[music] 0:00:08.6 Jackie Strohm: Welcome to PA Centered, a podcast designed to help listeners be a part of the solution to end sexual harassment, abuse, and assault. Each episode, we will take on a topic or current event to help spark conversation and break down barriers to building communities free from sexual violence. [music] 0:00:31.9 JS: Hi, I'm Jackie Strohm, the Prevention and Resource Coordinator at the Pennsylvania Coalition Against Rape. I'll be your host today as we're joined by Dr. Phyllis Sharps to learn about the effects of intimate partner violence on maternal and child health outcomes. Dr. Sharps is an expert in maternal and child health nursing. She is a researcher, a mentor to the next generations of Johns Hopkins nurses, and works at the forefront of Community and Public nursing. Much of her work focuses on the effects of intimate partner violence on the physical and emotional health of pregnant women, infants and very young children. In 2019, she was awarded Black Nurse of the Year by the Black Nurses Association of Greater Washington DC. Welcome, Dr. Sharps. 0:01:23.2 Phyllis Sharps: Hello. 0:01:26.0 JS: We are so excited to have you with us, so let's dive right in. Can you start by sharing with us how you became involved in this field and this work? 0:01:37.4 PS: Well, I've been a nurse for a long time, almost 50 years now. I didn't grow up wanting to be a nurse, I wanted to be a school teacher, but as I got further into high school, I just... I liked all of the subjects and was having trouble deciding. But when I was about 16, a girlfriend and I decided to be Red Cross Candy Stripers, and she always wanted to be a nurse and I was just going along. And she hated it. We laugh about it now. She hated it. She became a social worker, and I became a nurse. I started my career in active duty Army nurse, and I asked to do maternal and child health. I didn't think I would get that, but not many nurses that go into the military asked for that, so I got it, and I just... I mean, it was just fabulous. But one of the things I noticed early on is that even in the military where everybody has equal access to healthcare, women of color, brown and black women, seem to not have as good birth outcomes. And I was young in my career, and I didn't know what that was all about. And, of course, when I came off of active duty and started working in urban settings, which I've always worked in, I noticed the gap was even greater. 0:02:58.6 PS: And so I started looking at other issues related to child birth. I thought I wanted to be a midwife, and I had this amazing thought one day that really as exciting as birthing is to have healthy babies starts before they get to the delivery experience. And so, I gradually shifted my focus to community-based work and I started looking at some of the issues around mental health, partner relationships, access to food, poverty and those kind of things. And those are the things that really are so important to the mother's health and the baby's health. And gradually, I began to understand that partner relationships were important and not all women are excited about being pregnant. It's not that wonderful time for some women that we've all been taught that it should be. And some of it is related to the relationship with the partner, and so I've really tried to focus on helping women stay safe. Pregnancy is a special time for a lot of women, and some women hope that the pregnancy is gonna make a difference in their relationship with a partner that's abusive, and that often does not happen. So while they may not necessarily be in a position to leave an abusive partner, we can at least talk about how we might be able to help them to stay safe. 0:04:39.1 JS: That's great and I would love to talk more about that, but first, I would love to kinda talk about your current role. And right now you direct three health and wellness centers that provide care in a Baltimore shelter for homeless battered women and their children. So can you share with us a little bit about what that's been like? 0:05:00.9 PS: Yeah, so I like to call our approach to community health cradle-to-grave, because our three centers are all very different. One of the centers, as you've mentioned, is in the House of Ruth Maryland and Shelter for Battered Women. One of our centers is in a public school, a K-8. And one of our centers, the Wald Center, which is our first and oldest center, established in around 1994, provides service to community members that walk in who often do not have insurance or are under-insured, and we have some outreach activities in senior housing buildings. So we have populations of all ages. I started my practice work when I came to Johns Hopkins almost 20 years ago in the House of Ruth Maryland shelter, and it is a shelter for women and children. So the shelter was there when I came and John Hopkins Community Nursing was there when I came. And the history is that they were building an additional building to be the shelter residence, so separate from the administrative building, and the nursing faculty, the community-based faculty said, "If you build us a building that has a health suite in it, the School of Nursing will staff it." 0:06:28.2 PS: And so