Term
| domestic violence intimate partner violence sterotypes myths misunderstandings vs reality |
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Definition
• Victims are fragile, helpless women who have been abused by angry, mean, psychopathic men who could easily be identified in one interaction with them.
• Victims are severely physically abused, have extremely low self esteem, and fear for their lives on a daily basis.
-in reality...
• The stereotype exists ... AND
• Victims look like you, the person sitting next to you, the person who chairs your department, your friend’s partner, your co-worker, etc.
• Abusers use jealousy, social status, mental health, money, and other tactics to be abusive –not only physical aggression. |
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Term
| So What Is Domestic Violence? |
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Definition
The use or attempted use of physical, sexual, verbal, emotional, economic, or other forms of abusive behavior with the intent to harm, threaten, intimidate, control, isolate, restrain or monitor. Examples:
• Physical
- Hitting, punching, grabbing, slapping, twisting someone’s arm
• Sexual
- Experiencing unwanted sexual behaviors (verbal coercion to “allow” touching; threatening to use force; using force)
• Psychological
- Belittling, threats, monitoring whereabouts, restricted contact with family/friends... in person, via third party, and technology |
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Term
| daily patterns of domestive violency |
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Definition
| nothing 62.1% of days, psychological 27.1% of days, psycholicical and physical 6.3%, psycholicical physical and sexual 2.3% of days |
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Term
| implications of daily patterns of domestive violence research findings |
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Definition
-The finding that, on most days, no IPV occurred may help to explain the ambivalence some (women) experience about ending their relationships.
-The “breaks” in between incidents of IPV contribute to minimizing problems in the relationship and instilling hope that partners will change their abusive behavior.
-We need to better understand those days where no IPV occurs to identify factors that may contribute to the reduction/prevention of IPV.
-Findings underscore the importance of attending to psychological IPV. |
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Term
| overlap of intimate partner violence and HIV/AIDS |
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Definition
-Nearly 10% of women experiencing IPV in the
community are living with HIV, which is nearly 10 times the prevalence of women in the general population.
-How does IPV affect women’s engagement in HIV care?
-The findings that I present next can be generalized to other areas of medicine – both general practice and specialties. |
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Term
| In Women’s Own Words themes w IPV and HIV/AIDS |
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Definition
(1) Partners actively interfere in HIV care:
• “He used to fight with me and make me not take
my medicines...”
• “Well it got to a point where - you don’t want me to go nowhere, you know...”
(2) Partners passively interfere in HIV care:
• “Sometimes he would get mad at me and not
take me to my appointments. “
• “...he’ll forget... Well, he says he forgets.”
(3) Women’s self worth is so affected by IPV that they don’t engage in self care:
• “WhenIwaswithmyex-boyfriend,Ididn’ttakegood care of myself. But as soon as I got out of that relationship, it’s like everything fell in place. I started dressing more, taking care of my health.”
• “No,Iwantedtostopmyself[fromtakingtheHIV medications] so, like, that I could die. That’s how bad my nerves were. What I was going through, I just wanted to like die slowly.”
• “I got hooked into him. I stopped taking care of me and started taking care of him.”
(4) Physical harm may impact relationships with service providers:
• “Sometimes...itwasalways...Iwasbruised.And then, like I said, I didn’t want anyone to see that. And I
had refused to call the police. So I guess I was dodging the doctor, the police, and everything.” |
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Term
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Definition
Do you routinely screen for gestational diabetes or preeclampsia?
• Abuse is more common among pregnant women than gestational diabetes or preeclampsia. |
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Term
| Do Victims Want You to Screen? |
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Definition
| Approximately 8 out of 10 victims said they would like their healthcare providers to ask them privately about IPV |
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Term
| Victims Who Talked to Their Provider... |
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Definition
• Were 4 times more likely to use an intervention
• Were 2.6 times more likely to exit the abusive relationship
Health Care Providers Make a Difference! |
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Term
| Obstacles to Identifying Domestic Violence |
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Definition
Why don’t people disclose?
• Shame/Stigma
• Fear
• Gender
• Previous disclosure experiences (including blaming the victim)
• Not identified as “abuse” or “trauma” |
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Term
| Should you screen for DV? |
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Definition
| Only if you are prepared for the response. |
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Term
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Definition
Keep it simple screening
1. Support staff
2. Connect IPV to health
3. Safety card intervention (Futures Without Violence.org) 4. Have a protocol for warm referral and support |
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Term
| Safety Card Approach - Direct |
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Definition
"We’ve started talking to all our patients about domestic violence so they know how to get help for themselves and so they can help others.”
