Hey, everyone, we'd like to welcome you and thank you all for attending today's webinar, Diving into the Reality of Safety Planning for Survivors, Part 2. This webinar is being brought to you through IFN's Technical Assistance Project, and we're grateful to be able to host this with Tanya Moultrie-Pace and Mildred Muhammad. I want to share a few housekeeping items with you all before we begin today. Today's webinar is possible due to funding provided through the Office on Violence Against Women, and the presenters of today's webinar disclose no conflict of interest. If you have multiple people watching today's webinar with you, please send a list of all attendees that have not formally registered for the webinar to safetya.forensicnurses.org and share the evaluation link with them. As a benefit of membership, IFN members are eligible to receive 1.5 contact hours for this continuing education activity. The International Association of Forensic Nurses is an approved provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. For IFN members to obtain CE for this activity, they are asked to attend the webinar in full and complete the post-activity webinar evaluation to obtain a certificate documenting the content contact hours for this activity. For non-IFN members, with the completion of the post-activity webinar evaluation, you will receive a certificate of attendance. This webinar is being recorded today and will be available on the safetya website for viewing at a later date. IFN will send an announcement to all registered attendees once the webinar is available for viewing. I'm going to turn it over to Tanya to introduce herself. Hello, everyone. So happy that you're here. My name is Tanya Moultrie-Pace. Just a little bit of background about myself. I have been in the domestic violence movement since 2004. I started at the Ohio Coalition, working as the outreach coordinator to underserved populations and then into being the training technical assistance director. I left there in 2017 and moved to Maryland to join the National Network to End Domestic Violence, where I worked on their Coalition Capacity Team. And then I left there to pursue one of my other passions outside of domestic violence, which is diversity, equity, and inclusion work, and started my own consulting business where I still continue to work with domestic violence programs. So thank you. So great to see you. I will turn it back over to Lacey. Thank you, Tanya. We're so glad that you're able to be here with us today and that we're able to have Mildred Muhammad with us as well. Mildred is a recognized global keynote speaker, bestselling 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. Thank you so much for being with us, Mildred. And I'll go ahead and introduce myself. I'm Lacey Smith. I'm a forensic nursing specialist here at IAFN. My background in nursing has been mostly in pediatric inpatient acute care. I started forensic nursing in 2018 and have practiced in rural children's advocacy centers and sexual assault centers. So that's helped me. I'm going to turn it over to Angelita. Thanks, Lacey. My name is Angelita Olowu, forensic nursing director with IAFN. My background is trauma emergency room nursing and forensic nursing. My practice was out of Cleveland, Ohio the whole time. I've been a nurse since 2008 and been doing forensics since 2010. And I've been here with IAFN for the past six years. Our learning outcome for today, at the conclusion of this activity, participants will report an increased knowledge of trauma-informed, patient-centered approaches to safety planning with individuals experiencing intimate partner violence and be able to identify barriers to effective safety planning and strategies to overcome these barriers. Just a quick reminder before we get started, there are several different disciplines represented here today, victim service providers like advocates and other staff at victim service provider agencies, as well as clinicians, forensic nurses, and other clinicians that perform medical forensic exams. While we're on this webinar today, you will hear us, the forensic nurses, referring to the individuals that we're talking about as patients, and you will hear the victim service providers like advocates and other professionals like Tanya and Mildred refer to these individuals as survivors. We just wanted to go ahead and make that distinction here at the beginning to eliminate any confusion and to maintain our individual professional standard regarding. Just a quick recap of what we covered in the last webinar, we talked about the key aspects of safety planning, some considerations for safety planning, survivor-centered trauma-informed care, confidentiality, and we talked about the barriers to safety planning. We're going to do a quick recap of some of those on the next couple of slides. And I'm going to turn it over to Mildred. This is, thank you, Lacey. This is my book, Scared Silent, When the One You Love Becomes the One You Fear. I was asked to write my story from different coalitions because it would be more available to other people that may not be able to attend conferences where I am scheduled to speak. So I gave my story in part one of the webinar, so I'll just give a synopsis of what was said. The theory the prosecutor stated at the trial, that the theory for the shootings was that I was the intended target. He was killing innocent people to cover up my murder so that he could come in as the grieving father and gain custody of our children. He was also going to receive the $100,000 conversation that they were given to the victims of the D.C. sniper because of our children. And because they did not know at the time that he was the perpetrator, then he would have gotten those funds based upon their mother and they would have been receiving that compensation. The safety planning part for me was that, unfortunately, I was not given the tips that I needed because I did not have physical scars, so they didn't look at me as a victim. My help was slow in coming and a lot of what I did, I had to do on my own. When I went to the court, I talked to the clerk of court and she, although she was not able to give me legal advice, she would just slide a sheet of paper over and say, maybe you should do this or maybe you should do that. And most times when you don't have physical scars, unfortunately, even advocates don't believe and that was the other issue that I was going through. So when someone comes to you for help, don't put all victims in one box because we all are not the same as survivors. I try to reach back and help other people to understand that you don't have to have physical scars to be a victim or survivor of domestic abuse and violence. Everyone will not react the same. Some are outspoken, some are quiet. I happened to be one that was quiet. I did not yell or cry or any of the things to get your attention to help me. I was very reserved because it was difficult for me to trust anyone. So I didn't know if you would be able, if you had access to John or would post something. And that is another thing that we have to remind those who we help is don't put your information on social media. Social media wasn't around as much as when this happened to me. Unfortunately, the same issues that I was facing back then, they are still apparent today. And that was 24 years ago. If you would like to hear more about my story, you can go to my website, MildredMuhammad.com, or you can go to the part one of this webinar and you will be able to hear more about my story. Thank you. Earlier as Angelita stated, we discussed the barriers to safety planning because there are four specific ones that we highlighted. That's lack of resources and support services, fear of escalation and retaliation, cultural and social barriers, as well as complexity, legal and administrative systems. So we're going to talk more into that. So now turn it over to Lacey. Having back into the content that we plan to cover in this webinar, we're going to talk a lot specifically about strategies to overcome those barriers that Mildred mentioned and some specific safety planning strategies with a focus on cultural considerations for survivors with disabilities and survivors who are deaf or hard of hearing, some specific considerations for LGBTQIA plus survivors, and on collaboration to enhance safety planning. We're going to go over some resources that are available. I'm going to turn it back over to Mildred. The first one that we want to talk about is cultural competent approaches, the strategy and the impact. To overcome cultural barriers and safety plan for intimate partner violence, it is crucial to develop strategies that are respectful of survivor's culture, identity, values, and traditions. This can involve training advocates and professionals to be more aware