselves safe so that we can build upon that in terms of a personalized plan. If someone is like, no, I'm done, I'm out, I'm leaving, then let's think about that. And again, each of these plans are going to be individualized and different. So the other thing is, this is an ongoing process, right? So just because I created a safety plan with someone six months ago, six days ago, doesn't mean that that plan can't be adjusted. So if you have anything at your organization that's kind of a form in terms of a safety plan, I would say, great, right? I know being a new advocate, it's nice to have something to sort of hold on to to sort of, you know, remind you, did I ask about this, did I ask about these things, but not using that as it has to fit into this. And these are the only questions I can ask are the only things that we can do. So when we think about then the aspects, right, of safety planning, there's things that we want to think about, right? So we want to create an escape plan. So again, let's say as a survivor, they're like, you know, for whatever reason, you know, they're choosing to not leave at that particular moment, because not everybody's going to leave the very first time. Everybody's going to leave the first time we have that conversation. Some folks are never going to leave, right? It's not there for us to judge. We want to make sure that folks do have an escape plan, right? So when the violence is happening, where can they and their children safely go? How can they safely get out of the home or out of this or out of wherever the violence happens to be taking place, right? So that means, you know, identifying safe people they can go to, safe places. I appreciate what Mildred said, right? You know, if you are somebody that, you know, that even begins to say something that sounds like you're siding with the abuser, right, you are no longer really a good resource for that survivor to be part of, to engage with, right? We want to make sure, you know, do they need to have an escape plan with their children, right? And that may be something that they end up having the need to practice. We want to make sure that the increase of security. So Mildred spoke about, right, needing and trying to change those locks, right? So something like that, right, how that can increase the danger, but, you know, being able to like, figure out how can I change the locks, figuring out how to move important documents out of the home, right? Ways like, are there copies that they can make? Where are they going to leave those documents? So these are aspects that we want to think about. Financial planning. This is something that I think most folks don't think of when we think about safety planning, like, you know, I'm trying to, you know, make sure this person and their children are safe, physically safe, emotionally safe, but financial abuse happens. And it really does impact a survivor's ability to either lead the situation or to stay out of the situation, right? And so this may not be a long conversation that we have initially with the survivor, or, you know, if I'm in the hospital, maybe we're not talking about it, but asking them, right, like, do you have access to the bank account? Like, do you, right, kind of just getting them to think about like, oh, like, I do need to be thinking about finances. I do need to be thinking about, you know, is, you know, if I'm working, is my job a place where I'm in danger? Is my partner trying to sabotage my work or get me fired? You know, do I, am I not allowed to pay the bills? Do I not know where any of our accounts are? You want to have folks at least starting to think about that. And finally, another key aspect of safety planning is really thinking about emotional safety. So again, we often get very locked into and very focused on the physical harm that is happening literally that is high, right? We want to make sure that people are physically safe, but we also want to recognize, again, in domestic violence, people are experiencing emotional abuse, right? And so we want to think about that emotional safety. So who is that reliable network? Who are those folks that they can reach out to? Maybe it is family, maybe it's friends, maybe it's not, right? Maybe this really, maybe their circle becomes very small and it really just becomes the advocates that they're working with who are able to help provide that emotional safety in the beginning, right? And it may just be one or two people in their lives, but we want to make sure that they have someone who is there, who is supportive, who is like, yes, right? You know, again, if we go back into things like what Mildred just shared with us, you know, her mom was an emotionally safe person, right? Who was there, who was supporting, who was seeing the violence, who was absolutely impacted by it, but was also able to be there to be a support. So want to help folks identify who are those in their life, thinking about that safety planning. So what are we considering? So we've already touched on some of these, but we want to consider the physical harm, right? So physical harm, any sort of physical aggression or violence. So we often think about hitting, slapping, you know, those physical attacks. This is often the most common and most visible form that happens in IPV. But I would also say things like, you know, pushing someone into a wall, right? I worked with a woman whose batter would like tap her, like in the head with his finger really hard, right? It doesn't necessarily always leave a bruise, right? But it is a form of intimidation. Throwing things. So someone is saying like, he throws stuff at me. He, you know, that is also a form of physical harm, right? Very clearly. So, you know, we can look at things like, you know, obviously as there are guns or weapons in the house that clearly increases risk, but we want to think about all the different ways that survivors are being abused, especially if we're talking to someone and they may not yet be ready to admit to the abuse, right? Or people, you know, so much is made around being hit, slapped or punched, right? I know the woman I worked with whose partner like would hit her in the head like that. She didn't really identify that as part of the abuse, right? That was him being mean to her, but he, it wasn't until he started hitting and punching her that then she was like, oh, like there's something really here, right? So really thinking about that piece. So the frequency and the severity of abuse often vary. So the other thing is that, you know, most people are not