Content Disclaimer: This episode contains discussions about intimate partner violence that some listeners may find disturbing or difficult to hear.
SARAH: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families and communities. I'm Sarah Hexem Hubbard with the Pennsylvania Action Coalition and the Executive Director of the National Nurse-Led Care Consortium. This is the second episode in our two-part series about intimate partner violence. If you haven't heard the first episode, please go back and listen to that one before continuing on. You'll hear from Kalena brown about surviving intimate partner violence and how she's now using her voice to educate and support others.
And on this episode, Lizz Tooher and Mac Taylor will reference Kalena's story as they discuss IPV in Philadelphia and beyond. Mac is a paralegal with help MLP that stands for Health Education and Legal Assistance Project, a Medical Legal Partnership. It's part of Widener University. He works with NNCC on a project that supports families enrolled in home visiting programs across Philadelphia. And Lizz is a public health nurse and senior director of child health and education with NNCC. She works with families raising children ages five and under, through projects including the Mabel Morris Family Home Visit program.
Nurse home visitors go to their clients about twice a month, and they're trained to screen for IPV while there. Through their relationships with clients, they establish enough trust and familiarity to safely support those who screen positive. When that happens, they can turn to Mac one of two recently established IPV champions. Champions can help make plans to leave, secure housing and other resources and navigate legal processes such as obtaining a protection from abuse order or PFA, often working with partner agencies. It's also important to note that we're bringing you these episodes to coincide with mental health awareness month. And as Lizz and Mac discuss, IPV isn't limited to the impact of physical violence on survivors, but very often also manifests psychologically and emotionally, not to mention financially and otherwise. And now we'll go to Lizz to start the conversation.
LIZZ: I'm Lizz Tooher, a public health nurse and senior director of child health and education with the National Nurse-Led Care Consortium here in Philadelphia. I work closely with a number of projects supporting families, specifically raising children under five years old. The primary program I work with is a home visiting program, The Parents as Teachers model and our local program is called the Mabel Morris family home visit program, and we partner with families to support them on achieving their goals for their family, their children. Things like a medical home, safe and reliable place to live and play and work and thrive in Philadelphia. I'm joined today with Mac Taylor, dear colleague, paralegal with NNCC's Health Education and Legal Assistance Project. That is a Medical Legal Partnership or the HELP MLP, as we call it around here.
Today, Mac and I are going to talk about our work supporting survivors of intimate partner violence in Philadelphia area and beyond. First, we want to share a little about how and why we got into this work. For me, being a new nurse home visitor when I was starting my career here about 11 years ago, I think I noticed supporting families with intimate partner violence, the impacts and the effects of that violence on everyone in the family. What I've seen as a home visitor that when home isn't safe, it's hard to focus on any other challenges. When home isn't safe for you, for your children, for any reason, if your home isn't safe, that is really the starting point of my work with a family. How do we get safe housing for you, safe from physical violence and any other aspect. And growing up myself in a home that wasn't always safe, I really connected to wanting to shine a light on this too often unspoken, really epidemic levels of violence happening to families.
As I started working as a home visitor and supporting families living with intimate partner violence, I was so struck by these unhealthy relationships and IPV that it's just so pervasive. And the more I worked as a home visitor, the more I saw that it was a very tangled, broken web of support for families, and I just kept finding myself more and more drawn to this area of support for folks. And I think from there, I've just really been passionate about trying to untangle the systems of support and also lifting the weight off these family shoulders and raising awareness. Really shining the light there to get those agencies to respond to this crisis. Mac, as we said, you’re a paralegal with our Medical Legal Partnership, and you're also an IPV champion. Last year, when we started this champion project you stepped up and applied and were one of two chosen at NNCC. Could you tell us a little about what it means to be an IPV champion and what inspired you to take that step and be involved in this work?
MAC: Thank you, Lizz, for that great introduction. I chose to be an IPV champion because I've been a paralegal going on about eight years now. The first part of my career, I was also a victim advocate, and this is something that is near and dear to my heart. Just being in poverty is trauma and to experience domestic violence and intimate partner violence compounds on that trauma as well. That's where you tend to see IPV and domestic violence, and it shows up in multiple ways, not just physical, mental. There's financial exploitation and the effects that it has on families. So, myself, I've experienced poverty. I've had family members go through domestic violence. So, I believe in a systematic approach, and I believe me taking on this role allows me to be an active participant and not only helping people become whole, but also advocating for change in the system.