of cultural sensitivities, providing language appropriate resources, and ensuring that safety plans take into account specific cultural practices or family structures that may impact the survivor's ability to seek help or leave an abusive situation. Working with cultural leaders or community representatives to bridge the gap between survivors and services can also enhance cultural competence. So what would be the impact? When cultural competent approaches are employed, survivors from diverse backgrounds are more likely to feel understood, supported, and empowered to engage in safety planning. This builds trust between survivors and service providers, leading to better outcomes in terms of survivor safety and well-being. Furthermore, cultural adapted interventions help reduce feelings of isolation and increase access to services that survivors might otherwise avoid due to cultural or linguistic barriers. The second one is technology-facilitated safety measures. The use of technology in IPV safety planning, such as secure apps, GPS tracking, emergency alert systems, or cryptic communication tools, offers survivors a way to discreetly manage their safety and maintain control over their circumstances. However, these tools must be implemented with care to ensure that abusers cannot monitor or manipulate them. Survivors can be taught to use these technologies safely, and professionals can help with developers to design user-friendly interfaces that enhance survivor autonomy while minimizing the risk of digital tracking or surveillance. The IMPACT technology enables survivors to enhance their safety planning with greater flexibility and discretion. By providing survivors with secure technology tools, their sense of control and independence is strengthened while reducing the risk of abusers finding out about their safety strategies. Because the best strategy that a survivor has is the element of surprise, not knowing the abuser will not know when or where or how the victim or survivor is trying to leave, and therefore they can get away faster. Community Enhancement and Support Networks. Creating and leveraging strong community networks is essential to overcoming the isolations that often accompanies IPV. This involves collaborating with local community groups, faith-based organizations, or informed social networks that survivors already trust and are comfortable assessing. The IMPACT would be the community involved strengthens the survivor's support system, providing them with both emotional and practical assistance. Survivors may feel less alone and more empowered when they see that their community is committed to helping them and staying safe. And the last one is Complexity of Legal and Administrative Systems. The legal and administrative systems surrounding IPV, including restraining orders, custody battles, and immigration processes can be overwhelming and intimidating for survivors. Simplifying these processes by providing legal advocates offering clear explanation of legal rights and procedures and reducing administrative red tape can remove significant barriers to survivors' protection. And the IMPACT would be by reducing the complexity of legal and administrative systems, survivors can be more easily assessed the protections and services they need, such as restraining orders, legal representation, or financial support. When survivors understand the legal resources available to them and can navigate them effectively, they are more likely to receive timely intervention, which can be critical in situations of ongoing abuse. Additionally, clear and accessible legal systems empower survivors to assert their rights and seek justice. So the survivor strategy, when it is survivor-centered, tailored to survivor's needs and situation, should be personalized considering the individual circumstances, preferences, and experiences of the survivor to ensure relevant and effectiveness. Addresses safety concerns beyond physical violence. Safety plans can encompass various forms of abuse, including emotional, financial, and psychological aspects, ensuring comprehensive protection against their abuser's tactics. Strategy focused based on survivor's goals. Support should align with the survivor's intentions, whether they want to stay in the relationship or contemplating leaving or actively trying to leave. This ensures that the support is relevant to their current mindset. Review past actions and results. It's helpful to discuss what strategies the survivor has tried before and what outcomes they experienced. This reflection can inform future actions and avoid repeating ineffective strategies. Collaborative strategy development. Engage the survivor in the decision-making process by asking if they think a proposed strategy would work for them, rather than presenting it as the only or best option available. Respecting survivor's autonomy. If a survivor shows resistance to a strategy, it is important not to push them to change their mind. Instead, focus on their feelings and choices, allowing them to come to their own conclusions about what they want to do. Thank you so much, Mildred. So, we were talking, right, as Mildred has been talking about strategy, right, we focused a lot on who the survivor is and to really be able to understand that, right, we do have to think about culture and the role that plays both in the identity of the survivor, what resources they may want to access, and we're always working towards being better in terms of understanding people, in terms of their culture, making those connections with folks. And so, I just want to present to you just this circle of culture. It's a different way of kind of thinking about it. So, when we look at the inside of this circle, we've got celebrations and holidays, we've got socioeconomic status, geographical location, and this is not just, did you grow up on the west side of the country, the south part of the country, right, but this can also be, did they grow up in an urban or rural environment, and how, what does that mean in terms of access to resources, what does that mean in terms of just, you know, moving someone from a rural environment, I will speak as someone that grew up in a very small community, and putting me into a big town was something of a culture shock, right, And so when we think about survivors moving them to different locations, giving them different resources, that may not be something that they're necessarily familiar with. We think about education. Food is always cultural, we all know. It's usually one of the ways that most of us get introduced to different cultures. You know, people's politics. So you see lots of things in here, right? Appearance, right? So religion, spirituality, their values and beliefs, codes of conduct. And when we look at that inside of that circle, if you think about this for yourself, I would say probably each and every one of us could talk about different stories in our lives that attaches to those, right? That's how we get to know people is through their storytelling. And this is a space when we think about the inside of the circle, think about that as who you are, right? This is the stuff that makes you up. We see disability and sexual orientation, that may be known or unknown. So there are many people that maybe have a disability that we see them using some sort of assistive device. And so it's okay, a person has a disability. But there's also lots of people that have disabilities that no one knows anything about. And it changes how they engage and move through the world, because they just show up earlier for a meeting, they will take to make sure they're there so they can walk, take slower to walk somewhere because they have a bad back or some other issue, right? And so we don't always know if someone has a disability, but it definitely can impact how they engage with the world, how they maybe are engaging with us. And same thing with sexual orientation, this could be known or unknown, right? So when we talk later on about resources for the LGBT plus community, we want to make sure that this as we're asking this question, because that becomes a community that we want to make sure when we're safety planning with survivors, when we're talking to them, when they're sharing their story with us, that we are being culturally responsive and aware, right? This also means that because I don't know someone's sexual orientation, I just don't always want to assume the gender of their partner, right? So I want to leave that kind of open ended until that person identifies that particular gender. And then on the outside of the circle, you'll see race, gender, nationality and ethnicity. This is what we are. These are the things that people believe that they can see as soon as they can identify with us without really having to talk to us, right? Now we