June 2017

Project Updates

Wow, what a busy few months! Below are highlights of VEGA’s main activities since our March Newsletter.

  1. VEGA National Guidance & Implementation Committee (NGIC) meeting June 14-15, 2017
    We had a terrific VEGA NGIC meeting in mid-June; many thanks to all the NGIC members who participated, and to Howard Bergman and Karima Velji for co-chairing a superb two days! Members who attended the meeting did great work in reviewing the guidance on child maltreatment developed by the Child Maltreatment Evidence Review Group (see below for additional details on the systematic review), and looking at inter-professional referral pathways. A core part of the agenda was to discuss the evolving VEGA curricular framework and accreditation considerations, and think through initial ideas for curriculum delivery, including interactive serious gaming scenarios presented by Steve Wilcox of Wilfrid Laurier (Games Design & Development), and the use of animated teaching tools, such as digital white boards, presented by Mike Heinrich from Reframe Health Lab.We also updated members on progress, and planned ahead, especially in the area of knowledge mobilization strategies to prepare stakeholders to take up VEGA products, when ready.

  2. VEGA Practice Handbook: Recognizing and Responding Safely to Family Violence
    A key new product – the VEGA Practice Handbook: Recognizing and Responding Safely to Family Violence – was discussed by the NGIC. This online tool is envisioned as providing a bridge from the evidence-based guidance (largely text-based) to the foundational curriculum, which will include additional information (such as the prevalence, causes and consequences of family violence), as well as integrated learning outcomes and assessment strategies. The Handbook will be practice-focused, providing “on the ground” strategies, scripts and tools for health and social service providers. We are exploring various delivery methods, including web-based, printable (pdf), and “app” versions. More to follow!

  3. Knowledge Mobilization
    We are engaged in ongoing knowledge mobilization, which includes presenting VEGA content to a range of policy and practice audiences. We appreciate the various links made to new audiences by our NGIC members – please keep talking about VEGA, and visit the website home page for summary tools and infographics to share. We also post new resources on the Resources page on a regular basis.

An Update from the Child Maltreatment (CM) Evidence Review Group (ERG)

VEGA staff presented the findings of our systematic review for identifying and responding to children exposed to maltreatment to the Child Maltreatment Evidence Review Group (ERG) on May 4th and 5th, 2017. The ERG considered the following:

  • Whether to update the World Health Organization (WHO) guidelines – (Mental Health Gap Action Programme (mhGAP)) on Child Maltreatment identification, and
  • Whether to recommend four broad groups of psychosocial interventions for children exposed to maltreatment:
    • Counseling/therapy interventions;
  • Clinic-or community-based parenting interventions;
  • Home-based parenting interventions (often called home visiting interventions);
  • Child-focused skills training interventions

Evidence for additional interventions, such those related to foster care, will be reviewed later in 2017 for presentation at the next NGIC meeting.

Draft Guidance statements were reviewed by the Evidence Review Group, and the high-level evidence by the NGIC. The guidance statements will be made publicly available on the VEGA website, when finalized.

Partner Perspectives

The partner perspectives feature offers insight into various components of the VEGA project, as well as the ways in which different health and service providers approach recognizing and responding to family violence within their own practice areas. The Knowledge Mobilization team would like to thank Victoria Leck for her valuable contribution to this edition.

Victoria Leck (RDH, MHM), Canadian Dental Hygienists Association

Victoria Leck (RDH, MHM), Canadian Dental Hygienists Association

Tell us about yourself and your work

I have 26 years of experience as a dental hygienist, with 18 of those spent in public health. I am a graduate of the dental hygiene program at Canadore College, hold a Bachelor’s degree in Health Administration from Ryerson University, and a Master’s degree in Health Management from McMaster University. Currently I am the Manager of Professional Development at the Canadian Dental Hygienists Association and in that capacity, sit on VEGA’s NGIC, as well as on its Education and Curriculum Leader Table.

As Manager of Professional Development, it is my privilege to assist our 17,000 members in meeting their continuing competency requirements through offering quality professional development opportunities and promoting resources developed by others.