LIZZ: Thanks, Mac. So, we should define what we're talking about. What is intimate partner violence? The CDC defines it as abuse or aggression that occurs in a romantic relationship with an intimate partner. Can be current or former spouses. It can be a person of any age or gender. Can vary in how often it happens, how severe it is, and can range from one episode that could have lasting impact to chronic or severe episodes over many years. It can include one or many types of behaviors, several of which we saw in Kalena’s story, the incremental steps of increasingly isolating behavior from the person choosing abuse. The psychological, emotional and financial aspects beyond the physical violence that I think folks might think of first. Mac what do you think of when you think of the definition of IPV or intimate partner violence?
MAC: I try to break it down into simpler terms. A partner tries to make someone do something that they don't want to do. They're unwilling. And it can be a variety of things, and I know what happens is, is that the perpetrators usually use, we call them red flags, but really just some tactics, like they try to isolate them from their family. They become hyper critical of every decision they made. They want to be in control of everything, excessive, like frequently contacting them, and they know they don't want to be contacted. And I've even seen it their financial exploitation. So that's how I would sum it up.
LIZZ: I like that you changed the language a little bit because it's a heavy title, and it's a heavy title to say to a person living in IPV it's also important to note that with the population that we support, fighting poverty during pregnancy, becoming parents, raising young children, those times are just so tumultuous for any parent. There's so many decisions, and who can you trust when you layer on the violence of an intimate partner. It can be so confusing to know what's real and what's not, especially when your home is not a safe place. So, I think IPV is the inability to trust your instincts and to trust yourself. Can we talk a little bit about risk factors? And you started to mention some red flags?
MAC: I see fear. It is not just fear of physical abuse, but the fear of isolation, right? And this is why I value our home visitors so much, because they have those established relationships, and sometimes the home visitor is the only lifeline they can get to. There's so many clients that I've worked with that they didn't even know the state of their financial affairs because the abuser has shut them out of everything, and this is what they deal with every day. They're also parents, and they don't want, nobody wants, to break the American dream of the two-parent household and how does that impact the kids? And oftentimes, they suffer the abuse because they simply don't want to have to abandon their kids or put their kids in a bad situation. And with our home visitors, because they have the interactions with them, they can see these red flags, and then they start to say, I may need to offer them this service. And how can I help them? What can I do to help alleviate some of this victimization.
LIZZ: So, Mac, I know you know that home visitors are very keen on promoting protective factors as a way to mitigate risk factors. We work with families to recognize the strengths that they have, and we work to build up those protective factors. Can we talk a little bit about what protective factors we might be looking for in families to help insulate them from the risks of intimate partner violence?
MAC: I can tell you one of the things when I do a consult with a home visitor, and depending on their assessment, one of the things I always recommend, well, can you arrange to meet the client in the community and take them out of that abusive environment, and then you can have create a safe space where they can be open and honest about what's going on. Most of the clients, they don't know the state of the financial affairs because the abuser has been so controlling. They don't know the electric bill, they don't know the gas bill, they don't know how much money is in the bank account. So I always tell them, you can always recommend your client go to a different bank and set up their own account, and if they don't have the proper documentation, they can also possibly help them acquire that documentation that they would need to open up an account. Sometimes, when people experience domestic violence, they don't even have access to their own vital records, like they can't access their passport, their birth certificate, their social security card. That goes back to that controlling factor. They don't know the terms of their lease. They don't know what's on their credit. The abuser could have been using their credit to acquire things without the victim's acknowledgement or permission. So these are things that all come up as red flags as far as financial stability. And once again, most of the time, survivors are in fight mode. I don't want to be harmed tonight, so I'm gonna do whatever I'm asked to do, whatever I'm told to do, because I don't want to get beat tonight. I don't want to be abused mentally tonight, and if I do this, if I do something wrong, my kids may not be safe. So they don't even think about their selves. They're just thinking about their children.