know gender is not, it's not binary, and it's not just male, female, right? We know that gender now happens on a continuum. And a lot of times, unfortunately, folks still try to decide what somebody's gender is just based upon looking at them rather than engaging in that conversation. All of these pieces are important, right? So we think about race, ethnicity, nationality, and your gender, that's what you are, right? And then you have all the good stuff inside that makes up who you are. When you put that together, you have a complete person. So we want to make sure that we're paying attention as we go down this path of talking with survivors, hearing their story, connecting with them, that we really are taking into consideration all of these pieces that make up a person's identity. Don't just look at me and assume, oh, Tanya is a Black woman, and so I need to give her these resources, right? Those may work for me, but there may be some other things that you can also connect with. Again, I didn't grow up in an inner city, right? I didn't grow up in a big city, so I much more connect with and identify with small rural places. And so we want to make sure as we are safety planning, as we are thinking about this, that we are taking time to get to know who that survivor is so that we can connect with them better. So just wanted to give us that background before we move on. So in terms of planning a strategy to escape, the first thing to do is, as victim service providers, healthcare, asking them, do they have a place to go? Because most times there isn't anywhere to go. But to identify a place would be a family, member, friend, or maybe they have a hotel. I know that there are some organizations, if the survivor has a restraining order in place, they can go to a hotel for up to 30 days. And if it needs to be extended, then the organization is able to do that. So pack a bag to go. I created a safety plan mindscape, which also has a list of things that the survivor should take with them when they plan to leave, so that when they get ready to start their lives over, then they'll be able to do that. The most important things that they should take with them are identification for themselves and children, lease and agreement, and payment history, children's birth certificates, hide in a safe place, preferably outside of the home, that is easy to assess. But when you're packing a bag, take at least three items of clothing, like a suit for each one item, either at work or in your trunk. Make sure that the items that you take, you don't have to go back home to get them because that's when unfortunately, many find themselves trapped, because they went back for something. If you get, if you have it, leave, if you can get it later. Practice escape routes with your children, include that in a game. I saw criminal minds where the father was playing with his son, he was about six or seven, and they played a game called hide and seek. So that he was teaching him if it's any trouble, then all he had to say was, we're playing hide and seek. And the son would know exactly where to go in order for him to find him. And he was to stay there until the father came. So we have to make it like a game for children that are younger than six or seven. But if they're older, then give them age appropriate language, explaining to them what is happening so that they aren't afraid and don't have any anxiety. Practically, if the child is already in a toxic environment at the home, they pretty much know what's going on. So giving them additional instructions on how to stay safe, would help their anxiety level to go down. A code word shared with a trusted friend or family member, a word would signify that they should call 911. You can either use a number like 44-VC-44, text you 44, call the police. Some people use flickering of the lights, but everybody's not always outside. If it's a word, then your friend would know, but don't tell everybody. Tell only one trusted friend because you don't know who the abuser knows, and he could get back to the abuser before you're able to move out on your land to escape. Even when you're setting up a safety plan, don't tell any more than one person. There is an underground railroad for victims of domestic violence. Unfortunately, everybody don't know what that is because I hand off a survivor to Tanya. Tanya doesn't tell me what's happening next. Tanya's going to get new identifications, a place to stay, and then she's going to pass that person on to Lacey. So myself and Tanya have no idea what Lacey and Angelita will do with that survivor. That is safety. So anybody that comes and say, hey, do you know where Sarah is? Sarah who? I have no idea because we don't know. So in actuality, we will be telling the truth. Just to keep this person alive to move on is just like what the FBI would call, what's that term when they hide people where they don't want them to find you? It's like that, and it's important. Again, only tell one person. You don't need to tell everybody in your family. Only tell all your friends, hey, this is what I'm planning to do. Because for me, and when I was doing that, there were people that were watching me for John. So anything I did, they would report back to him to tell him what I was doing. Even when I went to the hospital, I didn't tell him I was in hospital, but he had someone watching the house. And once I went to the hospital, he called the hospital. So only one trusted friend. We all have that one person we go to, and all they're going to say is, what are we doing? What do we need to do? And that's it. Hand it back to Tanya. Thank you, Mildred. Yes, with this protection. With this protection. Thank you. With this protection. That's what it's like for victims of domestic violence. That's the safety plan that comes into effect with that. Absolutely. Absolutely. In terms of the say that strategy, we may look a little bit different then, right? So if we're working with the survivor, who's not ready to leave at this point, right? For whatever reason, not everybody's going to leave. And so some folks are going to stay, and some folks may be like, I might leave, right? Or I may leave for a while and come back. So I know work that I did, I worked with women who would leave for a period of time, but their strategy was never, or their goal was never to stay away. They were still going to go back home. Some of that's, again, based around religion, some of that's cultural. So we want to be able to support survivors wherever they are. And so in talking with them, if they say, nope, I'm not leaving, I'm going to stay, then we want to start talking to them about what tactics are they currently using to reduce the violence and how do they keep their abuser at peace, right? And we want to encourage them to use those strategies that have been working for them in the past. We want to make sure they're confiding in someone that they trust, again, that one person, or calling the domestic violence advocate. So sometimes part of that staying strategy is they know how to contact a hotline, they know how to get that emotional support, they know how to access those resources. Again, if they need to leave for a period of time to get out of the situation for themselves or for their children, then they need to know how to access the DV shelter, and that would be with the advocate. For some people, again, based upon their spiritual beliefs, this may be a spiritual leader that they're talking to. And I know that there are, when I was in Ohio, there was a real big push around starting to make sure that clergy, pastors, that faith leaders were really being trained in domestic violence and understanding how abusers can also use spiritual and religious beliefs as part of the violence and to keep someone there. Make sure they're documenting the abuse. This is only if it's safe to do, if they're taking pictures or someone, if this trusted friend takes a picture that is uploaded to the account, to a cloud account so that all evidence can be erased to that. And then identify what we would call safe zones in the home. So these are places that they can get to, or maybe they can lock the door. Again, even for the children, being able to identify what those safe places are. So we always want to meet survivors where they are at. Again, if they're, if they are not ready to leave, us pushing them to leave can cause them to shut down and not continue to seek help. And we don't want to do that. When we think about some safety planning strategies for children, as Moser said, we want to make sure that we're discussing that plan with children and practicing it with them. We want to make it into a game. We want to make sure that we're walking children through whatever that plan is. If they're older, if they can get out of the house, do they know where