VEGA Newsletter – October 2018

As we head toward the final National Guidance and Implementation Committee (NGIC) meeting on March 28th & 29th 2019, the VEGA Project continues to work on the development of curriculum resources, website design and online content. Initially, the plan was to seek feedback on individual curriculum products, but we have revised the process so that we will ask for feedback from front-line members when most of the curriculum is developed and integrated on the new website (plans to complete our online website before the fall were somewhat ambitious!). In this issue of the VEGA newsletter, we update our activities since the March 2018 NGIC meeting and start laying out the plan to project completion.

Progress Update

Since our last NGIC meeting (see meeting summary here) and our Spring 2018 newsletter, VEGA’s emphasis has been on refining the educational content developed with the NGIC and getting everything online. VEGA’s Recognizing and Responding Safely to Family Violence Online Platform will be a highly integrated educational intervention supported by relevant instructional materials, including the VEGA Online Handbook, interactive learning games, and other practical resources. A summary of key activities is provided below.

VEGA Brief Guidance Statements

These statements provide a very brief summary of the results of VEGA’s systematic evidence review and GRADE guidance creation process for all three of our core topics: child maltreatment, intimate partner violence (IPV), and children’s exposure to IPV. They will be translated into French and posted to the VEGA website.

VEGA Curriculum

Based on the VEGA Competency Framework, the curriculum will include modules highlighting core content from VEGA’s four competency domains:

  • Module/Domain 1: Know About Family Violence and its Impacts
  • Module/Domain 2: Recognize and Respond Safely to Family Violence
  • Module/Domain 3: Facilitate Access to Ongoing Care or Service
  • Module/Domain 4: Contribute to Service Cultures that are Safe and Supportive

We are currently in the process of creating “courses” that bring these competencies together into learning outcomes reflective of the core skills that we emphasize VEGA learners acquire through the curriculum.

VEGA Online Handbook

The three sections of the Handbook – child maltreatment, intimate partner violence (IPV), and children’s exposure to IPV – have been developed and are being integrated into the online platform.

VEGA Learning Games

We are in the process of completing scenarios for each of the two games. VEGA is securing a game development company to create polished versions of the game-play simulations.

VEGA Videos

The English version of the “Why VEGA?” video has been finalized and is currently being produced in French. In addition, and based on feedback from students, VEGA will produce “how to” videos – for example, “how do conduct a safety assessment” with a patient/client who is experiencing IPV. These are currently being developed with the use of simulated patients/clients.

Next Steps

Key decisions regarding content and instructional materials were made by the NGIC in March, including advice to integrate all aspects of VEGA – those focused on interactions with patients and clients, as well as on education – into an overarching curriculum. This has meant additional instructional design and technical resources, and time, to bring all of these resources together into an effective, efficient, and usable web platform. We are grateful for the Public Health Agency of Canada’s ongoing support of this project.

A next major step will be to get feedback on the curriculum products mounted on the integrated website from frontline providers from NGIC organizations, including those pre-and in-service. NGIC member will be asked to provide direct access to members who can give VEGA this feedback, likely in early 2019.

There will be one more NGIC meeting in Ottawa on March 28th and 29th 2019 to review final products.

Thank you to retiring NGIC members…

We thank outgoing NGIC members Mary Ann Carmichael, who ably represented the Canadian Association of Community Health Centres, and whose “VEGA journey” is described in a feature story below. All the best in the next phase, Mary Ann! Also, we extend our best wishes to Victoria Leck  – a staunch VEGA advocate and champion from the Canadian Dental Hygienists Association – as she moves on to new endeavours with the Canadian Medical Association. Victoria was featured in a previous VEGA newsletter. Please keep in touch!

NGIC Champions: VEGA’s Ongoing Knowledge Mobilization (KMob) Work

This section of our newsletter highlights some of the important work that VEGA NGIC partners are undertaking to both bring the issue of family violence to the attention of their stakeholders, as well as feature VEGA’s work. We invite all NGIC partners to share the work they or their organizations are doing in this area, and talk to Harriet MacMillan, Nadine Wathen and/or KMob lead, Anita Kothari, about opportunities for collaboration to share VEGA’s work.

  • In April 2018, Michelle Ward, Harriet, and Nadine were invited to present on VEGA at the Canadian Dental Association’s (CDA) Canadian Oral Health Roundtable in Ottawa. In a 3-hour session on family violence, we discussed the role of oral health professionals in recognizing and responding to adults and children experiencing these forms of violence, and were gratified by the enthusiastic response. As champions in this area, the Canadian Dental Association has been very active in highlighting the important role of dentists and other oral health professionals in identifying and responding to family violence. For more information, and ideas of how your organization can contribute to awareness about VEGA, please see the CDA’s Report on the Oral Health Roundtable, as well as a video interview for the CDA Oasis channel featuring Nadine talking about VEGA.
  • In June, Susan Jack, VEGA Curriculum Co-Lead, Karima Velji, NGIC Co-Chair and Past-President of the Canadian Nurses Association (CNA), and Nadine, were invited by the CNA to conduct a Policy café at CNA’s Biennial Convention in Ottawa. This informal, action-oriented discussion sparked considerable interest among nursing leaders, with follow-up activities planned.
  • Amy Outschoorn and Bob Wollard, NGIC representatives for the College of Family Physicians of Canada (CFPC), presented an overview of VEGA at the spring meeting of the Family Medicine Chairs in Halifax. Thanks to Bob and NGIC Co-Chair, Howard Bergman, for arranging this opportunity. VEGA received very helpful input about how to seek frontline provider feedback.
  • By invitation from Jan Reimer, NGIC representative from Women’s Shelters Canada, Nadine gave a keynote presentation at September’s Annual Meeting of the Alberta Council of Women’s Shelters in Edmonton. The project was extremely well-received by the audience of primarily shelter Executive Directors, but also provincial and local stakeholders, including those from criminal justice, health, and education. As one person said, “We’ve been waiting for this for 25 years!

