In partnership with San Francisco Kaiser Permanente and La Casa de Las Madres, LEAP developed an innovative new safety plan that is low literacy, age-neutral, and gender-neutral. Beginning with the affirming statement “you deserve to be safe and happy,” LEAP’s transformative, patient-centered safety plan:

• Encourages a person to think about her/his feelings about a relationship;
• Recognizes the complexity and danger of trying to break free from an abusive and controlling relationship; and
• Does not assume that a person is ready to immediately leave his or her partner.

Other key features of the safety plan include:

• Tips for staying safe during a fight.
• Steps to building independence while in an unhealthy relationship.
• Questions to assess for signs of increased danger or lethality in the relationship.
• Advice on planning for the safety of children.

With both national and local San Francisco hotline numbers, the safety plan itself also serves as a resource list for people if or when they decide to seek help. By providing much more than the usual list of things to flee with in an emergency, the plan helps guide people and healthcare providers in assessing a victim’s feelings and empowering a victim to improve his or her safety. LEAP’s safety plans can be downloaded and printed in Chinese, English, Spanish, and several other languages from the Safety Planning page of LEAP’s website.

These are all examples of the vicarious trauma that healthcare providers who deal with victims of intimate partner violence (IPV), sexual abuse, and other forms of trauma experience daily in their work. Through a new online curriculum and healthcare trainings, LEAP addresses vicarious trauma to improve trauma care and provider well-being.

What is vicarious trauma?
Vicarious trauma (VT), sometimes also labeled as “burnout” or “compassion fatigue,” is defined as, “...the process of change that happens because you care about other people who have been hurt, and feel committed or responsible to help them.” Over time, this process can lead to changes in a care provider’s psychological, physical, and spiritual life.

LEAP and VT
and then to check in with themselves about how their body, mind, heart, and spirit feel.” Co-facilitator Val Robb, from the UCSF Positive Health Program, explained that the VT training is crucial because, “learning about vicarious trauma is another way to maintain self awareness and actually grow rather than constrict in the presence of other's pain.”

Free VT Training Materials
The training materials, developed specifically for LEAP by Greg Merrill in consultation with other LEAP members, can be used in diverse service organizations. All the materials needed to conduct a one-hour training on VT, or a full day “train the trainer” conference are available on the LEAP website, including a guide for facilitating the discussion, a handout for participants, and a powerpoint presentation on VT. To learn more about vicarious traumatization, visit the training page of LEAP’s website, and download the podcast featuring special guest Greg Merrill to hear in his own words how this unique curriculum was developed. Over the course of a year, LEAP provided therapeutic vicarious traumatization training healthcare providers. to more than 150 LEAP’s trainings culminated in a “train-the-trainer” session in July 2010 to help prepare 20 professionals to facilitate their own workshops on VT at their respective organizations. Lead facilitator Greg Merrill, LCSW, Director of Field Education at UC Berkeley’s School of Social Welfare, described his hope that the trainings on VT, “give folks a space to reflect upon their original intentions as care providers

• Children’s Health Center at San Francisco General Hospital (SFGH)
• Cole Street Youth Clinic, a collaborative project of the San Francisco Department of Public Health, Huckleberry Youth Programs, and the University of California, San Francisco’s (UCSF) Division of Adolescent Medicine
• Family Health Center at SFGH
• Maxine Hall Health Center
• Multi-Service Center South Clinic, a UCSF medical student-run clinic.
• Positive Health Program at SFGH
• Silver Avenue Health Center
• Street Outreach Services of the San Francisco Community Clinic Consortium (SFCCC).

The primary goal of the Collaborative was to develop sustainable IPV screening programs that will ensure patients are asked about their experiences of abuse by a healthcare provider. In the hectic daily routine of a community clinic, the many competing demands on a healthcare provider’s time make it challenging to add new work to their responsibilities. Helping clinics to make IPV screening an integrated part of regular care will ensure that patients are routinely asked about their experiences of abuse, regardless of such challenges.

With the support of clinic directors and staff, LEAP conducted quality improvement reviews at each site to evaluate the IPV screening and intervention practices that were in place. Clinics were also provided with training on IPV screening and feedback on the results of these reviews. Participating clinics saw increases of up to 50% in the number of female patients screened for IPV by their healthcare providers. This is a huge accomplishment that requires the time, commitment, and dedication of an entire staff to achieve.

LEAP has also been working to increase awareness and knowledge about IPV and appropriate interventions among healthcare providers and health professions graduate students. LEAP has provided training on best practices in IPV screening, and shared screening tools through LEAP’s website. LEAP’s website provides a comprehensive online resource for healthcare providers tackling IPV issues with patients, including training videos, “how-to” screening guides, and reporting guidelines for San Francisco healthcare providers. Each year LEAP, trains over 300 medical students, doctors, nurses, social workers, and other care providers on IPV screening and intervention. Through this intensive work, LEAP is training not only current care providers, but also the next generation of providers, in the hopes that they too will make screening an integral part of practice for life in their respective fields. For more information on LEAP, and the IPV resources available for both patients and healthcare providers, please visit www.leapsf.org.

Fortunately, Jorge’s social worker had attended a training about U Visas. Jorge’s social worker educated him about his rights to seek a legal path to citizenship through the “U Visa” process—which was designed to protect our communities by allowing undocumented victims of crime to cooperate with the police. With the support of his social worker, Jorge sought legal help and began the process of applying for a U Visa, and is now attending therapy to heal from this traumatic experience.

The second Wednesday of October is nationally recognized as Health Cares About Domestic Violence Day. This day provides an opportunity to raise awareness about the effects of domestic violence on the health of men, women, and children, and to call attention to the unique opportunity that healthcare providers have to provide support and assistance to patients who are in abusive situations. On October 12th, in partnership with the San Francisco Department of Public Health, Maternal, Child, and Adolescent Health, Perinatal Services, and the Immigration Center for Women and Children (ICWC), LEAP co-sponsored a free lunchtime training at San Francisco General Hospital titled Immigration Options for Victims of Domestic Violence or Serious Crime.

The training was a great success, with 142 healthcare providers, social workers, and community- based agency staff members attending. Presenter Susan Bowyer, Directing Attorney of the ICWC San Francisco office, discussed the benefits and challenges of applying for immigration status under the U Visa and the Violence Against Women Act (VAWA). The training provided an opportunity for participants to learn not only about the basic eligibility requirements and steps for applying for these types of visas, but also about the potential these paths to citizenship have to free noncitizen men and women from the cycle of abuse that victims of domestic violence face. For more information about ICWC and the legal services they provide, please visit www.icwclaw.org.