living, you know, horrific long-term physical violent abuse, right? That we see the abuse may be infrequent, right? Maybe it happens a couple of times a year and that's not to diminish it. What happens is that batterers figure out that I can threaten you. And if keeping you in mind is the threat or reminding you about the abuse that occurred, that's enough, right? To get you to stay in line and do what I'm asking you to do. I don't have to constantly beat and abuse you. So even if someone says it only happened this number of times, or this is, you know, it only occurs whenever, we still want to make sure that we're safety planning around that because violence, if someone starts talking about leaving, we know that that is often the most dangerous time and that it can increase. Another type of abuse that we want to consider is the emotional and the psychological abuse. So this is the verbal threats and manipulation. This is damaging, right? Maybe just sometimes more damaging than the physical because the physical, at some point we will heal physically, right? But emotionally, that name calling, that tearing down, that destroying of your self-confidence, making you question your own thoughts, right? Like being like, you know, this is gaslighting. This is all of those things. You know, people are experiencing long-term trauma from this that will continue to haunt them, that they have to deal with for the rest of their lives. Survivors can develop anxiety or depression or just have this constant sense of fear, this presence of somebody else. That is something that we want to make sure that we are both thinking about in the safety planning process in the short term and then also the long term. Two other main factors to consider is the sexual violence that occurs. This is oftentimes some of the hardest information for survivors to share. It is often sometimes the most humiliating things that has happened to survivors. People do not always still identify that rape can happen inside of a marriage. And so, you know, again, there's lots of things that can become a hindrance, but we want to make sure that we broach that with the survivor when we're talking to them around safety planning. So this is anything that is non-consensual, any sort of coercion, you know, when we think about this, it is, you know, under sexual violence, we can even talk about something like not allowing her to have access to birth control, right? So if they're sharing this and they're like, oh, like, I can't use birth control, right? That is absolutely part of sexual violence. Keeping your partner pregnant, right? That is part of sexual violence. It's a way of being able to control someone, right? Because she can't leave if she's always pregnant, right? And she's got all these kids to take care of, and that ties into the financial abuse as well, right? So sexual violence, when folks are talking about this, may not always show up in the ways that we think. You know, obviously, if they're constantly being exposed to sexually transmitted diseases, those kind of things, that is also part of the sexual violence. And finally, economic abuse. So this is about, again, that access to those financial resources. That's why I was saying, we have to ask about financial planning. You know, do they have access to the bank accounts, anything of that nature? This is so common, right? That people get controlled in this way, that they're not allowed to have access or control their own finances, because it makes it very difficult, right, for you to leave. The other way economic abuse shows up is destroying her credit or his credit, right? So whoever the survivor is, because we have both male and female survivors of domestic violence, so we can definitely talk about, right, like if they're deliberately tearing down this person's credit, that is also another way of controlling them economically. And so we want to think about this as we're moving through this process, right, that we are centering the survivor. This is this person's story. This is their safety plan. They are the person who is going to have to carry out the safety plan. So it shouldn't be something that we're like, well, you should do this, this, and that, because those may be things that either increase my risk or won't work for me, right? So we want to make sure we have individualized support plans. Once again, nothing that's cookie cutter. And we want to make sure that we're doing lots of active listening and that we are really validating this survivor's experience. We want to make sure that we are validating that the violence is not their fault. They are not doing anything to cause their partner to do this, right? So part of the survivor-centered advocacy, right, is that we're centering that voice of that person. We're listening to their experiences. We're also taking into consideration the whole survivor. They are more than just the violence that they're experiencing in this relationship with their partner. So we want to understand, you know, their cultural experiences, their family, their friends, their background, right? That's going to help us help to develop and to provide better resources to them in that way. But that comes to us really actively listening and validating them and really creating that space for survivors to be like they are able to talk to us. So I think we have a question that we're going to ask you. So and this is a chat question. So you can just drop your answers into the chat. So please share some strategies that you use to create a safe space for the survivor or patient. So just really quickly, just kind of, you know, think about sort of like what are some of those strategies that we, you know, maybe something that I've talked about, maybe something that I haven't touched on yet. So I'm going to be quiet for a moment and let you think. Okay, I sort of have a hard time being quiet, so there we go, I will keep, yes, absolutely. Thank you, Chris. So yeah, so helping to find a shelter, helping them with their protective orders, right? That paperwork is legal paperwork, right? It's not always really clear to folks what they're supposed to answer, how they're supposed to respond. If you are in a state where advocates are maybe not allowed to help with the paperwork, let's figure out like, who do we then, can we get to help survivors? Can we answer general questions? Those kind of things. Getting survivors re-engaged with their culture, absolutely, right? There is strength that people draw from their culture and getting reconnected, especially if they