to run to be able to meet you in a safe location? If they live near family, can they get to a family member? So we want to make sure that children know what they should do, always in the chance of keeping themselves safe. Especially if we have children that are more likely to want to jump in and try to protect the survivor, fight the abuser, which could end up meaning that they get hurt. So we don't want them to intervene in the violence. We want them to get themselves safe. Assure kids that violence is not okay, right? It's not okay to hurt other people and this is not their fault. So many times children in these situations believe that if they were just better, if they whatever, you know, that the violence would not occur. And we know that where we find domestic violence, there is often an overlap with child abuse. And so the children may also be being harmed in there. Teach those kids to dial 911 and ensure that they know their address, right? This is something to make sure that kids and even little kids can like figure out what their address is. Again, making it into a game. And ensure that the schools and daycares have a list of who can pick up kids. This is especially important if a survivor has left, right? And the abuser does not have legal custody or access to the children or is on a protective order. We want to make sure that information is shared with those schools and daycares. When we think about a safety planning strategy, we have lots of systems that survivors are going to interact with. And sometimes this is also about helping survivors understand what those systems are, what they can and cannot do. So when we think about folks interacting with the police, again, there's lots of communities that may not want to interact with the police. We may have survivors that have their own arrest history. We might have survivors that have mental health or substance abuse issues. So they may not want to involve the police because of their own history or their own fear of maybe their children being removed. So lots of reasons why folks may not want to engage with the police. But helping people understand the police can provide immediate assistance. They are trained to assess for who is the perpetrator. So when they come into a situation, police are supposed to separate the parties, right? And they can be able to do an assessment so that they're arresting the appropriate person. They can assess for lethality and connect the survivor with domestic violence services. So this is a lethality assessment program that I know lots of police departments and DV programs across the country have engaged in. And this is a way for police to be able to talk to survivors and see if they want to talk to someone immediately on the scene. And they can also enforce violations of protection orders. So again, if something is happening, we want to make sure survivors are documenting it and that they're calling that information in so that if a batterer is violating that protection order, that eventually it can lead to arrest. Clearly that can take some time. And so we also want to make sure that we acknowledge that some folks don't always have the best interactions with the police as well. So they don't want to interact with the police, or they do, and they find themselves in the courts. So understanding working with the courts and what does that look like. So why would I go to the courts? The court is where they can issue a protective order or a restraining order, whatever that happens to be called in your state. They can incarcerate the abuser, right? Those things can happen. And they can also order an abuser to attend a batterer's intervention program or abuser's intervention program. It's called a different thing. And or substance abuse treatment. So we also see in these cases, there's oftentimes some overlap in terms of violence that's occurring in substance abuse. The substance abuse, I would just say this as a former chemical dependency counselor, substance abuse does not cause the violence. I worked with plenty of people who are totally sober and were still hurting their partner and people who had addiction issues that were not hurting their partner. But we do see where those two things can be commingled and it can make the violence more dangerous or more extreme. But helping folks understand those courts are really educate yourself in your state. What does a protective or restraining order mean? And how does what can be added into that, right? So that when survivors are going in, this is something legal advocates would be able to help with, legal services. We want to make sure that folks know what they can ask for in terms of protective orders. So since we're talking about systems, someone had sent a message about police and law enforcement needing to do a better job determining dominant aggressors in their community. They're saying that there's a lot of abused women that are being arrested in jail because they actually are leaving some kind of mark on the abuser. I don't know if you wanted to touch on that just a little bit or spend a little space talking about that. Oh yeah, definitely. Yes, the training for law enforcement definitely needs to be continuous and that is true, right? We have a lot of unfortunately survivors that end up being arrested because if all law enforcement is looking for is who left a mark, then we either get both people arrested, right? And they just figure the courts will sort it out or we end up with the survivor being arrested. I know I have worked with survivors where in their particular community it was whoever got to the phone first, whoever called the police first and they would just come in and arrest the other person. It does not always happen where they are coming in and doing their predominant aggressor assessments and that becomes a place of where training has to happen, continuous training has to happen. And this is really a place where local domestic violence programs can help provide that support and that and that's why building that relationship at the local level between advocates and police becomes so important. And this is also a place where coalitions can also push as well at the state level with state police and pushing that down and making sure that those trainings are happening and that folks are really doing predominant aggressor assessment on scene. Same thing with the lethality assessment. So certainly do not want to make it sound like it's all peaches and roses out there. There is still unfortunately a lot of harm that ends up happening which also then becomes a reason why survivors may not choose to engage with police or with courts in terms of being able to leave. And if you are working with the survivor and you say anything about the police or the courts and they like pull back or they're like no or they start to shut down and disengage, that's just not, it's going to be a no-go for them in terms of safety planning and we have to move into other, thinking through other resources, right? We don't want to push them to use a resource that could ultimately end up being harmful to them and their family. Thank you, that's a great question. We do see here in terms of safety planning strategies for domestic violence services, getting to know if you are a clinician, really getting to know who are your domestic violence service providers in your area, what resources do they actually offer. Again, when you're talking with someone, we want to give clear as much information and tell people this is what these folks are offering. They do operate a crisis line so these are typically running 24 hours a day. This is where somebody can speak to a trained advocate. This may be depending on what state you're in, it is either a state-run hotline that is answered 24 hours a day or it's individual programs each have their own hotline and so how to be able to access that. Having those numbers handy. They can use, they do support groups, they do legal advocacy, they provide residential, right? So there's lots of services there that that they can provide, as well as maybe if you don't have a lot of time with the survivor, getting them in touch with the DV provider then allows this deeper level of safety planning that we're talking about. They can provide that ongoing safety plan and the shelter as well. Getting to know these folks is critically important. Oh yeah, I was just going to add to that. I think it is so important, too, that clinicians know, like you said, the domestic violence services in their area and specifically if those domestic violence shelters in their area or in their state are able to house pets, I think it's so important to have in your toolbox so that when you're dealing, when you're working with a survivor that has a pet they are unwilling to leave, you're able to connect them to