LIZZ: So definitely the financial stress not being financially independent, or even just financially aware of the state of finances. And then you were talking about the role of community, and I think that's a real place that home visiting looks to support to that peer to peer, community member to community member experience. Whether it's just meeting your home visitor in a park in your neighborhood or the Dunkin Donuts, the library in your area. Or it's coming to an event with other families that are in home visiting or have young children, and these small ways to build community and break down some of this isolation. I think in Kalena’s story, we see some of that too with her own parents and family folks that want to step in or don't know how to step in. So that always brings out, for me, the education of IPV and how do we inform loved ones on how to help one another when these things happen too, and what to look for.
MAC: I agree. And I think, you know, this is such a unique program, because every survivor doesn't have access to a home visitor. So I always looked at as our home visitors on the ground running. And I think just recognizing the small things. For example, if a home visitor has to constantly call the partner to get a hold of the actual client, why is that? Why is it the client doesn't know why the gas got shut off? Are they not able to look at the mail? Do they not have access to the account? Why don't you know how much you have in your bank account? If you're working you have a direct deposit going in, you should be able to have access to it. So I think the home visitors are uniquely positioned. And then two, sometimes the clients have endured it for so long, they normalize it. They don't think anything's wrong, and they had that trusting relationship with their home visitor. A lot of times, the survivor is not in a place to take that first step, and you have to let them get to that point where they're ready to take that first step and then support them. And where it becomes challenging is, is that until they're ready to take that first step, how can you still support them?
LIZZ: Yeah, you brought up some tenets of home visiting. For sure, it takes time to build this relationship, this trust with a family and to sort of be let in. On top of the fact that they're having children and figuring out how to raise their babies, and there are a lot of competing challenges and priorities, and the complexity of leaving is not just one day I decide to leave. The shelters are often full or short term, or you have a history of trauma in the shelter system, or someone you love does and stories you've heard. So I think home visitors are also positioned to provide that support ahead of leaving, to start gathering those documents, to referring to your team Mac, for supporting getting those legal documents, and for making a plan, starting a savings, figuring out what assets you do have and can leverage here and those things can take years to develop.
We heard from Kalena just how critical her relationship with her children's pediatrician ended up being to her feeling seen and heard, supported enough to leave her abuser. And Kalena really pointed to a couple of different times that she was screened. She wasn't always disclosing, but she was always listening to see if the opportunity to disclose was there. It was always in her mind and I recall that even from my own childhood, just kind of that hyper vigilance of who is a safe person, who might have an idea of what's going on when you are in that survival, just kind of always being on alert for those moments and those people. And that's where I see our role with screening and with being the person that creates the space for a person to disclose when they get there, when it's time. So I know there have been more efforts for screening and having the support for when folks do screen positive and disclose there. So more access to resources or IPV champions, such as yourself Mac at these healthcare agencies or emergency rooms, where people might come in and really normalizing it. We've danced around this statistic a little bit, but we haven't come out and said that in North America, homicide is the leading cause of death for pregnant people, and that homicide is linked to IPV and or firearms. so these deaths outnumber obstetric causes, hypertension, sepsis, hemorrhage, the leading causes of obstetric death combined. That is a really important fact that folks also don't know just how prevalent it is in pregnant folks and how vital it is that we are doing more to support these folks and screen and look to our systems to respond to this. So Mac, I know that home visitors will refer to the Help MLP to your legal team, and from there, start working often on the PFA process. Can you tell us what PFA stands for? And well, I know you're a big advocate on PFAs and PFA reform, so would love for you to share that now with us,
MAC: Sure. So before I begin to talk about the PFA as a paralegal, I do have to give this disclosure that I am not an attorney and I cannot give legal advice, but I can speak on a PFA and how that works. A PFA, as is commonly referred to, is a Protection From Abuse order. You can get that in the city and county of Philadelphia. If it's Monday through Friday, you go down to family court and believe it is the either the second or the third floor. And you fill out a bunch of paperwork, and then you wait, and you wait, and then you get called in a to see a judge, and it's called the ex parte hearing, where the judge basically asks questions about what's on the form. It goes on the record, tells about the abuse, and that judge makes a determination if they can give a temporary protection from abuse order or deny it. If they grant it, do they evict the perpetrator out of the home? The judge makes that determination, and in a perfect world, a client will get that temporary PFA and will be scheduled for what we call a full PFA hearing within 10 days. So, I want to just kind of back up about going down to family court and filing for the paperwork.