have been isolated from their community, from their family. Asking questions to find out similarities between us, yes, right? Like we want to be able to share, we want to be able to engage with people, we want to build that sense of trust. Assisting with exit strategies, right, oh yes, so having a go bag, do they have a go bag? Do they have a burner phone? You know, do they need a disguise, right? Again, thinking about all those different things that someone may need if they have to leave very quickly, or if it can be a plan for exit, you know, in terms of when that person is gone and how do we get out. Asking the patient how we can best help them, absolutely, right? That is definitely survivor center, right? So y'all have got great stuff in here, I'm going to keep us moving, but please continue to write in there, because I think this is a way that we create, you know, in our community of advocates, how we share with each other and things that we may or may not necessarily always think about. So yes, oh, these are really good in here, so thank you so much. So I'm going to keep us moving, but please make sure that you read through those. So when we think about also then centering the survivor, we also want to think about those community-based, right, or participatory approaches. So engagement empowerment, which sounds like what some of you are absolutely doing, right? So we want to involve survivors in the design, the implementation, and the evaluation of our community services, right, and the policies that are affecting them. So this is beyond just their safety planning, this is also saying our services are for them, and are they really working, and how are we getting their information back, how are we getting their feedback, how are we including them in the process? You know, and it's not just, you know, an evaluation that maybe they fill out or an anonymous survey, right? We want to think about do we have them on advisory boards, or do we have a survivor advisory board? Do we, you know, how can we best really engage folks? Clearly not early on, maybe like when they're in the, you know, in the midst of the violence or they've just gone out and they've got lots of things that they're figuring out, but, you know, again, looking at Mildred's story, you know, at some point, you know, becoming part of the staff, right, helping to work with other folks becomes part of that. And then finally, we want to look at resource accessibility. So we wanted to make sure that the resources and the services are readily available. Again, the safety planning is all about survivors. It's a survivor-centered. Our role as advocates is to make sure that we are there. We know the resources in the community. We know how to connect people to resources. That is the best things that we can do. So we want to make sure that they're culturally appropriate. So we had a couple of folks that talked about relinking people with their culture. We want to make sure that we have information in a variety of languages, which means knowing the community that we're serving, knowing who's there. So do we have, do our brochures display people of various cultures, those kind of things, multiple languages? You know, if we have services that are either specific to the LGBT community or to be inclusive with the LGBT community, are we making sure that we're talking about survivors and identifying that there could be male survivors, which also happened in heterosexual relationships as well, right? So are we making sure that the language in our brochures is also welcoming, engaging, right, so that people can see themselves and know that we're there for them? So we want to make sure that we have all those different things, making sure that our facilities really are accessible for folks that have disabilities, all of those different kind of things in terms of those pieces. So thank you. I see you're still continuing to share in the chat. I am definitely going to go back and read those. And finally, we want to talk about meeting survivors where they are. So you know, it's like, great, Tonya, we've talked about all this, like, survivor-centered stuff, how do we do that? So before we, as an advocate, this is really for us, right, as professionals, before we start working with someone, I have to be aware of my own personal biases. We all have them, right? We all have biases. And so we really want to be aware of what our biases are as much as possible. And if it comes to us from a coworker, even from a survivor, someone points out an issue, maybe this happened in a conversation, maybe we inadvertently have said something that's caused some harm to somebody, has hurt their feelings. We want to make sure that we're, instead of becoming defensive and being like, oh, well, that's not what I intended, really stopping, listening to that person and what is it they're saying, and then sort of check in with ourselves, right? It can't always be the other person that's the problem. Sometimes it's me, right? So sometimes I have to be like, huh. Every time I work with somebody from this community or every time I see someone like this, right, I have this particular struggle or I kind of, you know, whatever it is. And that's a personal bias, which we can all, we all have and we can all work on them, right? Have an understanding of how your culture influences how you see and interact with the world around you. You also have a culture, right? And that means that that culture, that lens that we use to look out into the world and how we sort of make sense of things, you know, it doesn't always line up with the people that we're working with, right? And so understanding how I'm hearing something that's coming from that person, maybe I'm misunderstanding or is impacting me differently because of my culture and my understanding. Be open and willing to learn about different cultures and make sure that we're knowledgeable about culturally specific resources, again, and how to reach out to national sources for technical assistance. We're not going to know all of this, right? That's why we have lots of TA providers out in the domestic violence landscape that can help us that to support the work that we're doing. So we don't have to be out there on our own as advocates working through that. So I thank you. I am going to sit here and read the chat and also listen to Lacey as she takes it over. Yeah, before Lacey hops in, before Lacey hops in, I just wanted to piggyback off some of the things that Tonya has said, just from the perspective of a clinician, because