DOMESTIC VIOLENCEIT IS EVERYONE’S BUSINESS

Leah Rosenthal, PhDJennifer Brown, MFTClaudia Kruse, MFT

Kaiser Permanente Employee Assistance Program

It Can Happen to Anyone…

KP physician and employees victimsof domestic homicide

“An Equal Opportunity Destroyer”

Lisa Munoz1976-1999Optical Services

Cassandra Floyd, MD1966-2001OB/GYN

Stephanie Zalot1966-2003Quality Outcomes

Overview

• Establishing DV as a Critical Workplace Issue– Prevalence, health effects and costs– Why employers are getting involved– The important role of EAPs

• Building an Effective Workplace Program– Education - training staff and managers– Partnership - raising awareness– Prevention - promoting materials

• Responding to DV at the Workplace– Partnerships– Policies– EAP role

Kaiser Permanente by the Numbers

A healthy workforce requires

a healthy workplace.

• 8.7 million members• 156,000 employees• 13,729 physicians• 416 medical offices• 32 medical centers• 80% female workforce

Kaiser Permanente by the Numbers

Internal / Onsite:• Northern California• Southern California• Oregon / Washington

• Hawaii

External:• Colorado• Georgia• Mid-Atlantic States• Ohio

KP Employee Assistance Program is a division of KP Healthy Workforce and a National Shared Service.

DV is Common

New cases of breast cancer:

211,000

Number of women dying from cardiovascular disease:

484,000

Number of women who are victimized by DV each year:

1,500,000

Victims of physical DV during their lifetime (USA):

1 in 4 women1 in 14 men

A Look at National Statistics: DV Leads to High

Morbidity & Mortality

• 1 in 4 women, 1 in 14 men are the victims of DV at some point in their lives.

• DV is the leading cause of injury to American women ages 15-44.

• DV is a leading cause of pregnancy-associated mortality.

Thompson, R., et al., Intimate Partner Violence: Prevalence, Types, and Chronicity in Adult Women. Am J Prev Med, 2006. 30(6): p. 447-457.

Prevalence of DV has been Significantly Under-Estimated

• Among 3,429 Seattle women 18-65 years:– 8% are currently experiencing DV – 15% experienced DV in last 5 years– 44% lifetime prevalence– Highest prevalence occurs in working age

and parenting women• Associated with 4 times higher risk of severe depression+

+Thompson, R., et al., Intimate Partner Violence: Prevalence, Types, and Chronicity in Adult Women. Am J Prev Med, 2006. 30(6): p. 447-457

Group Health Cooperative assessing physical, sexual and emotional abuse (2006 data):

A Look at National Costs

• $5.8 billion per year.– $4.1 billion in direct medical and mental health

expenses.– $900 million in lost productivity.– $900 million in lost earnings by victims of

homicide.

• $18 billion per year for costs associated with law enforcementand criminal justice system.

Contributes to Future Health Care Costs

• Unintended pregnancy• Sexually transmitted

disease• Smoking as an adolescent• Becoming victims or

perpetrators of DV as adults

• Poorer health outcomes as adults:

�̶cardiovascular disease �̶emphysema�̶depression

Witnessing physical abuse of mother is strongly associated with health risk factors and conditions.

Based on CDC/Adverse Childhood Experiences studies conducted at KP San Diegohttp://www.cdc.gov/NCCDPHP/ACE

DV is a Costly Workplace Issue

• Hidden costs:– Abuse related absenteeism: 54% missed an average

of 3 days or more per month.*– Decreased productivity: 37% report job performance

affected.+

• Increased cost of DV + employees– $2,200/yr direct health care costs+

– $990/yr in productivity (CDC estimate)+

• Workplace security and liability– In a survey of EAP programs, 83% had

employees with restraining orders.

*Laurence, L. and R.Spalter-Roth, Measuring the Costs of Domestic Violence Against Women and the Cost-Effectiveness of Interventions. 1996, Institute for Women’s Policy Research.

+Cost of Intimate Partner Violence Against Women in the United States. 2003, National Center for Injury Prevention and Control, CDCP

Health Effects

More than physical injuries…• Headaches• Insomnia, fatigue• Chest pain, palpitations• Chronic pain syndromes• Substance abuse or relapse

Mental Health Effects

• Major depressive disorder

Occurs in 63-81% of abused women comparedto 7% in controls.

• Generalized anxiety

Occurs in 38-47% of abused women compared to 6% of controls.

DV is Closely Associated with Other Health Risks

• Smoking• Sexually transmitted infections• Not obtaining preventive care (breast and cervical

cancer screening, immunizations) • Sub-optimal control of chronic health conditions

(diabetes, asthma, hypertension)• Unintended pregnancy, complications during

pregnancy• Other chronic health problemsCenters for Disease Control (CDC), Feb 2008

Aiding Recovery

• The majority of women end abusive relationships.– On average, it takes about 5 years.– On average, leave 3-5 times.– Most do not have another abusive relationship.– Financial resources and economic stability are

extremely important.– Focus on safety.

Inquiry and Referral

Supportive Environment

Leadershipand

Quality Improvement

On-siteResources

CommunityLinkages

“Kaiser Model”

“The Systems Model” Health Care Approach to DV Prevention

Engaging Leadership

How to engage leadership:• Identify a “Champion.” • Begin a DV Prevention Task Force.• Build the business case for prevention by:

- examining prevalence.

- presenting financial and human costs.

KP Domestic Violence Champions

• Brigid McCaw, MD, MS, MPHMedical Director for Domestic Violence ServicesKaiser Permanente Northern CaliforniaBrigid.McCaw@kp.org

• Tammy JonesSenior Vice PresidentHealthy Workforce, National Human ResourcesTammy.Jones@kp.org

• Jerry O’Keefe, MFT, CEAPDirector, Kaiser Permanente National EAP ServicesJerry.O’Keefe@kp.org

Why are Employers Getting Involved?

A healthy workforce:

• contributes to organizational prosperity.

• fosters workplace safety (OSHA).

• reduces risk of legal and liability issues.

• enhances community improvement and positive business identity.

• decreases expenses associated with health care.

Building a Workplace Program

Raising awareness at work…

• Where to focus?

- Prevention• How to prevent?

- Education, partnership and promotion

Healthy and Productive

Healthy and Productive Risk Factors

DevelopRisk Factors

Develop Early ClinicalDisease

Early ClinicalDisease

Full Blown Clinical Disease

Full Blown Clinical Disease

Severe Disease and Disability

Severe Disease and Disability

Chronic CareManagement

When to Promote Health at Work?

Prevention and Health Promotion

Raising Awareness at WorkRaising awareness at work…

Domestic Violence at Work…Who is Affected?

• Victims– 12 months, affects 8% of female and 3% of male

employees.– Frequently associated with other conditions that

reduce work performance.

• Co-workers– Increased workload.– Concern about safety.

• Perpetrators– 20% of employees report they have known

co-worker who perpetrated DV on work time.

EAP and EmployersEducation, Partnership, Prevention

ReligiousLeaders

ReligiousLeaders

AdvocatesAdvocatesPolicePolice

EmployersEmployers

Health Professionals

Health Professionals

EducatorsEducators

FriendsFriends

Policy MakersPolicy Makers

Judges & Legal Professionals

Judges & Legal Professionals

Thank You!