they took us up. And so through our community volunteers programs, both at the School of Nursing and in partnership with Source, which is this School of Public Health program, we place nursing students and a faculty champion to oversee and work with the students in the shelter. So we like to do a health assessment for all women that enter the shelter and make sure that we can close any gap in their care while we're there. There is a fully qualified daycare center within the shelter, and so we do some work with the kids in making sure that they're immunized, and school-aged kids, also making sure that they're immunized and can stay in school. And that is so important for families, because often when women are homeless because of abuse, there's disruption in their children's lives and children's ability to be able to stay in school. And so, there are a number of other programs within the shelter with other partners that do art with the kids, that provide tutoring for the kids, and then, of course, there are health education and promotion. So we're very proud that that shelter came on in 1997 or so, so we've been a part of the House of Ruth shelter through our health and wellness suite during that same time period. 0:07:53.6 PS: And then for our other community services, we provide we call it gap services, so people that are needing to be in a health home or a medical home or navigate the health system. Sometimes those folks are experiencing partner abuse, elder abuse, child abuse. So while that might not be the focus of the other two health centers, we always keep that in mind. And we're particularly pleased at how well we've been able to continue during the pandemic. Initially, when the university closed, we made a decision to attempt to continue our services virtually because we do not wanna be competing with the main hospital for protective equipment and that kind of thing, and I'm very pleased to say that we've done some fabulous virtual programs and still meeting community needs both in the shelter. 0:08:56.4 PS: We now have a psychiatric telenurse program in the shelter. We've done some educational programs about COVID. We've been able to offer them in English and Spanish. We've developed a toolkit about vaccinations, addressing fears and myths and how to make appointments. So we've been able to do that kind of work and really still serve our community partners, and we're looking forward to hopefully gradual reopening in the fall of some of our walk-in services. We also had something called Ask The Nurse, which was gonna be a walk-in activity, but we converted it to telephone and we've been able to do some fabulous things through that also. 0:09:47.5 JS: It's been really neat to see how everyone has made adaptions during COVID, and it's great to hear that you've still been able to provide those really important services. You've also, I think, worked on something called the Domestic Violence Enhanced Visitation program or DOVE. Could you tell us more about that? 0:10:08.1 PS: Yeah, so that is my research activity, and I'm proud to say that we've had two NIH-funded grants. And one of the things that I became aware of is when you study maternal and child health, there's often issues around mental health or depression, and as I said earlier, violence-related issues for some women. And there were not a lot of interventions or what could we do, and a lot of the research around violence against women describes what happens in the outcomes, and I always felt, "Well, we need to do something, we need to fix something." So home visiting is a big part... Public health nurse home visiting is a big part of maternal and child health, and particularly targeting women who are either at high risk or not attending prenatal clinics and so forth. And so, I had done some work in another home visit program, and I like the notion of home visiting because we're taking healthcare to where people are. And so I thought, "Well, maybe we could combine some domestic violence information and then connect women... Help them develop maybe a safety plan and to connect women with resources." 0:11:34.9 PS: And actually it builds on another nurse who had developed an intervention that was published by the March of Dimes. It's a whole brochure, and I thought, "Well, suppose we did that in home visits." She had tested it in public health clinics and it worked very well, and so DOVE was an acronym for Domestic Violence Enhanced Home Visitation. So we took this 15-20 minute intervention, worked with a number of health departments in Missouri, Virginia and Baltimore, and implemented this brochure-based intervention for our first study, and we were able to help women stay safe, not experience... The women that came into the study had a history of violence or experience in violence during their pregnancy, and we were able to prevent any further victimizations. But, we also learned that it's still hard for public health nurses to ask people about violence, and I always joke with them, and I say, "This shouldn't be this hard, 'cause we ask people about how many bowel movements they have every day and a number of other really personal things, but... " 0:12:46.4 PS: So, we then thought, "Well, suppose we could use some of the new technology and we could put the screening tools on computer tablets, would that make it easier for home visitors to ask questions?" If they could just hand the woman a tablet and she could put in it her answer, and then the tablet would analyze what she said and tell the home visitor, "This is a woman at risk for abuse or being abused." And so we tested that intervention with our second NIH grant and we found out... I think the good news is, it doesn't make any difference how you ask the questions. There were no significant difference between whether nurses use traditional paper and pencil method or whether they use computer tablets. 