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Intimate partner violence

This track of training provides the resident with the opportunity to be part of innovative clinical work and programming to assist Veterans who have used and/or experienced aggression in their intimate relationships.

Intimate partner violence
Dr. Lauren Grabowski |
Dr. Josh Berger |

This track of training provides the resident with the opportunity to be part of innovative clinical work and programming to assist Veterans who have used and/or experienced aggression in their intimate relationships. There is a strong emphasis on use of Veteran-centered, strengths-based treatment from a psychosocial rehabilitation perspective. The postdoctoral resident will engage in direct clinical care; consultation; clinic administration; outreach and education; and program evaluation/development.

Specifically, the resident will further the four goals of the IPV program:

1. Primary prevention of IPV through promotion of healthy, respectful relationships and working toward the reduction of social and economic disparities that contribute to risk of IPV (CDC, 2010).

2. Consultation and training for clinical and support staff related to prevention, screening, and treatment of IPV.

3. Assessment and treatment of Veterans who have and/or are currently experiencing and/or using IPV.

4. Education and outreach around IPV, both within the VA and the broader community.

The IPV resident will also participate in a minor rotation in the outpatient Mental Health Clinic Recovery Services where they will be embedded in one of the Behavioral Health Interdisciplinary Teams (BHIP).

Veteran and military families are at increased risk for intimate partner violence (IPV). The stressors posed by military life, such as frequent moves, financial stress, and potential exposure to violence, are all factors associated with increased the likelihood of violence occurring in the home. In addition, there is a higher incidence of diagnoses associated with IPV, e.g., PTSD and substance abuse, in the veteran community. Due to this increased risk level, the Department of Veterans Affairs has designated funding and staffing to treatment of individuals impacted by IPV.

The Safing Center was established at VA Bedford HCS as a specialty mental health clinic focused on treatment and prevention of intimate partner violence. Staff in the Safing Center have been involved in supporting the development of the National IPV Assistance Program since 2011. One goal of the Safing Center has been to develop innovative clinical programming to assist Veterans who are at risk for using and/or experiencing IPV, positioning our clinic as a particularly well-resourced and unique program within the VA healthcare system.

The Safing Center primarily focuses on clinical treatment, providing individual, couples, and group therapy for veterans and their partners struggling with current or past IPV. Additionally, the Safing Center provides outreach and psychoeducation to staff and veterans at ENRM Veterans Hospital and the broader community on topics such as IPV screening; risk assessment and safety planning; documentation; veteran-specific considerations for individuals who use and/or experience IPV; and prevention through promotion of healthy relationship skills.

There are four primary domains to the IPV residency:

IPV screening and assessment
Intakes within the Safing Center include screening and assessment of IPV risk and severity, as well as assessment of associated risk and protective factors. Through the use of empirically supported measures and a structured clinical interview, the fellow will gain competency in conducting comprehensive IPV intakes and risk assessments that are used to guide treatment planning and interventions.

Individual, couples, & group counseling
The resident will be trained in the provision of trauma informed and evidence-based treatment for individuals that have used IPV, experienced IPV, or both. Individual and couples cases are referred from other programs within the hospital (e.g., Veteran’s Justice Outreach, Primary Care, Outpatient Mental Health, Addictions, Women’s Health Clinic) and community stakeholders. The resident will also provide group therapy or psychoeducational groups targeting promotion of healthy relationship skills and prevention and recovery from IPV.

Staff consultation
Often, individuals who have used or experienced IPV are hesitant to disclose due to a variety of factors (e.g., stigma, shame, fear of legal or custodial repercussions). Our clinic provides private and confidential support to staff, veterans, and loved ones related to relationship problems and concerns about IPV. The resident will have the opportunity to provide consultation to trainees, staff, veterans and their loved ones with regards to a range of relationship concerns

Training and education
The resident will engage in training and outreach for trainees and staff members toward raising awareness about IPV prevalence and veteran-specific considerations in screening, assessment, conceptualization, and intervention. In addition, there is the option of engaging in program evaluation and development in the Safing Center.

Secondary rotation
The IPV residency also includes a minor clinical rotation in the outpatient Mental Health Clinic (MHC). This provides the resident the opportunity to provide treatment in the context of an interdisciplinary treatment team that includes staff and trainee members of psychology, social work, psychiatry, and nurse practitioners. The MHC provides treatment for a wide range of diagnoses and associated life factors.

Learning objectives
1. Working knowledge of current and relevant research on IPV prevention, assessment, and treatment

2. Working knowledge of psychosocial recovery and strengths-based approaches to IPV intervention and treatment

3. Ability to screen and assess for the signs and symptoms of IPV use and experience

4. Accurately conceptualize overall client functioning from resident’s primary psychotherapeutic orientation and other salient psychotherapeutic orientations

5. Accurately conceptualize overall client functioning from a PSR-oriented recovery model

6. Ability to identify and attend to the relational process in psychotherapy

7. Ability to respond effectively to the content (client’s thoughts, feelings, and behavior) in psychotherapy

8. Ability to empathically join with the client

9. Ability to target and work toward specific goals in collaboration with the client and effectively implement clinical interventions for treatment of IPV-related issues.

10. Ability to effectively facilitate a psychotherapy group focused on IPV

11. Ability to work effectively with interdisciplinary providers who hold differing treatment orientations

12. Skill in outreach and education around IPV awareness, assessment, and treatment

13. Ability to design and implement programmatic changes

14. Ability to provide consultation to other staff members regarding IPV

Target professional experiences
1. Carry a caseload of approximately 8-10 psychotherapy clients in the Safing Center and 4-6 clients in the Mental Health Clinic Recovery Services (MHCRS), providing a minimum of 10 hours/week of psychotherapy through various modalities

2. Co-facilitate weekly group therapy in the Safing Center and MHC (e.g., Strength at Home, healthy relationship promotion, etc.)

3. Attend and participate in weekly Safing Center and MHC team meetings

4. Provide consultation and outreach to providers, trainees, and staff across the hospital and broader community

5. Participate in events to promote healthy relationships and IPV awareness throughout the hospital and community

6. Provide brief and in-depth trainings across programs throughout the hospital to increase awareness and knowledge of IPV among Veterans

7. Participate in needs assessment; program evaluation and development; and/or research within the Safing Center