The EMPOWER Project

    The idea for EMPOWER originated in 2008 with a group of medical students (class of 2011) under the ICE Service Learning Project (SLP) curriculum.  It was selected for implementation and funding from a pool of 21 other service-learning projects.  Additional members were then recruited from all disciplines to create the inaugural interdisciplinary EMPOWER board.

    The founding principle behind EMPOWER is to address the healthcare disparities of women affected by domestic violence.  This population represents a unique niche within the healthcare system because many of its members have access to health insurance and medical services but nonetheless receive insufficient medical attention.  One reason for this is that many abusers exert physical and/or financial control over their partners.  A survey from 2007 found that nearly one in five women reporting domestic violence during the preceding year had abusers who interfered with their healthcare.  Additionally, women fleeing violent situations often avoid medical attention out of concern for insurance reports or office bills finding their way back to an abuser.  Thus as these individuals are technically covered by insurance they are unable to access services at many community clinics that serve only uninsured patients.  Furthermore, women who are victims of domestic violence tend to be selfless and survival-focused while placing care for dependents (i.e. children or animals) as a main priority.  Diminished feelings of self-worth also contribute to an apathetic attitude toward personal health.  As a result of all of these factors, self-care of the domestic violence victim often suffers.

    At the national level, the Centers for Disease Control and Prevention (CDC) report that women endure 4.8 million episodes of intimate partner violence each year.  In Douglas County, the Douglas County Domestic Violence Coordinating Council (DVCC) reported that 10,502 domestic-violence related 911 calls were made in 2009.  As expected, these victims of domestic violence have been shown to endure medical problems at a greater frequency than the general population, along with a four-to-six-fold increase in incidence of depression. Female victims also have increased rates of sexually transmitted infections, pelvic inflammatory disease, menstrual irregularities, anxiety, substance abuse, and suicidal ideation, among others.

In an effort to address these issues locally, EMPOWER has forged a partnership between the Inter-professional Service Learning Academy (UNMC College of Public Health) and the YWCA of Omaha. The YWCA is a national association that is dedicated to helping women achieve personal, economic, and social successes by offering support in areas that include domestic abuse counseling, shelter assistance, legal guidance, and career services.  In 2008, the YWCA of Omaha and Catholic Charities provided services to a total of 4,617 domestic violence victims, underscoring the YWCA’s reputation as a trusted and reliable provider of services to Omaha-area victims.  Specific services include domestic violence education classes and 24-hour access to advocates (staff members who work with clients to develop individual plans for resolving domestic violence situations).  The majority of YWCA clients are unmarried women ranging in age from early 20’s to late 30’s, 75% of whom have at least one child.

    Founding members of EMPOWER were given the opportunity to speak with local victims of domestic violence in an effort to identify the primary areas of healthcare concerns.  At the top of the list was access to free-of-charge medical services including mammograms, blood pressure checks, pap smears, pelvic exams, body mass index, glucose and cholesterol readings, and STI and pregnancy testing.  There was also great interest in education on topics such as diabetes, diet and metabolism, exercise, over-the-counter drugs, vitamins, and herbal supplements.

    Board members developed a plan for addressing these specific issues.  EMPOWER services would be held on the first and third Monday of every month and include two 15-minute education workshops, with pairs of workshops offered on a rotating schedule.  Education sessions would cover the following topics:

·       Over-the-counter Medications

·       Common Medical Conditions

·       Immunizations

·       Child Safety

·       Nutrition—Healthy Eating on a Budget

·       Exercise at Home

·       Depression

·       Bed Bugs/Head Lice

    In an effort to incorporate EMPOWER activities into those of the YWCA, one of the two education workshops each night would be incorporated into the Monday evening YWCA domestic violence education class.  Throughout the evening, basic health screenings would also be offered.  These screenings would include blood pressure checks, BMI calculations, depression screenings, medication reviews, and risk assessment screenings based on healthy behavior analysis and family history trends.  A referral system would also be established for those women potentially needing more comprehensive medical services.  Following completion of this background work the first EMPOWER session was held in October 2009.

    Since its first session, EMPOWER has provided workshops and screenings to over 60 women of the Omaha area.  The next step is for EMPOWER to establish a free-of-cost well-woman clinic for female victims of domestic violence.  This clinic will address the unique healthcare situation of these individuals by providing free-of-cost care regardless of insurance coverage.  To ensure that EMPOWER serves this target audience, it will be required that all individuals be documented users of YWCA with specific affiliation with a YWCA advocate.  Finally, this clinic will be specific to well-woman services, though referrals will be offered for additional services.