Tonya pointed out lots of things as an advocate. And I just wanted to I wanted to just reiterate that basically everything Tonya said also applies to us as clinicians. But it also really highlights the importance of engagement with the advocates within your communities and understanding their role and understanding what the resources are and knowing what you have. So one of the slides that we may not have gotten to yet may talk about knowing what you have access to. But we do acknowledge that in some places there's not as much resources or access to services. So understanding if you don't have services, what you should do. And basically what Tonya just said applies to all the clinicians that may not innately have access to a DV advocate. But what you may have access to is social workers within your hospital system or within your health care system and understanding when to loop them in, when the issue was safety planning, making sure that you're thinking about safety planning, not at the end of your time with your patient, but from the very minute that they walk into the door is super essential. I just wanted to make sure that we all kind of on the same page when we do this webinar and make sure you didn't feel like Tonya's only speaking to advocates on the call. It really applies to everyone. It's important that we look at that through the same lens when we're looking at our patients slash survivors. So just to kind of think about as we're taking care of these individuals that have experienced intimate partner violence, we really want to focus on trauma-informed care. And I think most of the time we feel like in our practice that we are trauma-informed and we're doing all the right things. And then, you know, maybe we realize that something we've said or the body language that we use might not be the best. So just a couple of things to think about. The Substance Abuse and Mental Health Services Administration has four concepts for the trauma-informed approach. And the first one is that we realize that trauma affects individuals, it affects families, communities and systems. And each person that would come into contact with in various settings may have experienced and likely has experienced trauma of some kind. And then to recognize the signs of trauma, we may have a person that comes in to see us that, you know, just at face value seems like they're not really wanting to interact with us or they're hypervigilant or they may be hysterical. They may be going through this whole array of emotions. And it's so important that we understand those signs of trauma that even if our patient or the survivor hasn't told us anything about their story, that we know the way that they present themselves to us may be a response to the trauma that they've experienced. And so important that we respond appropriately to trauma and that we integrate trauma-informed training into everything that we do, you know, not just at the domestic violence shelter or at the sexual assault center or, you know, in any of these community based type organizations where we're seeing patients or survivors, but in all of our in our health care systems, in our workplaces, all those things that we're really looking at how we respond to individuals that have experienced trauma and not just patients that might come in to see us, but our staff and other people that we're working with, because likely if we look at statistics, we know that most people have experienced trauma in some form and that we resist for traumatization. And that is for ourselves, for other staff members and for the patients or survivors that we're seeing. Our language is so important, our body language, the situations or spaces that we put patients or survivors into. I know that I've worked with patients before that when I brought them into their kind of consultation room to talk with them, I like to close the door because I don't want anyone to be able to hear what we're talking about. But I've had a patient say, no, please don't close the door. I like the door to stay open. So, you know, thinking about things that we can do or even just giving our patient options or the survivor options to kind of move through this care process in a trauma-informed way is so important. Yeah, and to add to that, another thing that I think we should consider kind of piggybacks again off of something that Tanya said, Tanya spent a lot of time talking about understanding your own culture and what you bring to work with you every day as a person. But I also think that it's really important for us to take a step back and also understand the culture of your work environment, because sometimes you may have the best intentions and you may be totally on the right trap, but the environment that you work in and the other staff that work around you may not actually be on the same page that you are. And that's something that as much as we often want to make sure is 100 percent where it should be, we don't always have the capacity or the ability to be able to change everything around us. So what you can do, though, is pretty much have a good understanding of what is in your environment, what the people are like that your patient or your client is going to encounter before they get to you. And think about that in terms of how you're going to be responding, because you may actually have to do a little bit of repairing before you can actually start to build up some rapport with that individual yourself. So I think that's another additional component of trauma-informed care that we have to consider as well. I think it's also really important to talk about the patient-centered approach, and we have hit on a lot of these topics already, but I think really important that a lot of you said in the chat that you kind of ask your patient or the survivor, you know, what can we do for you today? What's your goal in this process? And it's so important that we know that from the start, kind of what the patient is there and what they're seeking, and that we understand they have life circumstances that can really affect the care that they're looking for and how we approach our patient or the survivor. They may have children at home and they're worried about how long they're going to be there in the emergency room because they have, you know, three kids at home that they are trying to get home to. They may not have insurance. They may be concerned about that. There are so many life circumstances that we need to consider when we're taking care of these individuals. We've talked a lot about values and