Community Spotlight: Lisa James, Director of Health, Futures Without Violence

As part of a National Health Initiative on Domestic Violence, James has collaborated with health care providers, domestic violence experts, and health policymakers in more than 25 states across the U.S. to develop statewide health care responses to domestic violence through training, health policy reform, and public education. A former ACEs Aware grantee, Futures Without Violence (www.futureswithoutviolence.org) has developed curricula, webinars, and other resources to train health care providers on improving responses to violence and abuse. Currently, James is leading an ACEs Aware pilot project addressing the health impact of ACEs and toxic stress in California’s farmworker communities.

How did you get involved with this line of work, and what motivates you to continue?

When I first started working at Futures Without Violence (formerly Family Violence Prevention Fund), I was passionate about promoting gender equity and preventing gender-based violence. One of my earliest projects nearly 30 years ago brought advocates from child protection together with those working on intimate partner violence (IPV), and through this project I saw firsthand that the siloed responses to child abuse and IPV were not serving survivors or their families well.

I soon became more focused on health solutions and the health care setting as a place for prevention and healing. Since 1997, I have been working on our National Health initiative on Violence, working in partnership with health providers and advocates across the country to build relationships to improve the health and safety of survivors and to promote prevention.

As part of that work, we partnered with the American Academy of Pediatrics to create national consensus guidelines to address IPV in pediatric settings, trying to underscore that the best strategy to help children can be to help the non-abusive caregiver. When I was introduced to the landmark 1998 ACE study by the Centers for Disease Control and Prevention and Kaiser Permanente, I was really struck by how significantly the experiences we had in childhood impacted our health and became even more motivated to expand my work with health professionals to include addressing child trauma, as well as IPV, in the health care setting.

What motivates me to continue is that I see we are making a difference. I continue to be inspired by the healing that takes place when providers break the silence on these issues, embrace the role they can play in prevention, and bear witness to the tremendous resilience of so many individuals and families. The resilience of survivors and the passion and commitment of my colleagues across the state and country who work in health and community-based advocacy programs – often with limited resources – keeps me going.

In your work, where do you see intersections between ACEs and IPV?

For an organization that has focused on prevention as well as health and social justice, the intersections are everywhere. If we want to do more about preventing IPV, we must help the people who were harmed as kids, and we must address the conditions that contribute to ACEs and IPV, including racism, poverty, and other inequities. I continue to learn from the deep and meaningful work coming out of the children’s team at Futures Without Violence, who, even as far back as 1995, were working to break down silos between child trauma and IPV.

For the core training we developed for the ACEs Aware initiative, we integrated these theories in several ways, including centering strategies to address inequity and systemic racism and bias in the health setting as a critical part of our ACEs prevention and response work; acknowledging health care providers’ own trauma and vicarious trauma and supporting their wellness; and finally, applying a universal educational approach to ACEs so everyone receives information about how to get help regardless of how they disclose on the screening questionnaire.

For the supplemental sessions, we wanted to build off what we’ve learned over the past three decades of promoting a health system response to violence, so we go deeper on how to create system changes that keep interventions sustainable, how to work with those who use violence, and how to implement strategies for adolescents, who are often an overlooked population that sits between ACEs and adult violence and trauma fields.

You are a past grantee and are currently involved in an ACEs Aware pilot project. What has led you to be so committed to ACEs work?

The ACEs Aware initiative has galvanized communities to identify and respond to ACEs, and we were excited to bring some of our tools and strategies to that effort, including the Connected Parents/Connected Kids tool. This tool helps health providers in multiple settings offer universal prevention education about ACEs and IPV and encourages a two- or three-generation approach to talking about complicated childhoods, what people deserve in relationships, the impacts these realities have on health, and what helps.

With this new pilot project, we want to think more broadly about resiliency and prevention and to address the gaps in our collective work – who are the individuals, families, and communities we are not reaching and why? I’m excited that we are now partnering with Alianza Nacional de Campesinas, Lideres Campesinas, Migrant Clinicians Network, RAND, and the UCSF Center to Advance Trauma-informed Health Care. Our work will engage farmworker leaders in providing feedback to our health centers on how to begin and expand ACE screening and response in a way that best engages farmworkers in California, evaluate that effort and develop strategies, curricula, and tools for clinics statewide.

We must interrupt the intergenerational cycle of ACEs and IPV, and that means recognizing that all people deserve help and hope. How do we set up programs to address care and empathy, and how do we reduce isolation? Also, how do we recognize systems of surveillance that have harmed families, especially those most marginalized? And how do we center equitable practices in our work? These are some of the questions I think the field needs to look at, and we are honored to work with our partners to engage the voice of the community to inform this work.

Looking to the future, where do you see opportunities in the health care setting to address IPV and prevention?

I think there is an opportunity to incorporate learnings and strategies of the IPV and ACEs work into the broader effort to address social needs, so that we can begin to systematically address some of the conditions that contribute to violence. I also think we must expand beyond the clinic walls to partner with community experts, including supporting care coordinators, wellness navigators, and community health workers, and invest in systems that support providers in building bridges in this work. We know time, relationships, and trust are all essential ingredients to making connections with families and increasing their likelihood to connect with warm referrals.

This takes time, and I think this can be done in a cost-effective and culturally relevant way.  We want to harness the power of committed providers and advocates to address the conditions in which people live and seek care and build trust between health providers and community members so they become partners in building resilience and helping all patients heal.