Dr. Alexa Yakubovich is working with the IWK and other partners to improve interventions. (Nick Pearce photo)
The Snapshot
Community health researcher Dr. Alexa Yakubovich is addressing Nova Scotia's high rate of violence against women by embedding within IWK Health to work more closely with frontline health professionals.
The Challenge
It's a public health epidemic that doesn't grab headlines like COVID or the opioid crisis. But when faced with the data, the urgency is hard to deny.
According to Statistics Canada, 44 per cent of women who have had an intimate partner relationship report experiencing abuse. Nova Scotian women report a higher rate of victimization from intimate partner violence than women living in Canada's other provinces. This striking distinction gives Dalhousie's Dr. Yakubovich a sense of resolve in her work to build interventions in women's care that have the potential to improve and save lives.
"Violence against women has a lot of negative health outcomes injuries, mental health problems, chronic pain, disease and more. And many times, healthcare is the only formal service victims will access," says Dr. Yakubovich. "Because we know that these women are more likely to access healthcare, it's a really important intervention point that can allow us to connect them to a wider array of supports that can help."
The Context
Beyond those immediately impacted, Dr. Yakubovich describes an expansive web of costs for society. The pressure of repeated visits to health providers in an already oversubscribed system. Missed days at work and job loss. A legacy of trauma for children who experience violence in their homes. She says all of it has a corrosive effect on quality of life and productivity that stretches well beyond the victims.
To provide stark clarity on what can result from unaddressed intimate partner violence, she details the example of the 2020 mass shooting in Portapique, Nova Scotia, which ended in the deaths of 22 people and began with the shooter assaulting his common-law wife.
"The mass shooting provides an example of a situation where there was a history of intimate partner violence. There was contact with different social, health service, and justice systems and, unfortunately, there were gaps in the response," says Dr. Yakubovich.
"But out of the mass shooting, there have been recommendations made provincially around how to strengthen the response to violence against women. This has led to a lot more space in terms of what we can do with research, policy, and practice."
The Solution
To get closer to the issue, Dr. Yakubovich has started a new program funded by Canadian Institutes of Health Research that embeds her with IWK Health, the leading provider of health services to women, children and families in Nova Scotia. The new partnership will allow her to work with programs most likely to see patients experiencing violence.
"Being immersed within the IWK and establishing this formal partnership facilitates the work that is going to be needed to get programs and providers on board with what is going to be a bit of a sea change," says Dr. Yakubovich. "It gives us more capacity to work directly with providers in their own environment and get their buy-in than if we were coming to them as outsiders."
Dr. Yakubovich says health providers cannot be faulted for not having the risk of intimate partner violence top of mind when caring for their patients. Their jobs are intensely busy and focused on addressing specific needs. She says the key is to help them notice the signs of abuse and catch it by creating processes to routinely inquire about the subject. Further, she says care providers need to be equipped with training, information, and tools to assist victims and connect them with available support and services.
While the primary partnership is with the IWK, Dr. Yakubovich notes that it extends to Nova Scotia Health and provincial government, especially in priority areas such as women's and newborn health, mental health and addictions, primary health, emergency, and trauma.
The initial goal of the work is to understand what initiatives are currently in place at the IWK and other organizations to link them and maximize their impact. She is also aiming to develop processes to capture reported violence safely and privately on health records. She says this will help reveal the burden of the problem within the health system, which programs are most likely to see patients experiencing violence, and how to better connect patients with available supports.
In tandem with this focus on data collection, she is working with the IWK and other partners to improve interventions.
"This includes healthcare provider training and the establishment of screening and referral interventions, so patients are asked questions and providers know what to do when they get responses," says Dr. Yakubovich. "They need to know how to connect patients to available supports within the health system, including sexual assault nurse examiners trained to respond to domestic and sexualized violence."
The Impact
Dr. Yakubovich has made partnerships with health care providers and communities a major focus of her research career, noting that it's the best way for health researchers to have a positive influence.
"Ultimately, this way of working with organizations and with partners is the best way to create a pathway for research to move into policy. This is really the only way to have the latest evidence put immediately into practice," she says.
She aims for changes implemented by the program to create a new culture in Nova Scotia health care that is primed to support victims of intimate partner violence. But ultimately her goal is focused on preventing the violence from occurring in the first place.
"In 10 years, that's really where I want to see the research program moving. But it involves other systems, as well. And so, the more we prepare the health system in terms of knowledge and capacity to respond to these issues, the more prepared they will be to play a role in that primary prevention strategy."