culture and how that can be integrated into our care, care preferences, you know, what our patient is really looking for, how they prefer to be cared for, whether that may be that, you know, they prefer a provider or advocate of a specific gender or specific race, whatever that might look like for the patient. Also important to consider their health status and symptoms that they have going on. If you have a person that comes in to see you as an advocate or even as a clinician and they have bruises all over them or maybe they have a really bad headache because they might have some kind of head injury or they have something that's going on that's causing them pain, how that can really affect the care that we can provide and focusing on their health and how we can maybe get them out of pain, hopefully get them out of pain before we continue on this care process. We've also talked about access, but, you know, in our in our communities that are more rural or more isolated, this access can be a real issue. And, you know, it's unfair to our patient to tell them, you know, you need to go have this test done or you can go to this place for this resource when they have no way to access that. Maybe they don't have a car or there's no public transportation. How do we how do we get them there? How can we facilitate that access, especially in places where we may not have as many resources? I also saw that someone mentioned the warm handoff in the chat, and I think that is really important to talk about when we're talking about safety planning. You know, the clinician and the advocate work together hand in hand, but there are so many ways that a patient can present for care, whether they are calling in on a crisis line or they come into the emergency department because they have an injury, or maybe they go to their regular primary care provider and then they're referred to one of our agencies for care. I've seen many times that maybe a patient goes into the emergency department to be seen for an injury and the clinician finds out that this injury was sustained in an intimate partner violence incident and they tell the patient, oh, you can call the local domestic violence shelter or you can call this crisis line. You know, it's so important that in order to really be trauma informed and survivor centered, that we are practicing this warm handoff, whether it's from our advocate partners to our health care partners or vice versa, that we're not just saying, here's the phone number or go to the nearest emergency department, but that we're saying, let me help you get to this place. Let me facilitate this handoff so that you know when you're coming from me, the clinician, to the advocate that I've introduced you to that advocate and that you know that this is a safe space and we can help you get to that place. So, confidentiality and safety. These are very crucial topics, because when a survivor is seeking help, the first people that she goes to or they go to are friends, family and religious organizations, not necessarily in that order. There are two scenarios that play out. One is acceptance. The other one is rejection. Unfortunately, rejection is the first reaction victims receive from these groups because they have witnessed the abuse and choose not to get involved, leaving the victim to determine their next move. That's when Googling for signs of abuse and resources begin, as well as watching YouTube videos on the subject as they try to figure out what type of abuse they are experiencing. Only when the situation is beyond their control will they call the police. Depending on the situation witnessed by law enforcement, CPS is informed of the abusive environment that children are subjected to. Housing and job discrimination. If the victim is working outside of the home, the abuser will create ways to either have the victim fired due to productivity and reduce hours or they will quit due to threats being made should they continue to work. Total isolation and control are the goal. However, many victims work and are threatened to bring their checks home to their abuser who doesn't work and the funds are spent according to the abuser's discretion. In the case of evictions, there are laws passed in favor of victims preventing them from being evicted. These laws vary from state to state. Fear of homelessness is one reason victims remain in an abusive relationship. Society believes that going to a shelter is better than remaining in an abusive relationship. However, shelters are full and they are temporary solutions. Six months to a year in some shelters. Other shelters offer shelter space for a year while learning home ownership. After that, you are eligible for transitional housing up to three years. So the next slide is about address confidentiality. And I went in my book and I found mine. I had I went through that process because as I was trying to when I lived in the shelter, they took us to the post office to sign up for it. Our mail will go to this P.O. box that's on the back of the card. They would go to the post office to pick up the mail and then distribute it to us in the shelter. This was a very timely and important process for me because I still felt connected to society in that way. I just didn't feel completely isolated from everything and everyone for which I was because when I was in the shelter, I was not allowed to reach out to my family, to reach out to anyone. It was the utmost importance for me to be hidden away for fear that he would kill me. That was real. The next slide is victim service providers. Privacy protection, this one is crucial to the safety of victims. The only time I have witnessed this violation is when the practitioner is a family member or friend to the abuser. All of these protective measures are no longer in place. The goal now has become to protect and rescue the abuser. The victim will unknowingly be manipulated in favor of the abuser. And I really want to stress that I didn't have an advocate when I was going through my ordeal. I had to figure everything out for myself. The people that were around me, I had to cut off because they would come and visit me and then go back and report to John what I was doing. So I was not in a safe place. The people, even people that knew him, worked in places where I could go to get help. But because they worked in those places, I didn't go. I called the Washington State Coalition, I called YWCA before I decided to do anything. And the first thing they wanted me to do was come in, but I was scared. What am I coming in for? I