Now, some organizations do have a navigator there that will help guide the survivor through filling out the paperwork and provide support while they go into the ex parte hearing, but it's a lot. You can go down there and they open at nine. You may not get called before 11 or even after lunch, and it's not a kid friendly place. So if you don't have childcare, and you have to take a child, you have to go through this process about a traumatic event and wait and wait and taking care of a child. You're not permitted to eat inside of the unit while you're filling up paperwork, but you have a child that you need to give a snack to. So you've gotten there, some people have gotten there at 830 to be first or eight o'clock. So now 12 o'clock comes, they want lunch, so they run outside and get something unhealthy to eat one of the carts they come back in. Oh, the judge is at lunch, but he called you a case, or she called your case. We might can get you in this afternoon, and you have to wait all over again, and then once you get that temporary PFA, they have to take that to the local police station, wait to give it to an officer, then sit there at the police district until the officer comes back, saying that they serve the person, and they have to give them a form so then they can take it back to the court. Because if the perpetrator does not get served with it, they can't conduct the hearing. And unfortunately, through the funding limitations, there's no like legal aid organization that goes in for that initial hearing at the temporary level. So, you have a person that is experiencing IPV and domestic violence, they're dealing with that trauma, and based off of our clientele, where most of them are experiencing some level of poverty, which is also a trauma. So they're going in there with double trauma, and now they have to go into a courtroom, which in itself can be intimidating. And so they endure all that, and then they still know that they had to come back to court.
LIZZ: Mac, it sounds like there are so many places in that process where a survivor would give up on top of the reliving of the trauma of whatever brought you to the place that you're ready to file this PFA. The physical pain or emotional pain that came with that, and then having to run around town to at least three different stops at least a day.
MAC: I would agree with you. And the problem is, let's just say the survivor after four o'clock says, I need a PFA. Now, instead of going to family court, they have to go to Criminal Justice Center. Which is even a longer process, and they can get a temporary PFA, but it's only going to be good until the next business day that family court is open, so that may only be 12 hours.
LIZZ: Generally. How long do they last?
MAC: A typical temporary PFA that is acquired in family court, and judge says yes and granted, the full hearing should be scheduled within the 10 day window. Things get rescheduled, things get continued, things get postponed. The biggest problem I see is there wasn't proper service on the defendant. However, it should be heard within 10 days. And it's a regular hearing. You have the survivor, you have the perpetrator, also known as the defendant. They can be represented by counsel. Judge conducts the hearing. Judge renders the decision. He can grant a full PFA for up to 36 months. He can do for six months, and if the burden is not met, he can say no. It's also important to note that when a PFA is issued, temporary or full law requires that firearms be removed from the defendant's possession. They must surrender them to the sheriff's office.
LIZZ: So why bother doing a PFA like, why should I tell you know, survivors to go for it, that it's worth it.
MAC: You know, sometimes I struggle with answering that question myself, but what I do tell clients, this is the first step in trying to regain your independence, and you trying to reclaim safety. But even with a PFA, it's not guaranteed. We all watch the news. You know, person did everything right, went and got a PFA. Unfortunately, the abuser shows up. You call 911, unless there's a gun involved, there's no telling how long it's going to take for the police to respond. And then the police officer comes, you got to have that PFA in your hand. They're not going to go look it up for you. They don't have that kind of time. We all know Philadelphia Police Department is short staffed. They have more violent crime happening. So a survivor will call police. The police will come, but by the time the police get there, the abuser is gone. If they're not witnessing it, that can be a whole other episode, a whole other debate. No, right?