© Alberta Council of Women’s Shelters, used with permission

  • Michelle Shouldice and Michelle Ward, together with their Canadian Paediatric Society (CPS) colleague Amy Ornstein from Dalhousie University, submitted a CPS Child Maltreatment Section Programming Proposal for an interactive workshop to address approaching child maltreatment with patients. Harriet is included as a presenter in this workshop, and VEGA’s material will be featured. 
  • In October 2018, Carol Couchie, NGIC representative from the National Aboriginal Council of Midwives (NACM), and Nadine gave the closing keynote address at the Canadian Association of Midwives (CAM) conference in Gatineau. The presentation authors included NGIC members Rebecca Wood and Amy McGee from CAM, and Darlene Birch from NACM. This was a tremendous opportunity to raise awareness of VEGA with hundreds of midwifery leaders and practitioners.
  • The Canadian Centre on Substance Use and Addiction (CCSA) has launched an initiative focused on the relationship between adverse childhood experiences (ACEs), brain development, and substance use risk – including an opportunity to move this knowledge into action. Click here to learn more, or contact brainstory@ccsa.ca.
  • In December, Harriet will present VEGA in a plenary session at a Continuing Medical Education event hosted by the Society of Obstetricians and Gynaecologists of Canada.
  • The Canadian Dental Hygienists Association has invited us to present VEGA at their national conference in Fall 2019. More to follow!

Partner Perspectives:
The key role of VEGA and the importance of being trauma-and violence-informed, by: Mary Ann Carmichael, MSW, RSW, Ottawa 

 I am a registered social worker psychotherapist with over 27 years at Centretown Community Health Centre in Ottawa, providing psychotherapy to clients who have experienced trauma and violence. Having recently retired from Centretown, I am reflecting on how my experience with VEGA has had a positive impact on clients, other care providers and the organization. I am hoping Centretown, indeed, all CHCs across Canada will benefit more broadly from VEGA’s “Recognizing and Responding Safely to Family Violence” practice resources and curriculum.

As a Carleton School of Social Work graduate in the late 70s, I was exposed to the Structural Approach, which made explicit the harmful effects of structural barriers, such as racism, poverty, and the impact of intergenerational abuse, on client experiences of, and access to, health services. Quite radical in its day, a more mainstream structural analysis of violence and trauma is beginning to emerge, thanks in part to the work of VEGA.

VEGA Approaches in Practice

In the past few years I have created approximately 20 trauma and violence-informed care (TVIC) educational sessions for all staff at my centre, as well as presentations to our Board, and in the community. Based in part on what I learned at VEGA meetings, and through discussions with VEGA leaders, I’ve been able to share accurate, up-to-date information about trauma and violence, its impact on clients and their families, and importantly on the staff who serve them.

What has been the impact on staff?

1. Learning about Trauma and Violence in a Trauma-and Violence-Informed Way: A New Experience 

As an educator, I knew from firsthand experience that exposure to new knowledge about trauma and violence can unintentionally create further harm by triggering trauma experiences among learners. Therefore sessions were designed using the trauma and violence-informed principles outlined in the VEGA TVIC Briefing Note. VEGA recognized that many in the health and social service professions themselves have “lived experience” of trauma and violence, both from before they started working, and/or as a result of their work experiences. Therefore, in designing training approaches, the possible impact of material discussing trauma and violence were carefully considered before presenting them. Feedback from participants was taken very seriously: no two presentations were alike, constantly being revised based on the experiences of participants.

Members were also alerted to the possibility of being triggered before attending the session, so they could bring whatever self-care tools they needed, or even choose not to attend. At the beginning of each session, they were provided with strategies to help them stay grounded, and they were encouraged to take breaks as needed, or even leave if necessary. Feedback from attendees at these various sessions indicated that for many, this was the first time a presenter had attended to their self-care needs, making them also consider how they themselves present this kind of content to colleagues and clients.

2. New Information May Affect Practice 

Thinking about structural factors, such as racism and intergenerational trauma, as ongoing forms of violence was a new concept for many, as was exploring their impact on the health, safety, and well-being of clients and care providers. Being able to cite VEGA’s upcoming resources and provide a link to www.projectVEGA.ca was invaluable; these will be the gold standard for evidenced-based practice in identifying, responding to, and managing the care of clients experiencing family violence or its effects.