0:13:37.0 PS: So I think for health departments who are struggling with funding and having to make decisions, as long as they have well-trained home visitors and staff that can ask questions that are comfortable, they could use either technology. And so, I think that's important. If I had more money, I think I would still continue to test the technology version, because I think that young women would really gravitate to that more, and we could do some real different videos and make it even more exciting than our first iteration around all of them is that if we screened women and identified women who were struggling with abuse, we could get them connected to resources to help them, and then prevent adverse birth outcomes for mothers and for babies. 0:14:33.4 JS: Right. I feel like, like you said, regardless of how you ask, it's just important that you ask. 0:14:38.5 PS: Yeah. Yeah. 0:14:40.0 JS: Yeah. So as you just shared, you have a lot of experience working with survivors of intimate partner violence who are also pregnant, and so do you have advice to share with advocates who are working with this population? 0:14:55.7 PS: I think it's important to understand that the issues that just go with pregnancy, that mothers or women who are pregnant or trying to develop an attachment with their infants, they're often conflicted about their abuser, because when it's good, it's a loving relationship. And we have a society that places a high value on parents and children having parents, and women are often, either through their upbringing, their culture, or whatever, their religious background, they wanna make that relationship work and even... I continue to be impressed. Even when men are in jail or in prison, women still want their children to know who their father is, that there's some qualities about him that he's an okay person. So I think that really calls upon us as nurses to... Even though we learn about it in school, not to place value, not to judge people, sometimes when you're sitting there in that day-to-day situation, it just is... Those other things that we may think about people comment is easy for that to seep in. So I think keeping an open mind, trying not to be judgmental. 0:16:21.4 PS: Before we did DOVE, we actually tested the home visit version just with women leaving the shelters. And because the women said, "You guys follow up more with the men in the batterer program than us women who leave the shelter." And so that's... I tested it and we found that we could do home visits with women that had a history of abuse, 'cause people said that you couldn't do that safely. If you tell me I can't do something, I'm gonna show you that I can do it. And it's particularly devastating for women of color, because so often women of color are very conflicted about, they want the abuse to stop, they certainly want help from law enforcement and police and that kind of thing, but they also know that if they call for help, it is likely to not end well for the man. They want him to be responsible and held accountable, but they also know that there is unfair treatment of men of color, and so it's just really hard. 0:17:35.7 PS: And so I think you have to understand that, have some compassion around that. And to help women think about staying safe, that how can you be safe regardless to how the relationship is going, and are there resources? So much of what people want to do is to separate men who are abusive from women, but maybe we need to re-think about that and figure out how we can help people to be safe and how we can help men. And I talk about men but sometimes pregnant women are in abusive relationships with a female partner. And I admire greatly the work of Oliver Williams in University of Minnesota, who works with batterers. And so, I think that we have to keep that in mind, that while we may feel very negative about the abuse, women sometimes still have positive feelings about the abusers, they just want him to stop hurting her and the children often. 