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[…] when they added mental health care to their advocacy services. What lessons and wisdom could they pass on to all of us? Where along the integration spectrum do you see your organization? Below are questions to consider or revisit – whether your domestic violence organization is just getting started with integration of services or your organization has been working with mental health providers for a while.  Thank you to all the advocacy programs who shared their experiences and knowledge with all of us. What does it mean to integrate mental health care into a domestic violence advocacy program? In short, it’s the level to which these services are integrated within the day to day program operations and advocacy services. Integration exists on a spectrum from simply offering mental health referral services and a warm hand off to employing a mental health provider* and making mental health care an integral part of advocacy service delivery and collaboration. Planning – where to start? It may be easier to think about how to start adding mental health care to your advocacy services, if you approach it in small manageable chunks with a long-term goal of integration.  Many domestic violence organizations that have incorporated mental health care and have shared that “integration is super important.” Step one – Referrals only Building a mental health provider list of referrals is not always easy.  Start with your local community health clinic for potential resources.  Sharing your referrals with all staff is a first step towards integration with a big benefit for survivors. When offering referral services there are challenges to keep in mind for program participants.  Many survivors have no insurance, have high deductible healthcare plans, or only a shared plan with their abuser preventing access to services.  When survivors qualify for Medicaid, your relationships with community-based mental health providers that have understanding or experience in domestic violence are always the best choice. Step two – Referrals with known experience Building a consistent process for making referrals and sharing these steps with all staff and volunteers will move your organizational practices toward integration of mental health services.  Ask each other: how do we make referrals? What do we all know? Do we all know the same people? Have we had any feedback from survivors about the professionalism and quality of the providers on our list? While some of you may already be providing mental health referrals, it is important to revisit this conversation every year, and understand how referrals happen among staff, and to learn about the education and experience of the providers and the importance of directly linking clients. A referral, in the basic sense, entails giving the survivor phone numbers to call. “Linking” is making a warm connection on behalf of a survivor. If we know and have relationships with providers, our connection helps survivors to feel supported through the process. If we can say things like “I have met Jane and I hear good things about her from other survivors,  I send a lot of clients to her, and she understands our agency and a lot about this advocacy and domestic violence,” that’s a much more supportive assist to treatment then saying “here is a list of providers in the area you can call.” Developing a specific list of referrals that is built on your directly asking about each mental health provider’s experience and training in trauma informed and domestic violence practices and it is the next step in integrating quality services for survivors. Step three – Integration happens and continues to grow   It is exciting! Your organization is ready to hire a mental health provider as part of staff or as a contractor for continuous services.  There are some key questions to consider as you move forward to integrate mental health care in your domestic violence advocacy services.  “With integrated mental health services, we see people heal in all the right ways.” –Executive Director Hiring considerations It’s important to know most mental health providers receive very little to no training on domestic violence.  Some social work programs include a marriage and family therapy programs; but that does not mean that domestic violence training is included.  When interviewing potential mental health providers, it is critical to ask what type of knowledge and experience they have in working with people experiencing domestic violence.  “By having a therapist on staff, it really takes the burden off helpline and walk-in services.” Executive Director Consider this! If you are hiring a mental health provider with no domestic violence training or experience, your agency must be committed to supporting continued professional development that will enable providers to be successful and do no harm to survivors. This could look like shadowing advocates, taking trainings offered by organizations that provide domestic violence advocacy services, and learning opportunities focused specifically on the context and tactics used by persons causing harm and the impact on survivors and their children. Let’s talk contracts We have been really successful in finding people who have their hearts in this. Advocate What to include in a contract? If you are contracting with a therapist, there are some points you want to be sure to include: the provider’s scope of work; alignment with your organizational mission and purpose; expectations for on-going professional development in domestic and sexual abuse related dynamics and trauma; collaboration expectations with your organization’s staff; understanding of your organization’s practice regarding confidentiality and privacy obligations of written records and conversations with program participants (for example, the provider should not assume that the participant’s files are open for their review without permission of the survivor); clinical supervision (if applicable); funder requirements; other specifics around providing mental health services, such as offering a limited number of sessions in a brief therapy model versus long term ongoing mental health support and assessment expectations. What is the duration of the contract? With a new therapist, consider a short-term contract in case it isn’t a good fit. This could be something from 3-6 months. Collaboration between advocacy staff, leadership and the mental health provider There is a tendency to silo the mental health provider in their own little corner because it seems like the work they do is so different from that of everyone else’s. For a provider, this isolation from staff can make it harder to understand the role of advocacy, how to best support survivors and how they fit into the overall mission of the organization.   “We really believe it requires a team effort. The therapist goes to team meetings, and everyone working with clients meet with each other to work on client issues . . . it helps avoid triangulation.”   Executive Director Connection is the antidote to isolation.  Spending time together allows everyone to learn from each other and understand everyone’s valuable contributions. Find ways to make sure your mental health provider feels like they are part of the team! Invite the provider to events, to meetings, to virtual calls – get creative. There are different models of collaboration. Some depend on organization size; but most depend on the organizational culture and values. Executive directors and middle managers set the tone for collaboration.  One advocate said, “I think that starts at the top.” This statement highlights the influence of the leadership culture and values on collaborative efforts. Prioritize time together – understand each other’s expectations It is important for both the mental health provider, the advocacy staff and leadership, to understand the scope of the provider’s mental health practice and the advocacy role. Therapy and advocacy fill two very different roles with minimal overlap. Building a shared understanding happens when everyone takes the time to explore what the leadership and advocates expect of the provider, and in turn, what the provider expects of advocates and the leadership.  Sometimes there is a tension between therapeutic goals and advocacy strategies.  During therapy, a mental health provider can identify issues that need advocacy expertise and support. This allows the provider to focus their efforts on their strengths – the therapeutic interventions.  Even though the provider may bring up specific needs of their clients to advocates, they are not filling the role of advocates in these moments.  The provider is responding to what is presented in therapy which may bring up the need for specific advocacy services.  It is important for leadership to equally review and value both the advocates and the therapist’s opinion.  Leadership should be careful that the education and credentials of a provider do not appear to be valued over advocacy expertise.  Because advocates work tirelessly to aid survivors in multiple ways, they offer critical information about a survivor’s priorities, wants and needs. Supervision of mental health providers How can we provide supervision for mental health care needs, if we do not have a mental health care background? Many of you may have this question or may be in a situation where you are the supervisor of a therapist but do not have any clinical expertise. This limits your scope to providing only administrative supervision which means your therapist is not receiving the clinical support they may need. If you are hiring or contracting with an intern or associate level therapist**, then by law it is required that the therapist obtains clinical supervision.  An associate therapist includes most counseling professionals with less than three years of practice such as licensed mental health counseling associate, licensed marriage and family associate, and licensed clinical social worker. Some advocacy programs have staff that can provide supervision; but most therapists must find and pay for their own supervision. This may make it harder to find a therapist to hire or contract with for your organization. The average cost of supervision is $100 per week.  Try this! When working together to respond to the specific needs of a survivor, create a list that shows who on the team is providing support. Safer planning for the survivor and their children when negotiating strategies with child welfare -> Advocate Survivor needs help negotiating a private/public lease with landlords for housing -> Advocate Survivor reveals that they have recently started using substances to cope with their depression -> Mental health provider Also, be aware that the supervisor that is retained by the therapist […]