Appalachian Violence Outreach Network (AVON)

Domestic violence and sexual assault appeared to be underreported in the region, even though data suggested a very high rate of interpersonal violence. Women in the community seemed to be unaware of the services available to them, and services that were available were difficult to access. A steering committee of community agencies decided that the public health department was the safest and most likely place for women to learn about, and be connected to, help for interpersonal violence.

The independent Breathitt County Health Department provided a “home base” for coordinating wellness services during the last 16 months of the project. The University of Kentucky Institute on Women and Substance Abuse designed the screening tool to assess women’s needs and assisted in training the wellness coordinators. The Kentucky State Department of Protection and Permanency, the social service agency that protects area women and children in abusive or neglectful situations, trained and assisted the wellness coordinators.

The project administered a screening tool with nine questions about stress, depression, eating problems, self-esteem, sexual abuse, and domestic violence to female patients at the health department. Clients who reported any of these problems were referred to a wellness coordinator, who provided information, support, and assistance to meet the client’s needs. Clients were eligible to participate in a series of eight workshops focusing on stress, depression, food and mood, relaxation, exercise, safety nets, positive parenting, and how to make health-positive life changes.

During the final 9 months of the grant, a HRSA-funded psychologist was hired to provide intensive psychotherapy for those who needed it. Psychotherapy was provided free of charge to clients. The project also established resource centers at each of the health departments that provided information on interpersonal violence.

At first, it was difficult to get women to participate in educational workshops. As a result, the project began offering Wal-Mart gift certificates as an incentive. Clients who attended four or more workshops received a $20 gift certificate. Those who attended all eight workshops received a $50 gift certificate. This approach was extremely successful.

One of the project’s biggest challenges was establishing relationships between clients and wellness coordinators. Many clients were not willing to confide in someone they did not know or trust. But the project learned that clients were significantly more willing to talk openly about the problems in their lives if the wellness coordinator was someone from the community—someone they knew and trusted.

The educational workshops were well received by clients, but only after the project provided Wal-Mart gift certificates as incentives to attend. The Foundation for a Healthy Kentucky recognized AVON as one of its 2005 “Models That Work.” In addition, Kentucky Educational Television featured the AVON Wellness Workshops in a program aired in October 2005.

The project succeeded in establishing resource centers in each of the four health departments where AVON staff members were located. The screening tool, a tremendous success, has been shared with local health care providers to identify women needing more intensive or specialized services. The project director, health department staff members, nurses, and social workers were offered trauma training, and those who received it earned continuing education credits.

The project also sponsored conferences on interpersonal violence, attended by clerical staff, social workers, nurses, doctors, attorneys, law enforcement personnel, health department staff, clinicians, psychologists, and the general public. A conference, which provided continuing education credits, was held in 2005 in conjunction with a specialized 2-day training for law enforcement professionals.

The project offers a manual and a training video on the workshops for communities interested in implementing a similar model. Several programs supported by the grant will continue, including the wellness workshops, the resource centers, local family violence councils, and psychotherapy (although mental health services will no longer be provided free of charge). The consortium members are exploring the possibility of working together on a future grant proposal that would enable them to establish a women’s community center.