resources for that specific situation. Yes. Absolutely. Yeah. The people will not leave their pets behind and abusers often have pets. Definitely making sure. That's a great flag. Thank you. Finally, in terms of our services that we want to recognize, there is the State Domestic Violence Coalition. You may not necessarily have a lot of contact with these folks, but they do provide lots of resources, lots of your trainings that happen across the state may be provided by some of the coalition staff. And coalitions also run, they may run some direct service programs, so they may offer housing or hotel vouchers. They may offer some legal services that they can get survivors attached, connected to. And they can also provide information on address confidentiality programs. This is available in your state. As often as I will talk for Ohio, it's run through the Secretary of State's office. And this is where, again, that witness protection idea, right? That we don't want folks to know where the mail is going. And it is oftentimes when survivors move, things can get lost in the mail because they're moving around. Batterers can obviously get hold of new addresses. And so this is an address confidentiality program. And typically the way this works is that the mail goes to a central location, right? To the Secretary of State's office, and then they mail it on from there, right? So you want to find out how this works in your state, if your state has it, and then how does it work. It is a great program that survivors can be able to access, and your state domestic violence coalition or your local service provider can tell you all about that so that that's information you can also provide as well. Again, get to know these folks. They can be super helpful and provide lots of resources and information to you and be a support. That is the whole role of the coalition is to provide training and support to providers. So I am going to say next slide and turn it over to Lacey. Thank you, Tonya. Another system that many of these patients or survivors are going to interact with is the healthcare system. And there's so many reasons why a patient might access healthcare, whether it's routine medical care, emergency medical needs that are not related to IPV, or they may be related to IPV, or they also might be accessing healthcare system for medical forensic services specifically after an IPV-related incident. And in all of those instances, it's really important for clinicians to ensure that patient privacy, confidentiality, and safety are the priority. And that really looks, when we're talking with patients that come in, and that's every patient, not just patient that might come in saying that they were involved in an IPV or sexual violence incident, but every patient, that we are asking them in private if they feel safe at home, that we are doing these screenings and making sure that when we're doing these screenings, that we're doing them with the patient alone, and that when we're asking the patient or asking whoever may be with the patient to leave the room, we may have to get creative with how we do that. It might be that we have to say, okay, we're going to walk, you know, across the hallway to the bathroom. If you're in an emergency department, you may not have a bathroom in every room. You may just have to take those few moments when you're alone with the patient to have that conversation and really build trust before you start having these conversations. And also to let the patient know early in the encounter what is to be kept confidential, making sure that they understand mandatory reporting. We talked a lot about that in the last webinar, but really keeping the focus of all healthcare encounters being the patient's privacy, confidentiality, and safety. Angelita, I don't know if you had anything that you wanted to add. I think it's just important for, regardless of what your primary field is in healthcare, just making sure that education spans across the whole department. So from the person that's doing registration to the person that may be the front desk clerk to the medical assistants that may be doing triage in a doctor's office, helping them to understand how to engage with individuals that are experiencing IPV. It will be said, sometimes a patient may be coming in for routine medical care, but a disclosure may happen real time in those visits. And so we have to know how to actually respond and continue to actually appropriately communicate and work with those patients. A lot of education across all of the team, all of the care team is really important. And I think we talked a little bit earlier about when an abuser might call the hospital and they know that the victim is there and making sure that all hospital staff are educated about what can be shared on the phone about patients and that even an acknowledgement that a patient is there could be very dangerous depending on their situation. Also, if we're calling to give any kind of follow-up care or if we're making phone calls with results of labs and things like that, that we're following HIPAA guidelines and ensuring that we're not leaving patient information or information about where the patient might have accessed health care. If you're at a hospital or sexual assault center or private clinic that you're not calling and saying, this is Lacey from this specific organization, so that if someone listens to their voicemail, they know that they had accessed health care at a specific location. Just maintaining that patient's privacy can really help keep them safe. So, we feel like it's really important to specifically talk about certain populations just to make sure that you have some key approaches to actually addressing these various populations appropriately. Of course, you're going to have an individualized assessment, right? So, every patient is different. You need to be adapting your particular exam process to the patient that you have in front of me. But that also means that you have to go into a little bit more detail about exactly what disabilities this patient may actually have because we do have disabilities that you won't know unless the patient actually shares them with you. And it's important to make sure that you understand all of the disabilities that the patient has so that you can make sure that the resources that you're providing them with are appropriate and that they're all covered. For example, if you're doing an emergency kit preparation or you are making sure that they have accessible emergency contact, you want to make sure that those contacts are going to be individuals that know about the particular types of disabilities, know how to work with that patient in regards to those disabilities, and that they actually, their space is an accessible space for that patient. If we have a patient with a physical disability that has an emergency contact that lives on the fourth floor with only stairs, that's not going to be the best place for that patient to actually try to make their connection to that if they were trying to leave. Just make sure that the emergency contacts all are aware of what, however many there are, hopefully there's not a lot of them, right? We've talked about having a select few so that you don't have too much, but that these are individuals that the patient agrees to, is familiar with, and that the information that is needed to make sure this patient has everything they need in place if they had to go to this person, so that works out. In terms of an emergency kit preparation, you want to make sure that the patient has been able to actually get everything that they need, everything that's going to meet their needs. For example, do they have medications that they take regularly that they can keep in this little, whether it be in one package or whether they keep them in certain spaces, so that if things are found, they do not have access to everything at once. Do they have any medical devices? Do they have any communication devices? It's really important to understand that communication devices and also accessibility devices such as wheelchairs and walkers, those type of things sometimes are withheld related to abuse, so we want to make sure that we understand the dynamics and that the patient has access to some form of those things in an emergency kit preparation. Make sure that any resources that you connect the patient to, I think we talked about this a lot already, but that they're actually resources that are going to be appropriate for that particular patient. Again, if you give a patient a resource to an organization that has never, that has, this person has a physical disability or they need interpreters or ASL and they don't have access to those and they're unable to provide it, that's not going to be useful to the patient, so we want to make