"I've started giving two of these cards to all of my patients— in case it’s ever an issue for you because relationships can change and also for you have the information so you can help a friend or family member if its an issue for them.”
Open the card and do a quick review:
"It talks about healthy and safe relationships, ones that aren’t and how they can affect your health.”
“On the back of the card there is a safety plan and 24/7 hotlines that have folks who really understand complicated relationships.”
In this “screening” process, disclosure is not the goal... but it does happen. |
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Term
| Discussion Approach – Less Direct |
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Definition
Normalize the topic and ask nonjudgmentally:
“Since I am your doctor, we need to have a good partnership. I can better understand your health if you would answer some questions about your relationship history.”
“I ask all of my patients this question because it is important for me to know what has gone on in their lives.”
“Everyone fights at home. What happens when you and your partner disagree?” |
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Term
| If Your Patient Discloses... |
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Definition
• “I am sorry this is happening. It is not okay, but it is
common. You are not alone.”
• “This is not your fault. Nothing you did caused this. Someone else made a choice to hurt you.”
• “What you’re telling me makes me worried about your safety and health.” |
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Term
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Definition
If your patient says, “yes”
• Evaluate current level of danger, violence, substance use, and general well-being .
Avoid acting as a therapist – but do provide support
“Do you have someone to talk to for support?”
“Would you like me to explain options and resources that survivors are often interested in hearing about?”
“Some survivors find talking to an advocate or counselor to be helpful.”
“What else can I do to be helpful? Is there another way I can be helpful?” |
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Term
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Definition
• Know that mandatory reporting requirements do not apply to IPV victims unless the victims are children or elders, or unless the danger is imminent.
• Then report to police.
• Mention the disclosure at future visit(s). |
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Term
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Definition
• If your patient does not disclose:
• Offer education and prevention information (like the card).
• Ask/assess again at future visits. |
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Term
| What more is there to do? |
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Definition
• Don’t assume autonomy and free will.
• Consider policies that limit the potential for abusive partners and relatives to influence care
• Privately inquire of patient(s) if the presence of a friend, relative, victim advocate etc. is desired or not
• Post flyers for support on the back of bathroom doors on in the rack in exam rooms. |
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Term
| Statewide 24 Hour Hotline |
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Definition
• Statewide 24 Hour Toll Free Hotline 1-800-774-2900
• Connecticut Coalition Against Domestic Violence (CCADV) http://www.ctcadv.org/ |
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Term
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Definition
Futures Without Violence. Org
Health Resource Center on Domestic Violence
Safety Cards
https://www.futureswithoutviolence.org/healt h/national-health-resource-center-on- domestic-violence/ |
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Term
| Definition of Child Maltreatment (Federal) |
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Definition
The Child Abuse Prevention and Treatment Act (CAPTA) set minimum standard:
“Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation”
OR
“an act or failure to act, which presents an imminent risk of serious harm” |
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Term
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Definition
• Non-accidental physical injury ...
• As a result of punching, beating, kicking, ... or otherwise harming a child
• Inflicted by a parent, caregiver, or other person who has responsibility for the child |
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Term
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Definition
• the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct;
or
• the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children |
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Term
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Definition
• Failure to provide for a child’s basic needs.
• Physical neglect
• Medical neglect
• Educational neglect
• Emotional neglect |
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Term
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Definition
• Pattern of behavior that impairs a child’s emotional development or sense of self- worth e.g.,
• Constant criticism
• Threats
• Rejection
• Withholding love, support, or guidance. |
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Term
| Preschool impact of domestic violence |
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Definition
feeling: Panic, anxiety Anxious attachment to both parents Separation anxiety Numbing of emotions Irritability
thoughts: Short-term memory for events
Limited understanding of violence
Concerns about disruption of routines
Wants family reunited
behaviors: Crying, whining, tantrums Withdrawal, passivity
Loss of developmental skills (incontinence, self- care)
Muteness, non- responsiveness Nightmares, sleep disturbances |
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Term
| school age impact of domestic violence |
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Definition
feeling: Depression, sadness, worrying Guilt, shame
Feels responsible and also helpless to intervene
Anxious, hypersensitive to danger cues Distrust of adults Ambivalent feelings toward violent parent (both attachment and doubt)
thoughts: Concentration and memory deficits Intrusive thoughts and images of violence
Fantasies of rescuing victim or family Attempts to understand violence Ambivalence about family separation
behaviors: Declining school performance Inhibited, passive social behavior Psychosomatic complaints (stomachache, headaches, etc.) Aggression. Defiance, disobedience Reenactment of trauma through talk and play.