Please share with us the impact of your work

Dental hygienists can play a key role in the area of family violence, as many physical injuries occur in the head and neck region, and can therefore be discovered by dental hygienists during an appointment. Our clients come to us when they are healthy and generally there is privacy afforded to the client and the provider, which can facilitate disclosure. Additionally, since our membership is overwhelmingly female, and women are frequent targets of intimate partner violence, dental hygienists can support co-workers, colleagues, and family members who may be experiencing violence in their personal relationships.

What are three practical tips that you would give to people in your field regarding care of adults and/or children who have experienced family violence and its impact?

  • Be aware and intentionally look for signs and symptoms that could indicate family violence;
  • Practice conversations that open up the topic, and ensure that you create safe spaces and relationships in your practice for these conversations to occur; and
  • Know where to refer adults who disclose that they require immediate assistance, and understand your responsibilities as a health care provider if you suspect a child has been a victim of, or exposed to, some form of maltreatment.

Related Work

This section has been added to highlight related work in VEGA’s core areas of family violence, mental health, and trauma-and violence-informed care that inform our work, or may be useful to those working in the field. Please send us ideas for featuring new or emerging projects that VEGA stakeholders may find noteworthy.

Trauma- and Violence-Informed Care in Action: Promoting Health Equity for Indigenous and non-Indigenous People in Emergency Departments in Canada
by Colleen Varcoe, University of British Columbia School of Nursing and VEGA expert Consultant

Emergency Departments (EDs) in Canada often operate over-capacity, and under significant pressures. In this environment, particular groups of people experience inadequate and inequitable treatment in EDs. These include Indigenous people, racialized newcomers, people with mental illnesses, those living in unstable housing or facing homelessness, experiencing interpersonal violence or using substances, and people involved in sex work. Such groups face higher levels of violence that are linked to social inequities. For example, Indigenous women are at least four times more likely to be murdered, and experience partner violence at over four times the rate of women in the general population; these elevated rates are related to socioeconomic conditions. (1-4) Due to these dynamics, trauma-and violence-informed care (TVIC) is basic to providing equity oriented care – that is, care that helps to address and reduce inequities – in EDs.

Our study, funded by the Canadian Institutes of Health Research, is testing an intervention to improve the capacity of EDs to provide high quality care to people at greatest risk of experiencing health and health care inequities. Through collaboration among Indigenous leaders, ED staff and leaders, and researchers, the project aims to improve care, safety, and access, and decrease adverse events for patients and staff. We are adapting the Equity-Oriented Care (EOC) interventions we previously developed for Primary Health Care (PHC) clinics, so that they apply to the ED context 5 . We will be drawing on and adapting tools developed from that study. See https://equiphealthcare.ca/toolkit/.

Trauma-and Violence-Informed Care (TVIC) is integral to the intervention, and is a core part of the emerging VEGA guidance and curriculum. TVIC helps practitioners to create health care environments that are as safe as possible for everyone, including people who have significant histories of violence and trauma. It also helps practitioners pay attention to the fact that people may currently be experiencing violence in their lives, and that certain conditions (e.g., inadequate housing, poverty, racism) may expose them to ongoing violence. Rather than "screening" people for a narrow range of violent experiences, practitioners are encouraged to offer a safe environment in which those with trauma histories will not be re-traumatized by care. And, those experiencing ongoing violence will feel safe to seek, disclose, and receive support.

Importantly, TVIC also focuses on the safety and well-being of practitioners and health care organizations. Staff in health care settings, and EDs in particular, are exposed to high levels of violence.6 According to WorkSafe BC, there were 3.6 injury claims per 100 health care and social service workers in 2015, which was higher than the provincial rate of 2.2. 7 From 2011 to 2015, 12% of injuries for health care and social service workers in BC were caused by acts of violence involving force.8 This intervention will consider how conditions of work and approaches to care can improve safety and well-being for staff.

TVIC works in tandem with two other approaches: cultural safety and harm reduction. Cultural safety focuses on creating a health care environment that is safe for all by addressing discrimination, stigma, and racism. Harm reduction focuses on preventing harm resulting from substance use, rather than judging people for, or trying to reduce, their substance use. This is important to TVIC, as substance use is highly associated with trauma and violence. It is especially important in the ED context because many people visit ED in relation to substance use. Our goal is to create a framework for enhancing equity, including TVIC, across diverse contexts.