A key message in the VEGA-TVIC resources is understanding that trauma and violence are about “what happened to you” rather than “what is wrong with you?” This re-framing has created a powerful shift in the Health Centre, from ‘shame and blame’ to a more compassionate response to those who have experienced trauma, including among staff. In fact, through the educational sessions, staff with personal experiences of trauma and violence seem to have become more open to sharing their stories with leadership, including their needs around self-care and continuing education.

3. Implications for Organizational Policies 

All staff have been encouraged as part of the training process to consider present procedures, practices and policies using a trauma- and violence-informed lens. Staff and the leadership team have started to consider how unexamined practices, policies and procedures may unintentionally create negative experiences for clients and as a result prevent full access to health care.

Equally important from a trauma- and violence-informed perspective is the idea of vicarious trauma or compassion fatigue. Working in settings with a mandate to serve the most vulnerable populations exposes staff to stories, and health and social impacts, which can cause difficulties to those caring and listening. New policies at the organizational level that support staff doing this difficult front-line work are emphasized in the VEGA materials, and are something that progressive leaders are willing to take on when given the right information.

4. The impact on my own practice from participating with VEGA 

Participation with VEGA’s National Guidance and implementation Committee came at exactly the right time in my own professional and personal life. As a frontline psychotherapist with personal experiences of trauma and violence, I have always tried to practice good self-care, including supervision, and ongoing professional education, and taking all my paid leave as strategies to protect from burnout. However, the past few years have been a struggle, and frustrating. VEGA’s emphasis on the cumulative impact of working with the most vulnerable populations, and the importance of organizational support through supervision, educational opportunities, and policies around leave suddenly made a great deal of sense! The VEGA materials, along with some self-reflection, helped me shift from blaming myself, to a compassionate acceptance of my situation. I also was able to encourage the organization to consider expanding the work being done to improve health equity to also include the impact on staff, citing VEGA resources to support my views. This was a very satisfying way to retire!

In conclusion, the VEGA learning and practice resources, firmly rooted in the best available research evidence and guidance available, will, I know, be a game changer to Community Health Centres, and beyond.

MaryAnn Carmichael, MSW, RSW is a Psychotherapist, and a Certified EMDR Therapist, in private practice in Ottawa. She was a frontline care provider at the Centretown Community Health Centre for many years, and represented the Canadian Association of Community Health Centres on VEGA’s National Guidance and Implementation Committee until her recent retirement in August, 2018. She can be reached at: maryanncarmichael@rogers.com

Other Activities

VEGA Evaluation

  • Working with Jonathan Sherbino and Meredith Vanstone of McMaster University’s Education Research, Innovation and Theory (MERIT), VEGA is developing a Curriculum Evaluation model and approach for use by NGIC member organizations to evaluate the uptake and impacts of the VEGA Curriculum.
  • Anita Kothari is leading VEGA’s Partnership Evaluation project. NGIC members will be asked for an individual interview immediately before, during or just after the March 2019 NGIC meeting.  These interviews will help us assess the effectiveness and impact of our integrated knowledge mobilization and partnership model.

Related Presentations and Publications

  • PreVAiL and VEGA members presented a symposium on mandatory reporting at the International Society for Prevention of Child Abuse and Neglect (ISPCAN) XXII International Congress on Child Abuse and Neglect in Prague, Czech Republic, last month – click here for more details.

From left: Drs. Jill McTavish, Lil Tonmyr, Andrea Gonzalez, Tracie Afifi and Melissa Kimber © Tracie Afifi, used with permission

  • Offord Centre Symposium – in May 2018, Harriet provided an overview of VEGA as part of a presentation on children’s exposure to IPV. 
  • In September, Nadine and Harriet, along with Marilyn Ford-Gilboe and Susan Jack (who Chaired the IPV and children’s exposure to IPV evidence review groups, respectively) presented a VEGA symposium at the Nursing Network on Violence Against Women International Conference in Niagara-on-the-Lake Ontario. At the same conference, Nadine and Colleen Varcoe gave a 3-hour pre-conference workshop on trauma- and violence-informed care and its integration into VEGA content. Both presentations were very well-received, with significant interest from international colleagues.

Nadine, Harriet, Marilyn & Susan at the NNVAWI Conference, September 2018

© Karen Campbell, used with permission

The following VEGA papers were published in peer-reviewed journals:

  • Afifi, T., McTavish, J., Turner, S., MacMillan, H.L., Wathen, C.N. (2018) The relationship between child protection contact and mental health outcomes among Canadian adults with a child abuse history Child Abuse & Neglect, 79, 22-30. Open access:
    https://www.sciencedirect.com/science/article/pii/S0145213418300310
  • Lewis, N.V., Feder, G.S., Howarth, E., Szilassy, E., McTavish, J.R., MacMillan, H.L., Wathen, C.N. (2018). Identification and initial response to children’s exposure to intimate partner violence: a qualitative synthesis of the perspectives of children, mothers and professionals. BMJ Open:8:e019761. doi:10.1136/bmjopen-2017-019761