sure that whatever we are actually connecting this patient to, whether it is an organization or we're giving them actual resources to look up on their own, that they actually are appropriate for that particular individual. The other thing I touched on a little bit was just making sure that there's training across the board, so I talked about training across a care team, but you want to make sure that there's training across all providers, so we're talking a lot about collaboration. We want to make sure that you have the appropriate people at the table, so speaking specifically about any type of disability, you want to make sure that you have collaborated with your community partners that specifically work with that type of disability to assist in training your providers on how to actually do the best job for that particular type of disability when you have a patient with that disability. It's super important to have that cross-training, and then you also want to make sure that when you're doing the cross-training across providers, when you're thinking about the victim service providers that you're working with, that everybody understands what everybody else's plan is, what their role is, and what the response is for each individual discipline within that particular community. And then the last thing that we have is just making sure that we're utilizing technology appropriately. I think it was Tanya who mentioned about how technology has advanced a lot, and there's lots of different things that we have access to. We need to make sure that, first of all, whatever we're accessing is going to be appropriate for that particular patient, that we're not disclosing information in spaces through apps and things like that, that we're using, if technology is being used as an assistive device, that we're knowledgeable about that, and that if we're passing that patient on to someone else that we are communicating, that those assistive devices are needed to communicate with that patient and make sure that they're familiar with how to utilize them, and making sure that if we are giving information about things like that, we actually have vetted them ourselves, vetted them with our community partners, with the advocacy, the victim service providers that work specifically with domestic violence, to make sure that they're actually safe apps and that they're going to be discreet for the patient. It's really important that, again, you work together to make sure that some of these needs are met because you really don't want to unintentionally set up a patient with disabilities for failure just based on the fact that you did not think through the things that they may need specific to their disability. Thinking about the patients who may be deaf or hard of hearing, it's going to be most ideal if you actually can have organizations that are for deaf, by deaf, that provide for deaf, by deaf services, versus having services that are made by hearing people. Every community does that, but it's really important for you to be able to learn what's in your community, learn what's locally in your state, because those are going to be the best services for patients that are deaf. The reason I say that, a person that has been deaf their whole life, it's going to be really different for a person that may have become deaf at some point. There's a difference in how they're engaging, how they're interacting, and sometimes even how they're communicating. A person that may have been deaf their whole life may not necessarily know ASL, versus the person who was not deaf their whole life may have learned ASL and now they are actually the person that is helping to translate things. The more you can actually have resources and have interactions and have advocates that work from the for deaf, by deaf perspectives, that's really important. If you have never thought about that in your own community, I suggest that you look into that. There are multiple different organizations that you can look into to learn a little bit more about where things are for your particular community. Communication is going to be really important. You need to make sure that you understand what the communication needs are for these individuals that you have based on who you have in front of you. Don't make assumptions. Don't assume that every single person reads lips. Don't assume that every person uses cell. Don't assume that ASL is the first choice language for a patient either. You need to make sure that we're actually assessing that and that we're meeting the needs on the patient based on that. I hit on this on the previous slide, but just making sure that we understand, particularly about communication devices, that sometimes that is a part of IPV, whether it's withholding it, sometimes damaging it so that the patient is not able to use it as appropriately, those things do occur, and we need to actually be mindful of that. Another thing for us to think about, especially in terms of safety planning for patients that come from Deaf communities, is that they're a really close-knit community. They talk to each other, work it out about things a lot. So a lot of times they may not feel as comfortable sharing as much information with the thought that it'll get back or the knowledge that it will get back. If I happen to be a provider and I send a person who is Deaf to a rape crisis center, that's the only rape crisis center, and they're the only ones that provide services to Deaf and hard of hearing, but it may not be the best form of services, but all is there, there's a potential that can get back to the community. It can get back to the abuser, and it can also silo the patient from within the community for multiple different reasons that Mildred covered in the first webinar. So just keep that in mind when you are working with this population that they really are close-knit, and it is really important to talk about privacy and confidentiality and what their comfort level is, specifically around resources and how you're going to set things up, even definitely with safety planning. And then also when you're thinking about giving information about shelters, really think through the shelter to make sure that the particular shelters that you are looking into or providing resources that you actually had a conversation with the providers of that shelter to make sure they actually can accommodate this particular patient population. There are very limited resources for patients that are Deaf in terms of shelters. I'm going to talk about some considerations for providers when safety planning for LGBTQI plus survivors. First is that the core areas of safety planning are the same, but there may be some additional strategies that the patient needs depending on the specific needs of the patient and their circumstances. It's critical that clinicians and victim service providers communicate with the patient or survivor that they're working with and determine their needs so that they can move forward with safety planning. It's also really critical that providers really examine their own biases and handle those before they begin this encounter so that we can provide the best safety planning for this patient. Really important to recognize that individuals in the LGBTQI plus community may have apprehension about seeking services from health care, law enforcement, the legal system, and other systems because of past experiences. And important that we have inclusive and informed practices in place so that we can build trust with these patients that are seeking out our services. Also important to understand that domestic violence tactics can be different in these relationships. The use of stereotypes about LGBTQI plus relationships can be used to control a partner. The abuser may question the ability of the victim's gender identity. It can be a lot easier to stalk and impersonate a victim if they're in a same gender relationship. And this is important for us to keep in mind when we're taking care of these patients providing services that their abuser may be the same gender. And if they're calling into our crisis line or our center or to law enforcement or to their job, it can be really easy for them to impersonate that victim. So something that we can do to help prevent that is to try to set up some kind of password or safe word with that patient when we're communicating with them so that we know who we're talking with. Or just if they're able to come in and speak in person so that they cannot be impersonated. Abusers may force a partner to have sex with them in a way that doesn't align with their gender identity. Identity theft can happen in these relationships and in cisgender relationships as well. Many abusers might threaten to out their partner and isolate them from the community. And abusers may withhold medications