More information at: https://equiphealthcare.ca/2016/11/23/bringing-the-lessons-of-equip-into-emergency-departments/

Contact the study lead, Colleen Varcoe, at colleen.varcoe@nursing.ubc.ca or the project Research Manager, Phoebe Long, at phoebe.long@nursing.ubc.ca or 604-822-3183.

1. Brownridge DA. Understanding the elevated risk of partner violence against Aboriginal women: A comparison of two nationally representative surveys of Canada. Journal of Family Violence. 2008;23(5):353-367.
2. Daoud N, Urquia ML, O’Campo P, et al. Prevalence of abuse and violence before, during, and after pregnancy in a national sample of Canadian women. American Journal Of Public Health. 2012;102(10):1893-1901.
3. Daoud N, Smylie J, Urquia M, Allan B, O’Campo P. The contribution of socio-economic position to the excesses of violence and intimate partner violence among aboriginal versus nonAboriginal Women in Canada. Canadian Journal Of Public Health = Revue Canadienne De Santé Publique. 2013;104(4):e278-e283.
4. Pedersen JS, Malcoe LH, Pulkingham J. Explaining aboriginal/non-aboriginal inequalities in postseparation violence against Canadian women: application of a structural violence approach. Violence Against Women. 2013;19(8):1034-1058.
5. Browne AJ, Varcoe C, Ford-Gilboe M, Wathen N, On behalf of the EQUIP Team. EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. International Journal for Equity in Health. 2015;14(152).
6. Phillips JP. Workplace violence against health care workers in the United States. N Engl J Med. 2016/04/28 2016;374(17):1661-1669.
7. WorkSafe BC. Industry Safety Information Centre. Available at: https://online.worksafebc.com/anonymous/wcb.ISR.web/IndustryStatsPortal.aspx?c=2. Accessed May 30, 2017.
8. WorkSafe BC. Statistics: Health care. Available at: https://www.worksafebc.com/en/health-safety/industries/health-care-social-services/statistics. Accessed May 30, 2017.

Upcoming Events

Sexual Violence Research Initiative (SVRI) Forum – September 18-21, 2014, Rio de Janeiro, Brazil

SVRI will hold its 5th Forum, bringing together over 450 researchers, gender activists, funders, policy makers, service providers, practitioners and survivors from around the world who are working to understand, prevent, and respond to sexual and intimate partner violence. VEGA Co-Lead, Nadine Wathen, and Curriculum Content Lead, Susan Jack, will present work from VEGA and related PreVAiL Research Network Projects. Colleen Varcoe, who is a core content expert for VEGA, is a keynote speaker, and VEGA Evidence Review Group members, Dr. Claudia Garcia-Moreno and Ms. Alessandra Guedes, serve on the Scientific Committee.

WHO’s 8th Milestones of a Global Campaign for Violence Prevention Meeting & PreVAiL – WHO Violence Prevention Alliance Pre-Meeting – October 19-20, 2017, Ottawa, Canada.

The Government of Canada is hosting the World Health Organization’s (WHO) biennial Milestones meeting in Ottawa this Fall. Harriet MacMillan and Nadine Wathen have been invited to give a joint keynote about the VEGA Project. This is an excellent opportunity to share our work with key violence decision-makers on an international stage, as well as compare best practices in educational design across countries.

In addition, our PreVAiL Research Network will co-host a pre-meeting, on October 18, 2017, with the WHO’s Violence Prevention Alliance (VPA); the agenda will feature PreVAiL projects in the areas of child maltreatment and intimate partner violence from experts who have contributed to VEGA’s evidence reviews, including Drs. Tracie Afifi, Andrea Gonzalez, and Susan Jack.

Those interested in the Milestones Meeting must request an invitation for registration, at:

For more information please contact Nadine Wathen (nwathen@uwo.ca).

Futures without Violence National Conference on Health & Domestic Violence – September 27-28, 2017, San Francisco, USA

This conference, held every two years, highlights research and practice. Several of our PreVAiL Research Network members will present relevant research, including IPV Evidence Review Group Chair and core content expert, Dr. Marilyn Ford-Gilboe.

Fore more information: http://nchdv.org/

Please feel free to contact Harriet or Nadine, or the VEGA experts named above, regarding these events. Please also send information about other events of interest to VEGA members so we can feature them in future newsletters.