mean, how are you? Are you going to really protect me? Are you really going to do everything that is written in this brochure? Is this really everything you're going to do on this website? Are these just words? Are you really going to do this to help me? So for the victim service provider, this is really important. Trust and safety is also important. Survivors are between a rock and a hard place, while neither are good places or choices. Here are a few tips to consider as you are made aware your patient is a victim or survivor of IPV. One, excuse yourself from the room. Two, after leaving the room, stand in the hallway, take a deep breath and clear your mind of personal biases. Touch your badge to turn off your emotions so you can be logically present and not emotionally present. And what do I mean by that? As Tanya said, that you don't want to be emotional when you're trying to help somebody. Keep your personal biases outside the door. Did I do that? Outside the door, because if you're trying to help someone, they want to know that you're there for them. Re-enter the room with a smile, which will help your patient's nervous system to relax. After examining her or him for the conversation shifts to abuse, ask one question, how can I help you? And wait for the response. Don't give examples. Allow the victim and survivor to express themselves without interruption. Should they ask, what do you mean? Respond with, I'm here to help in the capacity you need with resources. Don't put yourself out there as a lifeline. Remember, you are a step in the journey of a victim trying to figure out their next move. The reason you should not go beyond your capacity of assistance is because we don't want you to incur burnout and your mental health is affected. Turning off your emotions at work is one way to persevere your mental capacity, preserve your mental capacity. Once you're off from work, touch your badge again to turn on your emotions for your family and friends. Legal and ethical standards regarding resources. They are given at the discretion of the advocates. We found out during the pandemic, women of color were not given those resources. They were treated as if they did not deserve to have those life changing resources. We have to increase and improve our efforts of making sure every victim and survivor, regardless of race, gender, financial, occupational statuses, religion, as well as whether or not they have children, receive those resources without our personal biases of what we think or believe they need. Don't play the hero in someone's story. Inform the victim of your process of contacting law enforcement and allow them to determine their next step. If they say no, respect their decision and stop asking if they are sure they know their circumstances. You only know the information that has been given to you. We're going to talk briefly about some confidentiality considerations for clinicians specifically, and this goes for all medical encounters, not just patients that have disclosed IPV or other forms of violence. We know that discussions about those sensitive topics should be held in private. And it's often not enough to just ask a patient in front of whoever they may have with them, like, is it OK if we talk about this in front of this person? Because they may feel pressured to say, yes, it's OK, even though they don't feel like it is. They're just sometimes when we may need to just let that person know that we're going to have this conversation in private. And we want to consider the patient's choices about how communication takes place, especially after that clinical encounter, when we may be communicating with them by phone or sending them something in the mail, making sure that if we're going to make a follow up phone call to that patient, that the phone number that we get from them is safe to contact. We don't want to ever assume that it's OK to just call the phone number that a patient gives us without explicitly asking them if it's OK for us to call that phone number. Also, if we're leaving a voicemail for a patient, we want to make sure that that voicemail is HIPAA compliant first and that it's safe for the patient, that we're not leaving any identifying or sensitive information in that voicemail message. And that includes sensitive or identifying information about the patient and also about where you're calling from. We don't want to call a patient, leave a voicemail saying, hey, this is Lacey from the sexual assault center. Please call me back. Because then if someone listens to their voicemail, then they can ask you, why was that person calling you from that sexual assault center, that domestic violence shelter? Making sure that we're not leaving any identifying information and if we're communicating with patients by phone, that we ensure that we know who we're speaking with. Some confidentiality considerations for medical records. There are many federal protections for medical records that we're all familiar with, HIPAA, FERPA, HITECH and the 21st Century Cures Act. These all kind of discuss how information is shared and protections for that information. It's also really important to know that many states and jurisdictions have protections that exceed HIPAA and to know your state and jurisdiction's confidentiality laws about medical records. Mandated reporting is also something that we really need to carefully consider and discuss with our patient before any disclosure takes place and before the medical encounter begins. Mandated reporting can be a huge barrier to seeking care for many of our patients. They may be afraid that if they tell us something that happened and it involves their children, that a mandated report will be made and their children will be taken away from them. So we want to make sure that before we start getting any information from our patient, that we really let them know what the mandated reporting requirements are. Making sure that we understand the mandated reporting requirements for our state because those requirements are specific to your state. Making sure that if we have to make a report, that we're only reporting the parts of what the patient has told us that are reportable. We don't have to disclose every single thing that they've told us, but making sure that we make that mandated report on the reportable parts of what our patient has disclosed. And a couple of topics to discuss with our patients about confidentiality at the beginning of the clinical encounter. How the patient's health information is shared, how it is disclosed and