By Danielle Pierce

People who are pregnant are at higher risk of experiencing intimate partner violence (IPV) than those who are not pregnant. And Black people who are pregnant are more than twice as likely to die from pregnancy-associated complications as their white counterparts (80.7 compared to 35.3 per 100,000 live births). A new VCU program, powered by a recent $1.5M, five-year grant awarded by the U.S. Department of Health and Human Services, aims to reverse these statistics.

“Heartbeats” is one of 12 grants awarded across the country that gives health care providers and researchers the opportunity to focus on the significant risks to safety that pregnant and postpartum survivors of intimate partner violence, as well as Black pregnant people, experience.

“The overall program will address the barriers that pregnant survivors and postpartum women face when attempting to access appropriate medical care, forensic evidence collection, mental health services and community support,” said Carol Olson, assistant director of VCU Health’s injury and violence prevention - gender violence and IPV initiatives and counseling programming. “The goal is to reduce maternal deaths due to suicide, homicide and domestic violence. We want to be able to intervene earlier in order to identify domestic violence and provide enhanced services — whether it's emergency shelter, counseling or additional support.”

According to the Virginia Department of Health, 462 pregnancy-related deaths occurred in Virginia over a 10-year period. This is one of the highest rates in the nation. Since its launch in October 2021, Heartbeats has enrolled approximately five new patients a month.

The program is an extension of Project Empower, a hospital/community-based violence prevention and intervention program, dedicated to serving victims of sexual assault, domestic violence, intimate partner violence and stalking. Project Empower serves 100-125 pregnant or postpartum people annually. Many of these people are referred from the trauma center, Women’s Health, the OB MOTIVATE program and Labor and Delivery.

“Heartbeats is an expansion of the incredible work our team is doing with Project Empower,” said Amy Vincent, associate director of Injury and Violence Prevention Program. “With the Heartbeats grant, we can take this program to the next level and really hone in on some of our more vulnerable populations, like those who have experienced intimate partner violence.”

Patient support available for up to two years

Heartbeats uses the HITS (hurt, insult, threaten and scream) screening tool to assesses the behavior of the perpetrator or abuser by asking four questions on domestic and sexual violence.

Once individuals are enrolled, the program provides support through pregnancy and postpartum for up to two years. Pregnancy support can include doula support, pregnancy educational classes and pregnancy support groups. Each participant is assigned an advocate to help them leave the violent relationship and get the resources they need.

“We usually start out by providing crisis intervention, and this part is important because we're not only helping them stabilize, we also are establishing trust,” said Leann Ragland, lead advocate for Heartbeats. “That initial interaction is key because we’re providing a sense of safety and stability which is absolutely critical for survivors of IPV, especially those who are pregnant and newly postpartum.”

Postpartum support takes on many forms, such as housing assistance. This includes helping individuals find emergency shelter in case they need somewhere to live immediately following their discharge. Counseling, employment opportunities and community referrals are other ways the program provides support throughout the process.

VCU Health’s Injury and Violence Prevention Program (IVPP) integrates all prevention programs the health system offers as part of operating a Level I trauma center. Heartbeats participants receive screening and advocacy support from Project Empower, and then are connected to VCU Health’s counseling program for additional support.

Community partners are important to success

Heartbeats relies on the relationships VCU Health has established with area domestic violence programs, community services organizations and local health departments. Richmond Behavioral Health (RBH) is an example of one such partnership.

RBH has a Be Well Program serving mental health, crisis and domestic violence screening. It also has a perinatal program for those in addiction recovery. The Heartbeats staff has trained its team on the HITS screening and trauma response. In return, the Heartbeats program uses RBH for substance abuse treatment, mental health treatment and crisis support. For example, if someone who has been screened into Heartbeats also identifies as suicidal, they are connected with RBH for crisis support.

Doula training to reduce bias improves health outcomes

Systemic racism and bias in the medical field, sometimes compounded by IPV, can have a devastating effect on Black maternal health. Heartbeats aims to improve prenatal care for Black women in general, even if they do not need any other violence prevention-related services.

“We know that health inequities happen at a higher rate for Black women,” Olson said. “We're trying to reduce maternal deaths for all people, but we are paying close attention to Black women because their mortality rates are higher and they are battling obstacles — like racism and prejudice — that not everyone else has to battle.”

Heartbeats is partnering with doulas trained to understand the barriers women of color may face in a health care setting and can support and advocate for them pre-and post-pregnancy.

Discussions are also underway about ways to increase access to underserved and rural communities. Program staff are hoping to expand Heartbeats to VCU Health locations in Tappahannock, New Kent and South Hill in the coming year, in addition to partnering with other hospital systems in Central Virginia

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