LIZZ: Your team always reminds us, home visitors, that everything in writing, get that paper trail for every issue. Establish a paper trail. Get it in an email, anything, take photos of it. I think of specific populations that are explicitly more vulnerable in these situations, particular communities of marginalized folks. LGBTQIA community has definitely separate risk factors and harm connected with IPV. When you layer on homophobia, lack of inclusiveness in communities for queer people, and persistence of myths and stereotypes about who can be a victim of intimate partner violence. As well as transphobia, compounding the abuse, making queer people much more vulnerable to IPV than general population. I think of recent immigrants, often naturally isolated in different ways through language being in a new country, figuring out how to establish yourself, and IPV is particularly vulnerable then, as well as male survivors.
MAC: It’s underreported. Survivors don't like to talk about it. They don't seek help. When you look at the numbers. Male survivors rarely want to say anything, because one, people don't believe it, like a man can be a survivor of domestic violence, can endure domestic violence. I think it just goes back to the way society perceives men, but it does happen. As a home visiting organization, we do a good job of being able to support all levels of survivors that come to us, and I think that's because we've taken trainings and we all prepared for when it does happen. I wish I can say, in my experience as a victim advocate, prior to coming here, that every organization was like that. We have to continue to promote the organizations that will support survivors of domestic violence, regardless of gender, orientation or religion.
LIZZ: Thank you for that. It bucks up against some outdated stereotypes of IPV too and what an abuser looks like, a person that chooses abuse and what a person that is a survivor of abuse living with the abuse. And male survivors, queer people survivors are great examples of IPV affecting any person. In your nearly a decade of experiences here, have you noticed improvements, even if they might have been temporary, any improvements in any of the aspects of the process or outcomes?
MAC: Yes, we're seeing more people wanting to get involved in the IPV DV fight as an organization, we've really done a lot of training. We've now let our home visitors know that they're fully supported with these type of situations. On the legal side, we continue to look at ways of additional funding. We also maintain some great relationships that can really help our survivors get back to a good way of life. It's not just about a legal issue could be a housing issue. It can be a financial management issue. Having those relationships outside of the legal room can really help a survivor get back to a place of stability.
LIZZ: It’s great to hear that there's more interest. I'd like to think, I'd like to believe that the growing field of home visiting in the country, in Philadelphia the last 10 years also is supporting that push. And Mac I think our project having two IPV champions at NNCC, working with the broader team with the two other home visiting agencies, Maternity Care Coalition and Parent Child Plus, as well as the leadership of CHOP Policy Lab and the funding of Vanguard and the support from Philadelphia's Department of IPV Services and other community stakeholders on this project. The intensive training and the knowledge that you are able to share and empower the team with, I like to believe that these changes are lasting as well. Is there anything else that you can think of that could be effective? Have you heard about anything in your work, policy or other pilot programs like this one.
MAC: I'm hoping to hear some stuff as the new fiscal year goes forward. I'm constantly looking at the Victims of Crime Act funding to see if there's additional funding to expand services. What I will say that is very encouraging. I'm starting to see more diversity in victim services, especially around IPV and DV. I remember years ago, I went to an event, and I was the only man there at the time and a man of color. So, I think as we continue to see diversity in advocates that are helping the survivors of domestic violence, it allows for people to be more comfortable with reporting and seeking help. The numbers tell us that it's happening, but we all know that it's happening at a greater level, because everyone's not reporting. So I think by continuing to do the work we do, we create a space where people can feel safe to report, and we can meet them where they're at and help them navigate through that trauma that they're enduring. So thank you, Lizz, for your leadership on this project and keeping us together, and always having an open door where we can throw ideas and make a change. You know, sometimes just giving someone a burner phone can be life saving, and I can say that we have that available, and it's not a lot of corporate red tape to make it happen.
LIZZ: Thanks, Mac. Yeah, it's great partnering with you too and being able to really give the direct support to our families and our staff.
SARAH: Many thanks to Mac and Lizz for taking the time to share their expertise and perspectives. We would also like to thank our partners at CHOP Policy Lab and Vanguard Strong Start for Kids, for their work to advance precision home visiting. You can find our most current and past episodes of At the Core of Care, wherever you get your podcasts, or at pa action coalition.org. On social media, you can stay up to date with us through our handles at pa action and at nurse-led care. I'm Sarah Hexham Hubbard with the Pennsylvania Action Coalition and the National Nurse-Led Care Consortium. Thanks for joining us so.