any notifications on the limits of confidentiality. Their rights to access, correct, supplement and amend their health information. So important that we're de-identifying any health information that might be shared. And we want to find out our patient's communication preferences, how they want follow-ups to be made, whether it's by phone or through email. If they have any concerns about receiving mail like EOBs or other written communication, we want to make sure that we have that early on. Privacy safeguards and consents, making sure that we have consent to share the patient's information if we need to do that. And that those consents travel with that health information, that we're not just sending it on to the next clinician and that they're not considering what the patient has consented to be shared. And provider discretion for sharing information. It should be up to the provider to make the determination of whether to share specific information. If they think that sharing information about the patient could put them in danger, then that is up to the provider, should be up to the provider to make that decision to share that information with another clinician. Partitions, this is especially important in our electronic medical records that if we're in a hospital system where we're taking care of patients like in an emergency department where they may receive other forms of care and we're documenting in a medical forensic record that there is a partition between that medical forensic record and their medical record. That any provider that enters into their medical record cannot see that specific portion, that medical forensic portion. And penalties, there should be strong and enforceable penalties that exist for violations of privacy and consent both in the clinical setting and across information exchanges. So now we're just going to talk a little bit about considerations when it comes to billing. So we understand that a lot of times when patients are seen in healthcare facilities that most of the time the care that's provided, there's some kind of bill usually associated with it. They're usually being seen for billable services, although there's a handful of states that have actually established a way to pay for IPV-related medical forensic exams. The bulk of the states do not have that in place. So currently we still have to utilize billing the patient directly or billing the patient's insurance if that's necessary. So we just wanted to make sure that we touched on that a little bit. I think one of the first things that we have to think about, which we've talked about a lot throughout this, is really understanding what the patient is concerned about in terms of bills coming to their home. So if we're going to be directly billing the patient, is the patient concerned that an actual bill will come? Do they have another process set up in place where they can either send it to a different address or they have a different process on how they actually are receiving other types of information that is important to them, such as what we heard Mildred talk about earlier today. But if by chance they are billing the patient's insurance, there are other things that we have to think about. Again, same thing. What is the concern for the patient in terms of documents that may come from the insurance company? So maybe the abuser is the actual primary policyholder. So if that's the situation, explanation of benefits, EOBs, will actually be usually sent to the home of the primary policyholders. So the EOBs usually contain things such as data service that the care was provided, who provided the services, what exactly was provided and how much the insurance company paid. It's important for patients to actually know that because there are a few things that can be done in terms of reaching out to the health insurance company to ask for special requests. First thing I want to just let you know, it is totally up to the health insurance companies what they agree to, right? So each insurance company is going to be different, but you can usually call the 1-800 number on the back. Let them know exactly what your request is and what you want to happen. So for instance, you can ask to have an EOB de-identified with what actually happened, what the patient was treated from. So they will send out something that is kind of really plain, but it still gives some of the basic information that you will find on the EOB. Again, that is very specific to each insurance company. They can also provide an alternate physical address or email address and ask the insurance companies to work and communicate with them through that method. And then also get information around payment and deductibles to be that is usually sent to the policy holder. So that detailed information, again, is not provided to the policy holder. But who can assist the patient with doing that? So the patient can do that themselves directly. But also if they're in a healthcare facility and you have enough staff, sometimes sitting with the patient and going ahead and trying to make those calls and make the arrangements before they leave the healthcare office is helpful. Or if there is an available advocate can also assist them with that. That could be something that they can work with in the advocacy office. So we're talking about the barriers to safety planning. And that's the lack of resources and support, fear of escalation and retaliation, cultural and barriers and social barriers and complexities of legal and administrative systems. So the first one is the strategy behind safety planning should be to tailor or to assist having a safety plan that is varied. It because it varies in populations and cultures and behaviors. I know that when I spoke at a reservation in New York, they don't use the circle of power circle. They use a teepee because they believe that in the circle is a continuous loop of abuse. Whereas the teepee offers an opening under the bottom of the tent. So the impact would be to enhance trust and engagement, ensuring plans and relevance effective with cultural contexts. The next one is technology. We need to utilize technology for safety such as apps for emergency alerts. I've noticed that there are a lot of apps now from different organizations that victims and survivors can go to on their phones to help them to utilize those platforms. And the impact would be to provide discrete and assessing tools for monitoring and seeking help. The community foster partnerships with community organization, neighbors and social networks to support