like hormones, deny access to clothing, prosthetics, binders, and cosmetics that a transgender person might use on a daily basis. Some barriers to think about are a lack of access to resources, specifically shelters may be difficult to access, especially for patients that are transgender. The legal system and law enforcement may misinterpret the dynamics of intimate partner violence in LGBTQ plus relationships and more likely to make dual arrests in same gender relationships. It can also be more difficult to get restraining orders and the legal system may be more likely to grant a dual restraining order in same gender relationships. And there can also be a lack of access to resources for healthcare and other victim services where the patient feels that the service is safe. So that can be a really big barrier to access and to safety planning. Some strategies for safety planning for survivors that are LGBTQIA plus first is to know safe resources. Before we refer a patient to a specific resource, we should ensure that the agency that we're referring them to is knowledgeable, they're respectful and they're competent to address the needs of this patient and consider having conversations with these agencies before referrals are made to find out what their policies and practices are for LGBTQIA plus individuals. Also understanding hesitance to access resources, important to understand why that patient may be hesitant. Also important to know that they may not be hesitant. It really depends on the patient and their specific circumstances. I think I already said we should address our implicit biases and let go of any expectations or ideas that we may have about how this safety planning encounter is going to go or how an individual should access care and resources that we listen to the patient's needs, build on their strengths, offer help that's inclusive and give them some control over the encounter. Also making sure that they understand that the abuse is not their fault, especially if an abuser has really torn down that belief in the victim. Part of safety planning is identifying a support system. For many patients, the support system that they had before the abuse occurred may not be available to them after if it's the same support system as their abuser. In small communities like the LGBTQIA plus community and the deaf community, many times everyone knows each other and it can be really difficult to identify that support system or safe person when the community is so small. But even just identifying one person can be helpful. And considering additional items for the go bag for LGBTQIA plus survivors, specifically for transgender survivors, important to know there may be additional items that they need to put in their go bag. For identification, of course, driver's license or their state identification card. They would also wanna have a carry letter if their identification is not completely updated. They may need a surgeon's letter or any other records of their name or gender change. We would want to make sure that they have their hormones or any other medications specifically for transgender patients, prosthetics, any other prescriptions, binders, gender affirming clothing or cosmetics that they may need. And Forge Forward safety planning guide for transgender and gender nonconforming individuals has more detailed information about safety planning measures and resources. So I just wanted to just jump in and highlight something that you touched on very quickly and slightly was about stocking. You mentioned about stocking. We didn't talk much about stocking in this particular webinar, but I do think it is important to bring it into this space. And we're talking about safety planning for our patients, our survivors, to make sure that you are actually aware about stocking, that you're screening for stocking and that you're documenting it based on how the patient is actually explaining it, that they're experiencing it. So I thought it may be nice to bring that into this space. I don't know if anybody else has anything to add before we move on. Sorry. In some states, and you have to check because they change often, is that you have to have three documented reports before law enforcement will take it seriously. That means if they, one, you get a police report, has to be three before law enforcement will do anything about it. Some states is one, some it's five. It just depends on the state that you're living in, but it's important to check the laws in your state because they vary from state to state. Yeah, there's a project called SPARC, S-P-A-R-C, that has resources around stocking. They're also working on some stuff specifically for healthcare that is gonna be coming up really soon. Keep an eye out, but the SPARC has been around for a little bit now. They are through an OVW grant funding, FYI. We're gonna launch a poll just to get a little bit of an understanding of what's in your communities. In your community, are advocates available to accompany patients or survivors to medical appointments or other medical encounters if requested? And your choices are yes, no, sometimes, and unsure. Just give a couple seconds for you all to respond to that. That sometimes medical accompaniment through DVF programs can be scarce, even in bigger cities. We are completely aware of that, but we're just curious what it's looking like currently for you all. It looks like at this point we have about 40%-ish saying yes, 6% saying no, 30% saying sometimes, and the last 24% are unsure. Okay, that's helpful, thank you. We wanted to start to wrap things up, just really bringing this all back to collaboration. I think we heard some great, great information and great reasons to think about collaboration, but the biggest thing is just to remember that in order for us to actually be providing patient-centered or survivor-centered responses, we actually have to make it about the survivor. We actually have to include the survivor. We actually have to have that survivor working with us to do that. It's not about always what we can do for everyone else. It's about making sure that we are focusing on it and wrapping around the survivor. Thinking about the people that you're collaborating with, we talked about multiple different types of collaboration. We talked about collaboration with your community partners. We talked about collaboration with the neighbors and organizations, social networks, faith-based, really making sure that everybody has the same shared goal, but also that everyone understands their role. And when you are providing your appropriate response to the survivor, that all the skillsets are identified and everybody, all the skillsets that are needed to address all the particulars for that specific survivor are actually being met, right? And once you have all those things in line, you're guaranteed to be able to have some sort of resource or have some guidance on where to go for resources. It has to be a collaborative approach. We can't do any of this work in a silo. And we have to work together to make sure that patient survivors are getting the things that they need that are best for them, but are what they actually want. Tonya brought up the fact that not every survivor wants the same thing. Justice looks different for each survivor. Understanding that when we are actually working with them and creating their safety plan and trying to help provide resources to them is also really important. Keeping them center and listening to what they need is really the key for collaboration. As Lacey mentioned, we have some resources specific to safety planning that we've looked at. This slide really talks about resources that are for survivors. And we talked about multiple different populations. So we tried to definitely try to pull in as many different ones as we can find that kind of covered many bases. So these are specific ones that you can go to get information specifically for survivors to help them learn more about safety planning and to help them create safety plans or review safety plans on their own. So organizations such as Tribal Resource Tool, the Deaf Hotline, the National Domestic Violence Hotline, Deaf Hope, the VA has some specific resources, National Coalition Against Domestic Violence, domesticshelters.org, that's a website that you can use to actually go in and see where the local shelters are, Victim Connect Resource Center, Strong Hearts Native Helpline, My Plan, and then the Illinois Coalition also has some very good information specifically for survivors to be able to access. And then we have to have resources for providers and clinicians because in order for us to be able to do our best doing this, we have to know where to go to get additional resources for ourselves, for our team, and just to keep our knowledge up. So of course the National