0:18:49.1 JS: It's a very complicated relationship, and I think exactly what you just said. It's hard because people who abuse are usually people that we love and trust and want what's best for, but people just want the abuse to stop. So I like what you're talking about is finding ways to rethink and to not place that judgment on folks who choose to stay. 0:19:14.4 PS: Yeah. 0:19:16.5 JS: Do you find that it's different if the two people are married or not married? Do you find that it's different at all? 0:19:26.3 PS: No. I don't know that I can really say, because most of the women I work with are not married, but they are in longstanding relationships. So they're partnered, but not married. And so the few women, married women that I've worked with, there's often a lot more concerned about what others think because we value the institution of marriage so much. And some of them, particularly when there are cultural differences. People from other cultures that are here that we're working with, who have this notion that women should stay, and there are some religious groups also that women should stay because that's the expectation that you should somehow suck it up, get over it, and because generations of other women have done that. 0:20:29.9 PS: And I always point out to women that it isn't... They didn't stay because they liked it or they tolerate it, but often, there just weren't any other resources. And even among women who are concerned about religious teachings, I'm a Christian by background, a Baptist, and I always say, "Well, the Bible says that God loved the church that the church was his bride." And so, I don't think that He would have abused the church, and He describes the love and relationship that men and women have. And so, I therefore don't think that He would sanction or support men beating women. So I think people have to understand teachings and that even Christian values can be used to disenfranchise women or keep them in tough relationships. 0:21:32.0 JS: Yeah, that's really important to remember. Have you... As you've transitioned some of your services to be more virtual during the pandemic, have you noticed just... I know so many of us have been staying home and home a lot more, and for these women and people that have... Are part of these... Are in these abusive relationships, do you find that things are different because of the pandemic being forced to be at home so much? 0:22:03.7 PS: Yes, and earlier towards the end of last year, I actually did a presentation. We are concerned because not only women, children in homes often not a place where people can be separate, not a place where if a woman needs help, she's not able to call in a private place to get help even though, not many communities have set aside help, but you have to be able to access it. Kids that were going to school that other people may have made observations or could reach out of them for help, they don't necessarily now have that. And so yes, and many hotlines in other places have noticed more calls, but the calls are short and frantic, which again, kind of indicates that things are not as good. 0:22:57.6 PS: And we can't say necessary... It wasn't the pandemic that caused violence... I mean the people who are violent were probably violent before the pandemic. But now, they're in a situation where they have more access to their folks that they commit the violence against, and there's not a lot of oversight 'cause we don't invite people into our homes, and of course, we encourage not to, because of the pandemic. So yeah, I think that there has been a lot of concern about women that we shouldn't think that in some places, there's been documented an increase call volumes, but in other places there haven't been. And so we shouldn't take that decrease call volumes as a sign that things are getting better. We should be suspicious that things are not what they appear to be. 0:23:47.4 JS: Yeah, I think you make a really good point, sharing that the calls are shorter and more frantic because it's probably more of a risk to make those kinds of calls right now. 0:23:57.8 PS: And we talk about phone calls, but the user may have access to your computer or your iPad or other things. And so, it's just hard when you're not able to get out of the house. If you were going to work, you might have had a little bit more freedom to make the call. If you had legitimate reasons why you were leaving the home, that weren't suspicious, you might have more access to get to resources. But now, you have somebody looking over your shoulder all the time, questioning what you're doing, you know, "Why are you doing that kind of thing?" So, yeah. 0:24:38.2 JS: Yeah. 0:24:39.3 PS: The tensions of being home, the tensions of people who have lost employment, who are worried about housing, who've been discriminated, all of those things are... Make a really good background for tensions and conflicts that may escalate up to physical abuse to increase. 0:25:06.4 JS: Great. So I also know that you are retiring soon. 0:25:13.4 PS: Yeah. 0:25:13.8 JS: And with so many years of experience and wisdom, I'm wondering if you have any advice that you'd like to share for nurses and other folks doing this work. 0:25:28.1 PS: I think, whatever your career choices and one of the wonderful things about nursing is that there's just so many different things that nurses can do. I mean, I have nurse friends that are attorneys, nurse friends that work in engineering, that are in public health. So some work in hospitals, other work in community settings, in school, so there is... I think it's important to find the thing that excites you, that you can be passionate about, that when you get out of bed, you... Nursing is hard. It's hard work, both physically and mentally, and it can be mentally exhausting, but it should be something that excites you and you feel passionate about it, and after a good night's rest and replenishing your own bodies, you're ready to go back at it again. So I have always... Throughout all of my nursing career, I have been passionate about women's health. 