a creative environment. It also builds safety net for resources and allies, increases access to immediate assistance and long-term options. The complexity of legal and administrative resources or systems is to provide legal advocacy, which is I always make a point of communicating to victims and survivors that when you're seeking an attorney, make sure that they specialize in domestic violence because not all attorneys do. And the attorneys that specialize in domestic violence know all of the intricate details that they need in order to be successful with the outcome that they are desiring. So again, if it's survivor-centered, then we want to make sure that the survivors have an impact on what is being discussed. They want to address safety concerns posed by the abuser and not physical violence because we talk about the nine to 15 seconds, which is a lot of time. We want to make sure that the survivors have an impact on what is being discussed. We want to address safety concerns posed by the abuser and not physical violence because we talk about the nine to 15 seconds, which is the physical aspects of abuse, but we rarely talk about the one to eight seconds, which is the verbal, psychological, economic, and assault that lead up to the nine to 15 seconds. And it's important to have a strategy that is based on survivor's goal to stay, consider to stay, consider leaving or leaving. Because most of the times when the survivors decide to stay, it's because they have nowhere to go. They don't have any funds. There are no family members that will take them in and they would rather stay instead of ending up homeless with their children. The safety plan should be led by the survivors because they would know which is the best strategy for them. They live in the home. They know what are the triggers that the abuser has. They know how to maneuver better and how to maintain civility in the home, especially when children are present. So it is important that we ask them, how would you like to move about? What are these barriers that is causing you from leaving? But if they are resistant to leave, then don't push it. Just let them be able to have that time to think about how they want to go. And if they are leaving, they should only tell one trusted friend so that that friend can help them. Because I stress not putting that you're leaving an abusive relationship on social media because you don't know who is watching you for the abuser. And it's the best thing that you have is the element of surprise. And once you lose the element of surprise, then you have to start all over again. And that will take a lot of time and effort. When you are striving to leave, you should always take the most important papers with you. You should have your birth certificates and all the things that are here to start your life over in another place. If you're trying to leave and you're at home, take one partial of clothing with you every day until you are no longer in the home and you are able to leave. If you're trying to plan an escape route with your children, make it out of a game if they're smaller children and pick out a particular word that they would know in order to be safe. I remember a scene in Criminal Minds where the guy was breaking into his home and he said to his son, go get in the box. And he knew that was a place to go for safety. So we have to do that too. And that's a code word. We also have to give our family members, hey, if I text you 222, please call the police for me. If I call you and I'm giving you a certain word, that means to call the police. So in doing that, we ensure our own safety with family members and friends. Safety planning, I'm sorry. When you're considering staying or consider leaving. The statistics says it takes seven times for a woman to leave. But in those seven times, we don't talk about each one of those times. By the time you get to seven, it's because she has really, or he has exhausted all avenues of how to stay in an abusive relationship safely. Going out the first time, you're touching the water to really find out who's with you and who's not. Confiding in someone you trust, family or friends, domestic violence advocates and spiritual leaders. I think I've mentioned that earlier on that those are the three, including the advocate that are the first ones to be sought after. Document the abuse, document, document, document. Because now you can, in order to get a successful restraining order, especially when you do not have physical scars, you have to go back three months and document every incident. It is important to show a pattern of abuse instead of just an incident that happened here and happened there because the courts will not be able to find out or to get a picture of what it is you're going through. Upload pictures to the cloud, erase evidence from phones, have an automatic erasure after a few hours instead of a day. The phones are able to do that. Identify safe zones in your home. If it's a closet, if it's a room where you can go into, send your children there so that you will all be able to be safe until the situation dies down. And if you are working remotely from home, it is important to keep the sound on, the mic on so that other members of your workplace can hear what's going on. There was a victim that was saved in that process because they were able to hear the abuser in the background. They called the police and they saved the life of the victim. I'm gonna, Mildred, I'm gonna interrupt and I'm sorry in advance. We are really beyond time and I think we have mutually decided that we should stop and do a part two to wrap this up and give everybody a thorough opportunity to hear the rest of the strategies and the resources that we have. So with that, I definitely wanna say thank you to all of you for hanging in there with us while we ran over a little bit. Thank you to our TA2TA crew, Mary Kate and the captioners for being here with us. Mildred, Tonya and Lacey, you all were amazing. Thank you so much for being here. We will drop your emails in the chat. If you guys have any questions or need anything, feel free to reach out to us. But yes, we will come together, wrap up with a part two and get out information to all of you that were on this webinar, but also advertise it as well. Thanks everyone. We appreciate you.

Safety Planning

Survivors

Domestic Violence

Trauma-Informed

Patient-Centered

Confidentiality

Legal Considerations

Types of Abuse

Escape Plans

Financial Planning

Emotional Safety

Support Systems

Culturally Appropriate Resources