Disturbed relationship with peers. |
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Term
| adolescence age impact of domestic violence |
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Definition
feeling: Self-blame, guilt, shame, suicidal ideation
Anger, rage, explosive feelings Ambivalent allegiance to one parent Depression, hopelessness
Lack of empathy for others
Suspicion and distrust of adults
thoughts: Intrusive thoughts and images of violence Concentration and memory deficits Confusion of love with violence Belief that assault is normal
Blame others for own behavior
behaviors: Declining school performance Truancy
Running away from home
Increased sexual activity Substance abuse Antisocial behavior, delinquency Uncooperative with adults
Explosive and violent interpersonal behavior Violence and abuse in dating relationships |
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Term
| Obstacles to Identifying Child Maltreatment |
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Definition
Why don’t people disclose?
• Fear
• Shame/Stigma
• Previous disclosure experiences (including blaming the victim)
• Not identified as “abuse” or “neglect” |
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Term
| Reporting Suspected Abuse |
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Definition
• You are a mandated reporter
• Local Child Protective Services
-Suspected child maltreatment must be reported • Consider informing the patient that you must report and explain what was concerning to you
- Differs by state whether a child witnessing domestic violence is reportable |
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Term
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Definition
Child Protective Services
To make a child abuse or neglect report in CT, call 1-800-842-2288
Department of Children and Families |
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Term
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Definition
• In CT, an adult who is 60 years of age or older
• Usually referring to a vulnerable adult |
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Term
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Definition
• Lack of basic hygiene (food, clothing)
• Lack of medical aids (glasses, walker, teeth, hearing aid, medication
• Person with dementia not supervised
• Home is unsafe because of clutter, filth etc.
• Home without adequate facilities (utilities, refrigerator
• Untreated pressure “bed” soars |
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Term
| elder financial abuse/exploitation |
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Definition
• Lack of amenities the elder can afford
• Vulnerable adult “voluntarily” giving excessive reimbursements/gifts for care- taking
• Caregiver has control of elder’s money but is failing to provide for his/her needs
• Vulnerable adult has signed property transfers but is unclear about what that means |
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Term
| elder psychological/emotional abuse |
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Definition
• Unexplained/uncharacteristic changes in behavior
- Withdrawal from normal activities, alterness
• Caregiver isolates vulnerable adult
• Caregiver is verbally aggressive, demeaning, controlling, uncaring |
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Term
| elder physical/sexual abuse |
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Definition
• Inadequately explained fractures, bruises, welts, cuts sores or burns
• Unexplained sexually transmitted diseases |
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Term
| Obstacles to Identifying Elder Abuse |
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Definition
Why don’t people disclose?
• Fear
• Not identified as “abuse”
- Patient is unaware it is occurring
- Doesn’t see it as “abuse”
• Shame/Stigma
• Previous disclosure experiences (including blaming the victim)
• Systemic |
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Term
| Reporting Suspected Elder Abuse |
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Definition
• Adult Protective Services
• Consider telling the victim that you will need to report and what concerns you.
• Unlike child protective services, adult protective services does not take someone out of their home or respond, for example, in the middle of the night in an emergency. |
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Term
| Who to Call? for elder abuse |
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Definition
• 1-888-385-4225 (For suspected elder mistreatment in the home, in state line).
• 1-800-203-1234 (For suspected elder mistreatment in the home, out of state line).
• 1-866-388-1888 (For suspected elder mistreatment in long-term care facilities, in state line)
• 1-860-424-5200 (For suspected elder mistreatment in long-term care facilities, out of state line).
• 211 (For Suspected elder mistreatment in the home, in state, after hours) |
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Term
| Resources for elder abuse |
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Definition
| National Center on Elder Abuse • www.ncea.gov |
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