0:26:32.3 PS: I consider myself maternal and infant, but really I'm most interested in women because... And here's my bias, I think if we make women healthy, families are healthy, communities are healthy, schools are healthy and... 0:26:50.5 PS: And I think we have seen the value of women's power and commitment in this pandemic. Largely... Most nurses are women. But even if we look at some of the political leadership that happened during this time, in the past year or so, we are just foolish if we aren't enhancing fully the power of women. So that's my bias. Feminist, I'm not sure, but I've always been a strong advocate for women's health, women's opportunity, I even was at a presentation of the first woman leader of the World Bank, and she said, "The world and economies will never be as great as they can be as long as they are not empowering and engaging women to be fully employed." And around the world when women are educated, and even if they get a career in nursing, it means a lot for the family and the community. So women add value inside of the home, outside of the home, to the workforce and so I'll get off my... [chuckle] My soapbox. 0:28:12.0 JS: No, I think that's great. I mean, what you're talking about when you say health, we don't just mean physical health, we mean emotional health, safety, all of those things. And so yeah, it makes total sense to me that if we make sure that women are healthy, that it will have lasting and ripple effects within communities. 0:28:33.7 PS: And I say women, but you know it starts with girls, we need to... And I've done a little bit of work, but we need to make sure girls are able to go to school and complete their education both here and around the world. There are places where young girls are not able to go to school, things that we take for granted, for instance because they don't have sanitary napkins or those kinda supplies. So we should just always make sure that girls and women have the opportunities [0:29:06.5] ____ there's equity, I shouldn't say... There's equity and opportunities for women and girls. 0:29:17.4 JS: Yeah, absolutely. Is there any other advice or experiences you'd like to share as you're reflecting on your career and this upcoming retirement? 0:29:30.1 PS: Yeah, I value [0:29:30.7] ____ education, and I think that more education is good, is... Having access to education, people shouldn't worry about being too smart or too book learning or that kinda thing, because now... To me, education and knowledge is power. And I think too often people rely on other sources and other spokesmen, and they get themselves into believing things that often have no basis in facts or reality. So I think education, I think reading, all of those things are important. And it behooves all of us to make sure that that's accessible to people. And I... Yeah, and I think the thing that I learnt from my active duty career is we work hard, but we also play hard. And so I think it's [0:30:35.9] ____ to have a balance in your life of the things at... Outside of your work and your commitment to your work or your profession, that there should be things that feed your soul, your mind, your spirit that are not work-related. 0:30:53.6 JS: Yeah, that is so important. I know we often talk about self care, but it really is important to make sure you have that balance, especially when you're giving so much of yourself to other people. 0:31:06.0 PS: And I think too often when women... Because we are such caregivers across a lifespan, inside the home, outside the home, that we feel guilty when we engage in something that's pleasurable or self care. But we need to remove that guilt and know that you're... You will only be able to continue to do those roles when you take care of yourself, and so that's an important part of what you need to be doing. Regardless to what it is, whether it's having that dark piece of chocolate that you love or reading a book or taking a walk or a bubble bath or whatever it is, you should move away from guilty pleasure, just pleasure. [chuckle] 0:31:54.1 JS: I couldn't agree more. [chuckle] Well, Dr. Sharps, thank you so much for joining us to talk about the effects of intimate partner violence on maternal and child health outcomes and sharing a lot of wisdom with us, and we just wanna congratulate you on your upcoming retirement. 0:32:11.2 PS: Thank you. Thank you. 0:32:13.4 JS: Alright. Well, that's all the time we have today. But thank you all for listening to this episode of PA Centered, and you can learn more by visiting the links in our show notes. [music] 0:32:30.8 JS: If you or a loved one needs help, a local sexual assault center is available 24/7, call 1-888-772-7227 for more information or find your local center online at pcar.org. Together we can end sexual violence. Any views or opinions expressed on PA Centered by staff or their guests are solely their own and do not necessarily reflect the opinions of PCAR or PCAR's funders.