Network to End Domestic Violence, the Safety Net Project, Heal Trafficking, all of these are ones that are really specific to clinicians or providers to help with learning more about safety planning, creating safety planning. And also sometimes there's like templates and templates and sample things that you can actually download to be able to assist you with learning a little bit more in the past education on. Take a look at some of these different resources. They are available to you. We created, I'm not making that up, right? We created a handout that went along with the first webinar, which also be attached to this webinar as well. That will provide you links for you to be able to go out to these different sites for yourself, see what's there for clinicians and providers, but also please review the resources that are there for survivors specifically so that you have a good idea of what they are and you can actually share them with the patients and patient survivors when you're providing services. I'm gonna turn it over to Tanya for that slide. Thank you. So I wanted to just spend a couple minutes talking about the National Network to End Domestic Violence. So they were on, they're one of your resources for you as providers. I wanted to give you a little bit just a background about them. National organization, obviously. There's 56 state and territory coalitions. So every state has a federally designated domestic violence and sexual assault coalition. Sometimes it's a dual coalition. Sometimes they're separate. They engage in doing national advocacy. They build out national partnerships and they are really focused on systems change as well as social change. So they really are working in terms of building out those federal partnerships and working with funders and all the wonderful things. But they have a lot of really great exchanges and some folks that you can access for your own information. And then there's also some resources that they provide that are for survivors. We can go to the next slide. We'll look at some of the different teams that they have. So they have their communications team. They have the safety net team. So we've talked about technology. This is really done a lot in partnership with like Meta and Google and those kinds of things. Really thinking about how do you make technology safer for survivors. And so they do have a national conference that they run every year. They have tons of really great information. So if you're looking for information around technology and how to have technology be used safely, I would definitely say, look at safety net. They run an economic justice program. This is in conjunction with Allstate. And this is where they have done a lot of work with helping survivors in terms of financial planning and those kinds of things in terms of, because we know financial abuse is one of the ways that survivors often get trapped into these situations and they're not able to get out. Women's Law is actually an email hotline that they can, survivors can email directly what their legal questions are. They will be responded to. They have this book in English and in Spanish. And so that's a resource that they actually provide out to survivors. They have a national policy team that does amazing work in terms of connecting with senators and with the Congress folks up there. They also have collaborative housing, collaborative approach to housing solutions and transitional housing. They are the national provider. So if you have a domestic violence transitional housing program and you're state and it's funded under, I believe, OVW, then this is their team provider coming out of AABV. So they work a lot with transitional housing folks in terms of making sure that they're doing best in implementing best practices, trauma-informed care, being survivor-centered. Positively Safe is the HIV program that they actually run. Again, looking at the impact of HIV, since we also know sexual abuse is one of the tactics that abusers use when we see a high rate of survivors with HIV. And then there's the CTA team, which is the Capacity and Technical Assistance Team. This team works specifically with the 56 coalitions providing technical assistance trainings and support to them. Also works with FVPSA state administrators in terms of making sure that they're up to speed, understanding the rules of FVPSA. FVPSA, if you're not familiar with it, is the Family Violence Prevention Services Act. It's the only federal funds that are dedicated specifically to domestic violence. They have worked with, and then they also work with tribal programs across the country and have built great partnerships with the National Indigenous Women's Resource Center, as well as the Alliance for Tribal Coalitions to End Violence in terms of working with tribal communities to address the violence that happens there, as well as the Missing and Murdered Indigenous Women projects that happen. That's just so you have a sense of what NADV does and why would we reach out to these people and how could they be helpful. So that just gives you a brief overview of them. And then we can move on to the next slide, which is how you can contact each of us if you have further questions or wanna do any follow-up. So this is actually if you wanna contact NADV's capacity team, capacity and technical assistance team, this is how you would get in touch with these folks. If you have questions, they could help you. If you are a local program, a DV service provider, or at a coalition, this is definitely your folks that can help reach you. That is our contact slide right there. So I'm gonna turn it back over, thank you. Thanks, yeah, here's all of our contact information if you wanted to reach out to any or all of us, feel free. We are definitely here for that, but I do wanna leave space to open up for any questions or comments that anybody may have before we close out a couple minutes. While we leave space for that, feel free to drop anything in the chat or the Q&A. We are still watching it. If you can advance the slides, maybe Lacey, if you could just drop everybody's email in the chat, that'll be great. So Tonya did a great job of talking about what NNADV has to offer. I wanted to just re-highlight what IAFN has to offer in terms of technical assistance through our safety aid project. So we do have our professional resource line. You can call that anytime you'll get access to a nurse. The telephone number is 877-819-7278. You can also request technical assistance by completing a request form. So you would just go to safetyaid.org, click on request TA. It'll ask you some information specific to the questions that you have. A nurse will respond to you based off of that. On safetyaid.org, we have a plethora of resources. Today was all about safety planning. So if we were to go to our protocol section, there is the IPV protocol that came out last May. Within that protocol, there's a whole section that covers safety planning, covers confidentiality, and touches on quite a few of the things that we talked about here today. Talks about screening. So just know that those resources are available amongst many other things. We also talked about part one of this particular webinar. You can actually access part one, same space, safetyaid.org. You would click on the webinars toolbar, and it's listed as an archived webinar that you can view freely at any time at any point. Next slide. In terms of what we have coming up next, on October 31st, we have One Step Ahead, STI Prophylaxis Guidelines and Emergency Contraceptive Updates and Accessibility. And that will be presented by Chanel Vandenbroek. And Lacey, I'll let you talk about the next one because that's yours. On November 21st, we'll have Decoding Pediatric Expert Review Insights and Strategies with myself and Jennifer Stimson from the Midwest Regional CAC. Thank you. So really just want to thank everybody for being here today. Tanya, Mildred, Lacey, we want to thank you all for doing such a great job presenting. Rebecca, thank you for managing us and our slides and being here to support us. Just remember that you all have a post-webinar evaluation to get your CE. That should, I think we dropped it in the chat. Did we drop the link into the chat? I'm not really sure. It will be dropped in a chat if it has not been and it also got to you via email. Hopefully you will make it to, if not both, at least one of the webinars that we just talked about is upcoming. And we look forward to seeing all of you at the next webinar. Thank you so much. And again, thank everybody for presenting with us today.

safety planning

intimate partner violence

trauma-informed

survivor-centered

cultural barriers

personalized safety plans

community collaboration

LGBTQIA+

disabilities

National Network to End Domestic Violence

legal systems